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Modern theologies of stuttering and their therapeutic implications Watson, Charles Burton 1938

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MODERN THEORIES OF STUTTERING  AND THEIR THERAPEUTIC IMPLICATIONS Thesis submitted for the Degree of MASTER OE ARTS in. the Department of PHILOSOPHY AND PSYCHOLOGY The University of Br i t ish Columbia Charles Burton Watson Apr i l , 193 8 ACKNOWLEDGMENT The writer wishes to take this opportunity to thank Doctor J . W. Pilcher and Doctor J . E. Morsh of the Department of Psychology for the interest, counsel and time that they have so l ibera l ly given him at a l l times and especially on with the present piece of work. TABLE OF CONTENTS Chapter I . . . . . . . . . . . . . . . Orientation and Definitions Chapter. II Speech Defects Chapter III . . . . . . . . . . . . . Objectively Known Facts Concerning, Stuttering Chapter IV . . . . . . . . . . . . . . Some Historical Theories of Stuttering Chapter V . . . . . . . . . . . . . . . . Some Modern Theories of Stuttering Chapter VI . . Conclusion NOTE References are quoted ser ia l ly following Chapter VI CHAPTER I  ORIENTATION AMD DEFINITIONS •' CHAPTER"' I ORIENTATION AMD DEFINITIONS A feature which markedly sets man apart from the other animals is his superior abil ity, to shape the world about him to suit his convenience.- In the sphere of social relationships the culmination of this control, of.. environment has been the development of language: speech, writing and gesture.. Of these three forms of expression speech stands as the master Instrument with which man controls his fellow men. Speech Is not only the most important source,of stimulation for the human organism but Is also the most significant response made by man. For anyone dealing with people - psychiatrist, psychologist, minister or educator - a study of the speech of an individual and of his responses to verbal stimulation pro-vides a direct approach to his personality. We may well accept' as axiomatic the statement of Travis: "When a man speaks he always reveals something. It may not be what he Intended to disclose but nevertheless i t i s t e l l tale in some way". In the course of evolution man's lungs, original ly designed for the act of respiration, have become fundamental to vocaliza-tion.. Normal breathing for the physiological needs of the body is carried on independently of conscious control. At anytime, however, breathing may _ p be voluntarily controlled for the purpose of voice production. During inspiration the chest cavity is enlarged and, as the lungs expand to f i l l the space thus formed, air dram in through the nose passes down the trachea and Its branches into the a l -veolar cavities of the lungs. The enlargement of the chest cavity Is caused by the combined action of the descent of the diaphragm, a double dome-shaped muscle separating the thorax and abdomen, and the elevation of the r ibs . In expiration the air i s expelled from the lungs by the contraction of the thoracic cavity. Normally this is a passive movement caused by the relaxation of the chest wall and diaphragm and the elastic reco i l of the lungs. Speaking and singing demand the greatest voluntary control of respiration. For normal speech the vocal cords and the resonating and articulating chambers of the mouth and throat must be ac-tivated by a column of air which is sustained under constant pressure during a lengthened period of expiration. "The essential requirement for the production of voice consists, not in any alteration of the act of i n -spiration but in the production of a strong, steady and controlled act of (2) expiration." This prolonged expiration is maintained by the contraction of the abdominal muscles more "especially by the upper central part of (3) the rectus abdominus." This contraction forces the abdominal viscera upward against the relaxing diaphragm. The resulting pressure is suf f i -cient to provide the required stream of a i r . _ 3 -Table 1 shows a comparison of normal breathing U ) with breathing during speech and song, as summarized by Seth and Guthrie. "1, Expiration time equal to that 1, Expiration time greatly exceeds of inspiration, that of inspiration. 2. Automatic and involuntary. 2. Partly under control of w i l l . 3« Small amount of air used - 3* Large amount of air used -500 cc. 2000 cc. /+, Breathing through nose. Breathing through nose and mc-tith," TABLE 1 Speech is made up of fundamental laryngeal notes produced by the vibration of the vocal cords. These cords consist of a pair of membranous folds stretching across the larynx from front to back. The larynx i t se l f i s an intricate box-like structure situated at the upper end of the trachea. Its primary function is to regulate the amount of a ir entering the lungs and to protect them from the entry of foreign objects. When vocalization is taking place the cords are drawn together so that they offer resistance to the passage of air from the lungs, the pitch of the voice being determined by the tension of the cords. In adult males the cords are approximately 18 num. in length while in women they measure about 12 num. This difference in length accounts for the deeper pitched voices of men. The change to a deeper voice in boys during puberty is caused by the rapid growth of the larynx - 4 -at this period.-The fundamental pitch of the voice is determined by the vocal cords and the larynx but timbre (the characteristic Y/hlch makes voices of the same pitch sound differently) Is supplied by the re-sonating cavities, the pharynx and the mouth. The a ir waves are modified during their outward passage by changes in the relative positions of the tongue, l ips , teeth and palate. These changes mould the original vibra-tion produced in the larynx into articulate speech,, Travis summarizes the description of the speech mechanisms as follows? It would appear that there is not a single muscle group which has been developed to serve speech exclusively. The entire peripheral speech mechanism may be identified with biological ly older and more fundamental v i ta l functions which are seriously altered during vocalization. The movements involved in the earl ier established functions are generalized, and although readily amenable to voluntary .control, they are carried on largely unconsciously", (5) - 5 -CHAPTER I I SPEECH DEFECTS - 6 -CHAPTER II  SPEECH DEFECTS Normal speech depends upon the adequate formation and function of the various parts In the complicated speech apparatus. Abnormalities of formation or function on the other hand interfere with the speaking process and may have profaud effects upon personality development, If, for Instance, an individual has a c lef t palate or nasal malformation« he may f a i l to make himself understood and consequently his speech does not e l i c i t the expected response. This immediately produces a tension or inadequate adjustment between the •speaker and the one spoken to. The one wonders what the other i s thinking about his speech defect-while the other tries to guess what was said and what response should be made. Such tension producing situations when repeated tend to produce permanent unhealthy attitudes. Travis' definit ion of a speech defect embodies the concept just presented. He says:"Speech or voice defect may be defined as an unusually conspicuous deviation in the speech pattern of an i n -dividual which is incapable of bringing about an adequate social response and which by the same token constitues a maladjustment to his environment" (6) Generally speaking most of the speech disorders commonly encountered f a l l Into the following f ive-fold c lassif icat ion: 1. Delayed Speech. Children who are later than average in beginning to talk are said to have delayed speech. Cases of this type often show a paral lel retardation in other f ie lds of development and _ 7 -frequently are mentally subnormal. 2. Articulator"- Disorders, These defects are marked by the inabi l i ty of the individual to make the proper muscle movements in pro-ducing a particular sound. Consonant sounds produced by faulty tongue and l i p movements are usually involved. The specific disorders of this group are diagnosed by such terms as l isping, l a l l i n g , cluttering, speech clumsiness or oral inactivity, sound substitution, Infantile speech and foreign accents. Articulators disorders occur more frequently than any (7) other type* Surveys show, however, that the higher the grade in school the fewer the children suffering from these defects. 