Study of the problem of stuttering. The history of the development of the doctrine of stuttering

Topic 1. Stuttering. Background

Plan.

Hippocrates and Aristotle's views on stuttering.
Theoretical concepts and methods for correcting stuttering until the middle of the 19th century.
The significance of the works of Russian scientists I.A. Sikorsky and I.G. Netkachev in the study of the problem of stuttering in the late XIX - early XX century.
Views of Kussmaul, Gepfert and other Western European scientists of the late XIX - early XX century on the problem of stuttering.
Scientific development of the problem of stuttering in the 30-40s of the XX century.
Contribution of V.A. Gilyarovsky, N.A. Vlasova, Yu.A. Florenskaya and other scientists in the development of theoretical ideas about stuttering and in the organization of specialized medical and pedagogical assistance to stuttering children.
An integrated approach to corrective work with stutterers (V.I. Seliverstov).

The term "stuttering" (ba1bupes)- of Greek origin and means the repetition of convulsive contractions of the speech organs. Stuttering as one of the expressive speech disorders has been known since ancient times. Initially, this disease was called "battarismus", on behalf of the Kirean king Batta, who constantly repeated the first syllable of the word.

The first description of the symptoms of stuttering (without mentioning the term itself) apparently belongs to Hippocrates (460 - 377 BC), who saw the cause of speech disorders in brain damage as a source of speech impulses. "battarismus", in his opinion, depended on the "extraordinary moisture of the brain".

Aristotle (384-322 BC) built his understanding of speech formation based on the anatomical structure of the peripheral speech organs, and associated speech pathology not with changes in the brain, but with the pathology of the peripheral speech apparatus. The convulsive state of the speech organs was described by Etius Amidsky (527 - 565), Pavel Aginsky (625 - 690), Galen (130 - 200) and others. All of them came to different conclusions about the causes, symptoms and treatment of stuttering (according to I. A. Sikorsky , 1889).

Thus, already in antiquity, two directions were outlined in understanding the nature of stuttering. The first came from Hippocrates and considered the cause of stuttering to be brain damage; the second, originating from Aristotle, associated stuttering with the pathology of the peripheral speech apparatus. In one form or another, these two opposite points of view can be traced in subsequent approaches to the problem of stuttering.

In reviews of the literature on the history of the development of the doctrine of stuttering (I.A. Sikorsky, 1889; V.I. Khmelevsky, 1897; M.I. Pankin, 1941), it is noted that in the Middle Ages this problem (as well as many other issues science) were practically not engaged and, in essence, special literature on this issue until the beginning of the 19th century. has little theoretical or practical value. Since the 19th century, interest in the problem has increased significantly.

At the beginning of the last century, the French physician Itard defined stuttering as a delay in the speech organs, in which the development of a spasmodic, convulsive state of the muscles, or a state of weakness and paresis (tonic and clonic components of stuttering) could take place. Around the same time, Woodzen expressed the opinion that stuttering arises from a lack of central reactions to the muscular system of the organs of speech, and proposed special gymnastic exercises for the speech organs.

In the 40s. XIX century, the first surgical operations were performed (Diffenbach, Bonn) to treat stuttering - trimming the frenulum of the tongue or cutting out a piece of the tongue. The initial effect of the intervention was positive, but after the formation of the scar, the speech defect was restored, and this type of intervention was soon abandoned.

It is interesting to note here that a temporary change in the flow of reverse proprioceptive innervation from the muscles of the tongue can destroy the entire central pathological excitation structure that causes stuttering.

In the 80s. the main interest in the problem of stuttering is acquired by the central mechanisms, the most typical reflection of which are the works of Kussmaul (1877), Gutzmann (1888). From the point of view of these authors, in the presence of a neurotic predisposition, stuttering is based on insufficiency (congenital inferiority) of the motor centers of the respiratory, phonation and articulatory muscles, and stuttering itself was regarded by them as a spastic coordination neurosis. However, in the subsequent approach to stuttering as a result of an organic lesion of the central nervous system was not confirmed by pathological and histological data, and attempts were made to replace the concept of organic inferiority with the concept of functional inferiority.

In 1889, I.A. Sikorsky in his monograph "On Stuttering" gave a broad and comprehensive description of speech impairment in stuttering. The latter was considered by him as the result of an irritable weakness of the motor center of speech, leading to a violation of the coordination of speech movements and convulsions of the speech muscles. Attaching great importance to mental factors in the development of stuttering, I.A. Sikorsky, in the practice of treating stuttering, along with “speech gymnastics”, recommended the effects of a psychotherapeutic order. In terms of the depth of observations, this work is of value at the present time.

In 1909, in the book “On Stuttering”, D. G. Netkachev developed a different point of view: he considered stuttering as an independent psychoneurosis, in which there is a convulsive functional speech disorder associated with obsessive mental states (excessive emotionality and constant timidity). The main attention in the treatment of stuttering D. G. Netkachev paid psychotherapy.

Thus, the idea of stuttering as a functional disease of the type of neurosis gradually developed.

3. Convulsive hesitation appears in children aged 3-4 years.

4. The appearance of convulsive hesitation coincides with the phase of development of phrasal speech.

5. The onset of stuttering is gradual, out of connection with the traumatic situation.

6. There are no periods of smooth speech, the quality of speech depends little on the speech situation.

7. Attracting the active attention of stutterers to the process of speaking facilitates speech; physical or mental fatigue worsen the quality of speech.

Topic 3. Stuttering mechanisms

A priority direction in the study of stutterers, conducted under the leadership of R.E. Levina. Proceedings of R.E. Levina, S.A. Mironova, V.I. Seliverstova, N.A. Cheveleva, A.V. Yastrebova and others.
The concept of the functional system of speech-motor act.
Features of phylogenetic and ontogenetic speech memory.
The role of emotional structures of the brain in the formation of speech-motor program.
Ontogeny of motor speech stereotypes is normal.
Features of the program of action in the speech-motor functional system in stuttering.

Neurotic form of stuttering appears most often when exposed to pathogenic emotional effects of the external environment. Acute or chronic mental trauma experienced by a child is directly related to the appearance of "speech" convulsions. This indicates the importance hyperactivation of emotional structures of the brain with this form of stuttering.

For the appearance of stuttering is necessary "predisposition" (vulnerability) of specific speech structures to the appearance of pathological reactions. This "predisposition" is associated mainly with the innate features of the speech structures of the brain. (The fact that genetic factors play a large role in stuttering has long been known.)

A sharp advance in the development of speech at the lexical-grammatical level and a discrepancy to this level of motor (articulatory-respiratory) support indicate dysontogenesis of speech mechanisms in children with a neurotic form of stuttering.

In some children who have undergone mental stress with the subsequent appearance of convulsive speech stutters, the protective (compensatory) mechanisms of the central nervous system are quite strong and developed.

Some children have a low level of compensatory abilities of the brain. In these cases, a pathological functional system of speech is quickly formed.

Pathological functional system, i.e. stuttering, begins to suppress the normal functional speech system, which had previously developed in the child, it would seem, successfully.

Pathologically strong excitation in the emotional structures of the brain and the pathological system of speech disrupt the normal functioning of the nervous system. This leads to further development and deepening of the pathological process and chronification of stuttering.

Any increase in emotional arousal (wrong behavior of parents, overload of the child with impressions, etc.) worsens the state of the central nervous system, contributes to the "fixing" of the pathological functional system of speech, the child stutters more and more often.

The formation of a new pathological speech system in stuttering children against the background of an already developed normal functional speech system creates special conditions for the mutual influence and functioning of each of them.

Electrophysiological studies of speech muscles, respiration and other indicators of the functional system of speech indicate that the motor speech activity of the muscles and the coordinating relationships between speech respiration and articulation in neurotic stuttering in preschoolers are fundamentally similar to the norm. These data, as well as fluent speech in situations of emotional comfort, indicate that stuttering children of this clinical group have a normal program of action in the functional system of speech, in addition to the pathological one.

However, these physiological indicators are less stable than normal, and are easily violated when the speech task becomes more complicated. Such phenomena indicate the negative impact of the pathological speech system on the normal speech system.

The pathological functional speech system with the end result - stuttering - also experiences an inhibitory effect on the part of the normal functional speech system. During periods of strengthening of the protective mechanisms of the brain and, as a result, a decrease in the pathological activity of the emotiogenic structures of the brain, the speech of stutterers becomes smooth.

