Diagnosis F 80 Specific disorders of speech and language development (disease treatment)

Definition

An essential feature of expressive language disorder is a marked impairment in expressive language development that cannot be explained by mental retardation or inadequate learning and is not associated with pervasive developmental disorder, hearing impairment, or neurological disorder. A diagnosis should be made only if the disorder significantly interferes with success in school learning or normal daily life that requires expression in verbal (or signed) language.

The following are diagnostic criteria for developmental expressive language disorder.

• A. Scores obtained from a standardized measure of expressive language are significantly lower than scores obtained from nonverbal intellectual abilities (as measured by the Individually Administered Test 1(5).
• B. Disorder A significantly interferes with success in school and in everyday life that requires verbal (or sign) language expression. Evidence of this may include using a limited vocabulary, using only simple sentences, or using only the present tense. In less severe cases, there may be hesitations or errors in recalling some words, or errors in pronouncing long or complex sentences.
• B. Not associated with pervasive developmental disorders, hearing impairment, or neurological disorder (aphasia).

Correction

Correcting delayed development of expressive and impressive speech requires an integrated approach.

The specific set of measures taken is determined by the speech therapist, taking into account the actual data of a particular small patient:

• nootropic drugs (stimulate the activity of cells in the cerebral cortex, which improves memory in children, enhances attention, the ability to concentrate, normalizes sleep and general mental state, and so on);
• physiotherapeutic procedures (for example, microcurrent therapy, which involves the active impact of minimal current discharges on biologically active areas of the cerebral cortex);
• developmental classes with a speech therapist and defectologist (specialists focus their efforts on improving the little person’s memory and general development of thinking);
• speech therapy massage (a complex effect on the facial muscles, promoting the development of speech in a small person);
• performing play-based exercises aimed at developing facial muscles (for example, “Clock”, in which a 2-3 year old child needs to stick out his tongue and move it from side to side; onomatopoeic exercises (imitation of rain, animal voices, etc.) or voicing poems (the adult shows - the child voices his actions, after which the roles change).

Expressive and impressive speech should normally be developed in children at a basic level by the age of 4-5 years. In speech therapy, there are a large number of ways to stimulate a child’s ability to correctly express his thoughts, which he can practice not only with a specialist, but also at home alone with his parents.

Despite the importance of the speech aspect in the overall development of a growing person, adults are not recommended to put moral pressure on the child and force him to study. Instead, you should talk to him as much as possible, take an interest in the child’s opinion and expand his horizons.

Clinical features

Severe forms of the disorder usually appear before age 3. Less severe forms may not be recognized until adolescence, when language typically becomes more complex. An essential feature of a child with expressive language disorder is a significant impairment in the development of age-appropriate expressive language, resulting in the child using verbal or signed language that is significantly below the expected level given the child's intellectual abilities. This child's understanding of language is not difficult; decoding remains relatively intact.

The disorder begins to be suspected around 18 months of age when the child does not spontaneously pronounce or even repeat certain words and sounds. Even simple words such as "mama" and "dada" are not in the child's active vocabulary, and the child uses gestures to express his desires. It is clear that the child wants to communicate, he maintains eye contact, treats his mother well, and enjoys games.

A child's vocabulary repertoire is very limited. At 18 months The child can at most understand simple commands and point to simple objects when they are named. When the child eventually begins to speak, the language deficit becomes more apparent. Articulation is usually immature. Numerous articulation errors occur, but they are not constant, especially with sounds such as r, s, z, which are either omitted or replaced by other sounds. By age 4, most children with this disorder can speak in short sentences, but they forget old words as they learn new ones. Once they start talking, they learn much more slowly than normal children. Their use of grammatical structures is significantly lower than would be expected at this age. Their developmental milestones are slightly delayed. Articulation development disorder is often observed. Developmental coordination disorder and functional enuresis in such children are often concomitant disorders.