3» Rhythmic Disorders. The disorders fa l l ing in this group are characterized by poor temporal co-ordination in the operation of the speech apparatus. The resulting condition is commonly known as stammering or stuttering. U> Voice Disorders. The cases which f a l l In this category show speech with an abnormal phonation such as hoarseness or nasality. 5» Symbolic Disorders. The d i f f i cu l ty here is not in the formation of the sounds or in their proper patterning but is manifest in the inabi l i ty to set the words in acceptable grammatical relationships. The disorders in this group are called aphasias. The condition is rare (8) In school children, the White House Conference Survey reporting less than one aphasic child per ten thousand. The third group, rhythmic disorders or stuttering, w i l l be emphasized in the present discussion, - 8 -Some in vestigators (e.g. Bluemel) use the term stammering rather than stuttering but apparently refer to the same phenomenon while others introduce several d i f ferent ia l diagnoses (e.g. Fletcher). There is also a third group of investigators which classif ies the various disorders in the rhythm of speech under the more inclusive term spasmophemia (Travis end Stinchfield). Both stammering and stuttering are probably the result of the same basic conditions but these disorders are distinguished (9) by Warren -and others on the basis of their characteristic rhythms. Thus stuttering is used to indicate the repetition of sounds, words or phrases (e.g. p - n - n - never m - m - m - mind) while stammering refers to so-called speech blocks (e.g.. ah - ah - ah - good-morning). When we con-sider, however, the repetition of the same sound or word as a transient speech block (an alternation between blocks and releases) any super-f i c i a l difference becomes of minor Importance. Physiologically;, repe-t i t ion of sound i s , in terms of muscular reaction, clonic act ivity and blocking is tonic activity or a marked extension of the refractory phase of the clonic reaction. CHAPTER III OBJECTIVELY KNOWN FACTS CONCERNING STUTTERING - 10 -CHAPTER III OBJECTIVELY KNOWN FACTS CONCERNING STUTTERING Some of the findings of the Committee on Defective (10) Speech of the White Hou.se Conference w i l l now be presented, as an orien-tation to the various theories which have been advanced to account for stuttering. Certain, other objective!]" known facts concerning the dis-order w i l l .also be included. The White House Conference Committee based i ts report upon a questionnaire which i t sent out to 48 c i t ies with popula-tions over 10,000. The results of this questionnaire disclosed that on (11) the average five percent of school children exhibit speech defects. On the basis of this sampling there are some 1,200,000 children with defec-tive speech in the schools of the United States. The Committee has analyzed i ts data to show the relative incidence of the various disorders coming under the broader term of speech defects. The most common type of disorder was found to be articulatory defect, such as sound substitution and oral inactivity. Over 1,6 percent of the speech abnormalities reported resulted from such (12) . poor vocal habits. Stuttering is next on the l i s t with an incidence of about 22 percent of the speech cases reported or approximately one (13) percent of the school population investigated. This finding is in close' agreement with the results of others who have studied-the incidence of - l i -the disorder-(14) Conrad. I in a survey embracing 87,4-4-0 children in American City Schools found that 2,1,6 percent had speech defects and 0,87 "oercent were stutterers, (15) Wallin made a study of the school system of St. Louis (89,057 pupils in a l l ) and found that 683 or 0,7 percent were stutterers according to his definitions "Stutterers - pupils who spas-modically or uncontrollably repeat the i n i t i a l sounds of words (usually consonants) or who spasmodically repeat syllables or words". These 683 cases Wallin has subdivided as follows: -486 cases or 71 percent, of. the speech abnormalities found were classified, as mild while he classed as severe 197 cases or 28 percent of the speech defectives, (16) Loutt.it and. Halls report the results of a speech disorder Investigation made in the Indiana schools. They found approxi-mately one percent of stutterers in the school population that they • (17)-studied, The grade distribution is shown,in Table 2. 12 -GRADE PERCENT STUTTERING New 1st Grade 0.93 1 0.73 2 0,97 3 . 0,80 4 ' 0,88 5 0,81 • 6 0.77 7 0.80 8 0,62 ,. 9 0.69 10 0,66 11 0,39 12 (.)„/.! TABLE 2 There Is no available information on the incidence of stuttering in Canadian school children but It i s safe to assume that the American percentages are applicable to Canada, Table 3 shows the number of children enrolled in the elementary' and secondare schools of (18) (19) (20) Canada, Brit ish Columbia and Vancouver in 1934 and the probable number of stutterers, i f we assume that one percent have the defect, PLACE NUMBER IN SCHOOLS NUMBER OF STUTTERS Canada Br i t ish Columbia Vancouver 2,242,553 115,792 38,997 22-425 1,157 °-8Q TABLE 3 There Is a definite sex difference In the i n c i -dence of stutteringj the disorder being much more prevalent anion e boys (21) " (22) than among g i r l s . Table L, using the data of West and Louttit and Halls gives the ratio of boys to g i r ls in the' various grades, SEX RATIO AMONG STUTTERERS GRADE West BOYS TO ONE GIRL Louttit and Halls I II III IV V VI VII VIII IX-X XI-XII 3-1 3- 4 3.6 4 - 2 4.2-4.0 4-8 3-7 3.7 5.5 3-3 3.8 3-0 2.3 2.6 3-4 3.2 3-7 2.7 3-9 TABLE 4. Stutterine characteristically manlf ests i t se l f (23) early In the l i f e of the child so af f l i c ted. Travis reports that generally the onset is gradual rather than sudden, especially in children's causes. Often i t is preceded by speech which is hesitant and uncertain (2A) and marked by the repetition of sounds and words, Silverman investigated a group of 50 stutterers and found.that 72 percent of them developed their speech defect before the age of six years when they started to school. Available evidence does not indicate that the (25) stutterer is possessed of inferior mentality. West reports on a group of 405? stutterers with an average Intelligence Quotient of 96.5. The dis-( 2 6 ) , tribution of these cases is Indicated in Table 5. INTELLIGENCE QUOTIENT NUMBER Below 50 3 50 - 60 27 60 - 70 100 70 - 80 4.17 80 - 90 806 90 - 100 IO42 100 - 110 840 110 - 120 531 Above 120 293 TABLE 5 In spite of the fact that stutterers as a group are endowed with normal intelligence they are about one and one half years retarded In their school work. Using as his raw data. Wallin's St. Louis (27) ' ~ figures Fletcher worked out the extent of retardation, Fletcher's findings are presented In Table 6, YEARS RETARDED NUMBER OF CASES• -1 (accelerated) 8 0 97 * 5 1 219 2 165 3 73 L, " 29 5 11 6 3 7 2 TABLE 6 (28) Wallin found that the average retardation was 1.6 years In the case' of both boys and girls., This retardation does not reflect the intelligence of the sxrtterer for in most cases the backwardnes may be attributed to the defective speech. The child., being unable to ex-press himself adequately in oral work, may pretend ignorance to escape the embarrassment of speaking, There Is a popular notion that it is unnecessary to make any effort to overcome speech defects as the?' are outgrown in the (29) process of maturation, Travis points out that while' there Is no reliable information upon the subject speech correction workers are of the op5.nion that 15 or 20 percent of children stutter at some time or other, usually between the ages of two end four years. If this be true, then most children do outgrow their defect for, as has already been indicated, about one percent of school children have the affliction. It Is interesting to make a comparison of the number of stutterers with the number of those exhibiting other disorders, (30) Travis estimates that there are about 1,000,000 stutterers in the United States of which number one quarter are children. He also reports that In 1920 there were 52,567 blind persons and 44,885 deaf mutes. From these figures i t i s obvious how great i s the extent of this disorder, for there are in the United States about three times as many stuttering children as blind and deaf mutes of a l l ages combined. The physical habitus-of the adult male stutterer (31) has been investigated by Travis, Malamud and Thayer. Using the methods and concepts of Kretschmer these investigators studied the physical types presented by 175 unselected adult males, 47 of whom stuttered and 128 of whom spoke normally. They found that the