The coexistence of two speech systems - pathological and normal - in the neurotic form of stuttering is clearly seen even with a severe degree of this speech pathology. Against the background of speech distorted by speech convulsions and a pathological choice of lexical means, short periods of smooth speech are observed at any age and for any duration of stuttering.

Adolescents with a neurotic form of stuttering (11-12 years old) develop logophobia, i.e. secondary neurotic pathological reaction.

In adult stutterers, often secondary foci of pathological excitation associated with fear of speech can play the role of a dominant, which is clinically expressed by a strong fear of speech with a relatively mild degree of stuttering.

These features of the relationship between the pathological speech system proper, the normal speech system, and the pathological psychological response system largely explain the significant difficulties in the rehabilitation of adult stutterers. Neurosis-like clinical form of stuttering with the similarity of convulsive speech stutters, it has a different clinical picture. Stuttering of this form appears in children in the age range of 3-4 years. It arises, as it were, gradually, for no apparent reason, and is not immediately detected by the parents.

Carriers of this speech pathology have a history of signs of an abnormal course of the pre- or perinatal period of life. Both in childhood and in adulthood, neurologically and electrophysiologically, mild residual phenomena of early diffuse organic brain damage are diagnosed. There is a delay in the development of motor functions of the body, as well as their qualitative differences from the age norm: coordinating disorders, a low level of development of a sense of rhythm and pace, various types of hyperkinesis. The behavior of stutterers of this group is characterized by motor disinhibition, they show a lack of active attention, some memory loss, etc.

Speech ontogenesis before the onset of stuttering in children with a neurosis-like form differs significantly from the speech ontogenesis of children with a neurotic form of stuttering. This applies both to the rate of speech development and to its qualitative characteristics.

Electrophysiological studies of various indicators of the state of the nervous system reveal in this group of stutterers, in addition to diffuse, zonal changes in cortical biorhythms and disturbances in the organization of muscle bioelectrical activity.

These data, as well as the features of motor skills, indicate about the presence of pathological activity of subcortical motor (strio-pallidar) structures of the brain and the weakening of regulatory influences from its higher (cortical) sections. There is reason to believe that the generator of pathological excitation in a neurosis-like form of stuttering is formed as a result of an organic lesion of mainly subcortical motor structures and a violation of cortical regulatory influences.

Thus, the combination of increased activity in the striopallidar structures of the brain, a special state of the speech zones of the cerebral cortex, and decompensation of the regulatory mechanisms of the brain are the main blocks of pathogenetic mechanisms in neurosis-like form of stuttering.
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The ideas of Hippocrates and Aristotle about stuttering. Theoretical concepts and methods for correcting stuttering until the middle of the 19th century. The significance of the works of Russian scientists in the development and practice of the problem of stuttering in the late XIX - early XX centuries. An integrated approach to corrective work with stutterers. Modern ideas about stuttering. Psychological and pedagogical aspect of the study of stuttering. A priority direction in the study of stutterers, conducted under the leadership of R.E. Levina.

Theoretical views of psychologists and teachers on the pathogenetic mechanisms of stuttering. Clinical aspect in the study of stuttering.

The problem of stuttering can be considered one of the most ancient in the history of the development of the doctrine of speech disorders. A different understanding of its essence is due to the level of development of science and the positions from which the authors approached and are approaching the study of this speech disorder.

In ancient times, stuttering was mainly seen as a disease associated with the accumulation of moisture in the brain (Hippocrates) or the incorrect correlation of parts of the articulatory apparatus (Aristotle). The possibility of violations in the central or peripheral parts of the speech apparatus in stuttering was recognized by Galen, Celsus, Avicenna.

At the turn of the XVII-XVIII centuries. They tried to explain stuttering as a consequence of the imperfection of the peripheral apparatus of speech. So, for example, Santorini believed that stuttering occurs when there is a hole in the hard palate, through which mucus supposedly seeps into the tongue and makes it difficult to speak. Wutzer explained this by an abnormal recess in the lower jaw, in which the tip of the tongue hides when it moves; Herve de Cheguan - an incorrect ratio between the length of the tongue and the oral cavity or too tight attachment of his short frenulum.

Other researchers associated stuttering with disorders in the functioning of the speech organs: convulsive closure of the glottis (Arnot, Schultess); excessively rapid exhalation (Becquerel); spasmodic contraction of the muscles holding the tongue in the oral cavity (Itard, Lee, Dieffenbach); inconsistency of the processes of thinking and speech (Blume); imperfection of the will of a person that affects the strength of the muscles of the speech-motor mechanism (Merkel), etc.

Some researchers have associated stuttering with disorders in the course of mental processes. For example, Blume believed that stuttering arises from the fact that a person either thinks quickly, so that the speech organs do not keep up and therefore stumble, or, conversely, speech movements "get ahead of the thinking process." And then, due to the intense desire to align this discrepancy, the muscles of the speech apparatus come into a "convulsive state."

At the beginning of the XIX century. a number of French researchers, considering stuttering, explained it with various deviations in the activity of the peripheral and central parts of the speech apparatus.

Thus, in the late XIX - early XX century. the opinion that stuttering is a complex psychophysical disorder is becoming more and more definite. According to some, it is based on violations of a physiological nature, and psychological manifestations are of a secondary nature (A. Gutzman, 1879; A. Kussmaul, 1878; I. A. Sikorsky, 1889, etc.). Others considered psychological characteristics to be primary, and physiological manifestations as a consequence of these psychological shortcomings (Chr. Laguzen, 1838; A. Cohen, 1878; Gr. Kamenka, 1900; G. D. Netkachev, 1913, etc.). Attempts have been made to consider stuttering as an expectation neurosis, a fear neurosis, an inferiority neurosis, an obsessive neurosis, etc.

By the 30s and in the subsequent 50-60s of the XX century. the mechanism of stuttering began to be considered, based on the teachings of IP Pavlov on the higher nervous activity of a person and, in particular, on the mechanism of neurosis.

R. E. Levina, considering stuttering as a speech underdevelopment, sees its essence in a predominant violation of the communicative function of speech.

Until now, researchers have been trying to consider the mechanism of stuttering not only from clinical and physiological, but also from neurophysiological, psychological, and psycholinguistic positions.

Of interest are neurophysiological studies of stuttering in the organization of speech activity (I. V. Danilov, I. M. Cherepanov, 1970). These studies show that in those who stutter during speech, the dominant (left) hemisphere cannot sufficiently steadily fulfill its leading role in relation to the right hemisphere. The position on the relationship of stuttering with indistinctly expressed dominance of speech is confirmed by the data of V. M. Shklovsky.

The development of the problem of stuttering in the psychological aspect is relevant in order to reveal its genesis, to understand the behavior of stutterers in the process of communication, to identify their individual psychological characteristics. The study of attention, memory, thinking, psychomotor skills of stutterers showed that they have changed the structure of mental activity, its self-regulation. They are less likely to perform activities that require a high level of automation (and, accordingly, a quick inclusion in the activity), but the differences in productivity between stutterers and healthy people disappear as soon as the activity can be performed at an arbitrary level. The exception is psychomotor activity: if in healthy children psychomotor acts are performed largely automatically and do not require voluntary regulation, then for stutterers, regulation is a difficult task that requires voluntary control.

Some researchers believe that stutterers are more inert in mental processes than normal speakers, they are characterized by the phenomena of perseveration associated with the mobility of the nervous system.

It is promising to study the personality characteristics of stutterers both with the help of clinical observations and with the use of experimental psychological techniques. With their help, an anxious and suspicious character, suspicion, a phobic state were revealed; insecurity, isolation, a tendency to depression; passive-defensive and defensive-aggressive reactions to a defect.

Consideration of the mechanisms of stuttering from the standpoint of psycholinguistics deserves attention. This aspect of the study involves finding out at what stage of the generation of a speech utterance convulsions occur in the speech of a stutterer. The following phases of speech communication are distinguished:

1) the presence of a need for speech, or a communicative intention; 2) the birth of the idea of the utterance in inner speech; 3) sound realization of the statement. In different structures of speech activity, these phases are different in their completeness and duration and do not always unambiguously follow one from the other. But constantly there is a comparison of the conceived and the implemented. I. Yu. Abeleva believes that stuttering occurs at the moment of readiness for speech if the speaker has a communicative intention, a speech program and the fundamental ability to speak normally. In the three-term model of speech generation, the author proposes to exclude the phase of readiness for speech, in which the entire pronunciation mechanism, all of his systems: generator, resonator and energy, “breaks down” in a stutterer. There are convulsions, which are then clearly manifested in the fourth, final phase.

