MENTAL WELFARE.
The Education of Children Suffering from Defects of By J.
Speech
H. VAN THAL.
In an article on the International Society for LogoP0edia which appeared in the Journal for Mental Welfare in 1928, I discussed, amongst other matters, the desirability of special schools for children suffering from defects of speech. an account of the Readers of this Journal may therefore be interested in recen y. of visiting an opportunity Speech Schools at Hamburg, which I had
recapitulate:
T
.
A.
0
International Society for Logopse la (, Remedial Speech Training) passed a resolution to the effect that it was considered desirable to establish schools at which children suffering from disorders of speech e con ei could receive their ordinary education as well as speech training. stammerers. for ence condemned limited courses of lessons, especially under In a number of towns in England and Wales we have speech classes the auspices of the Board of Education. These, however, confine themselves to the treatment of stammering: other defects of speech have to rely on hospital receive clinics for their cure. In Lancashire there are some classes where children othertheir and each of day a certain amount of speech training at the beginning lessons from the same teacher. But we have no special school for the treatment and which the International of all speech defects, such as I am about to describe, recommend. to for Society Logopsedia continues The first conference
THE
The
roughly
as
the
.
HAMBURG SPEECH SCHOOLS.
of the establishment of the
history
follows
of
Speech
Schools in Hamburg
is
:
for In 1888 a charitable association undertook to provide speech lessons was this for undertaking stammerers in elementary schools. By 1900, support the State (we must remember that Hamburg is one of the mdependen lacking, but " children Hansa cities), which had realized the benefit that stammering derived from the speech classes, and had for some time granted them a subsidy, came to the rescue, and the Education Authorities undertook the maintenance of the speech lessons. and that there Finding, however, that the percentage of cures was low, of the pupil, the were many progress relapses, as well as much that impeded a group class and teacher, of teacher of speech to the lack of co-operation owing of experts began to urge the necessity of establishing special classes, where the e stammerer would receive his speech lessons and his general education from interterence and extra lessons, same teachers. In this way the strain of taking with school attendance in consequence would be eliminated. The scheme at hrs first class was established. met with much antagonism but finally, in 1912, the The need for more was soon evident, besides which it was realized that 1 was defect or speech not enough to provide for stammerers only, since even an organic interferes with the pupils' progress, and functional defects such as delayed speech, word deafness, and neurotic lisping needed special treatment as urgently as any other. Hence the number of classes for children suffering from defects of speech has grown steadily, especially since 1920, until there are at the present day, two with 10 and 13 Volkschule speech schools, with the full curriculum of the classes respectively, attended by about 400 pupils. "
MENTAL WELFARE.
6
At the beginning of each scholastic year a questionnaire is sent round to the heads of all elementary schools, asking for particulars of new pupils, or any that have been overlooked in previous years, who appear to speak defectively. Such children are then sent to the speech schools, which are conveniently situated to Where there is any doubt, the serve the most populous districts of Hamburg. child is kept under observation for a while, and finally recommended for the type of school most suitable for its case. It is interesting to note that at first there was some prejudice on the part of parents and employers against these schools. The former opposed the admissions of their children, the latter refused to employ them on leaving. This idea was soon lived down, however, and the difficulty now is to find room for all who apply for admission. The classes at the school in the Stiftstrasse, are distributed in the following manner :
?
8th Form 7th Form 6th Form 5th Form 4th Form 3rd Form 2nd Form 1st Form N.B.
The
throughout
...
...
...
...
...
...
...
The 8th Form
table the school over
following
...