Development is normal

Expressive and impressive speech in speech therapy are one of the key indicators of the general development and health of the child. Depending on the age of the young patient, the doctor, according to basic standards, identifies the need for correctional classes or consultations with specialized specialists (neurologist, psychiatrist, psychologist, neurosurgeon, and so on).

According to the generally accepted norm, by the age of 7-8 years, a child must master a number of expressive speech skills, including:

• hooting;
• bumming;
• laughter;
• cry;
• babble;
• imitation of sounds produced by parents;
• the ability to describe one’s thoughts descriptively, which appears at the age of 8-9 months. – 1.2 years (for example, instead of the specific word “dog”, children say “woof-woof”);
• vocabulary of at least 200 words (up to 2 years);
• the ability to formulate sentences consisting of at least 3 words (at 1.5 – 2 years);
• expansion of vocabulary at the age of 4-5 years (at this stage, the child’s active vocabulary should consist of no less than 1500-2000 words);
• active use of all parts of speech when expressing your thoughts;
• the ability to compose complex and complex sentences without lexical errors;
• mastering, understanding and using the grammatical rules of the native language in speech;
• mastering ethnic skills (accent, dialect).

Speech therapists manage to understand at what stage of development the impressive component of a particular child’s speech is by correlating the actual skills of the little patient with generally accepted norms.

Such as:

• response to speech addressed to them (occurs when the child reaches 6 months);

• the ability to relate what is heard to a specific image (for example, on a card or in the environment around the child);
• the ability to correlate an action shown by an adult with a related image (for example, if a parent imitates hitting nails with a hammer, the child must take out from a box with different tools exactly the working tool shown to the adult);
• understanding of vocabulary related to the description of actions and the quality of household items (colors, material, texture, size, etc.);
• the ability to implement instructions consisting of 2 or more stages;
• understanding the meaning of prepositions and conjunctions used in speech (for example, normally a child should not confuse “and” with “or” and so on);
• the ability to perceive fairy tales with the help of the organs of vision (up to 4 years), and later only with the help of the organs of hearing (from 4-5 years).

Complications

School-aged children may develop low self-esteem, frustration and depression. Children with this disorder may also exhibit a learning disability manifested by reading delays, which can result in serious problems with academic performance. Most learning difficulties lie in the area of ​​perceptual skills or the ability to recognize and process symbols in appropriate sequence.

Other behavioral problems and symptoms that may appear in children with expressive language disorder include hyperactivity, short attention spans, autistic behavior, thumb sucking, mood swings, accident proneness, bedwetting, and disobedience. and conduct disorder. Many children have neurological pathology. It includes mild organic disorders, decreased vestibular reactions and pathological EEG changes.

What is expressive speech

The term means a verbal form, expressed out loud, colored emotionally. In children, this ability is formed as a result of imitating the actions of adults: first an idea arises, then an internal statement, and then voicing.

The auditory analyzer and Wernicke's area are responsible for understanding written and oral speech, correct perception of sound signals, and word formation.

In early childhood, it is necessary to encourage and stimulate children's desire to speak without adapting to slurred pronunciation.

Social adaptation with the development of emotional intelligence occurs through regular verbal contacts, so it is useful for a child to listen to the clear diction of adults and practice independently.

Course and prognosis

Overall, the prognosis for expressive language disorders is good. The speed and extent of recovery depend on the severity of the disorder, the child's motivation to participate in therapy, and the timely administration of speech and therapy interventions. 50% of children with mild expressive language disorders recover spontaneously without any signs of language impairment, but children with severe expressive language disorders may continue to show signs of mild or moderate impairment.

Stages of development of a child’s own expressive speech

The period of crying begins with birth; at this time, crying has important diagnostic characteristics, revealing deviations in mental or physical development.

Melodic humming appears by the 5th month, and at the age of 7-8 months, children enter the babbling phase and try to pronounce labial consonants. At 1-1.5 years, there is a stock of 6-8 short words that already have expressiveness, and the process of word creation begins.

