Neurotic stuttering is a type of stuttering caused by residual organic changes in the brain that occurred after undergoing pathological conditions in utero, perinatal or in early childhood. Neurotic stuttering is characterized by increased activity of speech, an abundance of concomitant motor skills, lack of logophobia, increased psychomotor agitation and after suffering from somatic diseases. As a rule, it occurs against the background of some delay in psychomotor development, certain motor disorders and insufficiency of the emotional-volitional sphere. Diagnosis is carried out by a speech therapist, neurologist and psychologist. The treatment plan includes medication therapy for cerebral disorders, speech therapy correction, classes with a psychologist and psychotherapy.
General information
Modern speech therapy distinguishes 2 types of stuttering: neurotic (logoneurosis) and Neurotic. The first is caused by psychotrauma and can occur at any age. The second is associated with disorders in the functioning of cerebral structures, which is why in practical neurology it is called organic. Neurotic stuttering, as a rule, develops during the period of intensive formation of speech function – in children 3-4 years old. In adolescence, such children may develop neurotic symptoms caused by the presence of a speech defect and more typical for logoneurosis. In this regard, many authors distinguish neurotic stuttering with neurotic layers, or the so-called mixed stuttering, as a separate type.
Causes
Unlike neurotic, neurotic stuttering has no connection with a traumatic situation. It is caused by functional changes in the central nervous system that have arisen as a result of one or another, perhaps not clearly expressed, organic pathology of the brain. The latter can be caused by adverse effects on the developing body of the child in the antenatal period, birth trauma, various diseases in the postnatal period. By the time stuttering occurs, organic changes in cerebral structures are usually residual, or residual.
Predisposing triggers that can cause neurotic stuttering include severe diseases of parents, usually of an infectious or neuropsychiatric type (tuberculosis, syphilis, schizophrenia, manic-depressive psychosis); harmful effects on the pregnant woman’s body (occupational hazards, smoking, substance abuse and drug addiction, taking medications contraindicated during pregnancy), complications of pregnancy (toxicosis, eclampsia, fetoplacental insufficiency, intrauterine infections, fetal hypoxia) and childbirth (asphyxia of newborns, intracranial birth trauma).
Not the least important are the hereditary factors underlying the genetic predisposition to stuttering. It is noted that many children with neurotic stuttering have close relatives with speech pathology.
Symptoms
Neurotic stuttering appears gradually and develops gradually, usually during the active formation of phrasal speech. The predominant localization of seizures in the articulatory apparatus is typical: lips, tongue and soft palate. They appear more sharply when pronouncing such consonant sounds as “b”, “g”, “p”, “d”, “t” and “k”. Speech activity is usually increased, tachylalia is characteristic. Often, neurotic stuttering appears against the background of pronounced dyslalia or existing dysarthria in an erased form. In some cases, there is a general underdevelopment of speech.
Usually, the speech movements of children with organic stuttering are insufficient in strength and volume, as a result of which their speech is monotonous and inexpressive, characterized by muffled pronunciation of sounds. Often such children accompany their speech with stereotypical movements (active gestures, sometimes with antics). In parallel, as a rule, there is monotony and some stiffness of movements, insufficiency of fine motor skills, poor facial expressions, elements of dysgraphy and dyslexia. Synkinesia is detected. Insufficient speed and dexterity in performing motor acts makes the child clumsy and sluggish. In the mental sphere, impulsivity, inertia, euphoria, switching difficulties, exhaustion and fatigue are noted. Fixation on one’s own speech defect is not characteristic, there is no logophobia. At the same time, the child does not have a special desire to get rid of the speech defect. In addition, overcoming stuttering is hindered by the immaturity of the emotional-volitional sphere.