2 2 2 1 1 2 2 1
classes classes classes class class classes classes class
the lowest standard.
the proportion of the principal types of defect period of three years :
gives a
Form
Stammering
Lalling
8
24% 37% 53%
67% 54% 36%
65%
23%
72% 77% 85% 86%
19% 14% 5% 5%
7 6 5 4 3 2 1
Others
9% 8% 10% 11% 8% 8% 9% 8%
From these two tables we learn that the largest proportion of pupils are in the lowest and highest forms, and that the proportion of stammering greatly increases in the higher standards, lalling decreasing to a negligible quantity. The commoner kind of articulatory defect soon yields to treatment and the children consequently return to the ordinary school in a year or two. Stammering at an early age also responds to treatment more readily, and therefore there are only sufficient pupils for one class of the 4th and 5th Forms. Then we get an influx of new stammerers, hence the next two forms are duplicated again. Serious articulatory defect is soon recognized and the child immediately sent to the special school. Stammering in its early stages is often overlooked, besides which the standard of intelligence of the stammerer is on the whole higher than that of the other cases, therefore, though the normal school is glad to be rid of the others, they frequently retain the stammerer until his speech actually begins to interfere with his schooling. Furthermore, the stammer often does not manifest itself until after a child has reached school age, while the trouble intensifies
MENTAL WELFARE.
7
during adolescence.
This accounts for the increase both in the number of and the proportion of stammerers in the higher standards. Here is another table giving
a
typical
class
pupils
:
6th Form. Number of Pupils, 20. Boys 14, Girls 6. Q Stammerers ? Stammering and lisping 1 Stammering and phonasthenia ...
~
...
...
*
Lisping Lalling
6
Cleft palates Word deafness
Aphasia
...
^ *
?
Chronic hoarseness
?
?
?
?
?
...
?
?
?
???
J *
The work is carried out with the object of deriving the maximum benefit for the pupil with the minimum of interference with his general education. Classes are small, the number of pupils in each being restricted to 20; which, however, is still too high. There is a supernumerary staff, so that there are always some teachers available for individual speech lessons. Children are withdrawn from their class, singly or in groups of 3 and given 15 minutes intensive speech training daily. Furthermore, the class teacher will take aside some of his pupils for special speech work during a writing lesson or some such time. It is also permissible to curtail a lesson in order to do voice practice m c ass. Ihis last, however, is not considered as beneficial as individual tuition. A great feature of the school is its parents' evenings, where Parents and guardians of the children are encouraged to come and seek advice as to the home treatment of their children and discuss their progress with their teachers. Most speech specialists consider that it is best to keep stammerers aPar from other cases, both on account of the different treatment required and tor the sake of the other children, for it will be observed that it is possible to have a case of stammering coupled with other functional or even with organic defects, and where there is already some abnormal speech the possibility of developing " a stammer by imitation " is enhanced. I noted, however, that at this school the opportunity of having a division of stammerers and a second of other cases, where there were two divisions of a form, was not utilized. This is probably due to the fact that, since individual speech lessons are given, the mental capacity of the pupils rather than their speech types influenced the grouping. Although the school is essentially one for children suffering from defects of speech, but o a normal standard of intelligence, there are many children in the lower who are decidedly backward, and even low grade mental deficients. The " schule," which is the right place for these children, refuses to admit them until their speech is fairlv intelligible, whereas in the Speech School they are a hindrance to the other pupils, and do not receive all the attention they require them-
^forms
selves.
The solution would be to establish a class for mental defectives who have also some disorder of speech, a common enough occurrence, with a teacher who has triple qualifications, in order to cope with them. A member of the staff informed me that they hoped to attain this shortly. There are 16 teachers on the staff of the school with its 13 classes. This includes the " leader " (as the headmaster is now termed) who has, of course,
MENTAL WELFARE.
