Speech defects in school children and how to treat them

Front matter

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Contents

Editor's Introduction vii

I. Importance of Good Habits of Speech . i n. Methods of correcting Defects of Speech 13

III. The Elimination of Minor Speech Disor-

II Methods Of Correcting Defects Of Speech

After this discussion of the constant and crying need for correction of speech disorders in pubUc schools, — a need which in many places is not noticed and in other places is not met, — we come naturally to the consideration of methods of eradicating these defects.

The methods and systems of cure should be uniform, scientific, and based upon a sound psychology. Members of the medical profession who have gone out from Boston clinics to establish centers of instruction elsewhere in the country are doing much to standardize treatment, but unfortunately elsewhere there is still little general agreement. The methods of eradication which are taught — particularly in the institutions of higher learning — are still numerous and varied.

It will be well to begin with a brief but careful consideration of some ways of approaching the problem.

/. Some gejieral methods — dividing classes

In general, the speech-disorder problem resolves itself into an attempt to raise the faulty into the normal voice, to eradicate speech defect and replace it by normal speech. One reason why so many of the weaker efforts made in this line result in only partial eradication lies in the fact that speech as a whole has not been understood. It is very important in studying methods to have a large idea of the field. I mean by this that we should abandon the usual narrow interpretation of speech defects and learn to view the speech mechanism scientifically and as a whole embracing the nervous system in both its physiological and its psychological aspects. In this view the mouth, which is usually the only factor considered, becomes merely a part of the external speech mechanism : lungs, throat, vocal cords, mouth, nasal cavities, and the intricate system of muscles that control these parts. Outside of this we have much more : a sensory nervous system and a low brain sensory registration area, a higher brain interpretation area, and intricate collaborative functions. On the motor side we have a high motor-control area, a low motor-output area, which includes the nerves that go down to supply nervous control to the numerous external parts of the speech mechanism. All this, then, is the field of approach, all this is our field of study, all this is the groundwork upon which we are to build perfected speech, and no one, without a thorough understanding of all these things, can expect to do very much with the speech mechanism. These considerations show the extent of the ground upon which our efforts are to be directed.

A few general ideas of method should be firmly fixed in the teacher's mind and should pervade all her efforts and undertakings in the details ot treatment. The first of these general ideas is that of the great importance of persistent, long-continued drill. My two clinics in Boston illustrate some very remarkable cases of improvement. The secret of this improvement lies more in the persistent and long-continued drill gone through in these cases than in any other one thing. We often think that the mere placement of an external speech part where it ought to be is enough, but those who are experienced in this line of work have found that very long persistent drill is the only means of attaining permanent results.

The patient should be held to the exact following of exact instructions. He should not be allowed to lapse, to practice wrongly, or to practice in a slovenly way. He should be constantly made to do his best.

It goes almost without saying that special attention must be given throughout the period of training to matters of hygiene. The aim should be to secure proper rest, exercise, and nutrition, so that the attainment of new vocal habits may progress as rapidly as possible.

Special attention must be given also to the proper division of classes. Speech defects differ in their characteristics, in the time necessary for eradication, and in their nervous or psychological background. They natually fall into the following three large divisions : stuttering, phonetic defect, and the speech of mental defectives.

2. Modem treatment of stutterijig

In speaking of the mode^m treatment of stuttering, I refer to that one which has been found, after numerous trials, to be the best in its final results. It not only eliminates the trouble itself in a majority of cases, but it develops the mentality of the patient at the same time and leaves him with a more rounded personality than other methods even pretend to give. As far as I know, no other method makes any effort to apply developmental psychology. Other methods partly re-

i6 lieve, sometimes wholly relieve, the stuttering itself, but they never give the patient a larger mental horizon, they never try to send him out a larger personality, they never make an attempt to broaden, deepen, and widen his visualization processes. When a method can not only cure stuttering, but can also develop personality, it has claims which no other method can put forward.

Before presenting the modern method of treatment, it will be well to say a word about some of the old methods in order to show the contrast in procedure and in point of view. The oldest form of treatment of which I know was that in which the physician attempted to cure the stutterer by the amputation of a part of the tongue. This was placing the diagnosis in the external speech mechanism. After this the diagnosis was placed in numerous parts of the nervous mechanism on the sensory-motor side. Not long ago some of the lesser lights in the Freudian constellation placed the diagnosis in the subconscious mentality.