Having considered different points of view on the problem, we can draw the main conclusion that the mechanisms of stuttering are heterogeneous.

In some cases, stuttering is interpreted as a complex neurotic disorder, which is the result of an error in the nervous processes in the root of the brain, a violation of the cortical subcortical interaction, a disorder of a single auto-regulated tempo of speech movements (voice, breathing, articulation).

In other cases - as a complex neurotic disorder, which was the result of a fixed reflex of incorrect speech, which initially arose as a result of speech difficulties of various origins.

Thirdly, as a complex, predominantly functional speech disorder that appeared as a result of general and speech dysontogenesis and disharmonious personality development.

Fourth, the mechanism of stuttering can be explained on the basis of organic changes in the central nervous system. Other explanations are also possible. But in any case, it is necessary to take into account the violations of the physiological and psychological nature that make up the unity.

Story– the problem of stuttering can be considered one of the most ancient in the history of the development of the doctrine of distance speech. In other times, stuttering was mainly seen as a disease associated with the accumulation of moisture in the brain (Hippocrates) or the incorrect correlation of parts of the articulatory apparatus (Aristotle). The possibility of violations in the central or peripheral parts of the speech-app during stuttering was recognized by Galen, Celsus, Avicenna.

At the turn of the 17th and 18th centuries, they tried to explain Z. as a consequence of the incompatibility of the periphery of speech. Santorini - Z. occurs when there is a hole in the hard palate, through the cat supposedly mucus seeps into the tongue and makes it difficult to speak. Wutzer - an abnormal depression in the jaw, the tip of the tongue hides in the cat during its movement. Herve de Cheguan - the wrong ratio between the length of the tongue and the oral cavity or too tight attachment of his short frenulum. Other research Z. was associated with disorders in the functioning of the speech organs: convulsive closure of the glottis, excessively rapid expiration, spasmodic contraction of the muscles that hold the tongue in the oral cavity, inconsistency in the processes of thought and speech, etc.

Z., as a nozol. unit was first clearly defined by the French physician Itard in 1817. He made a clear distinction between Z. and other pathologies. Ms. Li's technique gained great popularity, in 1825 in New York she organized an institute for the treatment of Z. There was an orthopedic approach method, scientists tried to invent a k-l adapted. for corr. Bite, change in anatomy in the region of the mouth. In 1841, there was a sharp surge of interest in surgical methods of treatment Z. The surgeon Diefenbach conducted operas. on cutting out part of the muscles of the tongue in a 13-year-old boy, And for some time 2 more operas, which had a positive success. There are few operas in Germany, almost none in England and Russia, and popularity in France. There were critical remarks about the operas, it was found that after the healing of the scar (2-3 months), Z. sometimes returned even more. In the second half of the 19th century, the pathophysiological features of the disease are studied, pedagogical and psychological approaches are being formed in corr.

In Russia, the majority of researchers considered Z as a functional disorder in the field of speech, convulsive neurosis (Sikorsky 1889, Khmelevsky), or defined it as a purely mental suffering, expressed by convulsive movements in the speech apparatus (Laguzen 1838, Netkachev 1909.1913), as psychosis (Kamenka 1900)

At the beginning of the 20th century, the doctrine of neuroses appeared and Z is considered as a neurosis - Pavlov - enough: 1-overstrain of excitation processes; 2-overvoltage of braking processes; 3-collision of the processes of inhibition and excitation. Violation of the interaction of these processes leads to the appearance of stagnant foci of excitation in the cerebral cortex. This affects the ratio of the cortex and subcortex, thus. disrupting the nervous regulation of the speech act.

Zhinkin - depending on the localization of the stagnant focus in the GM, different localization of convulsions in speech and various pronunciation disorders are found.

Conducting a series of experiments, scientists Danilov, Cherepanov, Nekrasov, Voronin, Zhinkin wrote that Z is the result of a mismatch between kinesthetic and auditory control in the process of pronunciation. Mismatch could be a consequence of neurosis or other failure in the interaction of speech-motor and speech-auditory systems.

Levina's theory - in the transition from situational speech to contextual speech, the speech plan and the means of its implementation become more complicated. In the process of speech, a clash of motives is detected, especially in dialogues, this is accompanied by emotional tension, iterations appear and they can be fixed.

By the beginning of the twentieth century. all the diversity of understanding the mechanisms of stuttering can be reduced to three theoretical areas:

· Stuttering as a spastic coordination neurosis, resulting from irritable weakness of the speech centers (apparatus of syllabic coordinations). This was clearly formulated in the works of G. Gutzman, I. A. Kussmaul, and then in the works of I. A. Sikorsky, who wrote: “Stuttering is a sudden disruption of the continuity of articulation caused by a spasm that occurred in one of the departments of the speech apparatus as a physiological whole ". Proponents of this theory initially emphasized the inherent irritable weakness of the apparatus that controls syllabic coordination. They further explained stuttering in terms of neuroticism: stuttering is convulsive-like spasms.

Stuttering as an associative psychological disorder. This direction was put forward by T. Gepfner and E. Freschels. Supporters were A. Liebmann, G. D. Netkachev, Yu. A. Florenskaya. The psychological approach to understanding the mechanisms of stuttering has been further developed.

· Stuttering as a subconscious manifestation that develops on the basis of mental trauma, various conflicts with the environment. The supporters of this theory were A. Adler, Schneider, who believed that stuttering, on the one hand, manifests the desire of the individual to avoid any possibility of contact with others, and on the other hand, to arouse the sympathy of others through such demonstrative suffering.

Thus, in the late 19th early 20th century. the opinion that stuttering is a complex psychophysical disorder is becoming more and more definite. According to some, it is based on violations of a physiological nature, and psychological manifestations are of a secondary nature (A. Gutzman, 1879; A. Kussmaul, 1878; I. A. Sikorsky, 1889, etc.). Others considered psychological characteristics to be primary, and physiological manifestations as a consequence of these psychological shortcomings (Chr. Laguzen, 1838; A. Cohen, 1878; Gr. Kamenka, 1900; G. D. Netkachev, 1913, etc.). Attempts have been made to consider stuttering as an expectation neurosis, a fear neurosis, an inferiority neurosis, an obsessive neurosis, etc.

By the 30s and in the subsequent 50s - 60s of the twentieth century. the mechanism of stuttering began to be considered, based on the teachings of IP Pavlov on the higher nervous activity of a person and, in particular, on the mechanism of neurosis. At the same time, some researchers considered stuttering as a symptom of neurosis (Yu. A. Florenskaya, Yu. A. Povorinsky and others), others - as its special form (V. A. Gilyarovskiy, M. E. Khvattsev, I. P. S. Lebedinsky, S. S. Lyapidevsky, A. I. Povarnin, N. I. Zhinkin, V. S. Kochergina, etc.). But in both cases, these complex and diverse mechanisms for the development of stuttering are identical to the mechanisms for the development of neuroses in general. Stuttering, like other neuroses, occurs due to various reasons that cause an overstrain of the processes of excitation and inhibition and the formation of a pathological conditioned reflex. Stuttering is not a symptom or a syndrome, but a disease of the central nervous system as a whole (V. S. Kochergina, 1962).

Comparison of clinical, psychological, psycholinguistic and physiological data from studies of stutterers allows us to better understand the pathogenetic mechanisms of this complex speech disorder. Evolutionary stuttering or developmental stuttering usually occurs at the age when the child is intensively forming phrasal or monologue speech. In different clinical forms, the onset of stuttering is associated with different causes.

The first cause and condition for the appearance neurotic form of stuttering serve:

Pathogenic emotional factors of the external environment

acute or chronic mental trauma experienced by a child is directly related to the appearance of "speech" convulsions.

The phenomenon of convulsive stammering is not strictly specific only to people suffering from stuttering. Often and normally, there are single speech stutters of a convulsive nature at moments of high emotional stress.