majority of the stutterers and the minority of the normals f e l l into the leptosame group while the minority of stutterers and the majority of the normals f e l l into the athletic, pyknic and dyplastic groups. They state also that most of their stutterers showed the introvertive tendencies typical of the leptosome Individual. The authors sum up their research as follows? "Because of the striking relationship discovered here between stuttering and physical habitus i t seems reasonable to assume that constitutional determinants play an important role in stuttering. However,-it i s well to supplement, this statement, with the qualif ication that not a l l persons who are in this basic respect capable of stuttering need develop i t . Whether or not they wi l l develop stuttering depends upon further In-juriously shaping formative and predisposing influences". (32) This study gives rise to some interesting specu-lations. It is to be noted that the subjects were adult males. Perhaps - 17 -the dominance of stuttering leptosome adults may be explained by the tendency of the pyknics to outgrow stuttering more readily, The author has observed that those of leptosome habitus tend to stutter more severely and are less amenable to therapy than the pyknic and athletic types who usually show less severe stuttering and who respond more quickly to treatment. It should be stated that the preceding discussion does not imply an acceptance of Kretschmer's theory of types. Investiga-(33) tions by Pollock and others have not substantiated his contentions. Such defects as physical deformity or blindness exert a definite and known effect upon the personality of the crippled or blind individual as well as upon the conduct of the normal individuals associated with him. His defect Is thought of as an af f l ict ion which demands sympathy. The general public, however, do not seem to regard stuttering in as serious a l ight . They derive great pleasure from comedians playing the part of the stutterer but do not react in the same way to fun at the expense of certain other defectives. The thoughtless acceptance by the public of this r idicule unfortunately does not eliminate or minimize the stutterer's personality problems or improve his outlook which is intimately tied up with his abnormal mode of expressing himself. The influence of stuttering on the personality (3,4) has been studied by Johnson. He worked Intensively with a group of 80 subjects - 61 males and 19 females - whose ages ranged from 7 to 42 years, - 18 -the average age being 19«2 years. As a result of his study he concludes that the emotional and social maladjustments which are characteristic of stutterers are not the cause of the speech-trouble but rather are the re-sult of i t , He reports 8.1so that the stutterer does not react in any important way to stuttering as such but rather to stuttering as he preceives or defines i t , Johnson found that the common ways of defining (35) the defect were as follows: "1. a handicap 2. a. mark of infer ior i ty 3. a. way to talk, inconvenient at times but not an important reason for worry or shame A. an advantage with respect to certain kinds of adaptation." The stutterers who place their defect In the f i r s t or second categories are usually•retiring and shy and do not l ive a normal social l i f e . Hhej have a biased and distorted outlook upon others who have no a f f l i c t i o n . They are often very c r i t i c a l of the good times that they see those about them enjoying and, by their crit icism, indicate their own. longings to have part In the fun with the others. -Certain other stutterers, while sensitive of the definite handicap of their particular mode of speech, tend to make a more adequate adjustment. These people may compensate for the disabi l i ty by attaining s k i l l In some socially approved act iv i ty . A case in -point is that of a young man, 21 years of age? seen in the Provincial Psychiatric C l in ic , Vancouver. He is a ta.ll handsome lad with dark wavy hair a flashing smile who always appears well and neatly dressed, He Is well - 19 -endowed as far as intelligence Is concerned, achieving a superior adult rating on the 1916 Stanford Revision of the BInet-Simon Scale, He has a. very healthy outlook with regard to Ms disabi l i ty and he compensates for i t by his definite excellence upon the saxophone. He is not seclusive but Is rather an outgoing personality attending parties with his music, mixing with others of his own age and thoroughly enjoying himself. In his work, too, this young man has made a satisfactory adjustment; he is a. bookkeeper in a business concern where .he does not have to meet the public. This boy, however, is not reconciled to his d isabi l i ty , He regards i t as a decided restr ict ion upon his l i f e , both in the social and business worlds, and consequently is a co-operative, well motivated subject in speech correction work. In the treatment of stuttering the modern schools of speech therapy seem to have one thing in common, namely: consideration for the hygiene of the personality for each individual case. The social environment of the stutterer is carefully examined for any fa.ctors that tend to produce mental conflicts or other unhygienic mental states. If such conditions are found, pains are taken to remedy the situation. For instance, i f a case shows fear and embarrass-ment as a result of social reactions to his speech, this mental attitude must, be overcome as soon as possible and the stutterer's confidence in himself restored. He may be shown that he is misinterpreting the be-havior of his auditors and that the source of his discomfort and conse-quent distaste f'-or meeting and talking with people is this mistaken inter-- 20 -pretation of their thoughts and behavior, "A main goal to be achieved in the education of the stutterer's attitude toward his trouble is his Impersonal evaluation of his d isabi l i ty . He must learn to objectify i t and In some cases to accept i t . The common practice of shielding him has worked against i n -stead of for h i m , , , , . . He has often been taught to keep his trouble to himself, and as a consequence he often becomes undesirably Introverted. Let us and the stutterer acknowledge f i r s t of a l l that he has a defect and that he and we are going to study I t , " (36) - 21 -CHAPTER IV  SOME HISTORICAL THEORIES OF STUTTERING - 22 -' CHAPTER IV SOME HISTORICAL THEORIES OF STUTTERING Theories to account for stuttering and therapeutic methods based upon them are to be fo^ n^d in a l l ages. The early theories are unrefined as contrasted with most modern explanations and they deal with the most obvious aspects of the disorder- They postulate some: ana-tomical anomaly or physiological dysfunction in the peripheral apparatus of speech so they direct their treatment to this region, (37) There i s , for example, the prescription of Celsus, a Roman physician-, Reports state that he had his patient gargle a decoc-tion of thyme, hyssop and pennyroyal, drink.much water and have the heed, neck and mouth well rubbed. Further, he should chew such substances as mustard, garlic and onions, at the same time making decided efforts to articulate. There is no available record of the success attending this method of treatment but i t may be suspected that any curative value would l i e in suggestion or the distractive qualities of the medication. Surgery has had a place in the treatment of stuttering, operations being performed upon the structures of the mouth -the s T r m i p t o m center of the disorder. There is record that, as early as (38) 200 A, D. , Galenus employed cauterization of the tongue. In 18i,l Yearsley (39) and Braid were operating on the tonsils and uvula as a means of securing re l ie f . Another group of surgeons directed their efforts to the tongue. Fletcher aptly remarks; "Almost every muscle of the tongue seems in i ts turn - to have been cut in the hope that the seat of the trouble might be located. The hypoglossal nerve was severed, the tongue was pierced with hot needles and blistered with, embrocations of Croton o i l . The lingual frenum was severed in the belief that It interfered with normal tongue movements", (40) (41) In I84I Dieffenback published the results of his work in the f ie ld of speech correction. He claimed that a cure of stuttering resulted i f a transverse sl ice was cut from the'tongue, thus making i t shorter. His technique Is in contrast with the practice of those who cut the lingual frenum for this latter operation lengthened this organ, It Is probable that distraction and suggestion account for any success