After I had made a study of this situation, the only unexplored field seemed to me to be that of the conscious mentality. I therefore began a series of researches with the attempt to discover something constant behind the stuttering in the conscious mental make-up, and it is upon discov* eries made in the voice clinic of the Psychopathic Hospital in Boston that the modern treatment is based. Let us turn now to that.

Several normal individuals were tested with a list of some fifteen hundred questions to ascertain the conscious content of their minds during utterance. This conscious content was found to be a visual image. Then a similar series of stutterers was put through the same experiment and it was found that they constantly lacked this visual image while they were stuttering. Upon this research finding is based our treatment, which, in a word, consists in very gradually developing first meager and then larger and then very extensive visualization processes over the speech of the stutterer and so giving him that apparently essential faculty which is found constantly present over the speech of the normal individual.

From this general idea as to the foundations of the modern treatment, let us pass to the steps used in initiating this treatment. We begin with a series of breathing exercises. These are intended to instill control of the breath and to develop concentration. After this, the patient is asked to hold the voice on a single musical note or tone during the prolonged expulsion of the breath. Then, in addition to holding this note, he

i8 is asked to pronounce a word. After this, he is asked to hold the single note through the pronunciation of a sentence and of a stanza. This method is continued until the patient has developed sufficient concentration to hold the single note over quite long sentences. We next explain that the holding of the note with the voice is only an exercise in developing the power of concentration and nothing more than an introduction to the really important process — that of holding a visual image in the mind during utterance. After this has been explained and we think the patient has developed enough concentration to warrant our passing on to the exercise of the mental image, we begin with single words and proceed gradually to the use of short sentences, }ong sentences, verse and prose, short original stories, and long pieces of dramatic literature, until we have developed elaborate visualization processes to the more or less complete elimination of the stuttering habit. Uninterrupted suggestion accompanies these steps.

With this brief statement of the method which is employed, let us turn to the detailed exercises that are given in series from the beginning to the end of the treatment. The object of most of these exercises is to draw the attention from the words to be pronounced toward the notes held in mind and afterwards to the visual pictures.

Exercises

Position, Correct standing position, heels together, chest up, chin in, body straight, hands to the sides.

Exercise /. Take a deep breath slowly and exhale as slowly as possible. The inhalation and exhalation should be through the nose. At the same time the arms are raised during inhalation till the hands touch over the head and lowered slowly during exhalation.

Exercise 2. Same as Exercise i, but on exhalation sound the syllable "Ma," keeping it of even volume and intensity and prolonging the utterance as much as possible.

Exercise J. This is the same as Exercise 2, but instead of prolonging the "Ma" on an even pitch sing the scale with "Ma."

Exercise 4, Same as Exercise 3, except that "Ma" is sounded on low C, high C, and low C again prolonged as before.

Exercise ^. The w^ord "Mother" is now uttered. The voice is made to move up and down the octaveat about the speed of normal conversation. This ends the introductory exercises. The purpose of all these is to concentrate the attention on a mental note.

Word exercise. The patient is asked to apply this octave exercise to every word of the following stanza :

"Mary had a little lamb, Its feet were white as snow, And everywhere that Mary went, The lamb was sure to go."

Line exercise. When the patient has learned to execute this bit of vocal drill with fluency and ease, I teach him to jump the octave on the first word in the line, and then to let the voice run down the octave through all the succeeding words of that line until the note from which he started is reached. The stanza used in this exercise is as follows :

"Twinkle, twinkle, little star. How I wonder what you are!

Up above the world so high, Like a diamond in the sky."

Following this, I teach him to rise through the octave from the beginning to the middle of the line and then to let the voice fall gradually to the end of the line. The words on which the high note is struck are "glorious," "grass,"

" shine," and " twinkle." For this exercise I use the verse :

"When the glorious sun is set And the grass with dew is wet, Then you shine your httle Hght, Twinkle, twinkle all the night."

I usually follow this by having the patient tell stories with a vocal execution like that used in the three last exercises. He first tells a story in short sentences, the pitch of the voice rising and falhng with every word until the end of the sentence is reached. In the next story his voice is to leap the octave on the first word of the sentence and to decline on the rest. Finally, he tells a stor) with the voice taking the octave jump on some important or easily emphasized word near the beginning of each sentence and then declining on the following words. This series of exercises with short sentences might be followed by a similar series dealing with stories in longer sentences. This sort of exercise is kept up until the patient has acquired fluency and ease in applying it to any new thing that he tries to learn, say, or repeat. The process is suggestive.

