Stuttering is a widespread speech disorder. It often occurs in children aged 3-5 years, when their speech is most actively developing. At the same time, personality development occurs. The problem is a serious obstacle to the development of the child’s personality, as well as to his socialization.

This disorder and personality development are closely related, so this problem should be considered in conjunction with individual characteristics personality. Stuttering correction should be approached comprehensively.

Despite the fact that doctors have devoted more than a dozen years to the problem, the mechanisms of the disorder are still not studied today. Various factors can contribute to the appearance of a defect; the mechanism will vary.

The defect can be interpreted as a complex case of a neurotic disorder, which arose as a result of disruption of processes in the nervous system, in the cortical structures of the brain. The interaction between the cortex and subcortex is disrupted, auto-regulated speech movements (breathing, voice, pronunciation) are disrupted.

In other cases, the defect is considered as a neurotic disorder that resulted from memorizing an incorrect speech pattern that arose due to speech difficulties.

Sometimes the disorder is interpreted as extensive, which arose due to disharmony in speech development and incorrect individual speech development.

Doctors also explain the phenomenon of stuttering by damage to parts of the central nervous system.

As the defect was studied, each doctor proposed his own treatment method, based on his own ideas about the disorder. There are many treatment methods. This is due to the fact that the pathology has very complex structural manifestations, and it has not been sufficiently studied.

Scientific experiments and studies have proven that every case requires individual approach. The characteristics of each patient should be taken into account and special stuttering correction techniques should be used.

Types of correction

As the problem was studied, speech therapists around the world proposed different treatment regimens. On this moment Several areas of treatment are known:

1. Drug treatment.
2. Physiotherapy.
3. The use of speech correction devices.
4. Creative development.

When treating, it is advisable to combine different types of therapy, this way the most pronounced effect can be achieved.

Correction methods

To treat stuttering, doctors have invented many correction methods. But this pathology is serious, and it is difficult to overcome it even today, since there is little information about it. Popular methods include:

• treatment with;
• speech therapy exercises, tongue twisters;
• mechanical devices;
• surgical intervention;
• psychotherapy, etc.

Specialists use technical means during speech correction for stuttering. At the moment, there are 4 types of speech changes that can be made using various devices. Devices can affect muting, amplification of speech, rhythm development, and “delayed” speech. The devices make convulsive manifestations of stuttering less pronounced.

IN Lately Speech therapists began to use neurodynamic rhythmoplasty as a means of stuttering correction. This complex consists of physical therapy and choreography.

It is recommended to use different techniques, this is the only way the effect will be most pronounced. Work to correct stuttering should be carried out under the supervision of a psychotherapist or psychologist. The supervision of a speech therapist is also necessary.

Modern comprehensive methods for stuttering correction

Treatment of stuttering using methods from different specialists may differ significantly.

These specialists were involved in the correction of stuttering in junior schoolchildren. They assumed that for effective elimination pathology, you need to give the child exercises of varying levels of difficulty. The goal of this technique is to relieve the child of stress, make his speech free, eliminate incorrect pronunciation and reinforce correct articulation.

According to this technique, there are 3 stages of stuttering correction. At the first stage, the child must memorize phrases. The speech therapist teaches him correct recitation.

The second stage is characterized by an exercise in which the child must verbally describe the pictures and compose his own stories from a series of images or on their theme. Sometimes a person who stutters is asked to retell a text read by a speech therapist.

The third stage is the final one. The child consolidates the acquired skills in conversation with others.

Mironova's scheme

The speech therapist proposed using a scheme in which children with disabilities, as they progress through preparatory groups, kindergarten, will attend additional classes devoted to familiarization with the outside world, basic mathematical concepts, drawing, modeling, appliqué, etc.

Mironova’s stuttering correction method includes 4 stages. For mass kindergartens specialized for children who stutter, it is proposed to introduce a modified program that is based on the speech abilities of children.

The correctional methodology assumes that as a result, children should be able to freely master speech of any complexity.

Cheveleva proposed a unique system for correcting stuttering in preschoolers. She believed that first of all, it was necessary to develop fine motor skills of the hands. According to Cheveleva, for treatment the child must engage in making crafts. The more complex the speech, the more work the baby will have to do.

Her judgment assumes that speech consists of two levels - situational (simpler) and contextual (complicated). First, children use situational, then contextual speech. As we grow older, the two types of speech become mixed.

The system of corrective measures for stuttering included 5 periods. Complication occurs from one level of speech to another.

Seliverstov's scheme

The program is more designed for children in medical institutions. It includes the simultaneous use of different types of speech therapy exercises. According to the author, a speech therapist should be a person with a creative approach, since each child requires an individual approach.

The technique is three-stage. Corrective work for stuttering begins with preparatory stage, in which the child practices rhythm and independence of speech. Then comes the training, more difficult stage. The last stage is the reinforcing stage, at which the baby solves complex speech therapy problems (for example, contextual description).

Correction stages

Different methods involve different quantities stages. But, as a rule, all stages can be combined into three main ones - preparatory, training and consolidation. In all treatment regimens, the child engages in simpler tasks first, and then more complex ones.

Depending on which treatment regimen was chosen, the baby can either engage in creative development, either develop fine motor skills of the hands, or perform exercises to normalize articulatory muscles.

If a child has a stutter, parental support is very important to overcome it. There should be a calm and understanding atmosphere at home. If there is family disharmony, the work of a speech therapist will be useless.

1. enter a daily routine for the child;
2. adjust your sleep, it should be at least 8 hours;
3. you should speak to the child in a calm and quiet voice;
4. avoid raising intonation and aggressive tone;
5. do not interrupt the baby when he speaks;
6. refrain from frequent criticism;
7. Praise your child for his successes.

The child must understand that he will find support and support in the family. An aggressive environment can have an extremely negative impact on him.

Conclusion

The problem requires an integrated approach, it is advisable to resort to different types treatment. Family harmony is a very important factor. Therefore, you should pay attention to the well-being of the environment in which the child grows up. You cannot treat a child for stuttering on your own; you should always consult with speech therapists, psychologists and neurologists.

An article about an integrated approach to the correction of stuttering in adults and adolescents, used in the Center for Neurological Neurosurgery in the Department of Logoneurosis.

The article includes a general work plan. In the future, I intend to send material that will tell more specifically about developments in this area.