attributed to surgery in cases of true stuttering. Surgical treatment of stuttering has been succeeded by more rational schools of thought upon the disorder. Most modern schools agree that there is no anatomical defect in the speech apparatus of the stutterer. The trouble is.'that this equipment is not used correctly. An early example of the functional approach is the method of treatment known as the '-American Cure. The founder of this (42) system of therapy was Mrs, Leigh'who, in 1825? stated that the stutterer's trouble was that he pressed the tongue- against the lower Incisor teeth when .attempting to speak. Cure based on this theory was simple, The stutterer could be assured normal speech i f he would press his tongue against the roof of his mouth when vocalizing, - 2 4 -CHAPTER ? SOME MODERN THEORIES OF STUTTERING CHAPTER.V - . SOME MODERN.THEORIES OF STUTTERING ' The newer theories which have been formulated to explain stuttering are more elaborate. The advocates of these systems make an endeavour to f i t their hypotheses to the objectively known data on the disorder. Another mark of differentiation is that these newer theories do not content themselves with,treating the symptoms. They are inclined.to go deeper and make an attempt to remove whatever they conceive to be the underlying causes. The chief modern theories which endeavour to ex-plain stuttering are: 1. Dunlap1s Theory of Vocabulary Taboo. 2. Fletcher 1s-Theory of Fear Conditioned by a Social Situation. 3- Travis' Theory of Reduction of Cortical Dominance. L. Bluemel's Verbal Image Theory. .5- Swift's Visual Central Asthenia Theory. 6. Psychoanalytic Theories. , .7. Adler's Inferiority Theory. A theory of stuttering, which would account for the sex difference in the incidence of this condition,: has been advanced (43) by Dunlap. This is the Vocabulary Taboo Theory. . It may be summarized as follows: The young boy at about the time that he starts to school acquires from his youthful - 26 -companions a vocabulary of obscene Tore's and. expressions. He realizes that, this new mode of expression, while making him a "regular fellow" with his playground associates, will be severely dealt with by his teachers and parents if It is heard by them. Fearing that he may disclose his tabooM vocabulary, he hesitates before speaking any word that commences with a sound similar to one of the profane- words. This hesitation, Dunlap maintains, is essentially the beginning of stuttering: it tends to be-come more marked and spreads to other sounds. Of course all young persons with a vocabulary of obscenities do not turn into stutterers. The unrefined young slum dweller is not concerned with repressing his improper language to the same extent but the jroung lad from a home of culture and refinement, es-pecially if he be of a "nervous" disposition, has something to conceal. He has great fear of what would -happen If an obscene word slipped out and therefore he Is likely to become a stutterer. This theory a.e.counts for the small number of female stutterers by pointing out that young girls do not a.cqnlre an obscene voca.bulary. They have nothing to conceal from their parents and teachers so they do not get into speech difficulties. In more recent writings Dunlap appears to have modified his theory of causation. He now says that the causes are varied from case to case. In some instances the defect may be the result of malnutrition. The nutritional factor is not the sole cause but rather it acts as a predisposing influence to poor speech habits when the child, is - 27 -brought up under adverse psychological conditions. These, it is stated., are wholly the result of the actions of the adults in the child's social environment, "Sometimes the child. Is restrained from speech unduly, sometimes he is forced, to speak when he strongly desires to be silent. Sometimes his mode of speech is constantly subject to criticism. Some-times he Is in constancb? fear lest he inadvertently reveal something he would rather his elders did not hear. Often his general emotional atti-tude is constantly upset by family or school situations and this distur-bance Is reflected in disturbed speech expression." (45) This explana-tion s t i l l permits some eases of stuttering to be accounted for by the vocabulary taboo hypothesis but leaves an opening for other influences and conditions in the etiology of. the defect. The basis of Dunlap's cure is a specific case of his Beta hypothesis - voluntary stuttering on the part of the patient-Practice is the requirement for response modification - the responses may be fixed hj practice or they may be-changed. Thoughts, desires and Ideals are the conditions which determine whether a response will be strengthened ' as it stands or be changed. "What we are to do, therefore, is to teach the patient to stammer voluntarily as nearly as possible in the way in which he now stammers Involuntarily. Then we must cause him to practise stammering in this way under the conditions of thought and desire appro- • priate to the destruction of the habit which we are using as the basis for the practice," (46) ' The first task of the psychologist who attempts to cure a stutterer is to point out to the patient the nature of his defect. Then he should motivate the patient so that he is desirous of speaking fluently. A speedy and effortless cure must not be'•promised, by the trainer, indeed, it must be impressed upon the subject from the start that a long course of treatment will be necessary. The stutterer must be warned not to try to avoid his disability except under conditions - 28 -prescribed by his trainer for such .an effort tends to f i x the habit. During the period of re-education, the stutterer's family should pay no attention to his speech and should refrain from comments. The practice period for speech therapy is usually about half an hour a day with best results from two quarter hour sessions. After three or four weeks of voluntary stammering a shift to ordinary speech may be attempted. If the patient has stuttered a phrase well, he Is told to speak It correctly. Should he succeed on the f i r s t t r i a l he Is asked to repeat i t a few times but, i f he fa i l s in this attempt, he is returned to voluntary stammering. From this point there Is an Increasing emphasis upon correct speech. According to Dunlap It may take from three to six months to attain some degree of normal vocalization depending 'on the Individual case. After treatment is suspended there should be frequent v is i ts to the•psychologist for observation. If there Is any sign of stuttering, the treatment is recommenced for a period unt i l the correct mode of response has been strengthened. The vocabulary taboo theory is open to criticism as an explanation of the sex difference in the incidence of stuttering. It does not provide any data to show that g i r ls do not have vocabularies of obscenities. To verify this theory It would be necessary to see If those g i r ls who do stutter have the obscene vocabulary. Then there should be a comparison of the vocabularies of stuttering and non-stuttering gir ls to see i f there is any significant difference. Again, the investigator* - 29 -should compare the v o c a b u l a r i e s of s t u t t e r i n g boys and g i r l s f o r elements of s i m i l a r i t y . Dunlap 's r e v i s e d theory seems to the w r i t e r to be one of the s i m p l e s t and most s c i e n t i f i c a l l y sound attempts t h a t has been made to account f o r s t u t t e r i n g . The t h e r a p e u t i c technique proposed employs acceptable p s y c h o l o g i c a l p r i n c i p l e s but r e q u i r e s f u r t h e r experimental v e r i f i c a t i o n to b u i l d up a body of s t a t i s t i c a l d a t a . F l e t c h e r considers s t u t t e r i n g to be a form of s o c i a l maladjustment. He would, t h e r e f o r e , probe the s o c i a l environment of each case to d i s c o v e r the b a s i c causes. This i n v e s t i g a t o r holds t h a t i n r e l a t i o n s w i t h h i s s u p e r i o r s the s t u t t e r e r i s p a r t i c u l a r l y s e n s i t i v e concerning the Impression t h a t h i s speech and a c t i o n s are making. F l e t c h e r s t a t e s : "The author b e l i e v e s t h a t i t ( i . e . s tut ter ing ' ) should be diagnosed and descr ibed as w e l l as t r e a t e d as a m o r b i d i t y of s o c i a l consciousness , a h y p e r s e n s i t i v i t y of s o c i a l a t t i t u d e , a p a t h o l o g i c a l s o c i a l response. The morbid elements i n t h i s s o c i a l response i n c l u d e t y p i c a l l y , f e a r , a n x i e t y , the f e e l i n g of i n f e r i o r i t y and k i n d r e d a t t i -tudes a r i s i n g out of a s t a t e of mind engendered by the r e a l i z a t i o n of the n e c e s s i t y to meet, through speech, c e r t a i n s o c i a l requirements . The memory of previous f a i l u r e s to meet s i m i l a r requirements serves to ' s e t o f f these r e a c t i o n s . Both the s o c i a l s i t u a t i o n and the emotional r e s -ponse to i t , we must p o i n t out, are s p e c i f i c not g e n e r a l , " (4-7) According to F l e t c h e r ' s theory the primary o r i g i n of s t u t t e r i n g Is i n a. chance occurrence . Upon on^e occasion when speaking w i t h a .superior the person f a i l s and t h i s I n a b i l i t y to express h i m s e l f makes such a profound emotional impression upon him that once again p laced i n a s i m i l a r s i t u a t i o n he stutter.