Speech Defect Case Treated at Columbia University
- Author:
Alice C. Hinckley.
Thomas T. is the nine-year-old son of Irish parents. Ilis father was a confirmed alcoholic for many years before his death from pneumonia last fall. His mother is a robust, energetic woman of emotional temperament, who supports her family by doing washing. During the summer she is caretaker of a residence on East Sixty-seventh Street, where living conditions are much more favorable than in the crowded section where the family spend the winter. Thomas has a brother and two sisters older than himself, all of whom speak distinctly. The younger of the girls, however, talked “baby-talk” until she entered school, and now she teases her brother by mimicking him.
He has attended a parochial school for three years, and was promoted in July to a grade equivalent to 5 A. He dislikes school, and never studies at home, but his teacher reports that he gets on easily with his class work. He likes athletic games, especially baseball, and his ambition is to become a professional player. He was a mouth breather; has bad teeth, a normal palate, and his left nostril is small. His tonsils were removed at St. Luke’s Hospital in September, 1910. He is not subject to colds or catarrhal affections. The only disease he has had is measles. He becomes dizzy and has headache from swinging or over-exercise.
At the beginning of the course of training it was practically impossible for anyone outside of his immediate family and playmates to understand him. His thirteen-year-old sister accompanied him to the Clinic as interpreter. His speech was an infantile stammer, with the following defects and substitutions: t for k or <7, dw for gr, tw for kr, t for ih, tiv for ilir, d for th, st for sk, n for nt7; f and v were doubtful, s uncertain with a lisp, and h totally absent. Words like walk, walked, neck and next ended with a little spasmodic catch in the throat. He was put through careful auditory tests with watches, tuning forks, and the sinking of scales alone and with the teacher for range or extent of discrimination. He was also tested for general observation and memory of what he had seen at given places, by visiting the school museum and garden, and so on. His hearing was normal, but he could recall very little that he had seen or done at school or anywhere else, and he knew practically nothing about the animal or plant life of the world. He seemed to possess average intelligence, but lacked training in observation, and had probably never distinguished the points of difference between his speech and that of others. He knew there was a difference, and that knowledge made him sensitive, shy, and uncommunicative. Suppressed expression had reacted on impression, with a resulting listlessness. The first change in his facial expression occurred in our second lesson, and was induced by my visit to his home.
The chief problem with this boy was to get him to regard me as one of his friends and talk to me freely, so that his difficulties might be located and furnish material for the lessons. School was not available as a topic, since it was uninteresting to him. His stock of ideas, so far as he disclosed them, centered around games, and boys, and streets, and “cops”. A common store of interests and activities was necessary as a basis for conversation. We compared notes as to our favorite fairy stories; we took walks, visited the school museum, the school garden at intervals to watch the growth of plants, and “Bronx Park, where we saw hay-making as well as the animals, and where he had his first ride on a pony. His initiative was stimulated by permission to show the garden to a boy who had not seen it, and T arrived in time to see him doing the honors, and to enjoy the walk with both of them. There were two one-hour lessons each week. Each lesson was planned with some special point in view, with the purpose of affording him the satisfaction of making conscious improvement, and giving him something on which he could practice at home for the next lesson. His sister, who came with him for the first half of the term, was of great assistance, reminding him of things which he might have forgotten. She became, indeed, too helpful in interpreting his language, so he was asked to come alone, as soon as he could make himself understood. Every lesson included a refoealizing of the correct articulation of consonants for motor ideas, and a drill in attention through the use of this articulation in words, sentences, conversation, or reading. His incorrect habits were ignored as far as possible, since one sound did duty for many consonants.
S was easily learned by explanation and demonstration of the position of the tongue so that the breath might escape with the sound of escaping steam, The initial 1c was worked on in the same lesson and in the same way, the imitation in this case being of a dog with a bone in his throat. After ten minutes’ practice on the sound, he said with effort cup, cap, cop. The words giving more trouble were kin, come, came. Kin was the most difficult of the words with initial k.
