Defects of
Speech By
MARION FLEMING
Speech Training and of the International Association), Travelling Teacher for the Correction of Speech
(Diplomee, Phonetics
among School Children
Central School of
Defects, C.A.M.W.
For many years the problem of dealing with the number of speech defects in Elementary Schools has been engaging the attention of experts interested in the subject of speech, and during the last five years or so, Education Authorities have become more and more alive to the necessity of taking steps to eradicate such defects, which are not only a very great handicap in themselves, but are liable to produce a marked effect upon the child's mental and psychological development. In many cases the speech defect is the first indication of some psychological disturbance. As such, it is extremely important that the defect should be tackled while the child is young and before the difficulty is of many years' standing. Many of the larger cities have appointed a full-time Speech Therapist (Birmingham, Leicester, Cardiff, to name but a few) whose function is to organise classes throughout the area for the treatment of all speech defects in the schools. In the case of smaller areas, however, there is not always sufficient work to occupy a specialist all the year round, and it was to try to meet the need of these smaller areas that in 1931 the Central Association for Mental Welfare conceived the idea of a Travelling Expert,
MENTAL WELFARE
54
whose duties should consist in visiting local authorities for a series of short visits in order to organise classes among the children in the area and to give such information to the teachers as would enable them to continue the work, at the termination of one visit, until the Expert's return. In September, 1931, I was appointed to this work, and at the conclusion of two years, it is interesting to look back and to try to form an idea of the results which have been obtained and the possibilities of further work on these lines. I have visited, for periods varying from one to three months, ten different areas?-two mining districts, one county, one town where the interests were mainly agricultural, and the remainder large industrial towns. In one of the largest industrial cities, the work was entirely among Special Schools for the Mentally Defective, and here one finds a great preponderance of the type of defect generally known as Baby Talk," an undeveloped form of speech which is due to mental causes. In most of the other areas, the percentage of speech defects to the Elementary School population was approximately the same, one exception to this being an industrial town where speech classes had previously been held for many years, the result of which was shown in a far smaller proportion of defects. One feels that in the case of slight defects such as Lisping and the milder degrees of Baby Talk, a very great deal might be done by the elementary school teachers themselves if they were qualified with the necessary knowledge. In these visits, therefore, I have tried to concentrate more upon giving as many hints as possible to the teachers rather than attempted to effect cures in the children. Indeed, it is utterly impossible to effect a cure, except in the very slightest cases, when one sees a child six times, at the most. With regard to Stammering, one feels very strongly that the treatment of this very distressing complaint should never be undertaken except by an expert or under expert "
supervision.
In order to understand the
causes of defective speech one must, first of of is what normal knowledge speech and what are the mental which it. In the first processes precede place, all speech is the result of imitaand to enable a child to learn to tion, speak he must have some kind of outside in the form of of stimulus, examples speech around him which he can imitate. A child, in the first instance, will naturally speak as his parents speak or those people with whom he is closely associated. The outside stimulus being provided, the child's brain is then brought into play to teach him, unconsciously, how to make use of the patterns he hears to acquire the faculty of speech himself. Any talking is said to require at least five regions of the brain for its proper execution:?*
all, have
I.
hearing, made). *"
The
some
A receptive organ for the sensory impression {i.e., the actual sense of which merely records that a sound of some description has been
Psychology
of
Language," by Pillsbury
and Header.
MENTAL WELFARE II. nised
as
An area in which the words. A connection
III.
the
regions IV.
for
mere
involved in
55
sound sensations are,
region which expression.
so to
will transfer this word
speak,
impression
A part of the brain in which the word is co-ordinated and
expression.
V. A motor area from which come the actual muscular movements which form a word.
recogto
prepared
impulses controlling
the
then carried out by the moveable speech and soft organs?the tongue, lips, jaw palate?and so a word is produced. It can thus be seen that speech is a highly complicated business which involves fine adjustments in the mental processes. When one considers the number of delicate movements performed in saying even such a simple word " as CAT," for example, it is apparent that very controlled muscular processes are also involved and that fine co-ordination between mind and body is essential. In the normal speech development of a child all the processes outlined above arc being exercised and developed unconsciously as he gradually acquires the faculty of speech. He will pass through the various stages of: The muscular
movements are
(1) Crying, screaming, cooing, etc., which are a way of exercising the are an expression of his feelings, but as yet have no definite
vocal organs and
form.
