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Stuttering, a little bit of history

Stuttering - a violation of tempo-rhythmic organization of speech due to a convulsive state of the muscles of the vocal apparatus.
Synonyms: Balbuties, Disphemie, Spasmophemie, Lalonewros.
The problem of stuttering can be considered one of the oldest in the history of the doctrine of disorders of speech. Different understanding of its essence is due to the level of development of science and attitudes with which the authors have come up and approach to the study of speech disorders.
In ancient times, mainly in stuttering saw illness associated with the accumulation of moisture in the brain (Hippocrates) or the wrong parts of the correlation of articulatory-tion apparatus (Aristotle). The possibility of disturbances in the central or peripheral parts of the vocal apparatus in stuttering recognized Galen, Celsus, Avicenna.
At the turn of the XVII-XVIII centuries, the phenomenon of stuttering was explained as a consequence of imperfections of the peripheral speech apparatus. Vuttser explained this abnormal deepening of the lower jaw, which hides the tongue in its motion, Herve de Sheguan saw the cause in improper relationship between the length of tongue and oral cavity or too tight attachment of his tongue-tied.
Other researchers have linked stammering with disturbances in the functioning of the speech organs: spasmodic closure of the glottis (Arnot, Schulthess) excessively rapid exhalation, spasmodic contraction of the muscles that hold the tongue in the oral cavity (Itar, Lee, Dieffenbach), inconsistency of thinking and speech (Blume), imperfect human will, acting on muscle strength Speech Mechanism (Merkel), etc.
Some researchers linked stuttering with disturbances in the flow of mental processes. For example, Blume believed that stuttering arises from the fact that a person thinks or quickly, so that the speech organs is not keeping pace, and because they stumble, or, conversely, speech movement"ahead of the thinking process". And then because of the intense desire to equalize this discrepancy muscles of the vocal apparatus to come "spasmatic state."
At the beginning of the XIX century a number of French researchers, studying stuttering, explained its various deviations in the activity of peripheral and central parts of the vocal apparatus. So, doctor Voisin linked the mechanism of stuttering to the lack of cerebral responses to muscular system organs of speech, ie, the activities of the central nervous system. Physician Delou explained the stuttering as a result of distortion sound pronunciation, organic lesions of the vocal tract or defective operation of the brain. He first noted the concentration of acoustic attention to stuttering speech. Physician Colombe believed stuttering is caused by a special contracture of the muscles of vocal apparatus, which arises due to its lack of innervation.
In Russia, most researchers have viewed stuttering as a functional disorder in the area of ​​speech, convulsive neurosis, or defined it as a purely mental suffering , expressed in the unit convulsive movements of speech, as psychosis.
By the beginning of the XX century the diversity of understanding of the mechanisms of stuttering can be reduced to three theoretical areas:
  1. Stuttering as spastic neurosis coordination coming from irritable weakness speech centers (syllabic unit coordination). This was clearly articulated in the writings of G. Guttsmana, IA Kussmaul, and then in the works of A. Sykora, who wrote: "Stuttering is a sudden discontinuity of articulation due to spasm, which set in a department of the vocal apparatus as physiological whole". Proponents of this theory initially emphasized the inherent weakness of the irritable machine that controls the coordination of the syllable. Later they explained in the light of neuroticism stuttering: stuttering – it cramp like spasms.
  2. Stuttering as an associative violation of a psychological nature. A psychological approach to understanding the mechanisms of stuttering has been further developed.
  3. Stuttering as a manifestation of the subconscious that develops on the basis of mental trauma, various conflicts with the environment. Proponents of this theory were A. Adler, Schneider, who believed that in stuttering, on the one hand, manifested a desire to avoid any possibility of an individual,s contact with others, on the other - to excite the sympathy of others through such demonstrative suffering.
Thus, in the late XIX - early XX century researchers think that stuttering - is a complex psychological and physical disorder. According to some, it is based on violations of physiological and psychological manifestations are secondary. Others considered the primary psychological characteristics and physiological manifestations - as a result of these psychological weaknesses. Attempts were made to treat stuttering as a neurosis expectations, anxiety neurosis, neurosis, disability, obsessive-compulsive disorder, etc.