With normal maturation of the brain already in childhood, regulatory inhibitory processes develop in the CNS, strong enough to suppress excessive excitation of the emotiogenic structures of the brain, block the spread of this excitation and prevent the formation of a focus of congestive pathological activity in these parts of the central nervous system.

The state of the child's nervous system, which may later develop a neurotic form of stuttering, is characterized by a special emotional reactivity. Such children are characterized by increased impressionability, timidity, anxiety, sleep disturbances, appetite disorders, emotional vulnerability, etc. This indicates congenital or early acquired deviations from the norm in the state of the nervous system, a special state of the emotional structures of the brain, which is mainly associated with a low level of adaptive capabilities of the body. Due to these characteristics of the central nervous system in such children, under the influence of mental stress, a focus of congestive pathological activity in the emotional structures of the brain can form.

Speech disturbance, which began after a mental trauma, corresponds to the psychomotor level of pathological response characteristic of young children. For the appearance of stuttering, additional conditions are necessary. Such conditions are: “predisposition” (vulnerability) of specific speech structures to the appearance of pathological reactions.

Stuttering in children appears in the hypersensitive phases of speech development, during the period of intensive formation of phrasal speech, since it is the period of the most intensive development of any functional system of the body that is especially vulnerable to pathogenic factors.

Violation of the motor speech act, once having arisen, tends to fix pathological relationships. An important mechanism for maintaining and aggravating pathological motor reactions(convulsive speech stutters), in addition to the focus of increased excitation in the emotional structures of the brain, is the flow of propreceptive impulses from the speech muscles involved in abnormal activity(reverse afferentation in the functional system of the motor speech act).

Thus, the pathogenetic mechanisms that contribute to the emergence of a neurotic form of stuttering are complex and cannot be reduced to the mental trauma experienced by the child.

The very fact of the appearance of convulsive speech stutters in children indicates the emergence of a pathological functional system of speech.

Some children have a low level of compensatory abilities of the brain. In these cases, a pathological functional system of speech is quickly formed. The new pathological functional system begins to suppress the normal functional speech system, which until then had been developing in the child so seemingly successfully.

the generator of pathological excitation in the emotional structures of the brain begins to combine various structures of the central nervous system (the stage of formation of a pathological determinant), including speech, into a complex pathological functional system and determine the nature of its activity.

The formation of a new pathological speech system in stuttering children against the background of an already developed functional speech system creates special conditions for the mutual influence and functioning of each of them.

In adolescents with a neurotic form of stuttering(11-12 years old) logophobia develops, i.e. secondary neurotic pathological reaction. They reduce the quantity and quality of communication. The presence of a speech defect becomes a traumatic circumstance for stutterers.

Logophobia begins to dominate, and convulsive speech hesitations seem to fade into the background. Even a mental representation of the situation of verbal communication causes pronounced vegetative disorders in such persons.

In adults suffering from a neurotic form of stuttering, even the background (i.e., those that are at rest) characteristics of physiological parameters change significantly. They show a violation of the stability of the regulatory systems of the brain, a decrease in cortical inhibitory influences due to the pathological activity of the emotional structures of the brain.

Under the influence of the pathological program of the speech functional system, stable changes occur in the relationship between the cerebral cortex and emotional structures, which is one of the mechanisms of generalization of the pathological process. In adult stutterers, often secondary determinants associated with the fear of speech can play the role of a dominant. These features of the relationship between the pathological speech system proper, the normal speech system, and the pathological psychological response system largely explain the significant difficulties in the rehabilitation of adult stutterers. Corrective pedagogical influences, aimed only at removing convulsive speech stutters, in adults turn out to be ineffective or effective only for a short time. Similarly, “one-time” removal of stuttering with the help of suggestive influences are also ineffective.

Another clinical form of stuttering is neurosis-like - with the similarity of convulsive speech stutters, it has a different clinical picture.

Stuttering of this form appears in children in the age range of 3-4 years. It arises, as it were, gradually, for no apparent reason, and is not immediately detected by the parents.

Carriers of this speech pathology have a history of signs of an abnormal course of the pre- or perinatal period of life. Both in childhood and in adulthood, neurologically and electrophysiologically, mild residual phenomena of early diffuse organic brain damage are diagnosed. Stutterers of this group are characterized by a certain delay in the development of the motor functions of the body, as well as their qualitative differences compared to the age norm: coordinating disorders, a low level of development of a sense of rhythm and pace, various types of hyperkinesis. The behavior of stutterers of this group is often characterized by motor disinhibition, they show a lack of active attention, some memory loss, etc.

Speech ontogenesis before the onset of stuttering in children with a neurosis-like form differs significantly from children with an asvrotic form of stuttering. This applies both to the rate of speech development and to its qualitative characteristics. Voice reactions - cooing, babbling words are little intoned, the voice has a slightly husky tone.

Words appear after 1.5 years, phrasal speech - after 3-3.5 years. Sound pronunciation has multiple violations. For the first time, convulsive hesitation begins to be noted by others in direct connection with the development of phrasal speech.

Expressed at first weakly, as the phrasal speech is formed, they acquire a stable character, accompanied by violent movements.

These data, as well as the features of motility, indicate the presence of pathological activity of the subcortical motor (striopallidal) structures of the brain and the weakening of regulatory influences from its higher departments.

In contrast to “transient” convulsive hesitation, when “exiting” from alalia, aphasia, dysarthria, when evolutionary stuttering occurs, a pathological functional system of speech is quickly formed.

The presence of a pathological determinant in the subcortical structures of the brain is not enough for the appearance of a neurosis-like form of stuttering. Additional conditions are decompensation of the regulatory mechanisms of the brain in connection with the active development of phrasal speech.

The choice of an organ - a target - in the form of a speech system suggests the presence in children with neurosis-like stuttering of endogenous disorders in the actual speech zones of the cerebral cortex. This is also evidenced by the speech ontogenesis of children with a neurosis-like form of stuttering: both verbal and phrasal speech appear with some delay compared to the norm.

One can imagine the following pathogenetic blocks of this system:

Pathological determinant associated with hyperactivity of striopallidar structures of the brain and a decrease in regulatory influences from the higher parts of the brain;

Central intermediate links of the speech motor system and speech zones of the cerebral cortex;

Central efferent links that regulate the highest level of coordination of “speech” movements.

Due to the plastic properties of the central nervous system, which fix only existing connections in the “memory”, as well as due to the constant activity of pathological connections within the speech system itself, the latter become more and more strengthened with the age of the child, and speech is increasingly disturbed by convulsive hesitation.

Since the integrative inhibitory control of the brain also turns out to be insufficient in children with a neurosis-like form of stuttering, the pathological program of the speech functional system is not spontaneously suppressed. In this regard, the neurosis-like form of stuttering usually does not have a spontaneous regressive course if the child does not receive speech therapy.

With age, in the absence of timely adequate therapeutic and pedagogical influences, stuttering becomes more and more resistant. Speech as a whole develops pathologically. At older preschool age, children with a neurosis-like form of stuttering show unformed basic levels of speech, monologue speech is characterized by a violation of both the semantic organization of the utterance and the operations of its structural and linguistic design.

In adults who stutter, these phenomena are pronounced. Speech is disorganized not only at the psychomotor level, but also at the highest mental levels of internal speech programming.

The pathological speech system with a neurosis-like form of stuttering becomes, over time, the core of a pathological stable state.

At the age of 16-18, a mental reaction to a speech defect and the associated secondary determinant with a focus of hyperactive excitation in the emotional structures of the brain is formed. Following this, the formation of logophobia is often possible, as a rule, expressed unsharply. This entails a change in behavior, a decrease in speech activity. Stutterers of this group are characterized by difficulties in adapting to external conditions, associated to a large extent with affective instability, a tendency to dysphoria, rigidity of thinking, impaired memory, and attention.

The primary lesion of the nervous system (in the neurotic form of stuttering - the emotional structures of the brain, in the neurosis-like - motor structures) and the weakness of its regulatory mechanisms create conditions for the onset of stuttering only in the presence of endogenous changes in the proper speech sections of the central nervous system.

The more branched and strong the pathological system of speech is, the more the integrative function of the brain is disturbed and its activity as a whole is disorganized.