(2)
"
exercise and movements
where he begins to make more formulated sounds for kind of play, enjoying the noises he produces and the physical used in producing them.
Babbling," as a
(3) Beginning to imitate and to understand words spoken around him. (4) Developing rapidly in understanding and in learning to speak new
words.
That is the normal course in a child whose hearing capacity and brain normal in every way. But suppose that a child has slightly defective hearing and does not receive absolutely accurate impressions of the sounds around him, it is naturally very difficult for him to reproduce those sounds correctly. When one considers the similarity between F and TH, between S and SH, between T and K, it is easy to understand how anybody who is even very slightly deaf may confuse them. Therefore the first thing to do in the case of a child with defective speech is to investigate his hearing and find out if there is any degree of deafness and whether it is possible to have it remedied. There also exists a condition known as Word Deafness, in which the " actual hearing is normal, but the area in which the mere sound sensations " are, so to speak, recognised as words (II, above) is defective or destroyed as are
MENTAL WELFARE
56
the result of an accident or illness. Extreme cases of this nature should only be treated by a specialist and are not very frequently met. But suppose that a child has some slight weakness in this area of the brain, or that, for some is it reason, undeveloped, then he may hear, for instance, the combination of CAT but as TAT or CA' sounds C-A-T, not as and consequently " in the word that form?" SING become TING or reproduce may TIN THING may be and so forth. The of defective FING," type " thus manifested is known as Lalling or Talk." A rendering speech Baby " of Sing a Song of Sixpence would be somewhat as follows: "
"
"
"
"
"
"
"
"
"
"
"
"
Tin'
ton' of Titpent' potet fu' of wye (or more Five an' tenty bat bird Bate in a pie; Wen de pie wad open De bird bedan to tin', Wadn' dat a dainty dit To tet before de tin','' etc. a
A
An still less
generally, WICE!)
marked degree of the same type of defect, showing development, is the following, where almost all the consonants are defective, double consonants not attempted, and finals completely lacking: even
more
"
"
Baa, baa, ba' see', ha'
any woo'? Ye' 'ir, ye' 'ir, fee ba' fu' One for ve ma'er, an' one for ve da' An' one for ve 'ickle boy who li' dow've la'." oo
Baby Talk is a perfectly natural and normal stage in development and constitutes a kind of practising for the difficulties of speech, but it should not continue beyond the age of 4 or 5 years. The fond mother who anticipates every need of her child and so relieves him of the necessity for asking for the things he wants, may be doing untold harm. If he finds that his requirements are met without any effort on his part to utter a sound, he naturally finds it easier and more satisfactory to remain in that condition, with the result that his speech faculties are not being normally exercised and his speech is very retarded and undeveloped. This undeveloped speech, in some form or other, is found among children of normal intelligence and may be due to the overprotective parent or to some weakness in the centres of the brain concerned with speech. It is, however, far more common among children of sub-normal intelligence and mental defectives, which is understandable when one considers the fine mental adjustments necessary to produce anv word correctly. The danger is that any child suffering from this type of defect may be very seriously misjudged and written down as retarded or even Mentally Deficient, when there is nothing wrong but his inability to express himself in normal speech. Among Mental Defectives, however, this type of undeveloped speech or "Baby
MENTAL WELFARE Talk
"
57
is often
sonant to
found, in any stage from the wrong pronunciation of one conspeech which is unintelligible through wrong pronunciation of many
sounds. It is induced not only by possible weakness in the brain centres, but also by the actual muscular difficulty the child may experience in producing certain sounds or combinations of sounds, such as BL, PL, ST, SP, SC, SL SM SN, etc. "BLACK" for example, may be rendered as BACK," BACKL," BAT," etc. There may be a mental laziness which reflects itself in slip-shod speech, there may be a lack of tone in the muscles and an inability to produce firm, decisive movements, which will give much the same effect. "
"
"
The treatment of such defects lies, first of all, in making the child LISTEN?listen to the best example of really good speech it is within the teacher's power to produce. He then requires actual muscular "Speech Drill" to help him to gain greater control over the movements of the speech organs, exercises to give flexibility and strength to the movements of jaw, lips, tongue and soft palate. Practice before a small mirror is excellent as it enables him to see exactly what he is doing. He will take far more interest in making the tip of the tongue touch the top of the teeth," if he can actually watch his tongue jumping up and down. He needs practice in all the consonants, taken individually, then combined with vowels, then in simple words and simple phrases, care being taken not to make him over-conscious of any one sound or to let him feel there is any particular sound which he is quite unable to say. The NAMES of the sounds should be avoided, their phonetic value used being always. Ten minutes' regular daily practice is of far more value than an occasional half-hour. "
Defects of
speech I.