The next 50-60th years of XX century stuttering began to be considered as a mechanism based on the teachings of Pavlov of higher nervous activity and, in particular, the mechanism of neurosis. While some researchers considered stuttering as a symptom of neurosis, others - as a special form of it. But in both cases, these complex and diverse mechanisms of stuttering are identical to the mechanisms of the neuroses in general. Stuttering, like other neuroses, is due to various causes strain on the excitation and inhibition and the formation of pathological conditional refleha. Stuttering - is not a symptom and not a syndrome and disease of the central nervous system as a whole.
In the appearing of stuttering pivotal role played by the broken relationship between neural processes (strain their strength and mobility) in the cerebral cortex. Nervous breakdown in the cerebral cortex activity may be due, on the one hand, the nervous system, its willingness to deviations from the norm. On the other hand, a nervous breakdown may be due to adverse exogenous factors, the importance of which in the genesis of stuttering has pointed Gilyarovskii. Reflection of a Nervous Breakdown is a disorder of a particularly vulnerable and vulnerable children in the area of ​​higher nervous activity - speech that manifests itself in violation of the coordination of speech movements with symptoms of arrhythmia, and convulsively. Violation of cortical activity is primary and leads to a distortion of the induction of relations between the cortex and subcortex, and disruption of the conditioned reflex mechanisms that regulate the activity of subcortical structures. In view of the circumstances under which the normal regulation of the cortex becomes distorted, there are negative changes in the activity striopallidarnoy system. Her role in the mechanism of stuttering is quite important, as is normal, this system is responsible for the pace and rhythm of breathing, tone articulatory muscles. Stuttering does not occur when organic changes striopalliduma, while dynamic deviation of its functions. These views reflect an understanding of the mechanism of stuttering as a kind of neurotic disorders of cortico-subcortical relations. As of children, according to some authors, the mechanism of stuttering is expedient to explain in terms of reactive neurosis. Reactive neurosis development is understood as an acute disorder of higher nervous activity. With the development of neurosis formation of pathological stereotypes occurs gradually, under adverse environmental conditions - overstimulation, suppression. Stuttering development occurs at an early age against a detainee "physiological tongues" in the transition to complex forms of speech to speech phrases. Sometimes it is the result of underdevelopment of the speech of different genesis. So, Boskis calls stuttering disease, "which is based on speech difficulties associated with the design of more or less complex utterance, requiring a sentence of expression". Speech difficulties may cause delays in speech development, transition to another language, cases of abnormal development of the individual with underdeveloped emotional and volitional necessity to express a complex idea, etc. Levina, treating stuttering as a speech underdevelopment, sees the essence of it in the preferential abuse of communicative function of speech. The study of speech therapy sector employees NIID USSR Academy of Pedagogical Sciences of the speech of general child development, the state of its phonetic and lexical and grammatical development, the ratio of active and passive voice, the conditions under which stuttering is enhanced or diminished, confirms the observations of RM Boskis, E. Pichon, B. Maison et al Speech difficulties, according to Levina, depends on different conditions: on the one hand, the type of nervous system, on the other - from the spoken medium of speech and common modes. The first manifestations of stuttering are characterized by emotional intensity that accompanies the more unbearable mental search operation words, grammatical forms of speech. NI Zhinkin with physiological analysis of the position of the pharynx is that the phenomenon of stuttering can be defined as a discontinuity in the selection of audio elements in the preparation of the algorithm differently metric words, a violation of the auto-adjust in the management of speech-movement level of style. Along with the neurotic stuttering began to be studied and its other forms of speech after the appearance of Alale and aphasia, post contusion stuttering; oligophrenics; patients with various psychoses, with severe violations sound pronunciation and delayed speech development, organic. Thus, E. Pichon distinguishes two forms of organic stuttering: the first type of cortical aphasia, when broken system of associative fibers and suffering internal speech, the second is a kind of motor speech impairment and the type of dysarthria is associated with damage to subcortical structures. The problem of organic stuttering still remains unsolved. Some researchers believe that stuttering is generally included in the category of organic diseases of the central nervous system and cerebral substrate directly affect the speech areas of the brain or related systems. Others see stuttering as primarily neurotic, frustration, regarding themselves as organic disorders "soil" for the breakdown of higher nervous activity and the function of speech.  