The presence of these general patterns in the development of the pathological process in the nervous system, leading to stuttering, affects the clinical, physiological, and psychological and pedagogical characteristics of individuals who are carriers of this speech pathology. Significant differences in many diagnostic indicators of neurotic and neurosis-like forms of stuttering that are present in children are largely erased by adulthood in the chronic course of stuttering.

When developing rehabilitation measures, one should take into account the nature of the primary lesion of the nervous system in neurotic and neurosis-like forms of stuttering due to the fact that the determinant of the pathological system is the formation most resistant to corrective influences.

With a neurotic form of stuttering therapeutic effects should be aimed at reducing the excitability of the emotional structures of the brain, which can be achieved using a combination of medications and various psychotherapeutic techniques, from stress therapy, hypnosis to autogenic training. Speech therapy classes against this background are much more effective.

Stutterers with a neurosis-like form speech defect need long-term correctional and pedagogical influences that contribute to the development of regulatory functions of the brain (stimulation of attention, memory and other mental processes), special drug treatment aimed at reducing the consequences of early organic brain damage. Speech therapy sessions should be regular for a significant amount of time.

Given that the end result of the pathological system is a violation of the rhythm of the flow of a speech psychomotor act, the complex of therapeutic and psychological and pedagogical influences necessarily includes methods aimed at the rhythmization of movements. Classes to music with rhythmic movements of the arms, legs, torso, and later the combination of these movements with singing, melody, reading poetic and prose texts have a normalizing effect on the course of a speech act.

Domestic researchers approach the study of stuttering from a dialectical position. Therefore, highlighting the physiological and mental aspects with all the variety of the clinical picture of stuttering, physiological disorders are considered primary.

On the basis of physiological disorders, the psychological characteristics of the personality of a stutterer are formed, which aggravate stuttering. Psychological changes often come to the fore.

For the first time, the most complete symptomatology of stuttering was presented in the work of I. A. Sikorsky "Stuttering" (1889). The manifestations of stuttering in individuals in different age periods were studied by M. E. Khvattsev, M. Zeeman, E. Freshels, V. A. Gilyarovskiy, N. P. Tyapugin, S. S. Lyapidevsky and many others. Currently, two groups of symptoms are conditionally distinguished, which are closely interconnected: biological (physiological) and social (psychological).

To physiological symptoms include speech convulsions, disorders of the central nervous system and physical health, general and speech motility. To psychological- speech stutters and other violations of expressive speech, the phenomenon of fixation on a defect, logophobia, tricks and other psychological features.

The main external symptom stuttering are convulsions during the speech act. Their duration in average cases ranges from 0.2 seconds to 12.6 seconds. In severe cases reach 90 seconds. Seizures vary in form (tonic, clonic, and mixed), localization (respiratory, vocal, articulatory, and mixed), and frequency. With tonic convulsions, a short jerky or prolonged spasmodic muscle contraction is observed - tone: "t-opol"1. With clonic convulsions, a rhythmic repetition of the same convulsive muscle movements is observed, with a less pronounced tension - clonus: “this-and-poplar”. Such convulsions usually affect the entire respiratory-voice-articulatory apparatus, since its function is controlled by a holistically working central nervous system and, therefore, it works as an indivisible whole in the process of speech. Depending on the predominance of seizures in certain organs of speech, respiratory, vocal and articulatory are distinguished.

There are three forms of respiratory failure in stuttering: expiratory (convulsive exhalation), inspiratory (convulsive inhalation, sometimes with sobbing) and respiratory (convulsive inhalation and exhalation, often with a break in the word).

Convulsions in the vocal apparatus are characterized as follows: convulsive (convulsively closed vocal folds cannot open in a timely manner - the voice is suddenly interrupted, or a clonic or protracted spasm is formed - a bleating intermittent is obtained

In the articulatory apparatus, convulsions are distinguished- labial, lingual and soft palate. More often and sharper they appear when pronouncing consonant explosive sounds (k, g, p, b, t, e); less often and less intensely - slotted. Convulsions appear more often in voiced, as more coordinatively complex, than in deaf ones, especially when they are combined with vowels, as well as at the beginning of a word heading a phrase, syntagma or paragraph. Students stutter less when retelling well-prepared study material. Rhythm of speech is of known importance in relation to the frequency of stuttering.

In the expressive speech of stuttering children, phonetic-phonemic and lexical-grammatical disorders are noted. The prevalence of phonetic and phonemic disorders in stuttering preschoolers is 66.7%, among younger students - 43.1%, secondary - 14.9% and older - 13.1%. Among stuttering preschoolers, in addition to violations of sound pronunciation, in 34% of cases there are deviations in the development of speech, in the timing of the appearance of words, the formation of phrasal speech.

Violated word stress, intonation, rhythm. Speech is intermittent, with unreasonable pauses, repetitions, the volume and pace of pronunciation change, the strength, pitch and timbre of the voice associated with the speech intention, the emotional state of the stutterer.

The study of the unstable frequency of paroxysms of stuttering makes it possible to substantiate the concept of preserved areas of correct speech, the determination of the level of preserved speech, depending on the varying degree of complexity of speech activity and speech situations. Identification of the level of preserved speech is of decisive importance for the main correctional tasks at each stage of consistent speech therapy work.

In the manifestations of stuttering, various violations of speech and general motor skills are characteristic, which can be violent (speech convulsions, tics, myoclonuses in the muscles of the face, neck) and arbitrary tricks. Tricks include assistive movements used by stutterers to mask or ease their difficult speech.

Often there is a general motor tension, stiffness of movements or motor restlessness, disinhibition, discoordination or lethargy, switchability, etc. Some researchers point to a connection between stuttering and ambidexterity (left-handedness).

As early as the beginning of the 20th century. T. Gepfner and E. Freschels emphasized that the “specific basis of stuttering” is the mental state on the basis of which “consciousness of a speech disorder” arises. Subsequently, F. Stockkert, Yu. A. Florenskaya, M. I. Paikin, M. E. Khvattsev, A. M. Smirnova, N. A. Vlasova, N. I. Zhinkin and others also noted the aggravating role of the fixed attention of stutterers to his defect.

One of the main phenomena from which the development neurotic disorder , is a sense of inferiority. And the more the patient's attention is fixed on his painful symptom, the more stubborn he becomes. Thus a vicious circle is formed, from which the patient is in no way able to get out: the painful symptom forces him to fix his attention on it, and as a result of this, the symptom is still intensified and attracts the patient's attention to itself even more. N. I. Zhinkin, considering stuttering as a disorder of speech self-regulation, notes that the more the fear for the outcome of speech increases and the more pronunciation is assessed as defective, the more speech self-regulation is violated. This state, after several repetitions, turns into a pathological conditioned reflex and occurs more and more often, now before the start of speech. The process becomes circular, as the defect at the reception amplifies the defect at the output.

Researchers of stuttering put different content into the concept of fixation on a defect: a special property of attention (sustained, stuck, obsessive, concentrated), awareness of a defect, an idea of it, a different emotional attitude towards it (experience, anxiety, timidity, fear).

Based on the experience of working with stutterers of different ages and the general principles of a systematic approach in psychology (L. S. Vygotsky, S. Ya. Rubinstein, A. N. Leontiev, A. R. Luria, B. F. Lomov, A. V. Petrovsky, P. Ya. Galperin, V. D. Nebylitsyn, D. B. Elkonin, etc.), one can imagine a psychological model of the emergence and development of the phenomenon of fixation from the standpoint of the integral interaction of mental processes, states, properties and actions in stutterers. The difference between stutterers and fluent speakers is expressed not in the degree of productivity of this or that activity, but in the specifics of its course. From the first involuntary emotional response to a defect in stuttering children, their attitude towards it is gradually formed, associated with emotional experiences and is reflected in volitional efforts (actions and deeds) in an independent and unsuccessful struggle with stuttering.

The concept of the phenomenon of fixation in this case can be defined as follows: it is a reflection of an objectively existing speech defect (speech convulsions) in the entire mental activity of a stuttering person. This is the result of the processes of obtaining and processing information about speech difficulties (or interference) and related troubles, transformed in the mental processes, states and properties of a stutterer and manifested in his interaction with the surrounding social environment.

