発症初期の吃音に関わる問題点と吃音への治療的介入

Problems regarding initial stuttering and therapeutic intervention

　自験例から発症初期の吃音への対応に関わる問題点を明らかにし，発症初期の吃音に対する環境調整法による介入の方法と結果を示した．

　問題点として，親は言語聴覚士の指導を受ける前は吃音の悪化要因に該当する行動を自覚のないままとり続けていたことが判明した．具体的行動では吃音児の発話への干渉，吃音への罰，子どもの発話行動の消極的拒否が認められた．これらの吃音に対する親の行動は自覚がないまま行われていた．また親が吃音に気付いてから受診するまでの期間が長いことが認められた．受診が遅れた理由は，発話症状が一時期消える期間があるという初期吃音の特徴を親が治癒と誤解していたことにあった．これらの問題を改善するには吃音に関する知識を啓蒙する必要が認められた．また，吃音児の親が言語聴覚士に相談できる体制の構築が必要であることが判明した．環境調整法による結果として，初期吃音17症例のうち10例の治癒を報告した．

　We reviewed problems regarding the management of initial-stage stuttering based on our series of cases, and report the methods and results of intervention for initial stuttering using an environmental adjustment approach.

　The following problems were noted.　The parents of stuttering children were frequently unaware that their actions aggravated the stuttering, before speech-language-hearing therapists(SLHTs)' guidance.　Such actions included:interrupting their children when stuttering, punishing for stuttering, and negative refusal of children's utterance activities.　Furthermore, there was a long interval from the parents' recognition of stuttering until consultation with SLHT, because they misunderstood the characteristic of initial stuttering, namely, the transient disappearance of utterance symptoms, as healing.　To overcome these problems, guidance about stuttering should be made more readily available.　Furthermore, a system in which stuttering children's parents can consult SLHTs must be established.　Our environmental adjustment approach successfully achieved stutter-free speech in 10 of 17 children who were initially at an early stage of stuttering.