_Bradyphasia._--Children that can already frame sentences take a surprising amount of time in speaking on account of the slowness of their diction. In D and W _m_ in the cerebral cortex the hindrances are still great because of too slight practice.
(3) The Motor Processes centrally disturbed.
_a. Centro-motor Dysphasia and Aphasia, Aphemia, Asymbolia, Asemia._--Children have not yet learned, or have hardly learned, the use of language, although their intelligence is already sufficient. There is no longer any deficiency in the development of the external organs of speech, no muscular weakness, no imperfection of the nervous structures that effect the articulation of the separate sounds, for intelligence shows itself in the child's actions; he forms the separate sounds correctly, unintentionally; his hearing is good and the sensory word-memory is present, since the child already obeys. His _not yet_ speaking at this period (commonly as late as the second year) must accordingly be essentially of centro-motor character.
In the various forms of this condition there is injury or lack of sufficient relative development either in the centro-motorium M or in the paths that lead into it, _d_, _e_, _f_ as well as _i_, _l_, _n_.
_[alpha]. Central Dysarthria and Anarthria._--In the child at the stage of development just indicated articulation is _not yet_ perfect, inasmuch as while he often unintentionally pronounces correctly sounds, syllables, and single words, yet he can not form these intentionally, although he hears and understands them aright. He makes use of gestures.
_Ataxic Aphasia (Verbal Anarthria)._--The child that already understands several words as sound-combinations and retains them (since he obeys), can not yet use these in speech because he has not yet the requisite centro-motor impulses. He forms correctly the few syllables he has already learned of his future language, i. e., those he has at the time in memory as sound-combinations (sensory), but can _not yet_ group them into new words; e. g., he says _bi_ and _te_ correctly, learns also to say "_bitte_," but not yet at this period "tibe," "tebi." He lacks still the motor co-ordination of words.
At this period the gesture-language and modulation of voice of the child are generally easy to understand, as in case of pure ataxic aphasia (the verbal asemia or asymbolia of Finkelnburg) are the looks and gestures of aphasic adults. Chiefly _n_, _f_, and M are as yet imperfectly developed.
_Central Stammering and Lisping (Literal Dysarthria)._--Children just beginning to form sentences stammer, not uttering the sounds correctly.
They also, as a rule, lisp for a considerable time, so that the words spoken by them are still indistinct and are intelligible only to the persons most intimately associated with them.
The paths _d_ and _i_, and consequently the centro-motorium M, come chiefly into consideration here; but L also is concerned, so far as from it comes the motor impulse to make a sound audible through M.
The babbling of the infant is not to be confounded with this. That imports merely the unintentional production of single disconnected articulate sounds with non-coordinated movements of the tongue on account of uncontrolled excitement of the nerves of the tongue.
_Stuttering (Syllabic Dysarthria)._--Stutterers articulate each separate sound correctly, but connect the consonants, especially the explosive sounds, with the succeeding vowels badly, with effort as if an obstacle were to be overcome. The paths _i_ and _l_ are affected, and hence M is not properly excited. S, too, comes under consideration in the case of stuttering, so far as impulses go out from it for the pronunciation of the syllables.
Children who can not yet speak of themselves but can repeat what is said for them, exert themselves unnecessarily, making a strong expiratory effort (with the help of abdominal pressure) to repeat a syllable still unfamiliar, and they pause between the doubled or tripled consonant and vowel. This peculiarity, which soon passes away and is to be traced often to the lack of practice and to embarrassment (in case of threats), and which may be observed _occasionally_ in every child, is stuttering proper, although it appears more seldom than in stutterers. Example: The child of two years is to say "Tischdecke," and he begins with an unnecessary expiratory effort, _T-t-itt-t_, and does not finish.
Stuttering is by no means a physiological transition-stage through which every child learning to speak must necessarily pass. But it is easily acquired, in learning to speak, by imitation of stutterers, in frequent intercourse with them. Hence, stutterers have sometimes stuttering children.
_[beta]. Stumbling at Syllables._--Children that already articulate correctly separate sounds, and do so intentionally, very often put together syllables out of the sounds incorrectly, and frame words incorrectly from the syllables, where we can not assume deficient development of the external organs of speech; this is solely because the co-ordination is still imperfect. The child accordingly says _beti_ before he can say _bitte_; so too _grefessen_ instead of _gefressen_.
The tracts _l_ and _n_ are still incompletely developed; also S and W, so far as impulses come thence to utter syllables by means of M.
