Types and causes of stuttering

In the modern world, stuttering is a common disease. Both adults and children suffer from it. In the former, this pathology has been delayed since childhood; later on, psychological disorders associated with the fear of communication may increase.

The disease can manifest itself in different ways and intensify or subside in a certain environment or with the emotional state of the patient.

In this article we will talk about the clinical types, forms and degrees of stuttering in preschool and school-age children, adolescents and adults, and characterize the types of logoneurosis.

Severity

How many degrees of stuttering are there? Diseases are divided according to their severity. Therefore, there are 3 degrees of stuttering in children and adults:

1. Mild form of stuttering (logoneurosis). Practically does not interfere with free communication. The pathology practically does not manifest itself at all. But in a stressful situation or when trying to say something quickly, minor hesitations are possible.
   But in a calm situation, speech becomes smooth and articulate again. If a mild degree of stuttering is detected in a child, then parents should pay attention, because it is better to treat the disease at an early stage.

   Otherwise it may progress. This earliest and mildest form of stuttering can cause many problems in the future.

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2. Average. Stuttering is severe in a child or adult only at the moment of emotional excitement. The patient cannot complete the sentence. In everyday communication, moderate stuttering practically does not interfere with a person’s communication, although it makes it difficult.
3. Severe form of stuttering. Pathology manifests itself in any emotional state. The patient has difficulty communicating or avoids it in every possible way. High-grade stuttering is also accompanied by various kinds of complications: muscle spasms of the face, arms, legs, etc.

Adults suffer from stuttering from childhood. Precisely since then, when the pathology was not treated or simply ignored.

Usually a person begins to stutter when he is among a large number of people. It is accompanied by panic, a feeling of suffocation and a strong heartbeat. In adulthood, convulsions are recorded in all parts of the speech apparatus.

Speech is accompanied by unconscious and chaotic movements of the arms, legs and torso. A person usually tends to avoid communication. Very closed. Depression may develop on this basis.

Symptoms of stuttering

In the symptoms directly related to stuttering, one should consider those basic psychological characteristics that characterize people who stutter. Speaking about the causes of stuttering, scientists point out that it is the mental sphere that is predominant in this problem, which is accompanied by embarrassment, weakness of will, the mental states and worries we have already indicated. Based on comparisons of theories regarding stuttering and, in fact, practical results, the following mental features of people with stuttering have been identified:

• embarrassment and timidity that arise in the company of people;
• weakness of will in a relative form of manifestation;
• the vividness of fantasies, against the background of which stuttering intensifies;
• increased impressionability;
• the appearance of fear in situations where it is necessary to say something in the company of certain individuals, groups, companies, etc.;
• reduction of stuttering is achieved through the use of certain forms of psychological tricks, and it is possible to completely eliminate it in this way.

At the formal level, such forms of stuttering are distinguished as tonic stuttering, which occurs as a pause during speech or as a stretching of a sound, as well as clonic stuttering, in which, according to the definition, repetition of individual syllables, sounds or words occurs. In this case, mixed stuttering is also distinguished, in which both of these forms of stuttering are combined.

Meanwhile, based on another classification of forms of stuttering, two other options are noted: neurosis-like stuttering and neurotic stuttering.

With neurosis-like stuttering, a pronounced form of neurological defect manifests itself, in which motor skills in general and articulation in particular are subject to impairment. A typical companion is comorbidity (this term implies the relevance of additional clinical manifestations that exist or manifest independently, in addition to the disease that already exists in a person and in any case differs from it) with a disorder such as dysarthria.

Dysarthria, in turn, defines a pronunciation pathology that occurs due to insufficient innervation of the speech apparatus, which is preceded by damage to the subcortical and posterior frontal parts of the brain. This may also be accompanied by the development of neurotic reactions in patients, although these reactions determine little for the characteristics of the course of stuttering itself. As a rule, children for whom neurosis-like stuttering is relevant begin to speak quite late, and in general their development is defined as somewhat slow when compared with their peers. Electroencephalography (EEG) in the vast majority of cases reveals that the brain functions either pathologically or borderline.