II. III.
The
category,
"
as
are
usually
divided into three
categories:
Defects. Defects. Organic Functional Defects.
Articulatory
Baby Talk," of which we have been speaking, belongs to the first does also Lisping. The term Lisping denotes faulty pronunciation
of the sibilant sounds, S, Z, SH, CH and J. The most common form is what is known as Infantile Lisping, so called because it is generally a retention of childish habits, often developing at the age of second dentition. It consists in the substitution of the sound TH for S, due to the fact that the tongue is protruding between the teeth instead of lying just behind them. This may arise through there being gaps in the front teeth at the age of second dentition, the tongue forming the habit of protruding slightly and continuing even after the teeth have grown. In this case, practice in the correct position (with the help of a mirror), as suggested above, should bring about a cure quite quickly. In some cases, however, the defect may be due to irregularity of dentition, where the front teeth are so formed as to be unable to effect a closure. It is then difficult to bring about a complete and satisfactory cure, and one generally has to be content with the best result possible in the circumstances.
producing
MENTAL WELFARE
58
Organic defect is one in which the speech difficulty is directly physical malformation or disability. The chief of these are:
An some
1.
Defects due Defects due
to
due
to
Cleft Palate. Adenoids and
Enlarged Tonsils. A Cleft Palate is a division, at some point, of the palate, which forms the roof of the mouth and the floor of the nose. The cleft may extend right from front to back of the mouth, the upper lip also being cleft, in which case one has the condition known as hare-lip in addition. It may, however, not be apparent at all on the outside of the mouth, but extend through the hard and soft palates?or it may be merely the soft palate which is affected. In any The stream of sound, coming case, the effect upon the speech is very similar. from the and no to direct it forward through the larynx up finding palate mouth, ascends into the nasal cavities, with the result that there is an extremely ugly nasal quality in all the speech. It is, unfortunately, impossible to improve this to any extent until the physical condition has been remedied by surgical or dental measures. The cleft in the palate can be closed by an operation, which should be performed while the child is very young?if possible before he begins to speak. If this is not possible, or if, as in some instances, the operation breaks down, it is still possible to have a false palate inserted. These have been brought to a pitch of perfection now-a-days, and with one in the mouth the speech can be improved to such a degree that it is difficult to detect any abnormality. Cleft Palate cases are comparatively rare?which is fortunate, as the condition is a very distressing one and the speech practically unintelligible until remedial measures and Speech Training have been given. The same applies to Adenoids and Enlarged Tonsils. These are infinitely more common, and, as in the case of Cleft Palate, it is out of the question to effect real improvement in the speech until the physical condition has been remedied. Then it is possible to do a great deal. The third category of Speech Defects, those known as Functional, are defects in which the actual mechanism of speech is normal, but the use made of it is defective. The most common of these is Stammering, which is now definitely regarded by authorities as being not, strictly speaking, a Speech Defect, but a nervous disorder which happens to affect the speech. Contrary to the belief held by some people, this disorder appears to be as common among Mental Defectives as among children of normal intelligence. The approach to it differs completely from the methods used in dealing with Articulatory and Organic Defects. These can be treated largely by phonetic means, after any physical disability has been put right. A Stammer, however, is now held by competent authorities to be the result of a neurosis?" a disturbance of thought which affects the functions of the body." Hence the actual speech defect is merely a symptom of some more deep-seated trouble and it is not of 2.