_b. Paraphasia._--Children have learned some expressions in their future language, and use them independently but wrongly; they put in the place of the appropriate word an incorrect one, confounding words because they can _not yet_ correctly combine their ideas with the word-images. They say, e. g., _Kind_ instead of "Kinn," and _Sand_ instead of "Salz"; also _Netz_ for "Nest" and _Billard_ for "Billet," _Matrone_ for "Patrone."
The connection of D with M through _n_ is still imperfect, and perhaps also M is not sufficiently developed.
_Making Mistakes in Speaking (Skoliophasia)._--In this kind of paraphasia in adults the cause is a lack of attention; therefore purely central concentration is wanting, or one fails to "collect himself"; there is distraction, hence the unintentional, frequently unconscious, confounding of words similar in sound or connected merely by remote, often dim, reminiscences. This kind of mis-speaking through carelessness is distinguished from skoliophrasia (see below) by the fact that there is no disturbance of the intelligence, and the correction easily follows.
Skoliophasia occurs regularly with children in the second and third years (and later). The child in general has not yet the ability to concentrate his attention upon that which is to be spoken. He _wills_ to do it but _can_ not yet. Hence, even in spite of the greatest effort, occur often erroneous repetitions of words pronounced for him (aside from difficulties of articulation, and also when these are wanting); hence confounding (of words), wrong forms of address, e. g., _Mama_ or _Helene_ instead of "Papa," and _Papa_ instead of "Marie."
_c. Taciturnity (Dumbness)._--Individual human beings of sound physical condition who can speak very well are dumb, or speak only two or three words in all for several years, because they no longer _will_ to speak (e. g., in the belief that silence prevents them from doing wrong).
This taciturnity is not to be confounded with the paranoic aphrasia in certain insane persons--e. g., in catatonia, where the will is paralyzed.
It also occurs--seldom, however--that children who have already learned to speak pretty well are dumb, or speak only a few words--among these the word _no_--during several months, or speak only with certain persons, because they _will not_ speak (out of obstinacy, or embarrassment). Here an organic obstacle in the motor speech-center is probable. For voluntary dumbness requires great strength of will, which is hardly to be attributed to the child. The unwillingness to speak that is prompted by _fun_ never lasts long.
C. THE EXPRESSIVE PERIPHERAL PROCESSES DISTURBED.
(1) Dyslalia and Alalia (Peripheral Dysarthria and Anarthria).
The infant can _not yet_ articulate correctly, or at all, on account of the still deficient development, and afterward the lack of control, of the nerves of speech and the external organs of speech. The complete inability to articulate is called alalia. The newly born is alalic.
Dyslalia continues with many children a long time even after the learning of the mother-tongue. This is always a case simply of imperfections in _h_ and _z_.
_a. Bulbo-nuclear Stammering (Literal Bulbo-nuclear Dysarthria and Anarthria)._--Patients who have lost control over the muscles of speech through bulbo-nuclear paralysis, stammer before they become speechless, and along with paralysis and atrophy of the tongue occur regularly fibrillar contractions of the muscles of the tongue. The tongue is _no longer_ regulated by the will.
The child that has not yet gained control over his vocal muscles stammers before he can speak correctly, and, according to my observations, regularly shows fibrillar contractions of the muscles of the tongue along with an extraordinary mobility of the tongue. The tongue is _not yet_ regulated by the will. Its movements are aimless.
_b. Mogilalia._--Children, on account of the as yet deficient control of the external organs of speech, especially of the tongue, can _not yet_ form some sounds, and therefore omit them. They say, e. g., _in_ for "hin," _atz_ for "Herz," _eitun_ for "Zeitung," _ere_ for "Schere."
_Gammacism._--Children find difficulties in the voluntary utterance of K and Ks (_x_), and indeed of G, and therefore often omit these sounds without substituting others; they say, e. g., _atsen_ for "Klatschen,"
_atten_ for "Garten," _asse_ for "Gasse," _all_ for "Karl," _ete_ for "Grete" (in the second year), _wesen_ for "gewesen," _opf_ for "Kopf."
_Sigmatism._--All children are late in learning to pronounce correctly S, and generally still later with Sch, and therefore omit both, or in a lisping fashion put S in place of Sch; more rarely Sch in place of S.
They say, e. g., _saf._ in place of "Schaf," _int_ for "singt," _anz_ for "Salz," _lafen_ and _slafen_ for "schlafen," _iss_ for "Hirsch,"
_pitte_ for "Splitter," _tul_ for "Stuhl," _wein_ for "Schwein,"
_Tuttav_ for "Gustav," _torch_ for "Storch" (second year), _emele_ for "Schemel," _webenau_ for "Fledermaus," but also _Kusch_ for "Kuss." But in no case have I myself heard a child regularly put "sch" in place of _s_, as _Joschef_ for "Josef." This form, perhaps, occurs in Jewish families; but I have no further observations concerning it as yet.