As for the neurotic form of stuttering, early or normal speech development in combination with a similar state of motor development is relevant here. Initially, in children with stuttering, stuttering is observed in combination with a stressful situation or fear (this, in turn, can be either one-time or chronic). There are no pronounced forms of neurological disorders in such patients; an EEG reveals that the brain functions in a much more harmonious manner than in the previous considered condition with neurosis-like stuttering.

As for the severity of stuttering, it is determined by the characteristics of the functional state of patients. Thus, in a calm environment with actual neurotic stuttering, they speak almost purely. However, under stress, which can arise, for example, when talking with strangers or with a specific person, during a public speech or an unexpected question, patients with a neurotic form of speech disorder experience severe speech spasms, making it impossible for them to say anything at all. At the same time, such patients, due to the relevance of stuttering for them, develop a pronounced form of logophobia, manifested in the fear of speech, which, in turn, causes avoidant behavior for them. In general, the condition of such patients corresponds to the criteria that are defined for the pathology of neurosis itself, which explains the often application of the term “logoneurosis” to the neurotic form of stuttering. At the same time, some of the authors use this term as a synonym for the speech pathology we are considering (stuttering itself).

As we initially noted, the onset of the disease occurs before the age of 12 years, while in the vast majority of cases there are two acute periods - they, in turn, occur in the interval between 2-4 years, and also in the interval between 5-7 for years. Stuttering usually develops within a period of several weeks (possibly several months). It begins mainly with a repetition of the initial consonants or the entire word in a word, while the repeated words are at the beginning of the sentence. The gradual progression of the disorder in question leads to the fact that such repetitions in speech appear more and more often, and stuttering becomes more frequent when pronouncing especially important words or phrases. In some cases, stuttering does not occur when singing, reading aloud, or talking to inanimate objects or animals. The diagnosis of stuttering is made to patients in case of prolonged manifestation of this disorder (from 3 months or more).

Let's look at the main signs of stuttering. Thus, with clonic stuttering, interruption of speech occurs, manifested in the form of repetition of individual sounds and syllables (this can also be entire phrases). An unnatural specific stretching of sounds also occurs. In particular, the repetition of sounds and syllables in clonic stuttering is accompanied by their repetitions in a form similar to the following examples: “mm-mm-m-fly”, “pa-pa-pa-pa-package”. If we are talking about tonic stuttering, then there are often pauses in speech, which occur in a form similar to the following examples: “verto...let”, “globe”.

In addition, stuttering in almost all cases is accompanied by emotions such as tension, fear, anxiety, which arise against the background of the need to pronounce speech. Additionally, unnatural movements, tics, and possibly grimacing may be added - in these ways people with stuttering try to cope with the disorder that is relevant to them.

In many cases, stuttering is accompanied by the development of a corresponding type of phobia in patients. This, in particular, may be social phobia, which, as you can understand, is directly related to the fear of having to speak. Cases of such a condition as hikikomori cannot be ruled out. Hikikomori does not actually define a state of a special nature for the reader, because this term implies nothing more than a rejection of social life while striving for a rigid form of solitude and self-isolation. The reasons and factors that prompt this may be of a different nature in different cases, while in the context of considering the condition of stuttering that interests us, it is precisely this that is the cause (in combination, again, with the patient’s phobias and other factors accompanying the condition).

The disease defines four phases, into which specific age categories fall in appropriate order.

• 1st phase. In this case, children of the preschool age group fall under it. Their stuttering manifests itself in the form of individual episodes, which, in turn, are combined with periods during which their speech is completely normal. Stuttering is observed when the child is in an excited state, as well as when the child is in a current state of distress; the disorder may manifest itself in situations in which it is necessary to talk a lot. The preschool period determines the possibility of recovery.
• Phase 2. This phase manifests itself in children in elementary school, and stuttering here is chronic; normal speech appears within short periods. Realizing the shortcoming they have, children react extremely painfully to its presence in general. In this phase, stuttering occurs in the pronunciation of the main parts of speech, that is, nouns, adverbs, verbs, adjectives.
• Phase 3. The period of this phase occurs in the age group from years to adolescence. The manifestation of stuttering or its intensification is noted in a certain type of situation (shopping, answering at the board, telephone conversations, etc.). Some sounds, words and combinations may be particularly difficult for them to reproduce.
• Phase 4. This case examines stuttering in late adolescence and stuttering in adults. A typical form of preventing stuttering is the substitution of certain words; this result is also often achieved through verbosity. In this case, as in others, patients strive to avoid any situations that involve the need for verbal communication and, accordingly, may cause inconvenience for them associated with stuttering.

