Month: May 2020

What is Stuttering?

Characteristic features – frequent repetition or prolongation of sounds, syllables or words; or frequent stops, indecision in speech with violations of its smoothness and rhythmic flow.

Causes of Stuttering

The exact etiological factors are not known. Put forward a number of theories:

• The theory of “block stuttering” (genetic, psychogenic, semantogennaya). The basis of the theory is cerebral dominance of speech centers with constitutional predisposition to the development of stuttering due to stress factors.
• Theories of the beginning (include the theory of failure, the theory of needs and the theory of anticipation).
• The theory of learning is based on an explanation of the principles of the nature of reinforcement.
• Cybernetic theory (speech is an automatic process of the type of feedback. Stuttering is explained by the breakdown of feedback).
• Theory of changes in the functional state of the brain. Stuttering is a consequence of incomplete specialization and lateralization of language functions.

Recent studies suggest that stuttering is a genetically inherited neurological disorder.

Prevalence

Stuttering suffers from 5 to 8% of children. The disorder is 3 times more common in boys than in girls. In boys, it is more stable.

Symptoms of Stuttering

Stuttering usually begins before the age of 12 years, in most cases there are two acute periods – between 2-4 and 5-7 years. It usually develops over several weeks or months, starting with repeating the initial consonants or whole words that are the beginning of a sentence. As the disorder progresses, repetitions become more frequent with stuttering on more important words and phrases. Sometimes it may be absent when reading aloud, singing, talking to pets or inanimate objects. The diagnosis is made when the duration of the disorder is at least 3 months.

Clonic-tonic stuttering (disturbed rhythm, tempo, fluency of speech) – in the form of a repetition of initial sounds or syllables (logos), at the beginning of speech clonic convulsions with the transition to tonic.

Tonic-clonic stuttering is characterized by a rhythm disturbance, smoothness of speech in the form of hesitations and stops with frequent vocal enhancement and pronounced breathing disorders associated with speech. There are additional movements in the muscles of the face, neck and limbs.

During stuttering, there are:

• Phase 1 – preschool period. The disorder appears sporadically with long periods of normal speech. After this period, recovery may occur. During this phase, stuttering occurs when children are agitated, distressed, or when they need to talk a lot.
• Phase 2 occurs in primary school. The disorder is chronic with very short periods of normal speech. Children are aware and painfully experiencing their disadvantage. Stuttering concerns the main parts of speech – nouns, verbs, adjectives and adverbs.
• Phase 3 occurs after 8-9 years and lasts until adolescence. Stuttering occurs or increases only in certain situations (call to the board, buying in a store, talking on the phone, etc.). Some words and sounds are more difficult than others.
• Phase 4 occurs in late adolescence and in adults. Expressed fear of stuttering. Typical are word substitutions and bouts of wordiness. Such children avoid situations that require verbal communication.

The course of stuttering is usually chronic, with periods of partial remission. From 50 to 80% of children with stuttering, especially in mild cases, recover.

Complications of the disorder include a decline in school performance due to shyness, fear of speech disorders; restrictions in the choice of profession. For those suffering from chronic stuttering, frustration, anxiety, and depression are typical.

Diagnosis of Stuttering

Spastic dysphonia is a speech disorder similar to stuttering, but is characterized by the presence of a pathological breathing pattern.

Unclear speech, in contrast to stuttering, is characterized by erratic and disrhythmic speech patterns in the form of quick and sharp flashes of words and phrases. When speech is unclear, there is no awareness of his lack, while those who stutter are acutely aware of their speech disorders.

Stuttering Treatment

Includes several directions. The most typical is distraction, suggestion and relaxation. Stutterers are taught to speak simultaneously with the rhythmic movements of the arms and fingers, or in a slow and monotonous manner. The effect is usually temporary.