Neurotic stuttering is characterized by a relative constancy of the intensity of speech disorders. Its strength does not depend on external psycho-emotional factors, there is no increase in stuttering characteristic of a neurosis-like form in an unfamiliar environment or in contact with unfamiliar people. Neurotic stuttering increases due to psychomotor agitation and a large speech load. Some deterioration of speech may occur with overwork and after somatic (acute gastritis, cystitis, glomerulonephritis, etc.) or infectious (measles, chickenpox, acute respiratory viral infections, influenza, sore throat, etc. P.) diseases.
At the age of 12-15 years, it is possible to attach neurotic symptoms in the form of anxiety and logophobia in the presence of outsiders. There is a decrease in speech activity, there is a fixation on difficult-to-pronounce sounds. There is an increase in stuttering in a psychologically uncomfortable atmosphere, but it is unstable. Stuttering takes a wave-like course, because it depends on the mental and physiological state of the child.
Diagnostics
In the anamnesis of patients with organic stuttering, one or another pathology of the ante-, peri- or postnatal period can be identified, indications of a delay in psychomotor development in the first 1-2 years of life. A neurologist’s examination reveals scattered residual neurological symptoms, signs of cerebrastenic syndrome (increased irritability, exhaustion, fatigue), various motor disorders, difficulties in performing coordination tests, instability in the Romberg pose. Typically, a poorly developed sense of rhythm and a disorder of friendly movements.
Diagnostic examination of speech includes diagnostics of oral speech and auditory-speech memory, diagnostics of written speech in schoolchildren. Instrumental examinations are carried out to identify cerebral organic pathology. Radiography of the skull usually reveals signs of hydrocephalus. Echo-EG — intracranial hypertension. Electroencephalography — functional disorders indicating the presence of organic changes; often increased convulsive readiness. CT or MRI of the brain can exclude intracerebral tumor, hematoma, cyst, encephalitis, arachnoiditis, cerebral vascular aneurysm, which can also be the cause of stuttering.
Differential diagnosis
Since neurotic stuttering can have neurotic symptoms, and signs of microorganics can be detected with neurotic stuttering, the differentiation of these two types of stuttering is more based on the causes of occurrence (psychotrauma or organic cerebral pathology) and the features of the onset of speech disorders (sudden or subtle gradual).
Neurological examination makes it possible to distinguish organic stuttering as a separate nosology from speech disorders, which are a syndrome of some neurological diseases, for example, hyperkinesis (most often torsion dystonia), in which the disorder of smooth speech is associated with hyperkinetic contractions of articulatory muscles.
In some cases, it is necessary to differentiate neurotic stuttering from the so-called stumbling (in foreign literature – poltern). The latter is characterized by indistinctness and acceleration of speech with omission and rearrangement of letters and syllables, often occurs in children with hyperactivity syndrome. The pathognomonic feature of stumbling is the improvement of speech when reading an unfamiliar text and its deterioration when reading a familiar text. Typically, the lack of awareness of their own speech problems.
Treatment
Neurotic stuttering is an interdisciplinary disease and its treatment requires the participation of specialists of several profiles – a neurologist, a speech therapist and a psychologist. Treatment of cerebral pathology is carried out with nootropics (pyritinol, piracetam, pig brain hydrolysate), metabolic (phenibut, glycine, ginko biloba, vitamins gr. C) and absorbable (hyaluronidase) drugs. To reduce intracranial pressure, diuretics (acetazolamide), a solution of magnesium sulfate are prescribed. In complex therapy, the use of homeopathic remedies is possible.
Regular speech therapy classes on correction of stuttering, as well as correction of dysarthria and correction of dyslalia contribute to the reduction of speech defect. Of no small importance are classes with a psychologist aimed at the psychomotor development of the child. The use of psychotherapy methods in the treatment becomes appropriate with a mixed nature of stuttering. Psychocorrection, art therapy, family psychotherapy, group psychotherapy, etc. can be used. If necessary, psychotherapy can be supplemented with the appointment of sedatives (valerian, motherwort) and antidepressants (amitriptyline, St. John’s wort extract, fluoxetine).
