The period of speech development in children is of variable duration. Generally speaking, boys learn to talk later than girls. Under normal con ditions one may expect a child of three years to be able to talk. But very often there are delays, and occasionally really bright children of five or six years of age arc unable to speak plainly.
Deaf-mutism is a peculiar form of speech disturbance, which is to be re garded as an arrested development of speech, to differentiate it from con genital deafness. If the child be otherwise bright, deaf-mutism can be cured with certainty by careful education under the supervision of a specialist. It is well to attempt this in the fifth year. To wait longer retards the child's progress at school and affects its later development.
Muteness is frequently found in children as a consequence of inhibitory irritations. Children fall sick so easily, for instance from intestinal irrita tion ; and it has been observed that children have become dumb from gorging themselves with cake, and have not regained the faculty of speech until after vomiting. Furthermore, cases have been reported where children who have spoken fluently have lost the power of speech because of the presence of worms, and not regained it until after the removal of these parasites. These causes must therefore be borne in mind when children remain mute for a long time. Adenoid vegetations are frequent causes of delayed speech.
Stuttering and stammering are the most frequent and most widespread anomalies of speech. Stuttering denotes a spasmodic disturbance which causes an arrest of the flow of language, by repetition of sounds and syllables, by repression of the voice, or by faulty breathing. The stutterer also makes grimaces ; at times he stamps with his feet, throws his hands about, and distorts and turns his body, all in order to overcome his impediment. Stuttering is frequently a family failing, so that the child may have a predisposition to it. But, as has been said, it often occurs as a result of imitation. Usually it is caused by undue haste in an attempt to say something quickly. It rarely results from a blow on the back, or from a beating or fall, as some persons suppose. The treatment is to he left to the physician. As stuttering children are often scrofulous and suffer from rickets, medical advice must be governed by the existing condition. Eating too much meat often makes children nervous, or aggravates an existing nervousness, causing speech disturbances. In such cases it is necessary to regulate the diet, choosing a vegetable fare in preference to a more stimulating one. It is not a rare occurrence for such a change in diet to cure stuttering. But the main thing
is to guard against stuttering from the very beginning. If it has developed, one should begin treatment immediately ; the longer the delay, the more difficult it becomes to cure the affection. Treatment should, if possible, be begun before the child goes to school. If stuttering only begins at this time, the child should be taken from school until cured, even at the expense of its education ; it should be spared the psychic excitement produced by its affection, which is aggravated by the teasing and scoffing of its companions.
In addition to a general treatment most cases demand also a specific one. This consists of exercises in the normal motions of speech. The stuttering child must learn to breathe normally when speaking, to cultivate the voice properly, and to pronounce correctly and without hesitation or spasmodic movements. In severe cases these directions can be carried out successfully only with the aid of a specialist. At the beginning of stuttering, it may at times suffice to speak slowly to the child and ask him to repeat slowly and distinctly.
The term " stammering " includes all faults of enunciation, whether made in the pronunciation of vowels or of consonants. Stammering of vowels is characterised by the substitution of short " a " (as in can) for long " a " (as in ale), or " e " (as in pen) for " u " (as in fun), etc. Some children drop initial " h's," saying " ut " and " Anna " instead of " hut " and Hannah." These mistakes are made occasionally by children who have foreign nurses.
Lisping of vowels includes what is called nasal speech. This can be produced in various ways—either by a congenital perforation in the palate (see HARELIP AND CLEFT PALATE), or when, following a sickness (for instance, diphtheria), paralysis of the soft palate occurs, or, finally, from relaxation of the organs of speech. It also exists where there are enlarged tonsils, which interfere with the movements of the uvula. The treatment depends upon the cause. In cases of congenital or acquired perforations of the palate, the openings are best closed by operation, or the patient may wear an apparatus (obturator) which closes the space. Such an obturator is very effective. It consists of an artificial plate with a plug which corresponds to the perforation, and it is attached with clamps to the teeth, like artificial teeth plates. After the operation has been performed and an obturator applied, it is necessary to make certain speech-exercises. If the nasal speech be the result of paralysis of the uvula, massage and electricity will cure the affection. In these cases speech-exercises are likewise necessary.