8
teaching; such as, for instance, the interviewing of parents, sending round the questionnaire referred to overleaf, but he also gives a number of special speech lessons. The rest of the staff share the class teaching between them in such a way, that all in turn are available to give speech lessons at times, or in order that some may be free for research work, or, that those who are not yet fully qualified may pursue their studies. All are qualified teachers, which means that they have had University education, but since there is no recognized training centre for teachers of speech, the school has in part to serve this purpose. When the first special speech classes opened there were teachers with many years experience of both sides of the work available. The qualifications required of them, as teachers of speech were : General remedial training, a knowledge of the physiology of speech, phonetics, the diagnosis of central and peripheral defects of speech, especially of stammering and lalling, the technique of hygienic breathing." Continuing on these lines and although no special syllabus has been arranged for them, teachers attend lectures at the University and have their practical experience at the school. Their studies include experimental phonetics, speech hygiene, psychology and psycho-pathology, etc. There are several speech schools in Germany and many more groups of speech classes, but there is no recognized examination or training. This somewhat haphazard method is looked upon with disfavour by the Association of Teachers of Remedial Speech Training in Germany, and is one which most certainly requires attention, for not all towns have even such a good University course at their disposal as Hamburg has. Though it is a disadvantage to have partially qualified teachers on the staff, as is the case in Hamburg, the custom in other parts of Germany is even less satisfactory. The teacher is given three months leave of absence, during which he takes intensive training on the treatment of defects of speech; a method that can never be adequate. This situation with regard to the training of teachers is odd, considering It is to be hoped that some imthe excellence of the provision for the pupils. many duties besides
"
provement will
soon
be made.
THE USEFULNESS OF SPECIAL SPEECH SCHOOLS. There can be no doubt of the excellent results achieved by the special speech schools : cures are more thorough, and in those cases that were apt to relapse, more lasting than those usually obtained by giving occasional speech lessons only. The pupils are saved from much unhappiness and a feeling of inferiority which often goes coupled with defects of speech, so that there is not only the actual improvement to the speech, but one that manifests itself in the whole being of those that have attended these schools.
Such establishments are useful in all cases, and absolutely necessary in The latter are often the rarer defects of speech, and alas, they will not receive adequate attention until they can do so in company with the more usual types. An illustration from my personal experience may serve. A child at present attending the Speech Clinic at St. Thomas' Hospital, to be treated for word deafness, proved a great educational problem. The word-deaf have as a rule, perfect hearing, but owing to a defect in the speech centre are unable to understand the spoken word, and in consequence make very little effort to speak themselves. Intelligence tests which were founded on the development of speech have fortunately been abandoned, but the hasty are still apt to deem a child as mentally defective, who does not understand simple questions or commands. some.
MENTAL WELFARE.
9
The case I am quoting was further complicated by actually being somewhat hard of hearing too. At first, her school teachers, finding her unfit for ordinary education, it was suggested that a school for retarded children was the right place for her. The mother was unwilling for her to attend such a school, and at the speech clinic it was also deemed that in other respects the child was normally intelligent. A hard hearing school proved useless to her, and at present a compromise has been made, the girl attending a school for the deaf for her general education, and the speech clinic for her special defect. Here is an obvious case for a special speech school, where a special plan of educating such a child would be practicable. I should like to take this opportunity of again pointing out the danger of trying to judge of a child's mental development by its speech. There are several central defects of speech, which at first give such a child the appearance of being mentally defective, where in other respects their mental age is up to standard. As an example I quote a boy of 11, who was able to keep up with his class in all lessons, and was indeed in many things one of the " bright " boys. His eacners, friends and relatives had in the course of years got to understand him, a curious form of lalling, being able to articulate no consonant but "t" j which makes a very bad impression on strangers, who usually dismiss .CV th he child as or a silly poor thing." He has at last started speech lessons, lorn which, it is hoped, he will derive great benefit. Speech is our chief means of communication with our fellow men, and w here there is any interference with that communication, the whole of our lives aie affected. Statistics taken in one London district proved that there were nearly two per cent, of speech defectives amongst school children. Surely they have some claim on no opportunity to re-establish their means of communicasociety; tion should be neglected. As 1^ pointed out in my previous article, a defect of speech may seriously interfere with the progress of a normal child. With the retarded, that very fact orten makes speech defective as well. lhus schools for those suffering from defects of speech, for both types, are But not only the schools, but a doubly and trebly qualified staff. If ?,ur ie thing is worth doing, it is worth doing well. Let us learn by the experience ?thers, and not put the cart before the horse. Facilities for the training of eacners exist: let them be utilized from every point of view, whenever we get as ai as establishing speech schools in this country. Meanwhile, let it be our aim to perfect the existing facilities for the remedy of disorders of speech. "
"
^eal.