As a rule, stuttering manifests itself in a chronic form; it is characterized by partial remissions (weakening of the manifestations of the disorder). In 50-80% of cases, complete recovery is achieved, especially if we are talking about a mild form of stuttering.

There is also a completely understandable part to consider the disorder - complications of stuttering. They determine a number of interrelated factors. This is reduced academic performance, which is directly related to the fear of actual speech disorders and shyness against this background. The issue of choosing a profession is considered similarly, which is also associated with certain types of restrictions. Also, chronic stuttering is often accompanied by anxiety, states of frustration (arising from the perceived or very real inability to achieve satisfaction of certain needs; discrepancy between desires and the patient’s current capabilities) and depression.

Classification by flow type

It occurs as a result of the spread of excessive excitation of the motor centers of the brain to neighboring structures, including those centers that are responsible for emotions.

Spasms that occur in the speech apparatus (muscles of the palate, tongue, lips) or in the muscles of the larynx cause stuttering. It manifests itself when breathing is impaired, as respiratory spasms occur.

Pathology can occur in different types:

1. Regredient. Improvement in symptoms, disappearance of signs of stuttering and fear of speech, seizures and associated pathologies are reduced.
2. Chronic. If for some time (6 months) the signs of the disease do not go away, then stuttering is considered chronic. It occurs in the following ways:
   permanent. The signs and severity of the disease do not change over time. Associated symptoms: motor and psychopathic disorders also do not change. The disease progresses monotonously;
3. recurrent. Recurrent stuttering is characterized by periods of remission, when clinical signs fade, and relapses: stuttering appears again;
4. wavy. The patient’s speech is constantly changing: it either improves or worsens. Symptoms of wave-like stuttering can be seasonal, for example, worsening in the spring and summer, etc. Changes may depend on the age of the patient or some emotional reasons. But this type of disease also manifests itself in a person’s calm state, that is, for no apparent reason.
5. Progressive. There is a gradual deterioration in the patient's condition.

A concomitant complication—embolophrasia—is also detected. This disorder is characterized by the fact that the patient constantly adds extra words in his speech (in short, so to speak, well, this, etc.) or repeats them; they do not make sense.

This is done in order to stall for time and choose words or structures that are more convenient for pronunciation.

Examination of a patient who stutters

Treatment of stuttering in children requires a preliminary thorough examination of the patient. During the examination, the specialist must conduct a detailed interview with the parents of the stuttering patient. So, it is very important for him to find out the characteristics of the parents’ neuropsychic health and the presence of other diseases. The doctor also asks about how the pregnancy proceeded. It is important for a specialist to know all the information about how the speech of a stuttering child developed: when he began to babble, speak, said the first words and coherent phrases, what his speech environment is like.

Particular attention is paid to raising a child in the family. So, it is important to know how adults treat him, whether they help in the process of speech formation. The speech therapist asks parents in detail about when exactly the signs of stuttering appeared, how they expressed themselves, how the child speaks with people and when left alone. After all the questions have been answered, the doctor conducts a detailed examination of the child’s speech, as well as other processes that may affect his speech.

So, the doctor draws conclusions about sociability , speech characteristics , motor skills , and the characteristics demonstrated by the child in games and learning. In order for the research to be as complete as possible, books, pictures, and toys are used.

As a result, the specialist must determine what form of stuttering is inherent in the patient and how it arose, how often stuttering occurs, what other speech disorders, as well as other functions, occur. If possible, the specialist also finds out how the child himself feels about stuttering.

Characteristics according to etiology (causes of occurrence)

Pathology is also distinguished by the reason for its occurrence . Based on etiology, the following types of stuttering are distinguished: neurotic and neurosis-like.

