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In the diagnosis of speech disorders, there are almost as many different forms of defective utterance as there are cases, all of which forms, however, divide themselves into a few basic types. These various disorders might be broadly classified into three classes:
Regardless of under which of these three heads a speech disorder may come, it is commonly spoken of by the laymen as a "speech impediment" or "a stoppage in speech" notwithstanding the fact that the characteristics of the various disorders are quite dissimilar. In certain of the disorders,
While this volume has but little to do with speech disorders other than stammering and stuttering, the characteristics of the more common forms of speech impediment--lisping, cluttering and hesitation, as well as stuttering and stammering--will be discussed in this first chapter, in order that the reader may be able, in a general way at least, to differentiate between the various disorders.
LISPING
This is a very common form of speech disorder and one which manifests itself early in the life of the child. Lisping may be divided into three forms:
NEGLIGENT LISPING: This is a form of defective enunciation caused in most cases by parental neglect or the carelessness of the child himself in the pronunciation of words during the first few months of talking. This defective pronunciation in Negligent Lisping is caused either by a FAILURE or an INABILITY to observe others who speak correctly. We learn to speak by imitation, and failing to observe the correct method of speaking in others, we naturally fail to speak correctly ourselves. In Negligent Lisping, this inability properly to imitate correct speech processes, results in the substitution of an incorrect sound for the correct one with consequent faulty formation of words.
ORGANIC LISPING: This results from an organic or physical defect in the vocal organs, such as hare-lip, feeble lip, malformation of the tongue, defective teeth, overshot or undershot jaw, high palatal arch, cleft palate, defective palate, relaxed palate following an operation for adenoids, obstructed nasal passages or defective hearing.
NEUROTIC LISPING: This is a form of speech marked by short, rapid muscular contractions instead of the smooth and easy action used in producing normal sounds. Neurotic Lisping is often found to be combined with stammering or stuttering, which is quite logical, since it is similar, both as to CAUSE and as to the presence of a MENTAL DISTURBANCE. In Neurotic Lisping, the muscular movements are less spasmodic than in cases of stuttering, partaking more of the cramped sticking movement, common in stammering.
STUTTERING
Stuttering may be generally defined as the repetition--rapid in some cases, slow in others--of a word or a syllable, before the following word or syllable can be uttered. Stuttering may take several forms, any one of which will fall into one of four phases:
Simple stuttering can be said to be a purely physical form of the difficulty. The Advanced Phase marks the stage of further progress where the trouble passes from the purely physical state into a condition that may be known as Mental-Physical. The distinctly Mental Phase is marked by symptoms indicating a mental cause for the trouble, the disorder usually having passed into this form from the simple or advanced stages of the malady. Stuttering may be combined with stammering in which case the condition represents the Compound Phase of the trouble.
CHOREATIC STUTTERING: This originates in an attack of Acute Chorea or St. Vitus Dance, which leaves the sufferer in a condition where involuntary and spasmodic muscular contractions, especially of the face, have become an established habit. This breaks up the speech in a manner somewhat similar to ordinary stuttering. Also known as "Tic Speech."
SPASTIC SPEECH: This is often the result of infantile cerebral palsy, the characteristic symptom of the trouble being intense over-exertion, continued throughout a sentence, the syllables being equal in length and very laboriously enunciated. In spastic speech, there is present a noticeable hyper-tonicity of the nerve fibers actuating the muscles used in speaking as well as marked contractions of the facial muscles.
UNCONSCIOUS STUTTERING: This is a misnomer because there can be no such thing as unconscious stuttering. It appears that the person afflicted is not conscious of his difficulty for he insists that he does not s-s-s-s-tut-tut-tut-ter. Unconscious Stuttering is but a name for the disorder of a stutterer who is too stubborn to admit his own difficulty.
THOUGHT STUTTERING: This is an advanced form of stuttering which is also known as Aphasia and which is caused by the inability of the sufferer to recall the mental images necessary to the formation of a word. Stuttering in its simpler forms is usually connected with the period of childhood, while aphasia is often connected with old age or injury. The aphasic person is excessively nervous as is the stutterer; he undergoes the same anxiety to get his words out and the same fear of being ridiculous. In aphasia there is, however, no excessive muscular tension or cramp of the speech muscles. In these cases, the stutterer will sometimes repeat the first syllable ten or fifteen times with pauses between, being for a time unable to recall what the second syllable is. It is, in other words, a habitual, but nevertheless temporary, inability to recall to mind the mental images necessary to produce the word or syllable desired to be spoken. This condition is more commonly known as Thought Lapse or the inability to think of what you desire to say.
One investigator shows that the diagnosis of "insanity" with later commitment to an asylum occurred in the case of a bad stutterer. When excited he would go through the most extreme contortions and the wildest gesticulations in a vain attempt to finally get all of the word out, finally pacing up and down the room like one truly insane. This tendency to believe that the stutterer is insane because of the convulsive or spasmodic effort accompanying his efforts to speak, is a mistaken one, although there can be little doubt of the tendency of this condition finally to lead to insanity if not checked.
HESITATION
Hesitation is marked by a silent, choking effort, often accompanied by a fruitless opening and closing of the mouth. Hesitation is a stage through which the sufferer usually passes before he reaches the condition known as Elementary Stammering.
STAMMERING
Stammering is a condition in which the person afflicted is unable to begin a word or a sentence no matter how much effort may be directed toward the attempt to speak, or how well they may know what they wish to say. In stammering, there is the "sticking" as the stammerer terms it, or the inability to express a sound. The difference between stammering and stuttering lies in the fact that in stuttering, the disorder manifests itself in loose and hurried (or in some cases, slow) repetitions of sounds, syllables or words, while in the case of stammering, the manifestation takes the form of an inability to express a sound, or to begin a word or a sentence.
ELEMENTARY STAMMERING: This is the simplest form of this disorder. Here, the convulsive effort is not especially noticeable and the marked results of long-continued stammering are not apparent. Most cases pass quickly from the elementary stage unless checked in their incipiency.
SPASMODIC STAMMERING: This marks the stage of the disorder where the effort to speak brings about marked muscular contractions and pronounced spasmodic efforts, resulting in all sorts of facial contortions, grimaces and uncontrolled jerkings of the head, body and limbs.
THOUGHT STAMMERING: This, like Thought-Stuttering, is a form of Aphasia and manifests itself in the inability of the stammerer to think of what he wishes to say. In other words, the thought- stammerer, like the thought-stutterer, is unable to recall the mental images necessary to the production of a certain word or sound--and is, therefore, unable to produce sounds correctly. The manifestations described under Thought Stuttering are present in Thought Stammering also.
COMBINED STAMMERING AND STUTTERING: This is a compound form of difficulty in which the sufferer finds himself at times not only unable to utter a sound or begin a word or a sentence but also is found to repeat a sound or syllable several times before the following syllable can be uttered. Any case of stuttering or stammering in the Simple or Elementary Stages may pass into Combined Stammering and Stuttering without warning or without the knowledge, even, of the stammerer or stutterer.
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