I
"
"
The Education of Children Suffering from Defects of By J.
Speech
H. VAN THAL.
In an article on the International Society for LogoP0edia which appeared in the Journal for Mental Welfare in 1928, I discussed, amongst other matters, the desirability of special schools for children suffering from defects of speech. an account of the Readers of this Journal may therefore be interested in recen y. of visiting an opportunity Speech Schools at Hamburg, which I had
recapitulate:
T
.
A.
0
International Society for Logopse la (, Remedial Speech Training) passed a resolution to the effect that it was considered desirable to establish schools at which children suffering from disorders of speech e con ei could receive their ordinary education as well as speech training. stammerers. for ence condemned limited courses of lessons, especially under In a number of towns in England and Wales we have speech classes the auspices of the Board of Education. These, however, confine themselves to the treatment of stammering: other defects of speech have to rely on hospital receive clinics for their cure. In Lancashire there are some classes where children othertheir and each of day a certain amount of speech training at the beginning lessons from the same teacher. But we have no special school for the treatment and which the International of all speech defects, such as I am about to describe, recommend. to for Society Logopsedia continues The first conference
THE
The
roughly
as
the
.
HAMBURG SPEECH SCHOOLS.
of the establishment of the
history
follows
of
Speech
Schools in Hamburg
is
:
for In 1888 a charitable association undertook to provide speech lessons was this for undertaking stammerers in elementary schools. By 1900, support the State (we must remember that Hamburg is one of the mdependen lacking, but " children Hansa cities), which had realized the benefit that stammering derived from the speech classes, and had for some time granted them a subsidy, came to the rescue, and the Education Authorities undertook the maintenance of the speech lessons. and that there Finding, however, that the percentage of cures was low, of the pupil, the were many progress relapses, as well as much that impeded a group class and teacher, of teacher of speech to the lack of co-operation owing of experts began to urge the necessity of establishing special classes, where the e stammerer would receive his speech lessons and his general education from interterence and extra lessons, same teachers. In this way the strain of taking with school attendance in consequence would be eliminated. The scheme at hrs first class was established. met with much antagonism but finally, in 1912, the The need for more was soon evident, besides which it was realized that 1 was defect or speech not enough to provide for stammerers only, since even an organic interferes with the pupils' progress, and functional defects such as delayed speech, word deafness, and neurotic lisping needed special treatment as urgently as any other. Hence the number of classes for children suffering from defects of speech has grown steadily, especially since 1920, until there are at the present day, two with 10 and 13 Volkschule speech schools, with the full curriculum of the classes respectively, attended by about 400 pupils. "
MENTAL WELFARE.
6
At the beginning of each scholastic year a questionnaire is sent round to the heads of all elementary schools, asking for particulars of new pupils, or any that have been overlooked in previous years, who appear to speak defectively. Such children are then sent to the speech schools, which are conveniently situated to Where there is any doubt, the serve the most populous districts of Hamburg. child is kept under observation for a while, and finally recommended for the type of school most suitable for its case. It is interesting to note that at first there was some prejudice on the part of parents and employers against these schools. The former opposed the admissions of their children, the latter refused to employ them on leaving. This idea was soon lived down, however, and the difficulty now is to find room for all who apply for admission. The classes at the school in the Stiftstrasse, are distributed in the following manner :
?
8th Form 7th Form 6th Form 5th Form 4th Form 3rd Form 2nd Form 1st Form N.B.
The
throughout
...
...
...
...
...
...
...
The 8th Form
table the school over
following
...