This drill really marks and ends the introductory phase of the treatment, and after there is sufficient concentration developed to hold this note and apply it consistently on all sorts of material, I start the patient on the processes of visualization. First, I ask him to take some single word and utter it with the visual image naturally called up by that word distinctly in mind. Then he does the same thing in pronouncing a sentence, verses, prose, original stories. By these stages he gradually develops until he can render some pretty complicated dram.atic pieces.

This description of the method is almost enough to enable one to start in and carry it out, but for fear that some may need to have a series of exercises put down, I will give a series which I have used in my own practice.

The first selection for visualizing is usually the word "builders." I try to secure in the minds of my patients as clear and fine a picture of builders as possible, and I let this stand as the example and ideal for visualization processes in the work that follows. Next I turn to a sentence.

"Under the spreading chestnut-tree The village smithy stands; The smith, a mighty man is he, With large and sinewy hands," —

is a very good verse for a wider and more diflficult application of a visual image exercise. I train the patient to see the tree in his mind's eye before he begins to pronounce the word " tree," to hold that tree in mind while he is saying the word, and, when he comes to the description of the blacksmith, to replace the picture of the tree by ?.. picture of the smith standing at his forge under the tree.

«* The Chambered Nautilus " is another good verse to practice on, as it is pretty thickly studded with numerous and quickly changing visual pictures.

The "Witch Scene" in Macbeth is another good piece that may be used here. It runs as follows :

1. Witch. Where shall we three meet again? In thunder, lightning, or in rain?

2. Witch. When the hurlyburly's done, When the battle 's lost and won.

J. Witch. That -will be ere the set of sun. J. Witch. Where the place? 2. Witch. Upon the heath.

J. Witch. There to meet with Macbeth. J. Witch. I come, Graymalkin! 2. Witch. Paddock calls; Anon!

All. Fair is foul, and foul is fair, Hover through the fog and filthy air! {JB^xcwni^

After these one may feel at Hberty to choose whatever extracts from literature seem desirable. One of the best ones of which I know is the ** Dagger Scene " from Macbeth, and another ont

. 24 is the " Mad Scene " in the same play. Suggestion dominates the whole process.

The modern method of treatment for stuttering has been clearly outlined above, but I can conceive that some who misunderstand the background of this method might apply the exercises without reaching the results. I therefore advise some little experience in applying this method in the clinic or some observation of the process as practiced either in the clinics in Boston or under some of the numerous teachers who have graduated from the Boston courses and become centers of instruction in other parts of the country. I do not advise this because the method is particularly difficult. I think it is no more difficult than the proper teaching of reading in the schools. Teachers are not allowed to give instruction in reading, however, unless they have passed a nor mal course in the subject. Therefore I should most seriously recommend at least a little " trying it on the dog " before the method is tried on the pupil.

Now for the school application of this method of treating stuttering. I might say that the whole class for stutterers should be put through in unison, perhaps as far as the second stanza, of "Twinkle, twinkle, little star!" starting at the beginning of the year with only one or two exercises and adding one or two a week. It takes from two to three months to get through this second stanza. When the class can do any given exercise well in unison, I would spend the rest of the study period with individual treatment, giving each what his own individual case seems to demand.

J. Treatment of phonetic defects

Phonetic defects are departures from the local standard of the sounds of vowels and consonants. They are as numerous as are the phonetic utterances included in our language, multiplied by about ten or more to cover the different forms in which the defects appear. Some systems study minutely the form of the individual defect and try gradually to get the patient out of it. Others try to instill the correct mouth positions at once, with no other sort of exercises whatever. The best method differs somewhat from these, and is really a larger and more fundamental attack upon the whole process of phonetic utterance than any of these above processes can ever possibly pretend to be.

The method of phonetic correction may be considered under four large divisions: (i) Muscular development ; (2) ear sensitiveness ; (3) form of motor output ; (4) position of motor output. I mean by these, briefly, as follows ;

Muscular development as a basis for phonetic excellence is brought about by a systematic drill of all the muscles of the jaw, mouth, tongue, and throat. The purpose of this drill is to increase muscular control and thereby to increase the patient's ability to make exact and minute vocal coordinations. I consider this the most valuable of all possible foundations for the development of correct phonetic utterance.

