Training Defective Children
- Author:
Eileen C. Macleod
Officer-in-Charge, Orthophonic Department, King’s College Hospital, Hon. Speech Therapist, Tavistock Square Clinic for Functional and Nervous Disorders (Miss MacLeod will be remembered by many students of C.A.M.W. Courses at which she has lectured) In this series of articles I want to discuss and classify the various forms of defective speech which are frequently to be found among backward and among defective children. I hope also to be able to give some suggestions for treatment of individual cases, as well as a scheme of daily speech drill for groups of defective children.
At the outset I meet with a difficulty, the fact that in order to deal satis- factorily with any but the most simple speech defect, it is necessary to diagnose the defect by ear, for one may almost say that no two speech defects are identical. Obviously it is not possible for me to do this, except in a relatively few cases, and therefore I suggest that readers who need advice on the diagnosis or treatment of any individual case, preferably of the type under discussion in the current article, should send me detailed particulars. I will choose those cases which I feel are of interest to the majority of readers and give suggestions as to treatment in the next issue of ” Mental Welfare.” In this way, I hope to be of practical assistance in dealing with existing speech difficulties rather than of theoretical value only.
Article I RETARDED SPEECH IN BACKWARD CHILDREN ————————————–
Possible Causes :
Physical Deafness. General ill-health, illness between 1-3 years. Psychological Retarded mental development. Word-deafness. Environmental Neglect. Over-anxious parents. Fear. Uncertainty. Brothers and Sisters. Schools. Etc.
In the investigation of any case of defective speech, except perhaps a lisp or such other minor fault, the first step should be a thorough physical examina- tion by a general practitioner, the object being to ascertain the exact state of the child’s general health and physical development rather than to search for the specific cause of the speech defect. Too often, in my experience, the medical examination of children who do not speak and yet who are obviously not mental deficients, is restricted to an investigation of the nose, ears and throat. Tonsils and adenoids are often said to be the cause of the lack of speech, the idea being that the actual mass of the tonsils and adenoids prevents the move- ment of the speech organs, and so makes it impossible for the child to talk. This is quite a wrong idea, though it is true that enlarged tonsils are often a contributory factor in cases of delayed speech, not as obstructions, but because the septic discharge permeates the whole system and causes general ill-health; the actual adenoid obstruction is often a cause of ” nasal speech.”
It is necessary, though somewhat difficult, to test the hearing of a child who does not speak. One can, of course, find out whether the child is stone- deaf or not, but the exact degree of hearing is not easily determined; it is also extremely difficult to gauge the child’s power of distinguishing the various pitches and sounds of the human voice. Such investigations are, however, very necessary, as one can often exclude deafness by watching the expression on the child’s face as the sounds and pitches change. In short, then, the medical ex- amination and tests should be complete in every detail.
Having established the physical condition, the next step is the mental development (in this article I am referring only to children who are backward, not to mental deficients); this can be done partly by the regular ” intelligence tests,” though for children who do not speak, such tests are limited, and in my opinion do not give very safe information?there is always the possibility that the child is intentionally giving the impression of stupidity for reasons of his own.
It is of the greatest value in determining the psychological condition, to watch the children at play, alone and with other children. Naturally the child must not be aware of the observer’s presence. One often finds that when play- ing with other children or alone, the little one’s personality changes completely; an only child, lacking in initiative, apparently unable to do anything for him- self when in the presence of adults, may turn out to be the ringleader of the other children, possibly even a little tyrant. Then again a child who is stub- born, troublesome to handle, disobedient and self-willed at home, proves to be the willing slave of another child, who is able to secure prompt obedience where grown-ups have failed. It is also very important to find out what other children think of the particular child under observation; not by direct question- ing, of course, but in the course of ” casual ” conversation. In this way one comes to know various facets of the child’s personality.
It not infrequently happens that these ” personality ” investigations yield quite unexpected results. I have heard from parents that their child was sulky, dull and unwilling and lazy, unable to tie his own shoes, etc.; from the teacher that he was quite good at school, though his speech was almost unintelligible, that he seemed to do his best, but lacked originality and imagination and was bad at handwork, though willing to help tidy the classroom, fetch and carry, etc;; from the other children, that he was always ready for a game and could make boats and aeroplanes which could sail and fly, out of bits of wood, card- board and string. Perhaps the most astonishing thing of all was the boy’s little sister’s enthusiasm for the lovely stories he told her of the fairies in the trees and in the wind, rain and sunshine, and yet nobody else had heard him say one sentence intelligibly. Here we have four very different pictures of the same small boy, and it is difficult to reconcile one with the other.
Obviously, with his parents and elder brothers he was at his worst, alone with other children or with his little sister he was at his best, and at school, where he was both with children and grown-ups, he was only fairly capable; all of which points to the need of investigation from many sides. In this par- ticular case, the difficulty was between the mother and the boy; this had gradu- ally influenced the father’s attitude towards his son and then the elder children had adopted the same tone. The boy’s sulkiness, helplessness and dullness were all part of the armour which he had constructed to shield himself from the difficulty of his relations with his family, and because of his lack of speech he was left more and more alone, which suited him.
This unhappy state of affairs proved to be the result of a misunderstand- ing between the mother, the boy and an elder brother. The elder boy had done something wrong and when found out he had put the blame on the younger boy, whom he had frightened into silence. The mother, who was a very ” upright ” woman and believed it to be for her small son’s good, had given him a sound beating. The result of this was that the boy felt that he had been treated unfairly all round, became moody and resentful, sullen and difficult, and took as little part as possible in the family life. Happily, it was possible to re-adjust matters between the various people concerned, with the result that gradually he lost his sullen ways and became a normal happy boy again.
I have given details of a case in which the cause of the retarded speech was entirely environmental, where physical and mental examination give no clue to the situation, for I find that this type of case is fairly common, though seldom recognised.
Having found the key to the situation by means of personality investiga- tion, it was a question of a tactful and friendly explanation of the difficulty to the mother, which she accepted fairly willingly. By her altered attitude towards her son, she indirectly influenced the elder children’s relations with their young brother, and a series of seemingly unimportant talks between the small boy and myself completed the readjustment and he set to work with a will to learn to speak well and freely and accomplished this in the course of a few weeks.
The conclusions to be drawn from this case are:? (1) It is necessary to investigate thoroughly from many angles, (2) Collect all evidence before forming any opinion, (3) Frequently no organic or mental abnormality is to be found, (4) The primary cause may seem trivial to the adult mind and may there- fore easily be overlooked. It is necessary to train oneself to see the child’s point of view. (5) If the trouble is environmental, it is insufficient and ineffective to attempt adjustment of the child alone, there are always two, and frequently several, persons concerned.
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