2 2 2 1 1 2 2 1
classes classes classes class class classes classes class
the lowest standard.
the proportion of the principal types of defect period of three years :
gives a
Form
Stammering
Lalling
8
24% 37% 53%
67% 54% 36%
65%
23%
72% 77% 85% 86%
19% 14% 5% 5%
7 6 5 4 3 2 1
Others
9% 8% 10% 11% 8% 8% 9% 8%
From these two tables we learn that the largest proportion of pupils are in the lowest and highest forms, and that the proportion of stammering greatly increases in the higher standards, lalling decreasing to a negligible quantity. The commoner kind of articulatory defect soon yields to treatment and the children consequently return to the ordinary school in a year or two. Stammering at an early age also responds to treatment more readily, and therefore there are only sufficient pupils for one class of the 4th and 5th Forms. Then we get an influx of new stammerers, hence the next two forms are duplicated again. Serious articulatory defect is soon recognized and the child immediately sent to the special school. Stammering in its early stages is often overlooked, besides which the standard of intelligence of the stammerer is on the whole higher than that of the other cases, therefore, though the normal school is glad to be rid of the others, they frequently retain the stammerer until his speech actually begins to interfere with his schooling. Furthermore, the stammer often does not manifest itself until after a child has reached school age, while the trouble intensifies
MENTAL WELFARE.
7
during adolescence.
This accounts for the increase both in the number of and the proportion of stammerers in the higher standards. Here is another table giving
a
typical
class
pupils
:
6th Form. Number of Pupils, 20. Boys 14, Girls 6. Q Stammerers ? Stammering and lisping 1 Stammering and phonasthenia ...
~
...
...
*
Lisping Lalling
6
Cleft palates Word deafness
Aphasia
...
^ *
?
Chronic hoarseness
?
?
?
?
?
...
?
?
?
???
J *
The work is carried out with the object of deriving the maximum benefit for the pupil with the minimum of interference with his general education. Classes are small, the number of pupils in each being restricted to 20; which, however, is still too high. There is a supernumerary staff, so that there are always some teachers available for individual speech lessons. Children are withdrawn from their class, singly or in groups of 3 and given 15 minutes intensive speech training daily. Furthermore, the class teacher will take aside some of his pupils for special speech work during a writing lesson or some such time. It is also permissible to curtail a lesson in order to do voice practice m c ass. Ihis last, however, is not considered as beneficial as individual tuition. A great feature of the school is its parents' evenings, where Parents and guardians of the children are encouraged to come and seek advice as to the home treatment of their children and discuss their progress with their teachers. Most speech specialists consider that it is best to keep stammerers aPar from other cases, both on account of the different treatment required and tor the sake of the other children, for it will be observed that it is possible to have a case of stammering coupled with other functional or even with organic defects, and where there is already some abnormal speech the possibility of developing " a stammer by imitation " is enhanced. I noted, however, that at this school the opportunity of having a division of stammerers and a second of other cases, where there were two divisions of a form, was not utilized. This is probably due to the fact that, since individual speech lessons are given, the mental capacity of the pupils rather than their speech types influenced the grouping. Although the school is essentially one for children suffering from defects of speech, but o a normal standard of intelligence, there are many children in the lower who are decidedly backward, and even low grade mental deficients. The " schule," which is the right place for these children, refuses to admit them until their speech is fairlv intelligible, whereas in the Speech School they are a hindrance to the other pupils, and do not receive all the attention they require them-
^forms
selves.
The solution would be to establish a class for mental defectives who have also some disorder of speech, a common enough occurrence, with a teacher who has triple qualifications, in order to cope with them. A member of the staff informed me that they hoped to attain this shortly. There are 16 teachers on the staff of the school with its 13 classes. This includes the " leader " (as the headmaster is now termed) who has, of course,
MENTAL WELFARE.