much value cause
to
to attempt to correct the symptom before having traced the root and remedied it. The root cause is generally some psychological conflict,
MENTAL WELFARE due
59
situation in the child's environment, with which he does not feel competent to grapple. The feeling of inadequacy may be quite unconscious. One can cite cases of jealousy of other children in the family, of over-protection on the part of the parents, of lack of opportunity for the child to make satisfactory adjustment to the demands of the group in which he lives. Such environmental factors will not produce a stammer in every child, otherwise there would be a far greater number of Stammerers in the schools. There must be, in the child, some predisposition for the neurosis to take such a form. The predisposition may be either: to a
I. Physical weakness in the mechanism of breathing, in the diaphragm, the great flat muscle which forms the floor of the chest. This may be inherited or may be the result of illness, malnutrition, etc. " II. Mental weakness in word imagery," in forming really clear and definite mental conceptions of words, with the result that a certain amount of confusion and hesitancy are present. In some cases the difficulty is congenital and the child stammers from the time he begins to speak. More often it is induced by a shock or fright of some kind, or a bad illness, which for the time being slightly upsets the fine balance of the nervous system and allows the neurosis to take hold of the individual's weak spot?or it may be unsatisfactory adjustment to environment, as mentioned above. One boy of 7 stammered violently after having seen a playmate of his own age drowned before his eyes. They were playing on ice, which gave way, and the boy was unable to do anything to save his friend. Another boy stammered after a very severe scalding; another, a child of 5, fell from the top of a high wall upon which he was sitting, into a river, and somehow succeeded in struggling out by himself. Another child, at the age of 5, was frightened by her nurse with a tale of a headless woman who would chase her if she were naughty! One hears of cases where the stammer developed after a severe illness, of men who stammered as the result of shellshock. One could multiply examples, but sufficient has been said to give some idea of the underlying causes which may lead to this distressing complaint. Suggestions for treatment do not come within the scope of this article, but help can be given by seeing that the child has adequate rest and nourishment, that he is kept free from undue excitement and anxiety, and that everything possible is done to build up his self-confidence. Actual treatment should be given only by an expert who has had experience of this type of work. feature of any form of Speech Defect is not only that it is, in itself, an obvious handicap, but that it tends to produce a marked sense of inferiority in the child and consequently inhibits him from showing his true powers. Thus, for the fullest mental development of which he is capable, it is of very great importance to help him to express himself as freely and easily in speech as the other children around him. Over and over again it is reported by teachers that as a speech defect disappears, so the general standard of the The
worst
60
MENTAL WELFARE
child's work improves. Sufficient has probably been said at the beginning of this article to show that even the simplest form of speech requires a degree of mental and physical co-ordination and control. For this reason, scientific Speech Training is excellent training, not only for the speech itself, but also for the mind, and is of great benefit in the teaching of Mental Defectives. One " hopes that the day is not far distant when to minutes' daily Speech Drill will form part of the recognised curriculum in every school. "
Speech By
MARION FLEMING
Speech Training and of the International Association), Travelling Teacher for the Correction of Speech
(Diplomee, Phonetics
among School Children
Central School of
Defects, C.A.M.W.
For many years the problem of dealing with the number of speech defects in Elementary Schools has been engaging the attention of experts interested in the subject of speech, and during the last five years or so, Education Authorities have become more and more alive to the necessity of taking steps to eradicate such defects, which are not only a very great handicap in themselves, but are liable to produce a marked effect upon the child's mental and psychological development. In many cases the speech defect is the first indication of some psychological disturbance. As such, it is extremely important that the defect should be tackled while the child is young and before the difficulty is of many years' standing. Many of the larger cities have appointed a full-time Speech Therapist (Birmingham, Leicester, Cardiff, to name but a few) whose function is to organise classes throughout the area for the treatment of all speech defects in the schools. In the case of smaller areas, however, there is not always sufficient work to occupy a specialist all the year round, and it was to try to meet the need of these smaller areas that in 1931 the Central Association for Mental Welfare conceived the idea of a Travelling Expert,
MENTAL WELFARE
54
whose duties should consist in visiting local authorities for a series of short visits in order to organise classes among the children in the area and to give such information to the teachers as would enable them to continue the work, at the termination of one visit, until the Expert's return. In September, 1931, I was appointed to this work, and at the conclusion of two years, it is interesting to look back and to try to form an idea of the results which have been obtained and the possibilities of further work on these lines. I have visited, for periods varying from one to three months, ten different areas?-two mining districts, one county, one town where the interests were mainly agricultural, and the remainder large industrial towns. In one of the largest industrial cities, the work was entirely among Special Schools for the Mentally Defective, and here one finds a great preponderance of the type of defect generally known as Baby Talk," an undeveloped form of speech which is due to mental causes. In most of the other areas, the percentage of speech defects to the Elementary School population was approximately the same, one exception to this being an industrial town where speech classes had previously been held for many years, the result of which was shown in a far smaller proportion of defects. One feels that in the case of slight defects such as Lisping and the milder degrees of Baby Talk, a very great deal might be done by the elementary school teachers themselves if they were qualified with the necessary knowledge. In these visits, therefore, I have tried to concentrate more upon giving as many hints as possible to the teachers rather than attempted to effect cures in the children. Indeed, it is utterly impossible to effect a cure, except in the very slightest cases, when one sees a child six times, at the most. With regard to Stammering, one feels very strongly that the treatment of this very distressing complaint should never be undertaken except by an expert or under expert "
supervision.