_Rhotacism._--Many children do not form R at all for a long time and put nothing in place of it. They say _duch_ for "durch," _bot_ for "Brot,"
_unte_ for "herunter," _tautech_ for "traurig," _ule_ for "Ruhe,"
_tanen_ for "Thranen," _ukka_ for "Zucker." On the contrary, some form early the R lingual, guttural, and labial, but all confound now and then the first two with each other.
_Lambdacism._--Many children are late in learning to utter L, and often omit it. They say, e. g., _icht_ for "Licht," _voge_ for "Vogel,"
_atenne_ for "Laterne," _batn_ for "Blatt," _mante_ for "Mantel."
(2) Literal Pararthria or Paralalia.
Children who are beginning to repeat intentionally what is said, often put another sound in place of the well-known correct (no doubt intended) one; this on account of deficient control of the tongue or other peripheral organs of speech. E. g., they say _t_ in place of _p_, or _b_ for _w_ (_basse_ for "Wasser" and for "Flasche"), _e_ for _i_ and _o_ for _u_, as in _bete_ for "bitte," and _Ohr_ for "Uhr."
_Paragammacism._--Children supply the place of the insuperably difficult sounds G, K, X by others, especially D and T, also N, saying, e. g., _itte_ for "Rike," _finne_ for "Finger," _tein_ for "Klein," _toss_ for "gross," _atitte_ for "Karnickel," _otute_ for "Kuk," _attall_ for "Axel," _wodal_ for "Vogel," _tut_ for "gut," _tatze_ for "Katze."
_Parasigmatism._--Children are late in learning to utter S and Sch correctly. They often supply the place of them, before acquiring them, by other sounds, saying, e. g., _tule_ for "Schule," _ade_ for "Hase,"
_webbe_ for "Wasser," _beb_ for "bos," _bebe_ for "Besen," _gigod_ for "Schildkrote," _baubee_ for "Schwalbe."
_Pararhotacism._--Most children, if not all, even when they have very early formed R correctly (involuntarily), introduce other sounds in place of it in speaking--e. g., they say _moigjen_ for "morgen," _matta_ for "Martha," _annold_ for "Arnold," _jeiben_ for "reiben," _amum_ for "warum," _welfen_ for "werfen."
_Paralambdacism._--Many children who do not learn until late to utter L put in its place other sounds; saying, e. g., _bind_ for "Bild," _bampe_ for "Lampe," _tinne_ for "stille," _degen_ for "legen," _wewe_ for "Lowe," _ewebau_ for "Elephant."
(3) Bradylalia or Bradyarthria.
Children reciting for the first time something learned by heart speak not always indistinctly, but, on account of the incomplete practicability of the motor-paths, slowly, monotonously, without modulation. Sounds and syllables do _not yet_ follow one another quickly, although they are already formed correctly. The syllables belonging to a word are often separated by pauses like the words themselves--a sort of dysphasia-of-conduction on account of the more difficult and prolonged conduction of the motor-impulse. I knew a boy (feeble-minded, to be sure) who took from three to eight seconds for answering even the simplest question; then came a regular explosion of utterance. Yet he did not stutter or stammer. When he had only _yes_ or _no_ to answer, the interval between question and answer was shorter.
Here belong in part also the imperfections of speech that are occasioned by too large a tongue (macroglossia). When a child is born with too large a tongue, he may remain long alalic, without the loss of intellectual development, as was observed to be the case by Paster and O. von Heusinger (1882).
II. DYSPHRASIA (DYSLOGICAL DISTURBANCES OF SPEECH).
The child that can already speak pretty correctly deforms his speech after the manner of insane persons, being moved by strange caprices, because his understanding is not yet sufficiently developed.
_Logorrhoea_ (_Loquaciousness_).--It is a regular occurrence with children that their pleasure in articulation and in vocal sound often induces them to hold long monologues, sometimes in articulate sounds and syllables, sometimes not. This chattering is kept up till the grown people present are weary, and that by children who can not yet talk; and their screaming is often interrupted only by hoarseness, just as in the case of the polyphrasia of the insane.
_Dysphrasia of the Melancholy._--Children exert themselves perceptibly in their first attempts to speak, answer indolently or not at all, or frequently with embarrassment, always slowly, often with drawl and monotone, very frequently coming to a stop. They also sometimes begin to speak, and then lose at once the inclination to go on.