Classical psychoanalysis, psychotherapeutic methods are not effective in the treatment of stuttering. Modern methods are based on the point of view that stuttering is a form of learned behavior that is not associated with neurotic manifestations or neurological pathology. Within these approaches, it is recommended to minimize the factors that increase stuttering, reduce secondary disturbances, convince the stutterer to talk, even with stuttering, freely, without constraint and fear, in order to avoid secondary blocks.

An effective method of self-therapy based on the premise that stuttering is a specific behavior that can be changed. This approach includes desensitization, reducing emotional reactions, fear of stuttering. Since stuttering is what a person does, and a person can learn to change what he does.

Drug treatment is of an auxiliary nature and is aimed at alleviating the symptoms of anxiety, expressed fear, depressive manifestations, and facilitating communicative interactions. Soothing, sedative, fortifying agents (valerian, motherwort, aloe vera, multivitamins and B vitamins, magnesium preparations) are applicable. In the presence of spastic forms, antispasmodics are used: mydocalm, sirdalud, myelostane, diafene, amisyl, theofedrin. Tranquilizers are used with caution, mebikar 450-900 mg / day is recommended, with short courses. Significant effect is brought by courses of dehydration.

Alternative options for drug treatment:

• In the clonic form of stuttering, pantogam is used from 0.25 to 0.75 – 3 g / day., Courses lasting 1-4 months.
• Carbamazepines (predominantly tegretol, timonyl, or finlepsin retird) with 0.1 g / day. up to 0.4 g / day. within 3-4 weeks, with a gradual reduction of the dose to 0.1 g / day. as a supportive treatment, with a duration of up to 1.5 – 2 months.

Complex treatment of stuttering also includes physiotherapeutic procedures, courses of general and specialized speech therapy massage, speech therapy, psychotherapy using the suggestive method.

What are School-specific Developmental Disorders?

These disorders arise due to violations in the processing of cognitive information, which largely occurs as a result of biological dysfunction. Characteristically, the normal acquisition of skills is impaired from the early stages of development. They are not the result of adverse learning conditions and are not related to brain injury or illness. It is necessary to evaluate not the level of education, but school achievements, taking into account the dynamics of development, since the severity and lag in reading for 1 year at 7 years old has a completely different meaning than for 1 year at 14 years old.

The type of manifestation of the disorder usually changes with age – the delay in speech in preschool years disappears in colloquial speech, but is replaced by a specific delay in reading, which in turn decreases in adolescence, and in youth these are violations of spelling / writing. That is, the condition is equal in all respects, but the dynamics of growing up are taken into account. School skills are not only a function of biological maturation, they must be taught and mastered. Specific violations of school skills cover groups of disorders manifested by a specific and significant deficiency in teaching school skills in a given age group, class, population, and school.

These disorders are not a direct result of other conditions – mental retardation, gross neurological defects, emotional or gnostic disorders. Often combined with hyperactivity disorder and attention deficit, specific disorders of motor functions. It doesn’t mean at all that these are children with a delay in skills, and “will catch up with their peers over time” – such violations are observed in adolescence and in further education. They are associated with the appearance of secondary disorders in the form of a lack of interest in learning, a poor educational program, and emotional disorders.

Diagnosing Specific School Skills Disorders

Diagnostic Requirements

There should be the most clinically significant degree of violation of a skill:

• the presence of delays or deviations in the development of speech in the preschool period;
• associated problems – inattention or increased activity, emotional disturbances or disturbances in behavior;
• the presence of qualitative violations – a clear difference from the norm;
• inadequate response to therapy (lack of effect with increased care at home and / or school).

The violation is more strictly specific and does not depend on mental retardation or on a general decrease in the intellectual level. Diagnosis of violations is based on psychological and pedagogical testing. Violation should be present from the first years of training, and not acquired during education. Violations should not be due to untreated or uncorrected visual or auditory disorders.

Specific impairments to school skills include:

• specific violation of reading skills “dyslexia”;
• specific violation of writing skills “dysgraphia”;
• specific violation of arithmetic skills “dyscalculia”;
• a mixed disorder of school skills “learning difficulties”.