-F l e t c h e r ' s cure i s to place the s t u t t e r e r i n a s p e c i a l environment where a l l h i s a c t i v i t i e s are d i r e c t e d so t h a t he may become conf ident of h i m s e l f i n a l l ".his s o c i a l r e l a t i o n s h i p s » This author - 30 -scouts c l i n i c a l handl ing of the i n d i v i d u a l case i n the a r t i f 5 c i a l e n v i r o n -ment presented i n a c l i n i c s i t u a t i o n . F l e t c h e r suggests a complete change of the whole day of the s t u t t e r e r , , He would gather together the students who have the defect i n t o a s i n g l e classroom group. T h e i r courses would be the same as those of the other c h i l d r e n but the s t u t t e r e r s ' c l a s s would be conducted i n such a '-ray that no undue a t t e n t i o n would be drawn to the speech d i s a b i l i t y . , There would be no occasion to make comparisons w i t h normal c h i l d r e n i n t h i s way a ccentuat ing the " s o c i a l m o r b i d i t y " . The a i m ' o f .such a c l a s s would be to draw the c h i l d out of h i m s e l f , develop h i s powers of s e l f - e x p r e s s i o n and d i r e c t him so t h a t he would develop a heal thy s e l f - c o n f i d e n c e i n h i s s o c i a l . l i f e . F l e t c h e r ' s theory i s the best s c i e n t i f i c e x p o s i -t i o n of the mental hygiene approach to the problem of s t u t t e r i n g . Other more p o p u l a r l y known r e p r e s e n t a t i v e s of the same school of thought are the Greene speech c l i n i c i n New York and the Dennison speech center at K i t c h e n e r , O n t a r i o , An obvious c r i t i c i s m of F l e t c h e r ' s theory i s t h a t I t i s merely an hypothesis w i t h no attempt made to give i t s t a t i s t i c a l s u b s t a n t i a t i o n . This theory i s not In accordance w i t h the r e s u l t s of Johnson's s t u d y , a lready mentioned, showing t h a t p e r s o n a l i t y problems develop a f t e r s t u t t e r i n g has se t i n and' thus do not o r d i n a r i l y have a place i n the e t i o l o g y of the defect . (43) (49) T r a v i s and Orton have advanced the theory that s t u t t e r i n g may r e s u l t from a r e d u c t i o n of c o r t i c a l dominance of the speech apparatus. They regard the human organism as a dynamic whole which func-tions as a unit, under different centers of physiological dominance. The most highly differentiated structures and functions need a very eff icient center of dominance to bind them together for effective action. The highest function of the human organism, according to Travis, Is speech, For adequate vocalization the respiratory organs, the vocal apparatus and the articulator?/- apparatus must work in harmony. Thus, there is need for a center of unification to control the operations of these diverse elements and prevent them from reverting to their more basic act iv i t ies . Both Travis and Orton point out that the le f t cerebral hemisphere of s t r i c t l y right-handed persons and the right cere-bral hemisphere of s t r i c t ly left-handed persons, contains the center of dominance for speech, It follows that anything that Interferes with these centers w i l l affect the speech and i t is on this basis that change of preferred handedness i s regarded as a causative factor in stuttering, Travis states Ills position: "I conceive frank right-handedness or frank left-handedness as such to present no problem in the organism so long as either is permitted i t s natural expression. It is., when either is inter-fered with to such an extent that through faulty training no handedness is preferred; or when natively no handedness is pre fer red . . . . . . . . that d i f f i cu l t ies arise," (50) To cure stammering Travis states•that i t is necessary to establish and maintain a. dominant speech gradient in the central nervous system of the patient. This may be accomplished, according to Travis, by requiring the subject to practise certain exercises. There are five1 divisions each of which must be taken in i t s proper sequence. - 32 -"The f i r s t period consists in free-hand drawing of circles on the blackboard. In this exercise, as in the rest that follow, the natively preferred hand is employed,. The length of training for this stage lasts from two days to a week depending upon the age and the progress of the case. "The second period, requires the writing of the alphabet and numerals. The alphabet should be written both In capitals and small letters. This period should not be shorter than a week for any person, "The third period consists of speaking and copying at the same time. The Individual begins to write each word before he speaks it, thus having the writing movements precede the spoken word. "The fourth period,....... should not be begun until the individual has become a facile left-handed writer. It consists of having him begin to write the first letter of a word just as or before it Is spoken in ordinary conversational speech. "As an individual's speech improves the number of sounds with which he has difficulty is reduced. The last period requires the individual to write the first letters of only those words which do cause difficulty." (51) This theory has been subjected to a great deal of criticism, Wallin, in his svrvej of the '89,057 St. Louis school children, discovered 1.8.44 dextro-sinistrals and of these 17°> or 9-4 percent had (52) speech defects. Other surveys have tended to confirm Wallin's results. Thus It is probable that a relatively small percentage of school children who become dextro-sinistrals develop stuttering. Recent writers upon this topic are inclined to take the position that change of handedness when accompanied by emotional upsets resulting from faulty methods of motivation and training may bring about an Interference with the rhythm of speech. Dunlap makes the unequivocal statements "So far as studies show, there is no basis for the old theory (i.e. that change in handedness results in stuttering) and parents of left—handed children may not fear to have the children's right hands trained, provided the training is correctly done. There i s no doubt that the use of brutal and incompetent methods of training children,-not only in respect to use of their hands, but in any way, may contribute to the production of stammering, or any other neurotic t ra i t , " (53) Johnson says: "Cr i t ica l analysis of data con-cerning the relative frequency of stammering among children to whom training has been given in changing from le f t hand to right preference in manual acts gives no basis for explanation of stammering as a result of this change." (54) Dorcus•and Shaffer state their position: "There Is one factor which Travis has ignored in his discussion, namely, the widespread belief that a change in handedness produces s t u t t e r i n g . , , . , . It is 'possible that suggestion or belief in this idea is the predominant element in the situation. Since stuttering may be relieved by suggestion in many cases, auto-suggestion is not an improbable cause , . , . , . The writer wishes to stress the fact that a change in handedness i t s e l f may not cause stuttering but the method employed in changing the manual habits is of paramount importance." (55) Bluemel has advanced'a theory of auditory amnesia in the stutterer's brain when attempting to speak to account for the dis-order. His theory accepts as fundajnental the proposition that we speak as we think, If we think in English we speak English; If our thoughts are hurried so is our speech, "We make sl ips of the tongue only as we make (56) sl ips of thought". $he stutterer ?;ho says p - p - pounds or there - there -there does so because he repeats