Speech therapy work to correct stuttering in adults and adolescents

Stuttering is not always eliminated in childhood. Every adult who stutters and decides to get rid of a speech disorder will have to face more established pathological stereotypes of the speech act and more pronounced psychological problems.

A neurodefectologist-speech therapist, working with adults who stutter, needs to help the patient coordinate breathing, vocal and articulatory processes, “feel” this coordination and bring it to automaticity. There are a number of benefits to speech therapy work for adult patients. They study meaningfully and consciously. They can use the will to achieve their goals. At the same time, everyone understands that stuttering is a very complex speech disorder that requires systematic, consistent work.

Speech therapy work is considered as a system of correctional and pedagogical measures aimed at the harmonious formation of the speech of people who stutter, taking into account the need to overcome or compensate for the defect.

Speech therapy influence in the Center for Logoneurosis in the Department of Logoneurosis is carried out in two directions: direct and indirect.
Direct speech therapy intervention is implemented during group and individual sessions with people who stutter. These classes provide for the development of general and speech motor skills, normalization of the tempo and rhythm of breathing and speech, activation verbal communication.

In classes, psychological deviations in behavior are eliminated for people who stutter, and the correct attitude towards the defect is developed. Individual lessons are conducted in case of necessary additional exercises to develop skills correct speech.

Indirect speech therapy is a system of speech therapy for all routine moments for patients. The speech mode of adolescents and adults involves their choice of the necessary speech exercises, their understanding of the requirements of correct speech, systematic training of correct speech skills in different conditions.

Speech aspect speech therapy sessions includes regulation and coordination of respiratory, vocal and articulatory functions, education of correct speech.

Based on the position that “stuttering is a discordinative convulsive speech disorder that occurs in the process of communication through the mechanism of systemic speech motor neurosis, and is clinically represented by primary, actual speech, and secondary disorders, which often become dominant in adults. As with other neurotic disorders, psychological, socio-psychological and biological factors take part in the mechanisms of this speech motor neurosis. In many cases of stuttering, the so-called organic “soil” is noted in the form of cerebral deficiency of various origins.”, at the Center for Stuttering, a comprehensive treatment system was developed, which combines speech therapy classes and active psychotherapy, combining various variants of the suggestive method with work on restructuring impaired personality relationships, including through the use of modern group psychotherapy. All work is carried out in close contact with a speech therapist, psychologist, psychotherapist, psychiatrist, neurologist, specialists in physical therapy, massage and other methods.” book V.M. Shklovsky “Stuttering”. M. 1994. p. 8., p. 176.

Speech therapy work in a day hospital consists of: a diagnostic period and a period of restructuring pathological skills in the system of a comprehensive method of treating stuttering.

Diagnostic period

In order to establish a final diagnosis and outline a treatment plan, it is necessary to conduct a thorough examination of the patients by all specialists in the department (psychiatrist, psychotherapist, neurologist and speech therapist).

The examination of speech function in people who stutter is carried out according to methods generally accepted in speech therapy (L.I. Belyakova, E.A. Dyakova, E.V. Oganesyan, I.A. Povarova). The scheme of speech therapy examination includes the study of the state of the structure and mobility of the articulatory apparatus, speech breathing, voice, speech rate. When studying speech and motor disorders, the localization and form of speech convulsions, the duration and frequency of their manifestation, the presence of accompanying movements, verbal, motor and psychological tricks, the attitude of the subject to stuttering, the degree of fixation on it. Anamnestic and clinical data determining possible reasons appearance of stuttering, the group to which the patient can be classified according to V.M. Shklovsky’s classification is determined:

Group 1 - patients who did not have persistent neurotic disorders. The speech defect (it can be very pronounced) of these stutterers did not significantly affect the development of their personal and social status.

Group 2 - patients with persistent neurotic disorders. The speech defect (it can be very pronounced) of these stutterers influenced the development of their personal and social status.

Group 3 - patients who have even more pronounced neurotic disorders, combined with anxious suspiciousness and an insurmountable fear of speech.

The period of restructuring of pathological speech skills consists of three stages:

- preparatory stage

At this time, speech therapy classes are conducted to develop speech techniques according to the plan:

1. Removing muscle tension. Establishment of diaphragmatic breathing. Practicing long, uniform speech exhalation on sounds, a standard, automated series, in a phrase.

2. Work on a soft attack of sound, on unity, smoothness of voice, flight, height, strength of voice, prolonged pronunciation of vowel sounds, expanding the range of voice modulations, intonation of speech.

3. Normalization of speech rate.

4. Rhythmic speech with the support of the leading hand, gradual collapse of the external support, transition to the internal rhythm.

5. Pausing speech.

6. Work with articulation.

7. Use of facial expressions and gestures in verbal communication.

- the stage of consolidating rhythmic speech techniques on simple speech material.

1. Reading poetic texts with a short and a longer line.

2. Reading the roles of fables.

3. Reading aloud prepared and unprepared texts of varying complexity.

4. Retelling the texts read.

5. Dialogues based on the material read.

The stage of automation of rhythmic and prosodically colored speech techniques on complicated speech material.

1. Automation of speech technique skills with their introduction to all types speech activity and various situations.

2. The transition from prepared forms of speech to independent improvisations.

3. Formation of readiness for verbal communication in various life situations.

4. Developing resistance to speech and psychological difficulties that arise in life situations after completing the course of treatment.

Three months of systematic training is the minimum that will allow a stuttering teenager or adult to understand, feel and consolidate the acquired techniques in speech. Further automation of continuous and fluent speech will require at least another year of supervision by a specialist.

The authors of the first domestic method of speech therapy work with stuttering children of preschool and preschool age, N. A. Vlasova and E. F. Pay, build on the increasing complexity of speech exercises depending on the varying degrees of speech independence of children.

N. A. Vlasova distinguishes 7 types of speech, which, in order of gradualness, must be used in classes with preschool children: 1) conjugate speech, 2) reflected speech, 3) answers to questions about a familiar picture, 4) independent description of familiar pictures, 5 ) retelling a short story heard, 6) spontaneous speech (story based on unfamiliar pictures), 7) normal speech (conversation, requests, etc.).

E.F. Pay sees the task of speech therapy work as “to, through systematic planned lessons, free the speech of stuttering children from tension, make it free, rhythmic, smooth and expressive, as well as eliminate incorrect pronunciation and cultivate clear, correct articulation.” All classes on speech re-education for stuttering children are divided into 3 stages according to the degree of increasing complexity.