Comparative characteristics of neurotic and neurosis-like forms of stuttering are presented in the table:

Treatment of stuttering in childhood

If you have problems with speech of this nature, do not panic. If detected early, it can be easily corrected. Parents should be calm and not show their worries to the child. Diagnosis of the condition is carried out by a neurologist, speech therapist, psychologist, and psychotherapist. As a rule, a visual examination of the child is sufficient. Pay attention to vocal, tempo, and breathing characteristics. The presence of motor disorders, the shape and frequency of seizures are noted. Instrumental examination includes electroencephalogram, magnetic resonance imaging. After determining the cause of the disorder, a treatment regimen is drawn up.

Treatment of stuttering in children consists of several components:

• taking medications;
• hypnosis (for older children);
• massage;
• physiotherapeutic method;
• classes with a speech therapist.

There are two methods of treating stuttering. The first is to develop the child's fluent speech skills. This is achieved by teaching the patient self-observation and control of pronunciation. First, they work on one word, gradually expanding the stock to phrases and sentences. For example, “ball” – “red ball” – “big red ball” – “I have a big red ball.” The technique can be used in children of different ages.

In the second case, the task is to reduce secondary signs of logoneurosis. These include increased facial expressions, twitching, jaw clenching, and blinking. The method is effective for long-term disorders. Regardless of the degree of the problem, specialists manage to increase children’s confidence and improve communication skills. For some, it takes several months to get rid of cramps, for others longer - in any case, you need to be patient.

Speech therapy exercises

Breathing exercises: A) “palms” exercise; B) exercise “washing”

The speech pathologist will select exercises for the child to perform at home and in group therapy, teach breathing exercises, and correct the tempo characteristics of speech. In childhood, treatment is carried out in a playful way to interest the baby and keep his attention. To train the speech function, singing will be useful, during which the little patient is taught rhythm and intonation. The overall positive effect of such a game leads to the disappearance of internal barriers.

Examples of speech therapy exercises:

• “Funny carousels” - repetition of the phrase: “we are funny carousels, opa-opa-opa-pa-pa, tatati-tata-tata.”
• “Chicks” - alternate jumps on one leg with repetition of the phrases “clap-top-clap”, “oof-iv-av”, “tap-tip-rap-rop-tsip-tsip”.
• “Conductor” - the speech therapist conducts with his hands, and the baby pronounces vowels and consonants.

In a certain sequence, children with a speech therapist learn to present a narrative text, read poems, and practice presentation. Creating a comfortable environment is of great importance; the baby should not be afraid that they will laugh at him or scold him. With systematic practice, the rhythm and intonation change. After achieving positive results, the specialist teaches nuances of speech: raising and lowering intonation, placing accents, pauses. Various everyday situations are practiced to prepare the baby for society.

Therapeutic measures

The purpose of massage sessions is to relax the articulatory apparatus, improve blood circulation, and eliminate spasms. In the affected area are the neck, lips, shoulders, larynx, facial muscles. How to massage yourself? Before going to bed, the mother can use relaxing, soft movements to stroke the baby’s back, shoulders, and collar area. Duplicate speech with the fingers of your dominant hand. This way you send a signal to the area of ​​the brain responsible for its reproduction. Acupressure is based on influencing acupuncture points located throughout the surface of the body. It must be carried out by a specialist.

Strelnikova’s breathing exercises help improve blood supply not only to the speech organs, but also to the body as a whole. The child learns to speak words while exhaling, practicing integral pronunciation, without breaking them into syllables or individual sounds. Suitable for children of a conscious age.

Examples of breathing exercises:

• “Cat” - the child squats and turns the body in different directions, emphasis on exhaling while straightening the body.
• “Pump” - you need to take deep breaths and exhales, stretching your lips with a tube.
• “Ears” - try to touch your ear to your shoulder when tilting your head, inhale while tilting and exhale in the starting position.
• “Palms” - bend your elbows with your palms down; straighten your arms and exhale slowly, bend and inhale sharply.
• “Pendulum” - bending forward with exhalation and returning to the starting position with a sharp inhalation.

It’s even easier to inflate balloons, blow soap bubbles, and move toys on the water using your breath while swimming in the pool.

Side effects such as headaches and blood pressure surges may occur. Therefore, it is better to conduct classes under the guidance of a specialist.