In order to understand the
causes of defective speech one must, first of of is what normal knowledge speech and what are the mental which it. In the first processes precede place, all speech is the result of imitaand to enable a child to learn to tion, speak he must have some kind of outside in the form of of stimulus, examples speech around him which he can imitate. A child, in the first instance, will naturally speak as his parents speak or those people with whom he is closely associated. The outside stimulus being provided, the child's brain is then brought into play to teach him, unconsciously, how to make use of the patterns he hears to acquire the faculty of speech himself. Any talking is said to require at least five regions of the brain for its proper execution:?*
all, have
I.
hearing, made). *"
The
some
A receptive organ for the sensory impression {i.e., the actual sense of which merely records that a sound of some description has been
Psychology
of
Language," by Pillsbury
and Header.
MENTAL WELFARE II. nised
as
An area in which the words. A connection
III.
the
regions IV.
for
mere
involved in
55
sound sensations are,
region which expression.
so to
will transfer this word
speak,
impression
A part of the brain in which the word is co-ordinated and
expression.
V. A motor area from which come the actual muscular movements which form a word.
recogto
prepared
impulses controlling
the
then carried out by the moveable speech and soft organs?the tongue, lips, jaw palate?and so a word is produced. It can thus be seen that speech is a highly complicated business which involves fine adjustments in the mental processes. When one considers the number of delicate movements performed in saying even such a simple word " as CAT," for example, it is apparent that very controlled muscular processes are also involved and that fine co-ordination between mind and body is essential. In the normal speech development of a child all the processes outlined above arc being exercised and developed unconsciously as he gradually acquires the faculty of speech. He will pass through the various stages of: The muscular
movements are
(1) Crying, screaming, cooing, etc., which are a way of exercising the are an expression of his feelings, but as yet have no definite
vocal organs and
form.
(2)
"
exercise and movements
where he begins to make more formulated sounds for kind of play, enjoying the noises he produces and the physical used in producing them.
Babbling," as a
(3) Beginning to imitate and to understand words spoken around him. (4) Developing rapidly in understanding and in learning to speak new
words.
That is the normal course in a child whose hearing capacity and brain normal in every way. But suppose that a child has slightly defective hearing and does not receive absolutely accurate impressions of the sounds around him, it is naturally very difficult for him to reproduce those sounds correctly. When one considers the similarity between F and TH, between S and SH, between T and K, it is easy to understand how anybody who is even very slightly deaf may confuse them. Therefore the first thing to do in the case of a child with defective speech is to investigate his hearing and find out if there is any degree of deafness and whether it is possible to have it remedied. There also exists a condition known as Word Deafness, in which the " actual hearing is normal, but the area in which the mere sound sensations " are, so to speak, recognised as words (II, above) is defective or destroyed as are
MENTAL WELFARE
56
the result of an accident or illness. Extreme cases of this nature should only be treated by a specialist and are not very frequently met. But suppose that a child has some slight weakness in this area of the brain, or that, for some is it reason, undeveloped, then he may hear, for instance, the combination of CAT but as TAT or CA' sounds C-A-T, not as and consequently " in the word that form?" SING become TING or reproduce may TIN THING may be and so forth. The of defective FING," type " thus manifested is known as Lalling or Talk." A rendering speech Baby " of Sing a Song of Sixpence would be somewhat as follows: "
"
"
"
"
"
"
"
"
"
"
"
"
Tin'
ton' of Titpent' potet fu' of wye (or more Five an' tenty bat bird Bate in a pie; Wen de pie wad open De bird bedan to tin', Wadn' dat a dainty dit To tet before de tin','' etc. a
A
An still less
generally, WICE!)