Most authors studying stuttering in stutterers observed various autonomic changes. For example, Zeeman said that 84% of stutterers have vegetative dystonia. According to Szondi, out of 100 stutterers 20% had increased intracranial pressure, and extrapyramidal disorders. He believes that stutter are born vaso neurotic. Gerdner objectively shown a change autonomic responses in stutterers during seizures: 100% of the cases they observed mydriasis (midrioz), the normal width of the pupil speaking people during the speech does not change or there comes some of the constriction (miosis). In severe cases of violation of the autonomic nervous system actually stuttering recedes into the background, dominated by fear, excitement, anxiety, hypochondria, the total intensity, a tendency to wobble, sweating, reddening. In children who stutter have been observed sleep disorders: jerk before falling asleep, tedious, restless shallow dreams, night terrors. Older who stutter try to tie all of these unpleasant experiences with speech impairments. The thought of her frustration becomes sustainable in accordance with the constantly disturbed state of health. Against the background of general excitability, exhaustion, instability and constant doubt, it usually yields better only for a short time. The classes are often absent in stutterers dedication and perseverance. Underestimated their own performance as well as the improvement in his speech a little easier to overall health. In the 70 years in psychiatry have been proposed clinical criteria for distinguishing between neurotic and neurotic disorders and the tendency to stutter on the delimitation of neurotic and neurosis-form. So far, the mechanism of stuttering researchers are trying to consider not only the clinical and physiological, but also with neurophysiological and psychological. Of interest are the neurophysiological studies of stuttering in the organization of speech activity. The data show that in stutterers during speech dominant (left) hemisphere can not be sufficiently firmly to fulfill its leadership role in relation to the right hemisphere. The position of interconnection with stuttering clearly marked dominance of speech data confirm Shklovsky. Research the organization of functions in stutterers (Suvorov, 1984) have shown that they are characterized by a typical lateralization of verbal and visual features. Identified anomalies can be seen as a consequence of deficiencies bilateral regulation visual processes and biases in brain relations. Actual development of the problem of stuttering in a psychological aspect to the disclosure of its genesis, to understand the behavior of stuttering in the communication process, to identify their individual psychological characteristics. Study in stutterers attention, memory, thinking, psychomotor showed that they have changed the structure of mental activity, its self-regulation. They are worse than perform the work, which requires a high level of automation (and hence - quick inclusion in the activity), but the differences in productivity between stutterers and sound disappear as soon as the work can be done on any level. The exception is the psychomotor activity, if healthy children are psychomotor acts are largely automatic and does not require any regulation, the regulation for Stuttering is a complex task that requires voluntary control. Some researchers believe that stutter have greater inertia of the mental processes than normally speaking, they are characterized by the phenomenon of perseveration associated with the mobility of the nervous system. Prospective study of personal characteristics of stutterers as with clinical observations, and using experimental psychological methods. With their help identify anxiety-suspicious character, suspicious, phobic states, uncertainty, isolation and a tendency to depression, passive-defensive and aggressive-defensive reactions to the defect. It is noteworthy considering mechanisms of stuttering in terms of psycholinguistics. This aspect of the study involves figuring out at what stage of the generation of seizures occur utterance in a speech stammering.Distinguish the following phases of verbal communication: 1) a need for speech or communicative intention; 2) birth plan utterances in inner speech; 3) the sound implementation of the utterance. Different patterns of speech, these phases are different in their entirety and the duration of the course and not always clearly derived from one another. But the comparison is always planned and implemented. Abelian believes that stuttering occurs when ready-to-speech in the presence of a speaker,s communicative intent of the program of speech and the fundamental ability to speak normally. In the three-member model of speech generation author proposes to phase ready-to-speech, in which a stutterer "break" the whole pronunciation mechanism, all of its systems the generator, the resonator and energy. There are cramps, then obviously manifested in the fourth, the final phase. Having considered the various points of view on the problem of stuttering can make the basic conclusion that the mechanisms of stuttering are not uniform. In some cases, stuttering is treated as a complex, neurotic disorder, which is the result of collision of the nervous processes in the cerebral cortex, the cortico-subcortical disorders interactions, disorder Autoregulated single rate of speech movements (voice, breathing, articulation). In other cases - as a complex, neurotic disorder that resulted from the fixed reflex wrong speech, originally arose as a result of the speech difficulties of different genesis. Third - as a complex, predominantly functional speech disorder, which appeared due to a general and speech dizontogeneza and disharmonious development of personality. Fourth - the mechanism of stuttering can be explained on the basis of organic changes of the central nervous system. There are other possible explanations. But in any case must be considered violations of the physiological and psychological in nature, constitute a unity.
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