Hypnosis sessions are carried out with children of middle and high school age, provided they have a stable nervous system. Many children do not respond to hypnotherapy. In other cases, this can help in identifying the cause of the deviation.

Popular groups of medications are anticonvulsants, nootropics and angioprotectors to improve cerebral circulation, sedatives and vitamin preparations, muscle relaxants. For mental disorders, tranquilizers may be prescribed.

According to a separate scheme, the doctor can prescribe homeopathic remedies: Dormikind, Notta, Leovit, Baby-sed. Electrosleep is often prescribed as a physical treatment.

Alternative Therapies

Traditional medicine cannot be used as the main method of treatment. They are also not used for serious neurological conditions. Teas that contain herbal preparations with a calming effect, herbal baths, and inhalations with herbs will be beneficial for children.

Chamomile, sage, lemon balm, oregano, linden blossom, motherwort, lavender, and mint have healing properties. You can prepare teas yourself or buy them at a pharmacy chain.

Note! An allergic reaction to the components is possible; treatment should begin with small doses and monitor the child’s well-being.

According to the form of seizures and their manifestations

What other types of stuttering are there? Depending on their location, stuttering is divided into:

1. Tonic. The most common type of pathology. Excessive excitement is transmitted to the speech apparatus, where a spasm occurs. As a result, normal speech is disrupted.
   Usually the patient cannot pronounce any sound or start a new word. At the same time, the face and neck look very tense from the outside.

   There may also be prolonged contraction of the respiratory muscles and the patient often does not have enough air to continue speaking.

2. Clonic. It is expressed in the repetition of individual sounds, parts of a word or the entire word. This type of pathology is characterized by involuntary and frequent contraction of the muscles of the speech apparatus. Typically, stuttering occurs before pronunciation with sounds that are difficult to pronounce.
3. Mixed. The mixed form of stuttering can manifest as both clonic and clonic convulsions. One form can overlap another. The patient experiences long pauses or lapses in speech.

You can learn more about tonic and clonic stuttering in this article.

General information

Stuttering is a speech pathology that disrupts the tempo, rhythm, and smooth pronunciation of words. During stuttering, the overall coordination in the work of the voice , speech muscles , and breathing . These problems arise due to spasms in different areas of the speech apparatus. Such convulsions are divided into clonic (that is, the constant repetition of a certain sound or syllable, often the repetition occurs at the beginning of a word) and tonic (the occurrence of tension that does not allow one to overcome a malfunction that occurred during the speech process). Tonic-clonic stuttering is also diagnosed - it is a mixed type. Stuttering in children causes forced stops in the child’s speech during pronunciation or constant repetition of certain syllables and sounds. As a rule, stuttering in children appears between the ages of two and five. It is during this period that children actively develop speech, and the speech function has not yet become sufficiently strong and developed. It has been noticed that boys begin to stutter approximately three to four times more often. Experts explain this feature by the fact that males are less emotionally stable.

By localization

Convulsions that lead to hesitations in speech are localized in different areas:

1. Articulatory. The spasm can affect the muscles of the face (contraction of the muscles of the upper or lower lip occurs, resulting in the pulling of the corners of the mouth to the sides or its convulsive opening, in some cases the muscles of the neck, forehead and ears also take part), the muscles of the tongue (its involuntary falling out of the cavity mouth, involuntary opening of the mouth, etc.), muscles of the soft palate (in this case, the passage from the pharynx to the nasal cavity either closes or opens).
2. Respiratory. They are observed when inhaling, but they are hardly noticeable and appear as minor pauses in conversation. Occur with varying frequency and intensity. When exhaling, the patient has difficulty finishing a word or phrase. In this case, a strong contraction of the abdominal muscles occurs. The spasm affects the facial muscles, causing the face to become distorted. There is a feeling of lack of air.
3. Voice. The vocal folds constantly close and open, causing the patient's speech to become intermittent and vibrating. During a conversation, the vocal folds can close completely, which leads to a sharp pause and loss of voice, while the person lacks air. A spasm occurs when pronouncing vowel sounds, and the patient lengthens them to such an extent that shortness of breath often occurs. The neck muscles tense and the voice becomes unnatural. Articulation may not be evident.
4. Mixed. Convulsions during stuttering can alternate with each other and can overlap one another.