راهکارهای درمانی خاص در درمان لکنت زبان کلینیک تخصصی لکنت کرج جهانشهر- بلوار مولانا
that these are within normal limits, and even that the mismatch between an established ability to comprehend complex adult language whilst being unable to produce their own language is a factor in this stuttering subgroup. In the absence of normal verbal skills, communication consists of gesture, jargon and single word level speech. As language abilities slowly progress, poor syntax appears, which leads to disorganized speech, typified by silent pauses, which are not blocks, and hesitations, interjections and retrials, reworking of unfinished sentences and phrase revisions. There may also be a deliberate and sometimes audible intake of breath before a phrase is blurted out at high speed. Articula¬tion too may be affected, with anticipatory errors and phoneme transpositions common. Van Riper also suggests that there may be problems with self¬monitoring of speech, and that Track II children do not listen to themselves. (This is somewhat counter to evidence which links early onset stuttering to heightened levels of auditory awareness; see Bernstein-Ratner, 1997; chapter 3 this volume.) He also questions whether this lack of auditory awareness to their own speech might in part be responsible for the delay in the first place.
So now the Track II child is experiencing difficulties with speech, language and fluency, and auditory awareness, yet for all this the child does not usually experience frustration, and avoidance of phonemes or words is rare. With further development, situation fears can arise, however, but even these rarely reach the intensity of fear experienced by children from the other three tracks. Consistent with this lack of awareness and lack of fear, these children do not usually show secondary features, such as abnormal lip or jaw movement, head jerk or other nonspeech body movements. A particular and defining feature of later development of more severe examples of Track II is the perseverative type of stuttering, where the quick and dysrhythmic repetitions take on an almost compulsive quality. It seems almost impossible for the speaker to terminate the rapid and accelerating syllable repetitions, and often only ends when the intake of lung air has run out. There have been some reports of extreme cases where some older Track II children have been known to shout out in the middle of these repetitions in an attempt to stop the uncontrolled repetitions. In cases such as these, the act of stuttering as well as particular speaking situations may become