The development of ear sensitiveness enables the patient to differentiate accurately one sound from another, and also to differentiate between sound forms such as pitch, intensity, and other factors in vocal utterance. I hold that defects in phonetic output may have their seat in defective phonetic intake. Sounds ill-heard are likely to be ill-pronounced. When intake is perfected, it provides a good basis for the perfection of output.

By the phrase, form of motor output y I refer to the idea of an acoustic form which may be held in mind without utterance of the sound to which it corresponds.

I consider that concentration upon the sensory ear intake, and the development of that concentration into the ability to hold the form of a sound foi motor output, offer excellent training in the development of final phonetic excellences. Under the heading, position of motor output^ I teach the exact coordination and position of external vocal agents — tongue, jaw, teeth, lips, and throat — in the execution of a sound held in mind. Exercise in exact coordinations of motor output and in ability to hold these in the mind and to correlate them with the form of the acoustic idea is an essential process at the very foundation of all good speech instruction. We must acoustically experience good speech, to have it,

4. Management of the special class

The author was the first to formulate a program for a speech survey among special classes for the retarded, and to follow this by the compilation of a course of lectures, attacking the speech problem among mental defectives, illustrating the successful and in many cases marvelous results that have come from a special vocal drill applied to pathological minds and speech cases.

The great mistake commonly made in treating the speech of mental defectives has lain in the application to them of methods proper only to the treatment of normal pupils. We place these pathological mentalities in classes of their own, where they do not have the usual educational curriculum and are put to what is called '' industrial drill " — a vastly inferior method of education. Why, then, should the phonetics used in classes where minds are average be applied, with any expectation of valuable results, to special classes where minds are in many ways markedly inferior ? The situation is ridiculous, unscientific, unpsychological, ill-advised, — a work of the ignorant attempter.

The ideal system of phonetics for pathological minds is one that differs as markedly from normal phonetics as industrial drill does from the work in the normal grades. In other words, to reach the mental defective, we should take at least as big a step down from the phonetics proper to normal minds as we do in passing from normal grade work to industrial drill. This is what I have done in devising a new system for the phonetic training of the mentally deficient.

The mental defective is first put through a series of tests to see how much he can utter. I have him say the vowels, thus : " Ah, a, e, aw, o, 00." When he has said them separately, I note how many he can say in series. Then I have him practice them, first those that he can say in series, for ten or fifteen minutes three to five times a day, for one week. My next step is governed by the advance that has been made during the first week. Sometimes I have him repeat the first exercise for another week. Sometimes, when the patient was originally able to say only two vowels, I add three to those he can already pronounce. Or I may add six in series, when he has previously been able to say three in series. Then I have him begin with some consonant that he has already learned, and place that before each vowel. After this I have him pass through several other consonants that he already knows, and have him place each before each vowel. Then I have him place the same consonants after each vowel, and finally before and after. In this way I give him about one new vowel or vowel combination a week, insist upon intensive, constant, and prolonged drill, and then continue the process, making it more and more complicated as it ad\^nces. If these exercises are carried on for two or three months, a great deal of improvement results. With these I have known a mental defective in eight months to advance two years on his Binet scale.

I go on to familiar words after this and then to very short sentences, then to longer sentences, and finally to verse and prose, with the installation of visualization processes. The whole process is nothing but an increasingly complex arrangement of simple phonetic utterances. Each step in the process is minutely adapted to the capacities of the mental defective. It is not suggestive therapeutics.

5', How parents can kelp

One of the most important and valuable adjuncts to speech-improvement classes is to be found in cooperative influence of the family. The parents should be called in soon after their child has been put in any class for the elimination of speech defects and should be given a careful explanation of the dangers threatening the child because of his speech disorder. They should be shown that the child is likely to be kept back in the grades and to become a laughing-stock among his fellows unless his defect is cured. The strong likelihood that this defect, unless cured early in life, will become a permanent handicap in later life, resulting in retarded education, lack of friends, low pay, and general inefficiency, should be clearly presented to them. It should be made clear that the object of the speech teacher and of the assignment of the child to a speech-improvement class is simply that these dangers may be averted. This explanation will inspire interest at home, will induce the parents to see that drill and practice are carried out, and will enable them to help in many other ways.

I should also call the parents in later at frequent intervals so that they may observe the child's progress and report upon his faithfulness in practice at home. At the same time they may be influenced again to help in whatever is being done for their child in the class.

