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bances are modi able by environmental circumstances Thus a certain proportion of stutterers will become more uent under certain conditions, such as reading aloud; others will stutter more severely at this time Again, a majority of stutterers will be adversely affected by talking on the telephone; a minority are helped by this device Some stutterers are more uent under conditions of mild alcohol intoxication Nearly every stutterer is uent while singing Schemes such as the encouragement of associated muscular movements ( penciling, etc) and the adoption of a theatrical approach to speaking have been advocated Common to all such efforts has been the dif culty of achieving carryover into the natural speaking environment Progressive relaxation, hypnosis, delayed auditory feedback, loud noise that masks speech sounds, and many other ancillary measures may help, but only temporarily Canevini and colleagues have made the interesting observation that stuttering improved in an epileptic treated with levetiracetam, and Rosenberger has commented on other drug therapies Cluttering, or Cluttered Speech This is another special developmental disorder It is characterized by uncontrollable speed of speech, which results in truncated, dysrhythmic, and often incoherent utterances Omissions of consonants, elisions, improper phrasing, and inadequate intonation occur It is as though the child were too hurried to take the trouble to pronounce each word carefully and to compose sentences Cluttering is frequently associated with other motor speech impediments Speech therapy (elocutionary) and maturation may be attended by a restoration of more normal rhythms Other Articulatory Defects These are most common in preschool children, having an incidence of up to 15 percent There are several varieties One is lisping, in which the s sound is replaced by th, eg, thimple for simple Another common condition, lallation, or dyslalia, is characterized by multiple substitutions or omissions of consonants Milder degrees consist of dif culty in pronouncing one or two consonants For example, the letter r may be incorrectly pronounced, so that it sounds like w or y; running a race becomes wunning a wace or yunning a yace In severe forms, speech may be almost unintelligible The child seems to be unaware that his or her speech differs from that of others and is distressed at not being understood These and similar abnormalities of speech are often present in otherwise normal children and are referred to as infantilisms Why they persist in some individuals is not understood More important is the fact that in more than 90 percent of cases, these articulatory abnormalities disappear by the age of 8 years, either spontaneously or in response to speech therapy The latter is best started if these conditions persist into the fth year Presumably the natural cycle of motor speech acquisition has only been delayed, not arrested Such abnormalities, however, are more frequent among the mentally retarded than in normal children; with mental defect, many consonants are persistently mispronounced Another type is a congenital form of spastic bulbar speech described by Worster-Drought in which words are spoken slowly, with stiff labial and lingual movements, hyperactive jaw and facial re exes, and sometimes mild dysphagia and dysphonia The limbs may be unaffected, in contrast to those of most children with cerebral palsy The speech disorder resulting from cleft palate is easily recognized Many of these patients also have a harelip; the two abnormalities together interfere with sucking and later in life with the enunciation of labial and guttural consonants The voice has an.

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