At the first stage, exercises are offered in joint and reflected speech, in the pronunciation of memorized phrases and poems. Recitation is widely used. At the second stage, children practice verbally describing pictures based on questions, composing an independent story based on a series of pictures or on a given topic, and retelling the content of a story or fairy tale read by a speech therapist. At the third and final stage, children are given the opportunity to consolidate their acquired fluent speech skills in everyday conversation with surrounding children and adults, during games, activities, conversations and other moments in a child’s life.

The methods of N. A. Vlasova and E. F. Pay are based on different degrees of speech independence of children. The undoubted merit of these authors is that they were the first to propose and use a step-by-step sequence of speech exercises in working with young children, and developed instructions for individual stages of the speech correction system for stuttering preschoolers. For many years, the proposed method has been one of the most popular in practical work with children who stutter. Currently, speech therapists use many of its elements.

A unique system of correctional work with stuttering preschoolers in the process of manual activities was proposed by N. A. Cheveleva. The author proceeds from the psychological concept that the development of a child’s coherent speech is carried out through a transition from situational speech (directly related to practical activities, with a visual situation) to contextual (generalized, associated with past events, with missing objects, with future actions), and then throughout the preschool period, contextual and situational forms of speech coexist (S. L. Rubinshtein, A. M. Leushina). Therefore, the sequence of speech exercises with children who stutter is seen in a gradual transition from visual, facilitated forms of speech to abstract, contextual statements and includes the following forms: accompanying, final, preparatory.

The system of consistent complication of speech also provides for the gradual complication of the object of activity through an increase in the number of individual elements of work, into which the entire labor process in the manufacture of crafts is divided.

This system for overcoming stuttering in children includes 5 periods:

Propaedeutic. The main goal is to instill in children the skills of organized behavior, teach them to hear the laconic but logically clear speech of a speech therapist, its normal rhythm, and temporarily limit the speech of the children themselves.

Accompanying speech. During this period, children’s own speech is allowed regarding the actions they simultaneously perform. The greatest situationality of speech is provided by constant visual support. At the same time, it becomes more complicated due to the change in the nature of the speech therapist’s questions and the corresponding selection of crafts.

Closing speech - children describe the work already completed or part of it. By regulating (gradually increasing) the intervals between the child’s activity and his response to what he has done, varying complexity of the final speech is achieved. With a gradual decrease in visual support for the work performed, a consistent transition to contextual speech occurs.

Pre-talk - children talk about what they intend to do. They develop the ability to use speech without visual support, plan their work, name and explain in advance the action that they still have to do. Phrasal speech becomes more complex: children pronounce several phrases related in meaning, use phrases of complex construction, and construct a story independently. During this period, they are taught to think logically, express their thoughts consistently and grammatically correctly, and use words in their exact meaning.

Consolidating independent speech skills involves children telling stories about the entire process of making a particular craft, their questions and answers about their activities, statements of their own free will, etc.

The method of N. A. Cheveleva implements the principle of successively complicating speech exercises in the process of manual activity based on one of the sections of the “Program for the upbringing and training of children in kindergarten.”

S. A. Mironova proposed a system for overcoming stuttering in preschoolers during the process of completing the middle, high and preparatory groups kindergarten in the sections: “Acquaintance with the surrounding nature”, “Speech development”, “Development of elementary mathematical concepts”, “Drawing, modeling, appliqué, design”.

When going through a mass kindergarten program with children who stutter, some of its changes are proposed related to the speech capabilities of children: use at the beginning school year material from the previous age group, rearranging some lesson topics, extending the time frame for studying more difficult topics, etc.

The correctional tasks of the first quarter consist of teaching the skills of using the simplest situational speech in all classes. Vocabulary work occupies a significant place: expanding the vocabulary, clarifying the meanings of words, activating passive vocabulary. The speech therapist himself is expected to be particularly demanding of the speech: the questions are specific, the speech consists of short, precise phrases in different versions, the story is accompanied by a demonstration, the pace is leisurely.

The correctional tasks of the second quarter consist of consolidating the skills of using situational speech, a gradual transition to elementary contextual speech in teaching storytelling based on questions from a speech therapist and without questions. Great place It involves working on a phrase: a simple, common phrase, the construction of phrases, their grammatical design, the construction of complex sentences, the transition to composing a story. The sequence of studying program material is changing. If in the first quarter, in all classes, children are introduced to the same objects, then in the second quarter, the objects are not repeated, although objects are selected that are similar in terms of the general theme and purpose.

The correctional tasks of the third quarter consist of consolidating the skills of using previously learned forms of speech and mastering independent contextual speech. A significant place is devoted to work on composing stories: using visual support, questions from a speech therapist, and an independent story. Children's practice in contextual speech increases. In the third quarter, the need for slow learning of the program, characteristic of the first stages of education, disappears, and classes approach the level of mass kindergarten.

The correctional tasks of the fourth quarter are aimed at strengthening the skills of using independent speech of varying complexity. Work on creative stories. Along with this, the accumulation of vocabulary and the improvement of phrases begun at the previous stages of training continue. In speech, children rely on the questions of the speech therapist, on their own ideas, express judgments, and draw conclusions. Visual material is almost never used. The speech therapist’s questions relate to the process of the upcoming work, conceived by the children themselves. Correctional training is aimed at maintaining the logical sequence of the transmitted plot, at the ability to give additional explanations and clarifications.

The methods of N. A. Cheveleva and S. A. Mironova are based on teaching children who stutter to gradually master the skills of free speech: from its simplest situational form to contextual (the idea belongs to R. E. Levina). Only N.A. Cheveleva does this in the process of developing children’s manual activities, and S.A. Mironova does this when going through different sections of the kindergarten program. The very principle of the necessary combination of tasks of correctional and educational work with children who stutter should be considered correct and necessary in speech therapy practice.

V.I. Seliverstov’s technique is primarily designed for working with children in medical institutions (in outpatient and inpatient settings) and involves the modification and simultaneous use of various (known and new) techniques of speech therapy work with them. The author believes that the work of a speech therapist should always be creative and therefore, in each specific case, a different approach to children is necessary in finding the most effective methods for overcoming stuttering.