this in bis mind. He has no trouble in. saying the letter "p" or the word "there"; rather his d i f f i cu l ty is in passing on to what follows. Now, in the mental image of a word there are two elements, an auditory image, the sound of the word as we hear i t and a motor image, the kinesthetic Images as we speak the word. There are times when the motor image is recalled without the sound image. As a consequence 3U -of this partial reca l l the word as the subject speaks i t is fragmented. The speaker has only the motor image to go by.so his speech is broken thus: "p - p - pounds'.' He is unable to complete the word unt i l he hears i t mentally. To speak fluently i t i s necessary to have both the auditory image and the kinesthetic image of what is to be said. In the more severe cases of stammering the motor image as well as the auditory image may be lacking - the whole word Is absent from the mind. When this is the condition the stammerer makes no attempt to pronounce the word but repeats the preceding word in the hope that the missing images may return. His speech, in this type of stammering, is after the fashion; "there - there - there", Irf the most severe cases of stammering, a l l mental speech may be completely wiped out. There is no verbal imagery and as a consequence no attempt at speech. The only activity i s contortion of the fac ia l muscles, holding of the breath, writhing on the chair and similar movements. The speech output is n i l becau.se there is no verbal thought, states Bluemel,. Even If i t i s granted that stutterers have this amnesia there s t i l l remains the problem of accounting for the phenomenon. Bluemel attempts an explanation by theorizing that a rush of blood to the'., head or perhaps cerebral anemia, may account for the loss of imagery. The author does not state definitely the reason for the postulated circulatory disturbances but his writing suggests that fear of a social situation may be a causative factor. Here, apparently, - 35 -i s a v a r i a t i o n o f F l e t c h e r ' s t h e o r y . I n d i s c u s s i n g "social m o r b i d i t y " as a p r e c i p i t a t i n g f a c t o r i n s t u t t e r i n g i t was p o i n t e d out' t h a t e v i d e n c e seems t o i n d i c a t e that the s t u t t e r e r does n o t s t u t t e r because he I s a f r a i d o f a s o c i a l s i t u a t i o n but r a t h e r that he may be a f r a i d of a social situation because he s t u t t e r s v - . , Bluemel has f o r m u l a t e d a v e r y definite system for t h e cure o f stammering. He s a y s : "The remedy f o r stammering c o n s i s t s i n th o u g h t t r a i n i n g rather t h a n speech training. T h i s i s n e c e s s a r i l y so ? since stammering i s a thought d i s t u r b a n c e and n o t a speech defect. In the c o r r e c t i v e t r a i n i n g , thoughts a r e d i s c i p l i n e d by d u l l i n g them l i k e soldiersj t h e y a r e brought f i r s t i n t o l i n e , then I n t o s t e p and f ina l l y I n t o o r d e r l y maneuver," (57) During t h e c o u r s e o f t r a i n i n g t h e s t u t t e r e r speaks o n l y i n res p o n s e t o s i g n a l s g i v e n w i t h a c a s t a n e t by the instructor. A l i g h t t o p I s t h e s i g n t o speak, a l o u d one the s i g n t o s t o p ; w h i l e two l i g h t tops indicate t h a t the s u b j e c t is t o r e p e a t . By means of t h e s e s i g n a l s the instructor compels h i s s u b j e c t t o t h i n k one sentence a t a t i m e , thus a v o i d i n g t h e c o n f u s i o n o f r u s h i n g h e a d l o n g i n t o speech without s u f f i c i e n t t h o u g h t . The p u p i l is t o t r a n q u i l l i z e h i s emotions d u r i n g the pauses i n d i c a t e d by t h e instructor and d e c i d e what to say n e x t - If he s t a r t s t o s t u t t e r he i s im m e d i a t e l y stopped and t h e r e i s ' a p r o t r a c t e d , pause d u r i n g which he composes h i m s e l f . He i s then s i g n a l l e d t o c o n t i n u e . T h i s form of d r i l l is k e p t up w i t h g r a d u a l l y i n -c r e a s i n g l e n g t h s between the pauses u n t i l c o n s i d e r a b l e improvement i s ap p a r e n t . Then t h e s t u t t e r e r i s advanced a s t a g e . He i s a l l o w e d t o s i g n a l for h i m s e l f b u t h i s t e a c h e r i s always p r e s e n t t o c o n t r o l him i f h i s s t u t t e r shows a tendency t o r e t u r n . A f t e r a c e r t a i n f u r t h e r sts.Te o f progress i s reached the pupil i s permitted to talk without the signals. H e must speak with care and pause at the end of each sentence for the purpose of regaining composure and to permit him to formulate his next thought. This method of treatment is•consistent with the theory that stuttering i s a defect of thought and not of speech, for i t trains the pupil to think before he speaks. We are not,.'however, able to judge the efficacy of t h i s method i n practice for Bluemel supplies no s t a t i s t i c s . Of greater import than t h i s , however, i s the fact that the theory of causation i s open to serious c r i t i c i s m . In the f i r s t place i t i s not proved that there i s a lack of auditory images i n the mind of the stutterer when,he attempts to speak. Bluemel bases his hypothesis upon the returns of a questionnaire which he gave to a number of stutterers In an attempt to discover the nature of the characteristic imagery of t h i s type of speech defective. Data gathered from a small number of stutterers un-trained i n the exacting art of introspection cannot be accepted as adequate evidence of the presence or absence of auditory images. The nature of mental imagery i n normal people i s one of the psychological problems about which least i s d e f i n i t e l y known. Bluemel has, therefore, no standard type of mental imagery with which to compare that which he reports to be ty p i c a l of bis sjpeech defectives. The supposed cause may be one of the effects of the dis-order. I t may be that the stutterer while tal k i n g cannot f i n d auditory imagery because he i s entirely preoccupied with the formation of speech. Again, the ideo-metor theory Is inadequate to account for movement and speech. The cue to speech need not always be the auditory. image of the sound to be produced. While auditory images may be useful they are too vague to be the sole guide to the delicate processes of speech production.' A further theoretical c r i t i c i s m of Bluemel !s theory may be made of his assumption that speech and thought may be separated. Such an assumption runs, counter to the teachings of the- behavioristic psychology. The use of the castanet i n the correctional t r a i n i n g i s open to c r i t i c i s m on the grounds that i t i s : a distraction mechanism akin to arm beating, head moving and finger snapping, as employed i n certain popular cures. A theory similar to Bluemel's i s the "visual central as-(58) thenia" theory of Swift, who contends that faulty v i s u a l imagery, i s res-ponsible for stuttering. He worked with a group composed of stutterers and normal speakers and had them repeat test sentences such as, "The dog ran across the busy street". When a subject had repeated one of the sen-tences he was required to give,a report of his imagery for the period of speaking. ... Normal speakers, according to Swift, reported that they experienced v i s u a l imagery of the objects or situations about which they talked or of the words as seen on a printed page. The stutterers stated that they had l i t t l e or no imagery or visualization at the time of speaking. From the results of this experiment, Swift makes the generalization that severity of stuttering varies inversely with the clear-ness of visua l imagery at the time of speech. Swift would cure stuttering by strengthening the v i s u a l imagery of his patient. This might be done by requiring the subject to talk about pictures or scenes which are d i r e c t l y i n front of him. As his speech improves, the stutterer could gradually s h i f t to more remote and more abstract topics for his conversation. This theory may be c r i t i c i z e d on the ground that the CUB to speech need not always be a vi s u a l image. Many persons, indeed, report that they never experience vis u a l images at a l l . I t should also be pointed out that Swift has not proved that the stutterer lacks visual imagery at the time - of speech. The subject may be putting so much effort into his attempts to speakthat he f a i l s to Introspect and consequently i s unable to report any imagery he may experience. In the present hazy state of know-ledge with regard to imagery and the lack of support for Swift's findings, i t seems unwise to take too seriously the apparent differences i n imagery between stutterers and normal speaking individuals. This theory offers no adequate explanation for the transitory nature of the "visual central as-thenia". I t i s probable that cures based upon the therapeutic tech-nique proposed by th i s theory could be accounted for on the basis of di s -t r a ction of the subject's attention from the act of speech. Hollingworth aptly says: " I t cannot be too strongly emphasized that the effectiveness of therapy has very l i t t l e to do vrith the accuracy of the theory on which the therapy i s based. This i s true even i n getting r i d of mosquitoes".