marked degree of the same type of defect, showing development, is the following, where almost all the consonants are defective, double consonants not attempted, and finals completely lacking: even
more
"
"
Baa, baa, ba' see', ha'
any woo'? Ye' 'ir, ye' 'ir, fee ba' fu' One for ve ma'er, an' one for ve da' An' one for ve 'ickle boy who li' dow've la'." oo
Baby Talk is a perfectly natural and normal stage in development and constitutes a kind of practising for the difficulties of speech, but it should not continue beyond the age of 4 or 5 years. The fond mother who anticipates every need of her child and so relieves him of the necessity for asking for the things he wants, may be doing untold harm. If he finds that his requirements are met without any effort on his part to utter a sound, he naturally finds it easier and more satisfactory to remain in that condition, with the result that his speech faculties are not being normally exercised and his speech is very retarded and undeveloped. This undeveloped speech, in some form or other, is found among children of normal intelligence and may be due to the overprotective parent or to some weakness in the centres of the brain concerned with speech. It is, however, far more common among children of sub-normal intelligence and mental defectives, which is understandable when one considers the fine mental adjustments necessary to produce anv word correctly. The danger is that any child suffering from this type of defect may be very seriously misjudged and written down as retarded or even Mentally Deficient, when there is nothing wrong but his inability to express himself in normal speech. Among Mental Defectives, however, this type of undeveloped speech or "Baby
MENTAL WELFARE Talk
"
57
is often
sonant to
found, in any stage from the wrong pronunciation of one conspeech which is unintelligible through wrong pronunciation of many
sounds. It is induced not only by possible weakness in the brain centres, but also by the actual muscular difficulty the child may experience in producing certain sounds or combinations of sounds, such as BL, PL, ST, SP, SC, SL SM SN, etc. "BLACK" for example, may be rendered as BACK," BACKL," BAT," etc. There may be a mental laziness which reflects itself in slip-shod speech, there may be a lack of tone in the muscles and an inability to produce firm, decisive movements, which will give much the same effect. "
"
"
The treatment of such defects lies, first of all, in making the child LISTEN?listen to the best example of really good speech it is within the teacher's power to produce. He then requires actual muscular "Speech Drill" to help him to gain greater control over the movements of the speech organs, exercises to give flexibility and strength to the movements of jaw, lips, tongue and soft palate. Practice before a small mirror is excellent as it enables him to see exactly what he is doing. He will take far more interest in making the tip of the tongue touch the top of the teeth," if he can actually watch his tongue jumping up and down. He needs practice in all the consonants, taken individually, then combined with vowels, then in simple words and simple phrases, care being taken not to make him over-conscious of any one sound or to let him feel there is any particular sound which he is quite unable to say. The NAMES of the sounds should be avoided, their phonetic value used being always. Ten minutes' regular daily practice is of far more value than an occasional half-hour. "
Defects of
speech I.
II. III.
The
category,
"
as
are
usually
divided into three
categories:
Defects. Defects. Organic Functional Defects.
Articulatory
Baby Talk," of which we have been speaking, belongs to the first does also Lisping. The term Lisping denotes faulty pronunciation
of the sibilant sounds, S, Z, SH, CH and J. The most common form is what is known as Infantile Lisping, so called because it is generally a retention of childish habits, often developing at the age of second dentition. It consists in the substitution of the sound TH for S, due to the fact that the tongue is protruding between the teeth instead of lying just behind them. This may arise through there being gaps in the front teeth at the age of second dentition, the tongue forming the habit of protruding slightly and continuing even after the teeth have grown. In this case, practice in the correct position (with the help of a mirror), as suggested above, should bring about a cure quite quickly. In some cases, however, the defect may be due to irregularity of dentition, where the front teeth are so formed as to be unable to effect a closure. It is then difficult to bring about a complete and satisfactory cure, and one generally has to be content with the best result possible in the circumstances.
producing
MENTAL WELFARE
58
Organic defect is one in which the speech difficulty is directly physical malformation or disability. The chief of these are:
An some
1.