In the scheme proposed by the author for successively complicated speech therapy classes with children, 3 periods are distinguished (preparatory, training, consolidative), during which speech exercises become more complicated depending, on the one hand, on the degree of independence of speech, its preparedness, volume and rhythm, structure, and on the other hand the other - from the varying complexity of speech situations: from the situation and social environment, from the types of activities of the child, during which his speech communication occurs.

Depending on the level (threshold) of free speech and the characteristics of the manifestation of stuttering in each specific case, the tasks and forms of speech exercises differ for each child in the conditions of speech therapy work with a group of children.

A prerequisite for speech therapy classes is their connection with all sections of the “Program for raising and teaching children in kindergarten” and, above all, with play as the main activity of a preschool child.

The significance of differentiated psychological and pedagogical methods of education and training is revealed in the methodology of G. A. Volkova.

The system of comprehensive work with children aged 2-7 years who stutter consists of the following sections: 1) methodology of play activities (system of games), 2) logorhythmic classes, 3) educational classes, 4) impact on the microsocial environment of children.

The system of games, which constitutes the actual content of speech therapy classes, includes the following types of games: didactic, games with singing, movement, with rules, dramatization games based on poetic and prose text, table tennis games, finger theater, creative games at the suggestion of the speech therapist and according to children's plans. In classes with children, the principle of play activity is primarily implemented.

Conventionally, the following stages are distinguished: examination, restriction of children’s speech, conjugate-reflected pronunciation, question-and-answer speech, independent communication of children in a variety of situations (various creative games, in the classroom, in the family, kindergarten program material (with a change in the sequence of topics) and is aimed at achieving corrective, developmental and educational goals.The lesson is structured in a single plot in such a way that all its parts reflect the program content.

The focus of the methodology under consideration in relation to stuttering children from 2 to 4 years old and children from 4 to 7 years old is different. In the first case, the tasks are not so much correctional as developmental education and upbringing of children. At this age, speech therapy work is preventive in nature. In working with stuttering children from 4 to 7 years old, the corrective focus of speech therapy influence takes on leading importance, since the personal characteristics formed in the process of individual development influence the nature of the speech activity of the stutterer and determine the structure of the defect.

The methodology of gaming activity is aimed at educating the individual and, on this basis, eliminating the defect.

In the practice of speech therapy work with children who stutter (methodology by I. G. Vygodskaya, E. L. Pellinger, L. P. Uspensky), games and play techniques are used to conduct relaxation exercises in accordance with the stages of speech therapy: a regime of relative silence; education of correct speech breathing; communicating in short phrases; activation of an expanded phrase (individual phrases, story, retelling); re-enactments; free speech communication.

Thus, improving speech therapy work to eliminate stuttering in children up to school age caused by the 80s of the XX century. development of various techniques. The speech material of speech therapy classes is acquired by preschoolers in the conditions of step-by-step speech education: from conjugate pronunciation to independent statements when naming and describing familiar pictures, retelling a short story heard, reciting poems, answering questions about a familiar picture, independently telling about episodes from a child’s life, about a holiday etc.; in the conditions of gradual education of speech from the regime of silence to creative statements with the help of play activities, differentially used in working with children from 2 to 7 years old; in conditions of education of independent speech (situational and contextual) with the help of manual activities.

The speech therapist is obliged to creatively structure speech therapy classes, using known techniques in accordance with the population of children who stutter and their individual psychological characteristics. These methods of speech therapy intervention for stuttering preschoolers were developed in accordance with the “Program for the education and training of children in kindergarten”, which is a mandatory document for both mass kindergartens and special speech kindergartens and speech groups at mass kindergartens. The methods are aimed at organizing speech therapy work within the framework of the “Children's Education Program in Kindergarten”, since ultimately, children who stutter, having acquired the skills of correct speech and knowledge defined by the program, are further trained and brought up in the environment of normally speaking peers. Speech therapy, aimed at the speech disorder itself and associated deviations in behavior, the formation of mental functions, etc., helps a stuttering child to socially adapt among correctly speaking peers and adults.

Stuttering is one of the common speech defects. And its significance for a person is immeasurably great. Without speech there is no communication, friends and knowledge. Stuttering prevents you from getting your favorite profession and organizing your personal life. It changes character, creates passivity, vulnerability and uncertainty. Who treats stuttering? Previously, there was only one specialist - a speech therapist. In hospitals and district clinics, appointments were made for him a month in advance. But a complete cure was achieved extremely rarely.

Today times have changed. Psychologists and psychiatrists began to successfully treat stuttering. Modern science no longer follows the path of separation, but compiles the knowledge accumulated by individual disciplines.

Table. The work of specialists in the treatment of stuttering

SPECIALIST
SPEECH THERAPIST			PSYCHOLOGIST			PSYCHIATRIST
Relieves spasms of the larynx, lips, tongue, diaphragm, chest and abdominal muscles	Forms phase speech (i.e. eliminates the discrepancy between the speed of thinking and speaking)	Improves speech synchronization	Works with a combination of stuttering and neurosis in the background stressful situations	Relieves logophobia and fear of speech ridicule	Improves the communication process	Treats organic brain damage	Heals functional disorder CNS

Let's look at the table. Each specialist influences different areas of the human psyche. The speech therapist restores the structure of speech, the psychologist consolidates it, protects it from the possibility of a “breakdown,” and the psychiatrist monitors the general condition of the patient. Joint efforts are the key to success.

It is known that the longer a child stutters, the more difficult the treatment process becomes. Therefore, school psychologists must stand guard over this disease, diagnose the first symptoms in time, and also know basic treatment techniques. Forewarned means protected, says popular wisdom.

OUR GENES

Modern science classifies stuttering as a group of psychosomatic diseases. For its occurrence, a combination of two factors is necessary: ​​the hereditary soil and emergency circumstances affecting it. History has accumulated many examples confirming the inheritance of stuttering in both the male and female lines. This disease affects boys three times more often than girls, and the occurrence of stuttering is not affected by the nationality of the family or the sphere of work.

It has been proven that the characteristics of the central nervous system (CNS), as well as interhemispheric asymmetry of the brain, are inherited.

Recently I was asked to speak at a parent-teacher meeting at school. On the first desk, right in front of me, sat a bright blonde with huge green eyes and a frowning man in a checkered house shirt. He didn't seem to be listening to anyone, he was writing intently on a piece of paper, trying to be inconspicuous. She is the mother of Larisa Kudryavtseva, an active girl, the favorite of the whole class. He is the father of Anton Maksimov, a stuttering “nerd” whose eyes are invisible due to thick horn-rimmed frames. I was once again convinced that parents and children are so similar to each other.