(59) • Psychoanalysts have not neglected the f i e l d of stuttering. (60) The theory next to be presented, that of Borden and Busse, i s perhaps the best, elaborated treatment of the analysts on this particular topic. These authors c l a s s i f y stuttering as a defect of speech which develops on the basis of a neurotic personality. They make the statement: "The symptoms of stammering arise as the direct or Indirect result of the non-absorption of certain mental processes into the main stream of consciousness". (61) These non-absorbed mental processes arise as a res u l t of certain desires which the person must Inhibit and which, because of his Sensitive nature, he feels that he cannot acknowledge as part of his make-up. He does not make a healthy adjustment by admitting th e i r presence and attempting t h e i r control. Instead, he f a i l s t o assimilate them and, by "purposeful forgetting", represses them to the unconscious mind where they take on an "autonomous existence and act as i r r i t a t i n g foreign bodies (62) which are not properly absorbed by the digestive system". Thus stuttering i s the symptom which indicates that the subject i s the victim of psychic indigestion. The repressed desires of the stutterer are not content to remain i n the unconscious mind i n a state of i n a c t i v i t y . Instead, they are continually f i g h t i n g to get an opportunity to express themselves, and. i n very subtle ways too, for they are wily;,' enough to disguise their r e a l natures. They attempt to s l i p up past the censor i n symbolic forms which manifest themselves as stuttering. Thus stuttering i s a code language by means of which the repressed desires i n the 'unconspious mind of the patient come to expression. The anxiety which i s such an important item i n the symptom-atology., of stuttering i s to be interpreted as the person's fear of inad-vertently disclosing the presence of "The incestuous, criminal and asocial (63) desires which he has banished to the c e l l a r of his mind." This, fear .also has the effect of disturing the ordinary smooth flow-of speech. For the treatment of t h i s condition the authors recommend that the stutterer have recourse to a psychoanalyst. He w i l l interview the patient and w i l l discover the nature of his repressed 1desires by the . usual procedure of dream analysis and the examination of childhood memories. These.desires, when discovered, are explained to the patient and, once he. comprehends them, the symptoms of stuttering are said to vanish. The writers quote William Stekel, a Viennese neurologist, on the mechanism of the cure. "In psychoanalysis we open the graves of buried desires. Gut of them spring wild passions as from Pandora's Box. But these cannot stand the l i g h t of day. They fade and die, never to appear again. I t i s only the repressed thought that can l a s t i n g l y disturb the equilibrium of the soul". (64) This method of treatment i s for Borden and Busse "The only system of therapeusis that holds out the promise of a s c i e n t i f i c and (65) permanent cure". They do admit, however, that there are three disadvantages to t h i s method. F i r s t , there i s the d i f f i c u l t y of e n l i s t i n g the services of a s k i l l e d psychoanalyst. The second disadvantage i s the r e l a t i v e l y long time necessary for completion of the treatment and t h i r d there i s the almost prohibitive cost of treatment. The most obvious c r i t i c i s m of this therapeutic method i s to c a l l attention to i t s basis i n psychoanalysis. I t rests .upon such un-founded psychological assumptions as the unconscious mind, the eensor, Suppressed desires and catharsis. Since none, of these assumptions have been demonstrated s c i e n t i f i c a l l y and since t h e i r physiological mechanisms have never been demonstrated, the. theory which rests upon them tends to become suspect. Other members of the psychoanalytic school have discussed - (.66)' stuttering but not to the same extent,as Borden and Busse. Freud proposes an explanation based upon psychic trauma. He believes that the words upon which the patient stutters. • are related to: particular psychic shocks which he attempts to repress. , Conflict results and may manifest i t s e l f i n a hesitating mode of speech. (67) Idler has advanced an i n f e r i o r i t y theory to account for stuttering. He states : that this speech defect i s an attempt to withdraw by-means of passive resistance from the superiority of others. I t is. based upon an intense feeling of i n f e r i o r i t y i n the mind of the person who mani-fests the disorder. Adler holds.that the stutterer actually derives- s a t i s -faction from his a f f l i c t i o n . ; He believes that the patient thinks' thus: "What I would have been and done i f I were not a stutterer". This theory assumes that the stutterer's I n f e r i o r i t y i s not I n i t i a l l y connected with his speech but may be associated with any of . the bodily functions. There.is, however, no re l i a b l e evidence to indicate that stutterers, as a group, are i n f e r i o r i n any anatomical or physiologi-cal respect or that they experience feelings of i n f e r i o r i t y to a greater extent than non-stutters. I f Idler's contention i s correct, i t may be that - 42 -the increased feeling.of i n f e r i o r i t y on the part of the stutterer i s due to the fact that he stuttersvs. - A3 -CHAPTER VI CONCLUSION - 44 -CHAPTER VI  CONCLUSION It seems apparent that one .theory oennot adequately ex-plain the phenomenon which i s termed stuttering. Perhaps i t would be nearer to the truth i f we spoke of the "stuttarings" as we now speak of the epilepsies. Such a terminology would permit stuttering to be the symptom or end point of a number of physiologically or psychologically disturbing influences. Dunlap's revised theory,which makes provision for a number of causal factors, seems to be the most acceptable of those discussed; stuttering undoubtedly may result from a number of factors or combinations of factors. It does not seem probable, however, that one theery of stuttering can harmonize a l l the objectively known date upon the disorder into a satisfactory synthesis. Children of lowered visual acuity and those of weakened auditory acuity are given special classes or even a special school by the educational authorities of the Province. The mentally subnormal child has the advantages of a special class in which he i s grouped with other children of his own type. Here he i s able to com-pete with persons of his own level and his classroom instruction Is so planned as to develop his potentialities to their fullest extent, at the same time training him to be a useful citizen insofar as possible. At the present time there is a movement on foot to make some provision in the schools for the treatment of reading disability - 45 -eases for whom remedial instruction i s definitely indicated. Unfortunately, up to the present time, no serious at-tempt has been made by the school authorities anywhere In British Colum-bia to diagnose or treat speeeh defeets in the school population. From time to time there are itinerant speeeh trainers who come to the Prov-ince and, from reports received by the writer, i t mould appear that these persons make a financial success of their treatment. Most of the therapeutic techniques employed by such persons are of the type based on the principle of distraction. Methods of speech correction involv-ing this principle have already been discussed. The author would strongly urge the school administra-tors to Investigate the possibility of engaging the services of a sci-entifically trained speech therapist, to act as Director of Speeeh Correction. This person Bhould be empowered to hire the staff deemed neeessary and should organize and direct the correctional