Defects due Defects due
to
due
to
Cleft Palate. Adenoids and
Enlarged Tonsils. A Cleft Palate is a division, at some point, of the palate, which forms the roof of the mouth and the floor of the nose. The cleft may extend right from front to back of the mouth, the upper lip also being cleft, in which case one has the condition known as hare-lip in addition. It may, however, not be apparent at all on the outside of the mouth, but extend through the hard and soft palates?or it may be merely the soft palate which is affected. In any The stream of sound, coming case, the effect upon the speech is very similar. from the and no to direct it forward through the larynx up finding palate mouth, ascends into the nasal cavities, with the result that there is an extremely ugly nasal quality in all the speech. It is, unfortunately, impossible to improve this to any extent until the physical condition has been remedied by surgical or dental measures. The cleft in the palate can be closed by an operation, which should be performed while the child is very young?if possible before he begins to speak. If this is not possible, or if, as in some instances, the operation breaks down, it is still possible to have a false palate inserted. These have been brought to a pitch of perfection now-a-days, and with one in the mouth the speech can be improved to such a degree that it is difficult to detect any abnormality. Cleft Palate cases are comparatively rare?which is fortunate, as the condition is a very distressing one and the speech practically unintelligible until remedial measures and Speech Training have been given. The same applies to Adenoids and Enlarged Tonsils. These are infinitely more common, and, as in the case of Cleft Palate, it is out of the question to effect real improvement in the speech until the physical condition has been remedied. Then it is possible to do a great deal. The third category of Speech Defects, those known as Functional, are defects in which the actual mechanism of speech is normal, but the use made of it is defective. The most common of these is Stammering, which is now definitely regarded by authorities as being not, strictly speaking, a Speech Defect, but a nervous disorder which happens to affect the speech. Contrary to the belief held by some people, this disorder appears to be as common among Mental Defectives as among children of normal intelligence. The approach to it differs completely from the methods used in dealing with Articulatory and Organic Defects. These can be treated largely by phonetic means, after any physical disability has been put right. A Stammer, however, is now held by competent authorities to be the result of a neurosis?" a disturbance of thought which affects the functions of the body." Hence the actual speech defect is merely a symptom of some more deep-seated trouble and it is not of 2.
much value cause
to
to attempt to correct the symptom before having traced the root and remedied it. The root cause is generally some psychological conflict,
MENTAL WELFARE due
59
situation in the child's environment, with which he does not feel competent to grapple. The feeling of inadequacy may be quite unconscious. One can cite cases of jealousy of other children in the family, of over-protection on the part of the parents, of lack of opportunity for the child to make satisfactory adjustment to the demands of the group in which he lives. Such environmental factors will not produce a stammer in every child, otherwise there would be a far greater number of Stammerers in the schools. There must be, in the child, some predisposition for the neurosis to take such a form. The predisposition may be either: to a
I. Physical weakness in the mechanism of breathing, in the diaphragm, the great flat muscle which forms the floor of the chest. This may be inherited or may be the result of illness, malnutrition, etc. " II. Mental weakness in word imagery," in forming really clear and definite mental conceptions of words, with the result that a certain amount of confusion and hesitancy are present. In some cases the difficulty is congenital and the child stammers from the time he begins to speak. More often it is induced by a shock or fright of some kind, or a bad illness, which for the time being slightly upsets the fine balance of the nervous system and allows the neurosis to take hold of the individual's weak spot?or it may be unsatisfactory adjustment to environment, as mentioned above. One boy of 7 stammered violently after having seen a playmate of his own age drowned before his eyes. They were playing on ice, which gave way, and the boy was unable to do anything to save his friend. Another boy stammered after a very severe scalding; another, a child of 5, fell from the top of a high wall upon which he was sitting, into a river, and somehow succeeded in struggling out by himself. Another child, at the age of 5, was frightened by her nurse with a tale of a headless woman who would chase her if she were naughty! One hears of cases where the stammer developed after a severe illness, of men who stammered as the result of shellshock. One could multiply examples, but sufficient has been said to give some idea of the underlying causes which may lead to this distressing complaint. Suggestions for treatment do not come within the scope of this article, but help can be given by seeing that the child has adequate rest and nourishment, that he is kept free from undue excitement and anxiety, and that everything possible is done to build up his self-confidence. Actual treatment should be given only by an expert who has had experience of this type of work. feature of any form of Speech Defect is not only that it is, in itself, an obvious handicap, but that it tends to produce a marked sense of inferiority in the child and consequently inhibits him from showing his true powers. Thus, for the fullest mental development of which he is capable, it is of very great importance to help him to express himself as freely and easily in speech as the other children around him. Over and over again it is reported by teachers that as a speech defect disappears, so the general standard of the The
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child's work improves. Sufficient has probably been said at the beginning of this article to show that even the simplest form of speech requires a degree of mental and physical co-ordination and control. For this reason, scientific Speech Training is excellent training, not only for the speech itself, but also for the mind, and is of great benefit in the teaching of Mental Defectives. One " hopes that the day is not far distant when to minutes' daily Speech Drill will form part of the recognised curriculum in every school. "