The genetic predisposition of children to stutter should be understood not only as the direct presence of this defect in the parents, but also simply as fast speech, speech with swallowing endings, nervousness, and increased demands. After all, the colloquial, even somewhat rude expressions “all like your mother” or “all like your father” sometimes hit not the eyebrow, but right in the eye. In this regard, I recommend that psychologists working with large groups of children keep a separate notebook and enter there the results of their own observations of the behavior of children and their parents. Sometimes these records can shed light on problems that are unclear at first glance.

ATTENTION, LEFT-HANDERS!

At the beginning of this century, scientist S. Orton suggested that stuttering arises as a result of “competition” between the cerebral hemispheres for control of speech. Modern science is more definite. Stuttering is the inability of the larynx and left hemisphere to directly transmit impulses to each other. This means that this disease is closely related to left-handedness. In everyday life, by left-handed we mean a child who uses his left hand better than his right. Oddly enough, in my practice there was only one case of a stuttering left-handed teenager. Hidden left-handers suffer from stuttering much more often. In this case, the entire left half of the body is leading, taking into account the prevalence of left-footedness and sensory left-handedness.

Hidden left-handers, as well as children with a right-sided profile of brain asymmetry, unlike other children, more often suffer from colds and infectious diseases, but are better at solving anagrams, feeling the mood of other people and showing a tendency to mirror writing. Left-handers are more artistically and aesthetically developed. In my practice, there was a six-year-old boy who gave characteristics to flowers. For him, green was rough, red was convex, and blue was wet.

To identify a hidden left-hander and identify a circle of “at-risk” children, I recommend that school psychologists use the materials from the thematic issue of the weekly magazine “School Psychologist” (No. 7, February 1998).

RISK GROUP

The famous Russian psychiatrist I.A. Sikorsky called stuttering a childhood disease. Indeed, research shows that only 1% of adults and 2-3% of children stutter.

Stuttering usually begins at the age of 1.5–2 years. This is directly related to the increase in the frontotemporal region of the brain, which is responsible for the rhythm of movements, labor and speech. It is at this age that the child’s phrasal speech is formed, and stuttering can arise as a result of a mismatch between the speed of thinking and the speed of speaking. The first speech spasm is stored in long-term memory and retrieved from there at the moment of speech involuntarily. Stuttering first appears before the age of 10–12 years, that is, before the final formation of interhemispheric asymmetry of the brain. After that it never comes again.

Denis K., 7 years old, an amazing boy with shoulder-length golden curls. Before coming to see a psychologist, I stuttered for a year. He is affectionate and sweet, but only until he is asked... to draw. Then Denis bows his head low, closes his eyes and ears. He hates paints, colored pencils and paper. Ever since the teacher decided to teach him to draw not with his left hand, but with his right, he began to stutter. For him, school ceased to be a joyful meeting with friends and teachers, but turned into a black, dragging hole.

As can be seen from the example, the catalyst for the appearance of the first speech spasms can be any emergency circumstances and stressful situations. Of course, they are individual for each child. For some, it’s a banal fright or a quarrel, for others, it’s a divorce of parents. But stuttering does not always occur after negative circumstances. Any stressful situation, be it great joy or terrible grief, triggers a hormonal explosion in children’s bodies. I know of a case where parents recorded the first symptoms of stuttering in a ten-year-old girl after she was taken to the sea. New impressions, landscapes, unusual food had a negative impact on her unstable nervous system.

In this regard, I recommend that school psychologists take note of children who have experienced stressful situations, both positive and negative: who have changed schools and places of residence, participated in Olympiads, hikes, and are involved in the social life of the class.

NEUROSIS

Who are stutterers? They are often characterized as quiet and shy, and at times rude and explosive. Based on statements like these, stuttering is often called a neurosis. But it is not so. It is more correct to talk about two options: a combination of stuttering with neurosis and a neurotic overgrowth of stuttering.

Based on the practice of psychological counseling, I can conclude that stuttering is combined with three main types of neuroses: neurasthenic, hysterical and obsessive-compulsive neurosis. In this case, the primary problem is neurosis. As they say, pull the thread of neurosis and you will pull out stuttering. This is why the role of psychologists in the treatment of stuttering is so great.

Neurosthenic children are characterized by anxiety and overstrain associated with a feeling of increased responsibility for themselves, for others, for the cause. Neurosthenics are fearful, often expressing fears such as “I’ll be late”, “I won’t be able to”, “I’m not up to the task”. They suffer from diseases of the gastrointestinal tract that accompany neurosis.

Angelina M., 14 years old, first student in the class. She never skips classes and always does her homework. A skirt below the knees, strict pigtails and no makeup on the face. The parents are concerned about their daughter’s behavior, because the neighboring girls are already putting on heels, sneaking out on dates, and Angelina sits at her homework like she’s been sewn to. To diversify her daughter’s life, her mother enrolled her in the tennis section. Now the girl is sorely lacking time to do everything perfectly. From that moment on, Angelina began to often wake up at night complaining of obsessive thoughts, and she became afraid of school and answering questions in class. At the same time, the first signs of stuttering appeared.

Children with hysterical neurosis are characterized by violent behavior. In this way, known since primitive times, they try to attract the attention of people around them.

Sergey S., 9 years old, a handsome boy with angel eyes. At the psychologist’s appointment he behaves modestly, answering questions with a smile. In the conversation it turns out that his main problem is jealousy for his parents' love. After the birth of his younger sister, Sergei felt a lack of attention from loved ones and internal loss. The wayward boy could not come to terms with the new situation and began to actively fight. Poor studies, disobedience, tantrums - nothing helped to return the original parental love. Two years ago, during another family quarrel, I experienced a cramp in my throat and began to stutter. Since then, he stutters not constantly, but occasionally, only in the presence of his parents.

I especially want to draw the attention of psychologists to such cases. Children prone to hysteria require only psychotherapeutic help. Speech therapy work and increased attention to the problem will lead to the consolidation of the speech defect, because the child “works for the public.”

How many times have you seen children biting their nails or wrapping hair around their finger? With one hundred percent certainty they can be called obsessive-compulsive neurotics.