It is important to find criteria that characterize the increasing complexity of different levels (degrees) of fixation on a defect. As such a criterion, 3 options for the emotional attitude of stutterers to their defect (indifferent, moderately restrained and hopelessly desperate) and 3 options for volitional efforts in the fight against it (their absence, presence and development into obsessive actions and states) can be used. In this regard, the introduction of the working term " painful fixation» to distinguish, respectively, three groups of stutterers:

1 . Zero degree of painful fixation: Children do not experience infringement from the consciousness of the defect or do not notice it at all. There are no elements of embarrassment, resentment for his wrong speech, any attempts to overcome the defect.

2 . Moderate degree of painful fixation: older schoolchildren and adolescents experience their defect, are ashamed of it, hide it, resort to various tricks, try to communicate less. They know about their stuttering, experience a number of inconveniences from this, and try to disguise their shortcoming.

3 . A pronounced degree of painful fixation: in stutterers, feelings about a defect result in a constantly painful feeling of inferiority, when each act is comprehended through the prism of speech inferiority. These are mostly teenagers. They focus on speech failures, deeply experience them, they are characterized by going into illness, painful suspiciousness, fear of speech, people, situations, etc.

The study of the phenomenon of fixation of stutterers on their defect made it possible to establish the following:

1. Fixedness is one of the main factors complicating the structure of the defect and the effectiveness of its overcoming.

2. There is a direct dependence of it on the age of the children (or the experience of stuttering). This is due to the presence of adverse environmental factors, the improvement and complication of mental activity in connection with the formation of the personality of children, the appearance of shifts in the nervous and endocrine systems associated with puberty.

3. There is a connection with the increasingly complex nature of motor disorders. A tonic spasm can sometimes be seen as an attempt by a stutterer to fight his ailment. The nature of motor disorders in stutterers is usually associated with the emotional attitude of the child to the defect.

4. The effectiveness of speech therapy work with stuttering children depends on the different degree of their fixation on a defect: the greater the fixation, the lower the results of speech therapy work, and vice versa.

Awareness of a speech defect, unsuccessful attempts to get rid of it, or at least disguise it, give rise to various psychological characteristics in stutterers: vulnerability, defenselessness, timidity, timidity, suggestibility, and much more.

At present, attempts are being made not only to study the individual psychological characteristics of stutterers more deeply, but also to complete groups on this basis for a reasonable psychotherapeutic orientation of speech therapy work with them.

Depending on the favorable social conditions in which the child grows and is brought up, as well as on his pre-morbid features, mental phenomena can manifest themselves to varying degrees and for a short time or become fixed and develop into persistent mental states and personality traits, determining in general the psychological characteristics of stutterers. . Attempts to disguise speech difficulties give rise to various non-verbal and speech tricks in stutterers, which are observed in general motor skills (movements of arms, legs, body, head, etc.); less often - in speech motor skills (biting the tip of the tongue, lower lip, licking the lips, smacking, silent articulation of sounds, etc.) in the form of auxiliary sounds of their combinations or words (emboli): uh, and well, here, yes, etc. d.

There are three degrees of stuttering: mild - stutter only in an excited state and when trying to speak quickly. In this case, delays are easily overcome, stutterers speak without being embarrassed by their defect; medium - in a calm state and in a familiar environment, they speak easily and stutter a little; in an emotional state, a strong stutter is manifested; severe - they stutter throughout the speech, constantly, with accompanying movements.

The following types of stuttering are distinguished: constant - stuttering, having arisen, manifests itself relatively constantly in various forms of speech, situations, etc .; wavy - stuttering either intensifies or weakens, but does not completely disappear; recurrent - having disappeared, stuttering reappears, i.e., a relapse occurs, the return of stuttering after fairly long periods of free, without stuttering speech.

The problem of stuttering has occupied the minds of more than one generation of people. A different understanding of its essence is due to the level of development of science and the positions from which the authors approached and are approaching the study of this disorder.

Initially, a speech disorder such as stuttering was called Battarism, after the name of King Batta, who suffers from this ailment. Somewhat later, in the writings of Greek doctors and philosophers, the term “balbuties” is found, which means “stuttering” in Russian.

In ancient times, stuttering was mainly seen as a disease associated with the accumulation of moisture in the brain (Hippocrates) or the incorrect correlation of parts of the articulatory apparatus (Aristotle). Plutarch described in detail the method of self-treatment of Demosthenes. Ordering himself a full-length mirror, Demosthenes carefully studied the shortcomings of his speech and behavior. This allowed him to outline a whole system of various speech exercises. In them, he provided not only regular training in the correctness of his speech, but also the cultivation of certain personality traits. Demosthenes, along with gymnastic methods of treatment, attached great importance to the psychological impact on the personality of a stutterer. This indicates a deep understanding of the essence of stuttering already in the ancient era.

The possibility of violations in the central or peripheral parts of the speech apparatus was recognized by Galen, Celsus, Avicenna. At the turn of the 17th and 18th centuries, they tried to explain stuttering as a consequence of the imperfection of the peripheral apparatus of speech: the presence of a hole in the hard palate (Santorini); recess in the lower jaw, in which the tip of the tongue hides when moving (Wutzer); incorrect relationship between the long tongue and the oral cavity (Herve de Cheguan), too tight attachment of the tongue to the short frenulum. Other researchers associated with disorders in the functioning of the speech organs: convulsive closure of the glottis (Arnot, Schultess); excessively rapid exhalation (Becquerel); spasmodic contraction of the muscles holding the tongue in the oral cavity (Itard, Lee, Dieffenbach); inconsistency of the processes of thinking and speech (Blume); imperfection of the will of a person that affects the strength of the muscles of the speech-motor mechanism (Merkel).

At the end of the 19th century and the beginning of the 20th century, the opinion was asserted that stuttering is a complex psychophysical disorder . In Russia, most scientists considered stuttering as a functional disorder in the field of speech, convulsive neurosis (I.A. Sikorsky, 1889; I.K. Khmelevsky, 1897; E. Andres, 1894; and others). According to I.A. Sikorsky, stuttering is based on physiological disorders, and psychological shortcomings are of a secondary nature.

He considered stuttering as a special form of neurosis: the result of irritable weakness of the motor center of speech, leading to a violation of the coordination of speech movements and convulsions of the speech muscles.

Other researchers pointed out that psychological characteristics are primary, and physiological ones are manifested in stuttering (Chr.

Lagusen, 1838; G.D. Netkachev, 1909, 1913), as psychosis (Gr. Kamenka, 1900).

Netkachev G.D. considered stuttering as an independent psychoneurosis, in which there is a convulsive functional speech disorder associated with obsessive mental states.

In the same period of time, the mechanisms of stuttering began to be approached from a psychological point of view. Psychological theories of the mechanism of stuttering have arisen (Abeleva I.Yu., Angushev G.I., Netkachev G.D., Florenskaya Yu.A., Khavin A.B., Shklovsky V.M., etc.). the basis of stuttering is that mental state, on the basis of which the speakers have a consciousness of a disorder in their speech.

The psychological approach in understanding stuttering is implemented in her research by G.A. Volkova. The author defines stuttering as a peculiar and complex speech disorder caused by dysontogenesis of mental functions and disharmonic personality disorder.

By the 30s and in the subsequent 50-60s of the 20th century, the mechanism of stuttering began to be considered, based on the teachings of I.P. Pavlov, about the higher nervous activity of a person and, in particular, about the mechanism of neurosis.

In the works of a number of researchers, it has been shown that stuttering is caused by a violation of the cortical-subcortical interaction, as a result of which the pace, smoothness, and modulation of speech are disturbed, and convulsive spasms appear in the muscles of the organs involved in speech. Some researchers considered stuttering as a symptom of neurosis (Yu.A. Florenskaya, Yu.A. Povorinsky, etc.), others considered it as a special form of it (V.A. Gilyarovskiy, M.E. Khvattsev, I.P. Tyapugin, M. S. S. Lebedinsky, S. S. Lyapidevsky, N. I. Zhinkin, V. S. K;chergina, etc.) But in both cases, these complex and diverse mechanisms for the development of stuttering are identical to the mechanisms for the development of neuroses in general. Stuttering, like other neuroses, occurs due to various reasons that cause an overstrain of the processes of excitation and inhibition and the formation of a pathological conditioned reflex.

