Speech rehabilitation of the bright word-deaf child follows along the same lines as that of the congenitally deaf one. Such a child learns to lip-read quickly and is very facile at acting out his or her own ideas.
In this developmental defect the child seems unable to coordinate the vocal, articulatory, and respiratory musculature for the purpose of speaking. Again, boys are affected more often than girls, and there is often a family history of the disorder, although the data are not quite sufficient to establish the pattern of inheritance. The incidence is 1 in every 200 children. The motor, sensory, emotional, and social attainments correspond to the norms for age, although in a few cases, a minority in the authors’ opinion, there has been some indication of cranial nerve abnormality in the first months of life (ptosis, facial asymmetry, strange neonatal cry, and altered phonation).
In children with congenital inarticulation, the prelanguage sounds are probably abnormal, but this aspect of the speech disorder has not been well studied. Babbling tends to be deficient, and, in the second year, in attempting to say something, the child makes noises that do not sound at all like language; in this way the child is unlike the late talker already described. Again, the understanding of language is entirely normal; the comprehension vocabulary is average for age, and the child can appreciate syntax, as indicated by correct responses to questions by nodding or shaking the head and by the execution of complex spoken commands. Usually such patients are shy but otherwise quick in responding, cheerful, and without other behavioral disorders. Some are bright, but a combination of congenital inarticulation and mild mental slowness is also not uncommon. If many of the spontaneous utterances are intelligible, speech correction should be attempted (by a trained therapist). However, if the child makes no sounds that resemble words, the therapeutic effort should be directed toward a modified school program, and speech rehabilitation usually waits until some words are acquired.
Studies of the cerebra of such patients are not available, and it is doubtful if they would show any abnormality by the usual techniques of neuropathologic examination. Occasionally, suspicion of a lesion is raised by focal changes in the EEG or a slight widening of the temporal horn of the left lateral ventricle. All manner of delayed speech is often attributed to being “tongue-tied,” that is, a short lingual frenulum, but this idea now seems outdated. Also, psychologists have attributed incomplete development of speech to overprotectiveness or excessive pressure by the parents but these are certainly the result rather than the cause of the delay.
A fuller review of this subject can be found in the text The Child With Delayed Speech, edited by Rutter and Martin.
These difficulties occur in an estimated 1 to 2 percent of the school population. Often the conditions disappear in late childhood and adolescence; by adulthood, only about 1 in 300 individuals suffer from a persistent stammer or stutter. Mild degrees are to some extent cultivated and permit a pause in speech for collecting one’s thoughts, and stammering appears to be an affectation in certain social circles, as in the past among educated Englishmen (and some Americans).