Vova D., 8 years old, thin, clumsy boy. He sucks his thumb all the time. And at home and in class, in the yard and behind the TV, without even taking it out of your mouth for a minute. In the “fight with the finger,” parents and teachers tried everything: they smeared it with mustard, bandaged it, tied the hand and scolded it. We fought and fought and finally achieved it! A stutter appeared.

It’s stupid to blame moms and dads, adults for all mortal sins, because they were guided by the best intentions. More will pass some five years, and the child will experience much greater cruelty - alienation from peers, ridicule of the opposite sex, and as a result - loneliness. Children who stutter suffer and suffer, they hate their defect, but at the same time they are afraid of it.

NEUROTIC FOULING

If you look closely at a stuttering child while answering at the board, it is impossible not to notice pronounced symptoms of fear. Stutterers turn red, rub their sweaty palms, and experience stomach cramps. This condition is called neurotic overgrowth of stuttering and implies logophobia (fear of speech) and interpersonal stress of stutterers. All stutterers are hypersensitive to the ridicule of people around them. Any laugh behind your back is taken personally.

These symptoms do not appear immediately; they gradually worsen during adolescence. During this period, teenagers are gaining a place for themselves in society, and stuttering slows down this process, which is why it is perceived as extremely painful. The degree of logophobia usually corresponds to the degree of stuttering, and it can be determined using various questionnaires, as well as based on the opinion of the child himself. To do this, ask him to rate his own speech on a scale from “wonderful speech” to “worst speech.” Typically, children's self-assessment of speech anxiety corresponds quite well to the actual severity of stuttering.

Many teenagers prioritize throat spasms and facial redness, naively believing that by getting rid of the manifestations of fear for speaking, they will cure their stuttering. They try to pull themselves together, tighten their grip, internally persuade them not to worry, but nothing helps and a moment of complete despair sets in. This is also fraught with the fact that the first failure extends to all subsequent treatment. Even when achieving good results, the child seems to be unable to achieve anything. slowly but inevitably comes disbelief in one’s own strength.

The fear of stuttering is the desire to hide a speech defect. Therefore, in the fight against it, you need to choose the path of openness. As soon as the child admits his illness, that is, he is able to admit “I stutter” to himself and others, there is no reason for fear and improvement occurs.

The main task of a psychologist when treating logophobia is to explain to the child that fear of speech and fear of ridicule are only consequences of stuttering. It is useless to treat a disease without addressing its causes. Oh, how often, seeing the suffering of a stutterer, we feel sorry for him, try to protect him, protect him, and get into trouble. And thus we make an unforgivable mistake. We give him hope that the path to recovery can be walked easily, without effort. Meanwhile, the basis of stuttering treatment is demandingness - from the psychologist to the patient, from the patient to himself. Only by overcoming the pain and passing thorny path until the end, you can expect a full recovery.

FIRST COMMANDMENT

I think I know why practical psychologists don’t like working with children who stutter. They just don't understand where to start. Each case is unique in its own way, different from others, and it is impossible to find a universal cure. I do not recommend that school psychologists immediately take up therapy for long-term and complex forms of stuttering; it is better to start with mild forms, because, as one great philosopher said: “The main thing is not to cure, but not to harm!”

Before you roll up your sleeves and get down to business, you need to remember one thing important rule- It is not the parent or teacher who should turn to a psychologist for help, but the child himself who should want to cure stuttering, prepare internally, and mobilize strength to fight the disease. No matter how much you try, but without this small condition, your efforts will be in vain. Based on my experience, I can conclude that curing stuttering only 30% depends on the qualifications of the psychologist and on
70% depends on the patient’s wishes.

True, the child does not always realize the seriousness of his own problems. This happens when he is too young (2–6 years old) or has only recently started stuttering. The child does not yet complain of fear, but is already experiencing discomfort, is capricious, and sleeps restlessly. In such cases, one should not focus his attention on speech difficulties. Otherwise, the child may be intimidated.

LET'S START THERAPY

“Imagine that you don’t know how to walk. It's embarrassing, but you want to learn, so you asked for help at sports section. I am a coach, you are my student. During our training, I will teach you the basic rules of walking: balance, posture, rhythm. Here, under my guidance, you will only master the techniques, but you will practice them on your own. I will not push you or constantly control you. Based on the results, I will see how much time and effort you spent. Don't expect from me ready-made recipes, you won't get them. Get ready to show independence, ingenuity, responsibility for your actions and remember, until you yourself dare to “give up the crutches” of self-doubt, no one will help you” - approximately with these words I begin stuttering therapy classes.

First, the child needs to be taught relaxation techniques. This will help him get rid of accumulated internal negativity, bad mood, resentment and dubious thoughts. Relaxing your muscles is like opening a bird cage. A feeling of freedom, lightness and calm comes. This state helps the child to easily perceive and assimilate new material, enjoy life, and quickly forget failures.

Relaxation is carried out twice a day for 5–10 minutes, morning and evening. The time and frequency of relaxation can be increased as needed. It begins with taking a comfortable position lying or sitting in a chair. You need to close your eyes and, listening to quiet music, immerse yourself in pleasant thoughts and sensations. To do this, the child must imagine a nice picture: flowers in a vase, a beautiful mountain landscape, or remember something joyful. Adults, for example parents, can also participate in relaxation; a joint option is especially suitable for young children.

After relaxation, the child needs to perform a series of motor exercises. For the hands, “fists” are suitable - squeezing and unclenching the fingers; for the legs, “scissors” - straighten the legs apart and drop the relaxed ones to the floor. For the torso you can use "wash" or "athlete". The most important exercises in the complex are “frogs” (stretching the lips into a smile) and “stubborn tongue”. They are aimed at training the organs of articulation and neck muscles directly involved in speaking. In addition, having learned at will tense and relax muscles, the child can relieve nervous excitement in a difficult situation for him. For example, taking a deep breath and exhaling, understand which muscles are tense and relax them.

Many children who stutter do not know the rules of speech. Why did people, unlike animals, learn to speak? The point here is not so much in the volume of the brain, but in a familiar little thing that no one pays attention to - people know how to breathe through their mouths! When we need to speak out, we, without thinking, take a deep breath. Stutterers do not know the basic laws of speech, hence their inevitable breakdowns and mistakes. The rules of speech are: think first, speak later; speak only while exhaling at a calm pace; remember vowel sounds; take breaks; put semantic emphasis; When speaking, look at your interlocutor.