Stuttering is not a symptom or a syndrome, but a disease of the central nervous system as a whole (V. S. Kochergina, 1962). In the occurrence of stuttering, the primary role is played by the disturbed relationships of nervous processes (overstrain of their strength and mobility) in the cerebral cortex. A nervous breakdown in the activity of the cerebral cortex can be due, on the one hand, to the state of the nervous system, its readiness for deviations from the norm. On the other hand, a nervous breakdown may be due to unfavorable exogenous factors, the significance of which in the genesis of stuttering was pointed out by V. A. Gilyarovsky. A reflection of a nervous breakdown is a disorder of a particularly vulnerable and vulnerable area of higher nervous activity in a child - speech, which manifests itself in a violation of the coordination of speech movements with the phenomena of arrhythmia and convulsions. Violation of cortical activity is primary and leads to a perversion of the inductive relationship between the cortex and subcortex and a violation of those conditioned reflex mechanisms that regulate the activity of subcortical formations.

Due to the created conditions under which the normal regulation of the cortex is disturbed, there are negative shifts in the activity of the striopallidar system. Its role in the mechanism of stuttering is quite important, since normally this system is responsible for the rate and rhythm of breathing, the tone of the articulatory muscles. Stuttering does not occur with organic changes in the striopallidum, but with dynamic deviations of its functions. These views reflect the understanding of the mechanism of neurotic stuttering as a kind of violation of cortical-subcortical relations (M. Zeeman, N. I. Zhinkin, S. S. Lyapidevsky, R.

Luchzinger and G. Arnold, E. Richter and many others. etc.).

In young children, according to some authors, it is advisable to explain the mechanism of stuttering from the standpoint of reactive neurosis and developmental neurosis (V. N. Myasishchev, 1960). Reactive developmental neurosis is understood as an acute disorder of higher nervous activity. With developmental neurosis, the formation of pathological stereotypes occurs gradually, under adverse environmental conditions - over-irritation, suppression, pampering. Developmental stuttering occurs at an early age against the background of delayed "physiological tongue-tiedness" during the transition to complex forms of speech, to speech in phrases. Sometimes it is the result of speech underdevelopment of various genesis (R. M. Boskis, R. N. Levina, E. Pishon and B. Mesoni). So, R. M. Boschis calls stuttering a disease, “which is based on speech difficulties associated with the design of more or less complex statements that require phrases for their expression. Speech difficulties can be caused by delays in the development of speech, the transition to another language, cases of pathological development of the personality with underdevelopment of the emotional-volitional sphere, the need to express a complex thought.

1. History of the study of stuttering in world and national history

The problem of stuttering can be considered one of the oldest in the history of the development of the doctrine of speech disorders. In the Middle Ages, stuttering was predominantly seen as a disease associated with the filling of moisture in the brain (Hippocrates) or the incorrect correlation of parts of the articulatory apparatus (Aristotle). The possibility of violations in the central or peripheral parts of the speech apparatus in stuttering was recognized by Galen, Celsus, Avicenna.

At the turn of the 17-18 centuries. They tried to explain stuttering as a consequence of the imperfection of the peripheral apparatus of speech. For example, Santorini believed that stuttering occurs when there is a hole in the hard palate through which mucus leaks and makes it difficult to speak. Other researchers associated stuttering with a violation in the functioning of the speech organs: convulsive closure of the glottis (Arnot, Schultess); excessively rapid exhalation (Becquerel); inconsistency of thinking and speech (Blume); etc.

In Russia, most researchers considered stuttering as a functional disorder in the field of speech, a convulsive neurosis (I. A. Sikorsky 1889; I. K. Khmelevsky 1897, etc.) or defined it as a purely mental suffering, expressed by convulsive movements in the speech apparatus (Chr. Laguzen, 1838; G. D. Netkachev, 1909, 1913), as psychosis (Gr. Kamenka, 1900).

By the beginning of the 20th century, all the diversity of understanding the mechanisms of stuttering can be reduced to three theoretical areas:

1. Stuttering as a spastic neurosis of coordination, resulting from irritable weakness of the speech centers (apparatus of syllabic coordinations). This was clearly formulated in the works of G. Gutzman, I. A. Kusssmaul, I. A. Sikorsky. They further explained stuttering in terms of neuroticism.

2. Stuttering as an associative psychological disorder. Proponents of the theory A. Liebmann, GD Netkachev, Yu. A. Florenskaya.

3. Stuttering as a subconscious manifestation that develops on the basis of mental trauma, various conflicts with the environment. Proponents of the theory A. Adler, Schneider.

Thus, in the late 19th and early 20th centuries, the opinion that stuttering is a complex psychophysical disorder becomes more and more definite. By the 50-60s of the 20th century, the mechanism of stuttering began to be considered, based on the teachings of I.P. Pavlov on the higher nervous activity of a person and, in particular, on the mechanism of neurosis.

2. Stuttering: definition, structure of speech disorders, symptoms

Stuttering is a violation of the tempo-rhythmic organization of speech, due to the convulsive state of the muscles of the speech apparatus. Stuttering is a speech disorder characterized by frequent repetition or prolongation of sounds or syllables or words; or frequent stops or hesitation in speech, breaking its rhythmic flow. The diagnosis is made when these symptoms are significant.

Stuttering is a violation of the tempo-rhythmic organization of speech, due to

convulsive state of the muscles of the speech apparatus.

Symptoms: - physically (manifested regardless of the person's desire); - Mental (people can manage them); - external; - internal; -physiological; - psychological; - biological; social.

3. Mechanisms of speech impairment in stuttering

Stuttering is caused spasms speech apparatus: tongue, palate, lips or muscles of the larynx. All but the last - articulatory spasms, spasms of the muscles of the larynx - vocal (hence the name "stuttering" - spasms resemble hiccups). There are also respiratory convulsions, in which breathing is disturbed and there is a feeling of lack of air. The mechanism of occurrence of spasms is associated with the spread of excessive excitation from motor speech centers. brain to neighboring structures, including adjacent motor centers of the cortex and centers responsible for emotions

4. Etiology: predisposing causes of stuttering

Neuropathic burden of parents: nervous, infectious and somatic diseases that weaken or disorganize the functions of the central nervous system.

Neuropathic features of the stutterer himself: night terrors, enuresis, increased irritability, emotional tension.

Hereditary burden: stuttering, which develops on the basis of congenital weakness of the speech apparatus, which is inherited as a recessive trait. At the same time, it is necessary to take into account the role of exogenous factors, when the predisposition to stuttering is combined with the adverse effects of the environment.

Damage to the brain at various periods of development under the influence of many harmful factors: intrauterine and birth injuries, asphyxia; postnatal-infectious, traumatic and metabolic-trophic disorders in various childhood diseases.

5. Etiology: adverse conditions contributing to the onset of stuttering

Physical weakness of children.

Age features of brain activity; the cerebral hemispheres are mainly formed by the 5th year of life; by the same age, functional asymmetry in the activity of the brain is formed. Speech function is ontogenetically the most differentiated and late maturing, especially fragile and vulnerable. Moreover, its slower maturation in boys than in girls causes a more pronounced instability of their nervous system.

Accelerated development of speech (3-4 years), when its communicative, cognitive and regulatory functions are rapidly developing under the influence of communication with adults. Many children during this period have a repetition of syllables and words (itrations), which has a physiological character.

Hidden mental infringement of the child, increased reactivity on the basis of abnormal relationships with others.

Lack of positive and emotional contacts between adults and the child.

Lack of development of motor skills, sense of rhythm, mimic-articulatory movements.

The group of unfavorable causes includes:

Anatomical and physiological causes: physical diseases with encephalopathic consequences

a) injuries (intrauterine, natural, often with asphyxia, concussion);

b) organic disorders of the brain, in which subcortical mechanisms that regulate movements can be damaged;

c) exhaustion or overwork of the nervous system as a result of intoxication and other diseases that weaken the central apparatus of speech (measles, typhus, rickets, worms, whooping cough, diseases of internal secretion, metabolism, imperfection of the sound-producing apparatus in cases of dyslalia, dysarthria, ZPR).

6. Etiology: producing causes of stuttering.

1) injuries and diseases of the GM

2) severe somatic diseases

3) stress 59%

4) prolonged psychotraumatic situations 27%

5) speech overload

6) induced stuttering

7) retraining lefties

7. Forms of stuttering

According to the type of speech convulsions that occur in a child, stuttering is divided into clonic and tonic. Also, convulsions can be inspiratory and expiratory: depending on whether they occur during inhalation or exhalation. Due to the appearance, stuttering can be evolutionary and symptomatic. Evolutionary stuttering, in turn, is neurotic and neurosis-like.