8
teaching; such as, for instance, the interviewing of parents, sending round the questionnaire referred to overleaf, but he also gives a number of special speech lessons. The rest of the staff share the class teaching between them in such a way, that all in turn are available to give speech lessons at times, or in order that some may be free for research work, or, that those who are not yet fully qualified may pursue their studies. All are qualified teachers, which means that they have had University education, but since there is no recognized training centre for teachers of speech, the school has in part to serve this purpose. When the first special speech classes opened there were teachers with many years experience of both sides of the work available. The qualifications required of them, as teachers of speech were : General remedial training, a knowledge of the physiology of speech, phonetics, the diagnosis of central and peripheral defects of speech, especially of stammering and lalling, the technique of hygienic breathing." Continuing on these lines and although no special syllabus has been arranged for them, teachers attend lectures at the University and have their practical experience at the school. Their studies include experimental phonetics, speech hygiene, psychology and psycho-pathology, etc. There are several speech schools in Germany and many more groups of speech classes, but there is no recognized examination or training. This somewhat haphazard method is looked upon with disfavour by the Association of Teachers of Remedial Speech Training in Germany, and is one which most certainly requires attention, for not all towns have even such a good University course at their disposal as Hamburg has. Though it is a disadvantage to have partially qualified teachers on the staff, as is the case in Hamburg, the custom in other parts of Germany is even less satisfactory. The teacher is given three months leave of absence, during which he takes intensive training on the treatment of defects of speech; a method that can never be adequate. This situation with regard to the training of teachers is odd, considering It is to be hoped that some imthe excellence of the provision for the pupils. many duties besides
"
provement will
soon
be made.
THE USEFULNESS OF SPECIAL SPEECH SCHOOLS. There can be no doubt of the excellent results achieved by the special speech schools : cures are more thorough, and in those cases that were apt to relapse, more lasting than those usually obtained by giving occasional speech lessons only. The pupils are saved from much unhappiness and a feeling of inferiority which often goes coupled with defects of speech, so that there is not only the actual improvement to the speech, but one that manifests itself in the whole being of those that have attended these schools.
Such establishments are useful in all cases, and absolutely necessary in The latter are often the rarer defects of speech, and alas, they will not receive adequate attention until they can do so in company with the more usual types. An illustration from my personal experience may serve. A child at present attending the Speech Clinic at St. Thomas' Hospital, to be treated for word deafness, proved a great educational problem. The word-deaf have as a rule, perfect hearing, but owing to a defect in the speech centre are unable to understand the spoken word, and in consequence make very little effort to speak themselves. Intelligence tests which were founded on the development of speech have fortunately been abandoned, but the hasty are still apt to deem a child as mentally defective, who does not understand simple questions or commands. some.
MENTAL WELFARE.
9
The case I am quoting was further complicated by actually being somewhat hard of hearing too. At first, her school teachers, finding her unfit for ordinary education, it was suggested that a school for retarded children was the right place for her. The mother was unwilling for her to attend such a school, and at the speech clinic it was also deemed that in other respects the child was normally intelligent. A hard hearing school proved useless to her, and at present a compromise has been made, the girl attending a school for the deaf for her general education, and the speech clinic for her special defect. Here is an obvious case for a special speech school, where a special plan of educating such a child would be practicable. I should like to take this opportunity of again pointing out the danger of trying to judge of a child's mental development by its speech. There are several central defects of speech, which at first give such a child the appearance of being mentally defective, where in other respects their mental age is up to standard. As an example I quote a boy of 11, who was able to keep up with his class in all lessons, and was indeed in many things one of the " bright " boys. His eacners, friends and relatives had in the course of years got to understand him, a curious form of lalling, being able to articulate no consonant but "t" j which makes a very bad impression on strangers, who usually dismiss .CV th he child as or a silly poor thing." He has at last started speech lessons, lorn which, it is hoped, he will derive great benefit. Speech is our chief means of communication with our fellow men, and w here there is any interference with that communication, the whole of our lives aie affected. Statistics taken in one London district proved that there were nearly two per cent, of speech defectives amongst school children. Surely they have some claim on no opportunity to re-establish their means of communicasociety; tion should be neglected. As 1^ pointed out in my previous article, a defect of speech may seriously interfere with the progress of a normal child. With the retarded, that very fact orten makes speech defective as well. lhus schools for those suffering from defects of speech, for both types, are But not only the schools, but a doubly and trebly qualified staff. If ?,ur ie thing is worth doing, it is worth doing well. Let us learn by the experience ?thers, and not put the cart before the horse. Facilities for the training of eacners exist: let them be utilized from every point of view, whenever we get as ai as establishing speech schools in this country. Meanwhile, let it be our aim to perfect the existing facilities for the remedy of disorders of speech. "
"
^eal.
I
"
"