This last rule causes particular difficulties for children and adolescents who stutter. Speech defects often push them into quarrels, resentments and alienation. Stutterers are called angry, gloomy, and suspicious. Often, having remained silent at school, a child cannot restrain himself at home and takes his anger out on loved ones. In my classes, I teach children how to behave correctly in conflict situations: if you get excited, take a “time out”, ask what caused disapproval, if you are guilty, ask for forgiveness, use humor. One smile is worth it! She can express pleasure, superiority, envy, edification and disapproval. In my classes, children write posters for themselves with the words: “Look for every opportunity to enter into the position of the person you are communicating with” or “Anger is, first of all, an inability to show resourcefulness in any situation, an expression of helplessness in the face of events.”

Psychotherapeutic conversations are of great importance for children and adolescents who stutter. Topics may vary. You can read a story about a person’s resourcefulness or tell a funny story. Sometimes you just need to listen to the child and encourage him, answer the questions that arise. Children think that having learned to speak without hesitation, they will immediately become interesting interlocutors and team leaders. But in addition to correct speech, you need to have versatile knowledge that will be in demand by other people. To do this, you need to read, learn, and memorize a lot. Treatment for stuttering is only the beginning of a long journey towards self-correction.

Marina KUZMINA, psychologist

The article was published with the support of the disinfection service “Grand Service Disinfection Service”. Disinfection service of the city of Moscow "Dezsluzhba Grand Service" provides professional disinfection, deratization and disinfestation services. Disinfection service specialists will help you get rid of bedbugs, fleas, rats, mice and cockroaches in the shortest possible time and at a reasonable price, and will destroy ants, bark beetles, mosquitoes, and microbial viruses. Great experience successful work, modern equipment, effective drugs and free warranty service for all work performed ensure that services meet the highest standards of quality and reliability. You can learn more about the offer of the disinfection service “Dezsluzhba Grand Service” at www.dezinfektor.msk.ru

The main directions of correctional work with children who stutter:

1. Respect for silence

2. Correct speech breathing.

3. Articulation gymnastics and articulation massage.

4. Normalization of the prosodic side of speech.

5. Psychological method of treating stuttering.

6. Application of new computer programs.

Download:

Preview:

Main directions of correctional work with people who stutter

children

Stuttering is a complex speech disorder, to overcome which a complex of various correctional works is used, consisting of therapeutic and pedagogical measures. When eliminating stuttering, it is necessary to influence the entire body of the stutterer; work should be carried out aimed at normalizing all aspects of speech, motor skills, mental processes, education of the personality of a stutterer. When organizing correctional work, one should rely on the results of a comprehensive examination of a person who stutters, which make it possible to take into account the specific form of disturbance in the rhythm and fluency of speech and, accordingly, determine the main directions of treatment. Corrective methods involve the joint work of a neurologist, speech therapist, and educational psychologist.

From the above, we can conclude that both examination and correction of stuttering should be based on an integrated approach.

The leading direction of speech therapy intervention for children who stutter is work on speech, which consists of several stages and begins, as a rule, with observing a regime of silence (the duration of the stage is from 3 to 10 days). Thanks to this regime, previous pathological conditioned reflexes are inhibited, since the child no longer produces his convulsive speech. Also, during the period of silence, the stutterer calms down psychologically; he no longer has to worry about his defect. After the end of the silence regime, there is a transition to work directly on speech, which will now take place in conditions more favorable for relieving speech spasms.

Since play is the leading activity of preschoolers, in speech therapy practice most often work on speech development with children of this age is carried out in a relaxed playful form. This is what happens in the game comprehensive development child, not only speech is formed, but also thinking, voluntary memory, and independence. It is on the basis of this approach that the personal deviations of stuttering children are corrected and their speech is trained.

Correction of speech communication in school-age children is closely related to the leader at a given age educational activities. In the course of speech therapy work, schoolchildren receive enough skills and abilities necessary for the active use of acquired knowledge in order to adequately interact with other people in the process of performing various types activities in a variety of life situations.

It should be noted that in order to successfully overcome stuttering, it is necessary to organize speech therapy classes in such a way that stuttering is completely absent. To achieve this goal, speech therapists use forms of speech that help relieve speech spasms. These types include:

1. conjugate speech (speech together with a speech therapist);
2. reflected speech (repetition of individual words and small phrases after the speech therapist, while maintaining a given tempo and rhythm of speech);
3. rhythmic speech (beating a rhythm on each syllable or on a stressed syllable in a word);
4. whispered speech.

The transition to independent speech is carried out gradually, only at the final stages of speech therapy work does the child switch to emotional speech.

Researchers and practitioners have developed other specific techniques for correcting the speech of children who stutter. N.A. Cheveleva developed a method for eliminating stuttering in schoolchildren in the process of manual activity. Speech education using this method takes place in several stages: accompanying speech based on visual objects and actions, concluding speech about a completed action, preliminary speech without relying on a past action, consolidation of active speech or contextual speech. A.V. Yatrebova’s methodology is based on slightly different theoretical positions. She proposed a system of correctional education based on the use of a set of communicative exercises in working with children who stutter, aimed at developing their free communication skills.

Despite the fact that in speech therapy practice it is used a large number of of various techniques and methods aimed at working on the speech of children with stuttering, many experts still adhere to the opinion of the need for comprehensive treatment of this disorder.

The basis for correct speech is correct speech breathing. It has been established that the most correct and convenient for speech is diaphragmatic-costal breathing, when inhalation and exhalation are performed with the participation of the diaphragm and intercostal muscles. The lower, most capacious part of the lungs is active. The upper chest, as well as the shoulders, remain practically motionless.

In children who stutter, at the time of emotional arousal, the clarity of speech is usually impaired, and breathing becomes shallow and arrhythmic. Often children generally speak while inhaling or holding their breath. That's why the most important goal Speech therapy intervention in eliminating stuttering is the education of correct speech breathing.

To develop speech breathing skills, the following is most often used:

1. breathing exercises;
2. exercises to develop the skills of correct full inhalation;
3. exercises to train proper exhalation;
4. breathing exercises with movements.

In speech therapy work on the speech breathing of people who stutter, breathing exercises by A. N. Strelnikova are widely used.

It is also known that when stuttering, the strength, speed, range of movements of the articulatory apparatus, and switchability from one articulatory structure to another are impaired, so it is very important for a child who stutters to learn to relax, control muscle tension, and remove clamps and spasms of the articulatory apparatus. The authors of the most common methods for eliminating stuttering use such correction techniques as articulatory gymnastics and articulatory massage.