Treatment of Specific School Skills Disorders

The preferred treatment is corrective training therapy. Emotional reactions are more important than certain teaching methods. An effective neuropsychological correction with an integrative approach to mastering phonetic combinations and the spatial structure of words. Concomitant emotional and behavioral disorders should be treated with appropriate medication and psychotherapeutic methods. A good effect is provided by family counseling.

What are Specific Personality Disorders?

Personality disorders – persistent character anomalies, consisting of a combination of genetic and acquired properties that lead to social maladaptation. According to Gannushkin P.B., they are characterized by a violation of adaptation, the totality of the defeat of the psyche and low reversibility. Personality disorders are usually noticeable since childhood as special disharmonies and disproportionate development of the psyche. In dynamics, the phases of compensation and decompensation alternate. S.S. Korsakov pointed out that “The psychopathic constitution is a persistent painful disorder that is firmly connected with the characteristics of the mental warehouse, which already constitutes its fundamental weakness, becomes its characteristic property forever or for a rather long time.” O.V. Kerbikov divided psychopathy (the former name of specific personality disorders) into marginal, developing mainly under the influence of social factors, and nuclear, due to biological, constitutionally hereditary factors. M.O. Gurevich added organic psychopathies to these groups – the consequences of exogenous-organic harmfulness, manifested in anomalies of characterological development. An anomaly of personality grows in prepubertal from patho-characterological reactions, patho-characteristic development, therefore, the diagnosis of personality disorder is made from 16 to 17 years. They are related to borderline mental disorders. The exaggerated development of one of the character traits is considered accentuation (K. Leonhard, 1964), which is a variant of the norm.

E. Kretschmer considered character anomalies to be the result of development asynchrony, in which some character traits develop tremendously in connection with compensating for the insufficient development of other mental functions. J. Price believed that character anomalies are the result of a distorted development of the dominance function in the hierarchy system – this is the result of an incorrect awareness of one’s biological rank.

It is possible to distinguish constitutional genetic, organic and psychodynamic factors leading to the development of character anomalies. The contribution of genetic factors to the development of personality traits is up to 60%, most of the abnormal personality traits are transmitted according to a recessive or polygenic type. Theories of the late 19th century considered mental degeneration in families to be the cause of character anomalies. Long-term somatic and neurological disorders in childhood, pre-, postnatal pathology, traumatic brain injuries contribute to the formation of an abnormal nature. A significant role is played by upbringing in an abnormal and asymmetric family, the frequent background of which is the use by parents of psychoactive substances. Nevertheless, there are facts of the development of completely harmonious personalities even in the presence of all adverse circumstances, as well as facts of the development of abnormal personalities in outwardly harmonious and genetically prosperous families. Part of the abnormal personality traits develops as a kind of hypercompensation of mental deficiency (inferiority complex). From an analytical point of view, most personality abnormalities are associated with developmental delay and distortion of the stages of psychosexuality, while acquired abnormal features are more often the result of regression.

Symptoms of Specific Personality Disorders

General diagnostic guidelines for personality abnormalities are defined as conditions that cannot be directly explained by extensive brain damage or illness or other mental disorder. They must meet the following criteria:

• disharmony in personal positions and behavior, usually involving several areas of functioning, for example, affectiveness, excitability, control of motives, processes of perception and thinking, as well as the style of attitude towards other people;
• the chronic nature of the abnormal style of behavior that has arisen for a long time and is not limited to episodes of mental illness;
• an abnormal style of behavior is comprehensive and clearly violates adaptation to a wide range of personal and social situations;
• the aforementioned manifestations always arise in childhood or adolescence and continue to exist in the period of maturity, often sharpening of personality traits is noted at a later age;
• the disorder leads to significant personality distress, but this can only become apparent in the later stages of the course;
• usually, but not always, the disorder is accompanied by a significant deterioration in professional and social productivity.