The tonic form is manifested in long pauses in speech, or stretching of sounds. At the same time, there is a general stiffness of a stutterer, his face reflects tension, his mouth is either half open or closed with tightly closed lips.

The clonic form is manifested in the repetition of individual sounds, syllables or words. Clonic and tonic speech spasms can be observed in the same stutterer.

Due to the appearance of stuttering is divided into:

Evolutionary (in children aged 2-6 years);

Symptomatic (occurring at different ages in diseases of the central nervous system - traumatic brain injury, epilepsy, etc.).

Types of evolutionary stuttering:

neurotic stuttering

Reason: occurs after a mental trauma at the age of 2-6 years.

Manifestation: speech and motor development in such children corresponds to age periods, sometimes it can be ahead of them. In such children, clonic convulsions are more often noted, which increase with emotional stress and at the beginning of speech. Children are anxious before speech, refuse to communicate.

neurosis-like stuttering

Reason: As a rule, it is associated with certain brain disorders.

Manifestation: children with this form of stuttering quickly get tired, exhausted. They are irritable, their movements look "loose". In some cases, psychiatric symptoms are diagnosed, which are characterized by behavioral difficulties and movement disorders.

Stuttering occurs at the age of 3-4 years. It has nothing to do with psychological trauma. It often occurs during the intensive development of phrasal speech. Violations are gradually increasing. Speech worsens with fatigue and after illness. Speech and motor development may take place on time or with some delay. Sometimes neurosis-like stuttering occurs against the background of underdevelopment of speech. Children with this form of stuttering are not very worried about their illness. The situation around and the environment do not greatly affect the severity of stuttering.

8. Physiological symptoms of stuttering. Types of seizures

FS: 1) Convulsions; 2) respiratory disorders; 3) involuntary movements; 4) violations of general motor skills (coordination, increased agitation, increased inhibition); 5) disorders of the autonomic NS

The main external symptom of stuttering is convulsions during the speech act. Their duration is different: from 0.2 to 90 seconds (in severe cases).

Seizures vary in form (tonic, clonic, and mixed), localization (respiratory, vocal, articulatory, and mixed), and frequency.

With tonic convulsions, a short jerky or prolonged spasmodic muscle contraction is observed - tone: "t-opol" (a line after the letter indicates a convulsively prolonged pronunciation of the corresponding sound).

With clonic convulsions, there is a rhythmic, with less pronounced tension, repetition of the same convulsive movements - muscles - clonus: "this-that-poplar".

Depending on the predominance of seizures in certain organs of speech, respiratory, vocal and articulatory are distinguished.

9. Physiological symptoms of stuttering. Convulsions in the respiratory and vocal apparatus.

When stuttering, 3 forms of respiratory failure are noted: expiratory (convulsive expiration), inspiratory (convulsive inhalation, sometimes with sobbing), respiratory (convulsive inhalation and exhalation, sometimes with a break in the word).

Closing (convulsively closed vocal folds cannot open in time - the voice is suddenly interrupted or a clonic or protracted convulsion is formed - an interrupted bleating (“A-a-a-anya”) or a jerky vowel sound (“a-a-a-a” is obtained ).

Vocal, characteristic of children (drawing out vowel sounds).

10. Physiological symptoms of stuttering. Convulsions in the articulatory apparatus.

Spasms of the articulatory apparatus Articulatory spasms are divided into facial (lips, lower jaw), lingual and convulsions of the soft palate.

Facial spasms The clenching of the lips is one of the most commonly observed spasms in stuttering. It is already characteristic of the early stages of the development of this speech disorder. A lip clenching cramp is manifested as a spasm of the orbicular muscle of the mouth, as a result of which the lips are strongly compressed, while other facial muscles may not take part in the cramp. When trying to pronounce a sound, the cheeks may inflate under the pressure of air filling the oral cavity. With a closing spasm of the lips, the pronunciation of labial sounds (p, b, m, c, f) is disturbed. In severe cases, the spasm also disrupts the pronunciation of sounds that, by localization, are lingual (t, d, k).

Upper labial cramps are rare. It is manifested by a spasm of the muscles that lift the upper lip, and sometimes the wings of the nose. It occurs more often on one side of the face, while the oral fissure takes an oblique direction. The labial cramp is more often tonic in type. With this spasm, the pronunciation of all labial sounds is almost impossible. The face becomes asymmetrical, distorted.

The lower labial cramp is similar to the upper labial. Affects one or both muscles that lower the corner of the mouth. In the event that both muscles are affected, a sharp lapel of the lower lip is observed. Rarely seen in isolation.

An angular spasm of the mouth is characterized by a sharp retraction of the corner of the mouth on the right or left, along with elevation, vgo. The oral fissure warps in the direction of convulsively contracted muscles. There may be a spread of convulsions to the muscles of the nose, eyelids, forehead. An angular spasm disrupts the work of the circular muscle of the mouth. A person who stutters during a spasm is unable to close his lips, as a result of which the pronunciation of the corresponding consonants is upset. Angular mouth spasm can occur on both sides of the mouth. It can be both tonic and clonic.

Convulsive opening of the oral cavity can occur in two ways: a) the mouth opens wide with simultaneous lowering of the lower jaw; b) with closed jaws, teeth are sharply exposed. The outlines of the mouth take on a square shape. All muscles of the articulatory apparatus are extremely tense. The cramp is usually tonic in nature and often radiates and can capture the muscles of the forehead, eyelids and all the muscles of the face.

Complicated facial spasm. A complex facial cramp, as a rule, accompanies a spasm of the orbicular muscle of the mouth. According to some researchers, it is characteristic of severe stuttering in adults.

Lingual convulsions They constitute the second group of convulsions of the articulatory apparatus and are observed, as a rule, when pronouncing sounds in the articulation of which the tongue takes part. There are several types of spasms of the tongue.

Tongue tip spasm is the most common among articulatory spasms. The tip of the tongue rests against the hard palate with tension, as a result of which articulation stops, exhalation (and, therefore, phonation) stops at this moment, an unreasonable pause occurs.

Convulsive lifting of the root of the tongue is expressed in the violent lifting of the root of the tongue up and pulling back. During a spasm, the root of the tongue closes with the sky, as a result of which the passage of the air stream through the mouth is completely blocked. This spasm occurs when pronouncing posterior lingual sounds (g, k, x).

An expelling spasm of the tongue is characterized by the protrusion of the tongue outward into the space between the teeth. It can be tonic and clonic. With a tonic spasm, the tongue can be protruding from the oral cavity, and with a clonic spasm, it can periodically move forward and then be pulled inward with force. During a convulsion, the pronunciation of sounds becomes impossible, breathing is disturbed, even pain may occur. If the cramp is not pronounced, the tongue can remain in the oral cavity, only resting on the teeth. Hypoglossal spasm is characterized by the lowering of the lower jaw and the opening of the oral cavity. This cramp involves the muscles associated with the hyoid bone. Very seldom it has independent character, is generally combined with spasms of other localization.

Spasm of the soft palate This spasm in isolation is extremely rare. More often it is observed as part of a complex generalized convulsions of the articulatory apparatus. During a spasm, the soft palate rises and falls, causing the entrance to the nasal cavity to open and close, which gives the sounds a nosalized tone. Outwardly, the spasm is expressed by a sudden stop of speech and repetition of sounds. The subjective sensations of stutterers are expressed in a feeling of unpleasant tension, dryness in the nose. The severity of the manifestation of speech convulsions There are severe, moderate and mild degrees of manifestation of convulsions. The assessment of the severity of the convulsive activity of the muscles of the speech apparatus may not coincide with the assessment of the severity of stuttering, since this concept includes many factors.

The severity of stuttering in the same stutterer is variable and depends on a number of conditions:

the emotional state of the stutterer at the moment, the emotional significance of the communication situation for this stutterer; on the degree of difficulties associated with the formulation of the statement; from the presence of so-called "difficult sounds" in the words that make up the statement, etc.

Portal for the student. Self-training

6. Etiology: producing causes of stuttering.

7. Forms of stuttering

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