Articulatory gymnastics helps to achieve clarity of pronunciation, relieve tension in the articulatory and facial muscles, and develops strength, accuracy, and coordination of movements. To achieve the above goals, the muscles of the lower jaw, lips, tongue, muscles of the pharynx and soft palate, facial muscles are trained, and static and dynamic exercises are used. When performing gymnastics, it is important to form differentiation in the inclusion of various muscles, smoothness, symmetry and arbitrariness of articulatory movements.

Articulation massage has a great influence on the nervous system of a stuttering child. This is reflected in changes in general nervous excitability, lost or reduced reflexes are revived, and the overall state of the central nervous system changes. Also, when exposed to massage, tension in spastic muscles is relieved, and, conversely, the tone of weak and flaccid articulatory muscles increases, the volume and amplitude of articulatory movements increases, and those groups of muscles of the peripheral speech apparatus that had insufficient contractile activity are activated. The main massage techniques are stroking, rubbing, firm pressure, vibration and effleurage.

Since the speech of children who stutter is poor in intonation and monotonous, another main area of ​​stuttering correction is considered to be working on the expressiveness of speech.

Logical expressiveness – the most important condition any type of speech. This includes:

1. intonation;
2. logical stress;
3. logical pause.

Normalization of the prosodic aspect of speech includes the following tasks:

1. Development of the skill of intonation design of syntagmas and phrases in accordance with the four main types of intonations of the Russian language (interrogative, exclamatory, complete and incomplete).
2. Normalization of the process of speech pausing.
3. Formation of the skill of intonation division and highlighting the logical centers of syntagmas and phrases.

Work on intonation is carried out on the material of sounds, words, sentences, and small texts. The main elements of intonation exercises are the development of ascending and descending intonation, and work is also carried out on the rhythmic and intonation division of the speech flow. Children are recommended to observe the speech of the people around them, which allows them to compare and analyze intonation-colored and monotonous sound.

When stuttering, a variety of motor disorders are noted (instability of muscle tone, uncoordinated and chaotic movements, slow switching from one series of movements to another, tricks and auxiliary movements), as well as disturbances in the tempo and rhythm of speech. Experts believe that these disorders require a complex intervention for their correction, which must necessarily include speech therapy rhythms.

To overcome stuttering, speech therapy rhythms provide the following:

1. develops general motor skills, motor skills of the arms, hands, fingers;
2. normalizes the pace and rhythm of speech movements;
3. develops speech prosody;
4. helps overcome various kinds of unnecessary, including accompanying movements;
5. develops breathing, the correct ratio of inhalation and exhalation;
6. helps relieve speech convulsions;
7. develops auditory and visual perception, attention and memory.

The means of speech therapy rhythm is a system of gradually more complex rhythmic and musical-rhythmic exercises and tasks that underlie the motor, musical and speech activity of children.

A separate work by G. A. Volkova is devoted to the issue of the need for a phased and differentiated use of speech therapy rhythms in the correction of stuttering. Another one effective technique, based on the rhythmization of speech, was proposed by L. Z. Harutyunyan. A feature of this speech therapy technique is the synchronization of speech with the movements of the fingers of the leading hand, which determine the rhythmic and intonation pattern of the phrase.

Constant difficulties in speech traumatize the psyche of sick children, causing various neurotic disorders. That's why great importance in the treatment of stuttering, various forms of psychotherapeutic influences are used: group psychotherapy, autogenic training, self-hypnosis, hypnosis, relaxation exercises. All these forms are used so that a stuttering child can learn to voluntarily relax his muscles, free himself from excess tension and fatigue, and feel calm and relaxed.

For the first time, a psychological method of treating stuttering was outlined in the work of G. D. Netkachev. A modern methodology, which most fully takes into account various aspects of the clinical and psychological picture of stuttering, was proposed by V. M. Shklovsky.

However, not all experts recognize the effectiveness of psychotherapy in the complex treatment of psychological disorders in children who stutter. Neuropathologists most often use medications(tincture of motherwort, phenibut, tranquilizers) to normalize the activity of the central and autonomic nervous system, eliminate convulsions, and normalize the psychological state of the patient. But, unfortunately, the question of which method is more productive remains open.

However, most experts agree that to treat the nervous system, it is not enough just to take appropriate medications or perform special procedures. We should start by providing comfortable living conditions for people who stutter, which would help strengthen the nervous system and the entire organism as a whole. These conditions include:

1. correct daily routine;
2. proper nutrition with the exception of foods that have a stimulating effect on the nervous system (spicy foods, chocolate, strong coffee);
3. restful and sufficiently long sleep (daytime rest is especially important for children);
4. sufficient exposure to fresh air (walks);
5. do not overload the child with homework, since any physical and mental stress will result in an increase in stuttering;
6. full-fledged summer rest without overheating in the sun;
7. hardening;
8. activities that are calm and least dangerous species sports (such as swimming, cycling, skating and skiing);
9. avoiding watching psychologically traumatic and frightening television programs; after watching such programs, children are haunted by nightmares;
10. ensuring a calm environment in the family, avoiding stressful situations that force the stutterer to remain in a state of nervous tension;
11. a calm and friendly attitude of parents towards a stuttering child.

For complete stabilization mental health for children who stutter, it is also considered necessary to carry out consultative and methodological work with teachers, which is aimed at providing favorable conditions for influencing the child, at creating the right attitude towards him in kindergarten and school.

Currently, new methods are widely used to treat stuttering. computer programs - "Breathmaker" and "Zaikanie.net", with the help of which it was possible to createartificial connection between the auditory center and the center of speech pronunciation. The essence of these programs is that when a child speaks into a microphone, through headphones, his own speech is returned to him, but already corrected by a computer. It sounds smooth and without stuttering. The computer delays words for a fraction of a second and thereby slows down the overexcited speech production center. Therefore, the child will not say the next word until he hears the previous one. The processed speech that is fed into the headphones is also amplified. The brain is forced to choose a more powerful (correct) signal. Thus, the children’s speech stabilizes.By the end of training, a person who stutters loses the readiness of the muscles of the speech apparatus to spasm, causing stuttering. The child not only stops stuttering, but also acquires the ability to speak beautifully and expressively.