More than in any other way, the parents can help in overseeing the hygienic measures necessary to any real speech improvement. They can see to it that the child does not play too hard or too much ; they can see that he gets the proper amount of sleep ; they can maintain a diet of normal and advised standard and amount; they can look after the clothing and the baths, and minimize the outside work that some children are forced into, which saps their vitality to such an extent that no good work in phonetics can possibly be done with them.

Sometimes progress is found to be quite impossible unless family cooperation — the sympathy and good-will of the parents — is obtained and maintained throughout the whole period of treatment. This matter is of great importance. It may make all the difference between success and failure.

6. Function of the school physician

The teacher of speech disorder should endeavor to elicit the interest and the services of the school physician. The aid furnished by him may be invaluable to the teacher, mostly in the way of eliminating those physical causes of speech disorder which, with her lay training, she is incapable of finding. The school physician can tell when a tic — that spasm of related muscular movements — is interfering with the improvement of a stutterer. The physician can tell when chorea is the main cause of a sudden phonetic slump. He can explain the incurableness of the congenital syphilitic, as well as the permanent and unremovable defect presented in a juvenile case of tabes. Then he can discover the cases of speech defect due to idiocy and imbecility, and can save the teacher unsophisticated in medical subjects much time and effort by telling her that in those cases she need not expect any great amount of improvement. It is in this diagnostic service, this deeper, internal, medical interpretation of the background

S3 of speech disorder, that the school physician can give the teacher invaluable assistance. The teacher should respect his diagnosis and follow his medical advice. She should respect the diagnosis because it is the outcome of the accumulated knowledge of the medical profession and is really the physician's legitimate and exclusive function. Much of her success in managing her speech-improvement class depends upon her ability and tact in using the services of the school physician. While the physician can offer knowledge, diagnosis, and advice in medical matters, the teacher should realize the ignorance of the ordinary physician in regard to such special work as her own. He may advise that speech defects be let alone, so that they may be ** outgrown." He may assert that they really amount to nothing. He does not realize the relations of speech disorder to the school curriculum. He does not know that the speech defective is also a singing defective, a writing defective, a spelling defective, and sometimes even a mathematical defective. Far less does he appreciate the fact that the elimination of speech disorder by the methods indicated in this book means also, to a very large extent, the simultaneous elimination of all those other kinds of defects just mentioned.

The physician may be able to explain the nonprogress of medical cases, the background of which he has diagnosed and in which he has found some condition that makes progress impossible. This may excuse the teacher for apparent failures in regard to which a superintendent, not understanding the whole field, might perhaps blame the teacher, sometimes with a serious outcome. The physician can also relieve the teacher from much worry and anxiety caused by the non-progress of some of these hopeless cases. The physician can, in an authoritative way, advise the family to carry out hygienic measures where a teacher cannot, or he can occasionally remove a case from the speech class and put it in a special institution, a hospital, or a home for recovery.

7. What the superintendent should do

The superintendent's office should contain some one sufficiently interested in the speech problem in public schools to engineer the entire work. He should be the general supervisor and manager of all work done in the schools of his city in speech improvement. He should be constantly bringing new ideas from the outside world and inspiring the teachers under him to adopt them, as well as to obtain for themselves, in the proper places, advanced instruction, practice, and knowledge.

I think one superintendent or assistant alone should be relegated to this work. He should receive regular monthly reports of the progress made in every individual case listed in the speech-improvement classes. He should insist upon regular, complete, and scientific records of every case from the time of its entrance into the speech class. The entries should be made week by week and month by month, if not of tener, and should be sent to the superintendent as monthly reports. If of scientific value, they may well be used by the superintendent or by the teacher in the formation of papers to be read to societies or published, thus giving wider scope to the good work of the individual teacher. This will lead to increase of salary, new appointments, and wider opportunities for growth and progress.

The speech superintendent should acquaint himself with the special training of his speech teachers. He should understand the educational background of the instructors that his teachers have had. He should know the different institutions— medical schools, clinics, and special schools — where speech instruction is given. This knowledge will enable him to advise his present and future teachers intelligently in their search for further training. It will enable him to give them a timely warning against the fakes, charlatans, and untrained impostors that invade this field all over the country. All of these should be carefully tabulated and hung up in the Rogues' Gallery of his mind so that he can prevent any of his teachers from thinking that they have scientific and expert training in the field of speech when they have merely wasted their money on pretenders.