In the second lesson, after our introductory conversation, in which I made no comment on his language, he reviewed the old words, using them in sentences, and added successfully come, came, kick, cake, coke, cook. Kin and coal still gave trouble. The important point in this lesson was final k. There was some work on initial cr and final cs, but they were very imperfect. In the third lesson he succeeded in all old words, including kin, coal, coke, and all single sounds of k and g, whether initial or final. We worked fully ten minutes on the g, which was more difficult than the k, and was learned by comparison with it. The sense of touch was combined with that of sight and hearing by having the pupil feel the articulation first in my throat and then in his own. There was some drill on nk, ng, th, cr, gr, tlir. The r combinations were very difficult.
The fourth lesson was the most natural response he had given. He was pleased at his ability to say the words he had agreed to work on. He succeeded with conscious effort on cr, gr, tlir, nk, ng, sk. The game element was used in building up a list of words with which to practice these sounds, and this list was added to from time to time: cricket, cross, cry, cradle, creep, cruel, crow, crept, crop, grow, grip, greedy, grab, ground, grub, grumble, groom, three, throw, threw, thrice, thrill, thread, think, thank, monkey, sulky, bulky, worthy, skin, scat, skip, scold, escape, Scot, scum, school, sky, scowl, squeeze, scamper, scholar, skillful. These were still so difficult that he agreed to work on them at home for the next lesson, and we adopted them as a permanent list. H was still unmanageable.
The fifth lesson consisted mainly of a story of his own choosing, prepared at home, to see how well he could use the sounds he had already learned. He was allowed to read freely, with one or two interruptions where the words were very obscure. A discussion of the story, rather than of his manner of reading it, followed, then a review, and drill on the words and expressions which had given trouble. These were marked for home practice and preparation for the next lesson. Twelve minutes’ work by imitation was given to the elemental sounds involved in sk, squ, nk, cr, gr, tlir, for the purpose of establishing motor images as a A SPEECH DEFECT CASE. 183 basis for habit. The first three were reproduced fairly well, but the r combinations presented a serious difficulty. H was still impossible.
In the sixth lesson he was given a quick review of all old sounds and a short drill on imperfect ones. He re-read the story of the previous lesson, in which the difficult places had been underscored and worked on at home. There was some improvement, but not much. The main issue in this lesson was the letter h; and truly, “we met the enemy and it was ours.” In previous lessons such mild means had been employed as panting, and quick breathing out. Laughing, ha! ha! is not one of his accomplishments. Although hard on the h, it presents an opportunity for testing the skill of the teacher in humanizing a child. His trouble lay in the inability to associate or unite this breath with the word. Now, a deep breathing exercise was given with exaggerated, forcible exhalation, further emphasized by the muscular movement of raising the shoulders with each inhalation and dropping them suddenly with the exhalation. Gradually these exhalations were given the sounds of hit, ha, hi, hoe, he, ha, ho, hum, hot, hip, home, head, hat. At the close of this exercise he was handed the following selection, written clearly in a semi-vertical hand, to call forth his reaction to the thought:
“Some little drops of water, Whose home was in the sea. To go upon a journey Once happened to agree. A cloud they had for a carriage, Their horse a playful breeze; And through the air and sunshine They rode a while at ease. “But, ah! there were so many At last the carriage broke, And to the ground came tumbling These frightened little folk. Then through the moss and grasses They were compelled to roam, Until a brooklet found them And carried them all home.” 184 THE PSYCHOLOGICAL CLINIC. Thomas read it through silently and stolidly, with no apparent idea of what it was all about. For lack of time to develop the idea of the poem, he was asked to read it aloud for the purpose of locating the difficult places, and after some explanation of the meaning of the words, he was permitted to take it home with him for study.
For the seventh lesson we reviewed old sounds and searched our memories for new words in which to use them. Thomas was drilled on h, with the use of it extended to longer words and sentences. He did good work while the sounds were in the focus of attention, but lapsed when he attempted to use them in conversation. We worked out the idea of the poem while standing at the window and using as a basis a large white cloud floating in the blue sky. His limited observation was shown in the fact that he did not know that water flows down a slope. He enjoyed the idea of the carriage breaking and letting the little folks fall out. He read it aloud, and then we read it together for inflection. He was told to memorize it.