program. Logically, the work of such a correctional program would f a l l into three divisions. The f i r s t problem would be to dis-cover the speech defective children in the schools. It seems feasible to include a preliminary speech test as an integral part of the ex-isting system of medical examinations. The medical authorities would be responsible for reporting the speeeh defective children to the Director of Speech Correction. The second division of the work would be to diagnose the speech defect of the child. This would necessitate a complete e l i n i c a l examination of each child manifesting a speech disorder. Each, ease at this stage would be treated as an individual problem and would , be studied from a l l possible angles. Heredity and family history would be investigated for stuttering, left-handedness, reading disabilities and abnormal mental conditions. There should be a complete physical examination with considerable emphasis upon neurological tests. The developmental and health history of the subject should be correlated v/ith the physical findings. The emotional l i f e also warrants a thorough investiga-tion for often psychic trauma are as potent as physical injuries to the finely eoordinated functions of the human organism. There should also be an individual intelligence test and a thorough investigation of preferred handedness. The school history of the child should be at hand and, bearing in mind what the previously noted fields of investigation have disclosed, the examiner should attempt to account for any marked de^ viations in progress. On the basis of these data the c l i n i c a l group which studies the child w i l l probably be able to diagnose the particular speech defect involved. When the diagnosis has been made i t w i l l be necessary to determine the type of treatment to be advised. The actual treatment of the case constitutes the third step in the handling of the speech defective. It would be advisable - 47 -to group a l l stutterers of similar age and ability in elasses of their own. In a large school administrative area such as Vancouver i t might be well to have a special school for the estimated one per cent of the school population who stutter (approximately 389 children). In any f a i r l y densely populated rural area i t would seem feasible to gather a l l the stutterers from the area into one school where the trained speech therapist would work. Children in such schools or classes would study the ordinary curriculum but would have as a group work of a general correct-ive nature such as breathing exercises, speech in unison and singing. With such children the rivalry in the homogeneous group would be a pow-erful incentive to normal speech. Each case in a special class of this type would also receive individual correctional training for his particular disability. The writer would suggest the use of Dunlap's method for this part of the therapy program. That i s , the stutterer would be required to prac-tice voluntary stuttering to rid himself of his poor speech habits. The optimum time spent in voluntary stuttering would be approximately half an hour a day. It i s probable that in many cases such a treatment pro-gram would not be indicated. The nature of the specific individual therapy would be suggested by the causative factors as found by the c l i n i c a l study of the case. Some cases where handedness i s involved might profit more by the type of training advocated by Travis already -48-outlined in the discussion of his theory. Others might respond to the theory suggested by Bluemel. No matter what type of therapy is em-ployed the trainer must recognize that suggestion w i l l probably play an important part in the cure i f one is to be effected. The writer i s aware of the di f f i c u l t i e s that would l i e in the way of a system of speech correctional classes or schools of the type outlined. To secure the financial support necessary to i n s t i -tute and maintain the proposed program would be most d i f f i c u l t . It would be hard to recruit a trained personelle for this work from the teachers of the Province as they have no opportunity for developing speech correctional methods or techniques. As yet no Canadian univer-sity seems to be aware of the rapidly developing science of speech therapy as absolutely no provision for i t s study i s afforded in any existing university curriculum in Canada. No matter how great the d i f f i c u l t i e s involved in start-ing a speech correction program the writer sincerely believes that i t should be commenced immediately on as large a scale as possible. REFERENCES 1. Travis, i . . E.: "Speech Pathology" - Appleton-Gentury'-New York - 1931 - P- 35. 2. Seth, G. and Guthrie, D.s "Speech i n Childhood" - Oxford University^ Press - London - 1935 - P« 14-3- Ibid: p. 15-4. Ibid: ; p. 17. 5- Travis, L. E.: op. c i t . - p.. 9-6. Ibid: p. 36. 7. "Special Education: The Handicapped and the Gifted" being The Report of the Committee on Special Glasses of the White House Conference on Child Health and Protection - Century Co. -New York - 1931 - p. 376. 8. Ibid: p. 376. 9- Warren, H. C.:. "Dictionary of Psychology" - Houghton M i f f l i n - Boston - 1935 - a r t i c l e : "Stuttering" 10. "Special Education: The Handicapped and the Gifted": op.'cit. PP. 345-381. 11. Ibid: p. 356. 12. Ibid: p. 376. 13. Ibid: p. 376. 14- Conradi, E.: Speech Defects and I n t e l l e c t u a l Progress -"Journal of Educational Psychology" - 1912 -pp. 35-38. • . 15. Yfallin, J . E. 1.: " C l i n i c a l and Abnormal Psychology" -Houghton M i f f l i n - Boston - 1927 -' p. 464. 16. L o u t t i t , C. M.: " C l i n i c a l Psychology" - Harper and Brothers -New York - I936 - p. 436. 17. Ibid: p. 428. 18. "Canada Year Book 1937" - King's Printer - .Ottawa'-- 1937 -p. 963. 19. Ibid: p. 963. 1 20. "Annual Reports of Vancouver City Schools for Years Ended December 31, 1934 and December 31, 1935 - p. 56. - 50 -2 1 . West, Robert: "The Phenomenology of Stuttering" i n "A Sym-posium on Stuttering" - Edited by West, R. -College Typing Co. - Madison, Wis. - 1 9 3 1 -p. 1 . 2 2 . L d u t t i t , 0 . M.:. Op. c i t . - p. 4 3 6 . 23- Travis, L. E.: Op. c i t . - p. 1 0 1 . 24- Silverman, B.:/ Stuttering and A l l i e d Speech Defects - "Jour. Can. Med. Assoc." - V o l . 27 - p . 271. 25. ¥/est, P i . : Op. c i t . - p. 6. 26. Ibid: Op. c i t . - p. 6. 27. Fletcher, J. M.: "The Problem"of Stuttering" - Longman's New York - 1 9 2 8 - p. 81. 28. Ibid: p. 80. 29- Travis, L. E.: "Handbook of Child Psychology" - Edited by Murchison, C. - Clark University Press -Worcester, Mass. - 1 9 3 3 - A r t i c l e : "Speech Pathology" - pp. 6 5 0 - 6 9 8 . 3 0 . Travis, L. E.: "Speech Pathology" - Century - New York -1 9 3 1 - p. 1 0 1 3 1 . Travis, Malamud and Thayer: The Relationship Between Physical .Habitus and Stuttering -;"Jour. Abnormal & Social Psychology" - Vol. 2 9 , No. 2 -pp. 1 3 2 - 1 3 9 . 32. Ibid: p. 1 3 8 . 3 3 - Klineberg, Otto: "Race Differences" - Harpers - New York -1 9 3 5 - PP- 2 4 5 - f f . 3 4 - Johnson, W.: "The Influence of Stuttering on the Personality" -University of Iowa Press - Iowa City - 1 9 3 2 . 3 5 - Ibid: p. 1 3 1 . 3 6 . Travis; L. 1 / : . : Op. c i t . - p. I 8 4 . 3 7 . Fletcher, J . M.: Op. c i t . - p. 9 4 . 3 8 . Ibid: p. 9 5 -3 9 - Ibid: p. 9 5 . 4 0 . Ibid: p. 9 6 . 4 1 . Ibid: p. 9 6 . 42. Ibid: p. 99-43. Hollingworth, H. L.: "Abnormal Psychology" - Ronald Press -New Sork - 1930 - p p . 442-443. 4 4 - Dunlap, K.: "Habits - Their Making and Unmaking" - Liveright -New York - 1932 - pp. 196-210. 45. Ibid: pp. 198-9-4 6 . Ibid: pp. 2 0 2 - 0 0 3 . 47. Fletcher, J .M.: Op. c i t . - p.226.. 4 8 . Travis, L. E-: Op,, c i t . - passim. 49- Ortoh, S. T.: "Reading, Writing and Speech Problems in Children" - Norton - New York - 1 9 3 7 . 5 0 . Travis, L. E.: Op. c i t . - p. 59-51 Ibid: p. 187. 52. Hollingworth, H.L.: Op. c i t . - p. 43,8. 53. Dunlap, K.: • Op. c i t . - p . 198. 54- Johnson, B.: "Ghild Psychology" - Charles Ihomas - Springfield - 1 9 3 4 - P- 181. 55. Dorcus, R. M. & Shaffer, G.W.: "Text Book of. Abnormal Psychology" - Williams and Wilkins - Baltimore -1935 - p. 73. 56. Bluemel, C. S.: "Mental Aspects of Stammering" - fifilliams and Wilkins - Baltimore - 1930 - p. 4 0 . 57. Ibid: p. 53-58. Hollingworth, H.L.: Op. c i t . - p. 445-59. Ibid: p.'446. 60. Borden and Busses: "Speech Correction" - Crofts - New York -1929. 61. Ibid: p. 280. 62. Ibid: p. 280. 63. Ibid: p. 281. 6 4 . Ibid: p. 282. 65. Ibid: p. 283-- 5 2 -66. Hollingworth, E.L.: Op. c i t . - p. 4.39. 67. Ibid: p. 440. 

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