The eighth lesson began with a test in the form of an unprepared reading exercise, in which he made fewer lapses than in any previous lesson. This led up to a drill on walked and next, which were exceedingly difficult combinations for him. He told the story of the poem and then recited it. Practically every difficult place was passed with reasonable clearness by my pantomiming the articulation as he came to it. Then he recited it alone, carefully and deliberately. Two additional repetitions of the same poem were obtained easily, by asking our class instructor and a member of the class, both of whom had heard him at his worst, and who came into the room separately, if they would not like to hear how much he had improved. The ruse was not even suspected by the participants.
At the ninth lesson stress was put on remembering the right sounds while he talked. The subiect was some of the things he had done since I saw him last. He explained the games tip-onthe-birk, leap-frog and bnseball. Whenever he was not clear I asked him to repeat, and if necessary holped him with the pantomime. He used no final s sounds, so I said after him the words containing these sounds, and he repeated them correctly. Following this conversation was a ten-minute drill on d, z, h, Tcs, q, thr. He gave a prepared reading lesson, in which he corrected his mistakes as I pointed to the word incorrectly pronounced. The memory poem showed improvement by less exaggerated articulaA SPEECH DEFECT CASE. 185 tion. The h was now inclined to attach itself to initial vowels where it was not wanted as in at, on, up. We selected and went over another poem, “Little Brown Hands.”
Material for the tenth lesson was provided by our visit to Bronx Park the previous Saturday. The purpose of the lesson was to let him do the talking. He told of the fun he had watching the monkeys, why he rode the pony instead of the camel and why he did not care to ride both, and other interesting features of the day. He thanked me for giving him such a good time, and invited me to visit Central Park with him some day.
From this conversation we selected these words and drilled on them about fifteen minutes: Bronx, monkeys, neck, necks, next, scold, scrap, screw, grew, throw, whose. The sounds underscored were all difficult for him, and those doubly underscored he did not get completely. II gave no trouble. He took a list of words home with him for practice. The first memory poem was recited clearly enough without help. The only serious lapses were on final s and the ge in carriage. He read a prepared selection, and talked about another excursion we expected to have when school is out.
After some preliminary conversation in the eleventh lesson, there was a ten-ininute drill on our list of words. Final s was mastered, as well as the double consonants with the exception of r combinations. The triple sounds were secured by separating them, as nek-s-t, elec-t-ric, ek-s-cuse. He recited the memory poem with more ease and expression; read two stanzas of the new one with special attention to final s; read a selection which was new to him and did it better than those he had studied.
This was our last lesson?he does not think of our excursions as lessons?so he suggested that we visit the garden once more. He called my attention to the things that had grown and the changes that had taken place since our first visit. Much to his regret, he found that the wheat bed had been cleared. His sister Mary had thrown away his head of wheat, the first he had ever seen, and he probably wanted another. There were no more ladybugs and white butterflies. As we left, he told me he was taking home the faded tobacco flower and the onion seed-pod we had examined and talked about.
In this somewhat detailed account of the case, I have endeavored to show not only the progress in speech, but the development of observation and individuality, which, though retarded, responded promptly to suggestion and training. From a stolid, silent, appar186 THE PSYCHOLOGICAL CLINIC. ently stupid child, he has become bright and active in his movements; he wishes to see things that he can talk about, and he enjoys talking about what he sees, because he no longer needs an interpreter.
Without a single remark from me on the subject of polite manners, he has taken on such courtesies as raising his hat, walking on the outer side of the sidewalk, assisting me on and off cars, buying the tickets, finding me a seat, getting information from the conductor when necessary, saying “Excuse me” at the proper time, and being generally considerate and thoughtful. It has come about so naturally as to suggest intuition, but is more likely to be the result of a quickened power of observation. The result is parallel to that of removing a plant from a cellar to its rightful share of sunshine.
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