The stages of development are individual for each child, but the absence of pronunciation of elementary phrases at 2.5 years is not considered the norm and consultation with a specialist is required.

The diagnosis is preceded by detailed tests of hearing and the state of the nervous system, supplemented by a detailed interview and outpatient observation during the entire period of corrective classes.

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Diagnosis

The quality of language, verbal or signed, is significantly below average, accompanied by low scores on standardized tests of verbal and nonverbal intelligence, indicating a diagnosis. This disorder is not due to pervasive developmental disorder because the child expresses a desire to communicate. If there are any fragments of language, they are very reduced; vocabulary is small, grammar is too simple, articulation is variable. There is internal language or adequate use of toys and household items.

To confirm the diagnosis, the child must undergo standardized expressive language and nonverbal intelligence testing. Observing the child's patterns of verbal and sign language in a variety of settings (eg, schoolyard, classroom, home, and play areas) and his interactions with other children can help determine the severity and specific areas of impairment in the child and may help in early recognition of behavioral and emotional complications.

A thorough family history should include the presence or absence of expressive language disorders in relatives. An audiogram is recommended for young children and children suspected of having hearing loss.

Disorders

Expressive and impressive speech in speech therapy, namely the level of its development in a particular young patient, determines the direction of additional classes designed to adapt the child to age-related psychological and physiological changes. For the convenience of providing assistance to children, speech therapists decided to classify speech disorders into subtypes.

Having different views on the course of therapy, specialists have so far failed to come to a common decision. Despite the presence of many options, the most popular of them is the classification of L. O. Badalyan.

Associated with serious disturbances in the functioning of the central nervous system

According to Badalyan, it is advisable to classify lesions of the child’s nervous system at the stage of intrauterine development or after the birth of a child into several forms.

For example:

Associated with minor changes in the functioning of the central nervous system

Forms of speech disorder arising due to functional deformations of the central nervous system are:

• stuttering (when voicing one word, the child repeats the same compound syllable several times);
• mutism (the child does not respond to requests from other people and does not react to what is happening);
• surdomutism (the child is unable not only to perceive information by ear, but also to reproduce it independently).

Associated with deviations in the structure of the organs of the articulatory apparatus

The forms of speech disorders provoked by the imperfect structure of the organs of articulation are considered to be:

• mechanical dyslalia (the child does not pronounce sounds or deliberately distorts them due to the lack of physical ability to pronounce them correctly, for example, in the presence of a short frenulum of the tongue);

• rhinolalia (the child does not pronounce nasal sounds due to the incorrect structure of the ENT organs).

Various origins

Speech therapists include speech disorders of various origins as delays in the development of a child’s speech for non-physiological reasons:

• birth as a result of premature birth;
• the presence of serious diseases of the internal systems of the body;
• incorrect form of education and general development.

Differential diagnosis

With mental retardation, there is a complete impairment of intelligence, determined by a low level of intellectual tests in all areas. Nonverbal intelligence and achievement in other areas of children with expressive language disorder are within normal limits.

In receptive language disorder, language comprehension (decoding) is significantly reduced compared to the average level expected for a given age, whereas in expressive language disorder, language comprehension remains at the normal level.

In pervasive developmental disorder, in addition to the main characteristics, affected children lack internal language, symbolic or imaginary play, adequate use of gestures, or the ability to maintain warm and meaningful social relationships. In contrast, all of these characteristics are preserved in children with expressive language disorder.

Children with acquired aphasia or dysphasia showed normal language development at an earlier age, but language impairment developed after head trauma or other neurological disorders (eg, seizures).

Children with selective mutism also initially showed normal language development, and their speech was limited to communication with only one or a few surrounding family members (eg, mother, father, and siblings). Selective mutism affects girls more often than boys, and affected children are almost always shy and withdrawn outside the family.

Main reasons

Children's age is sensitive to various kinds of influences. Severe pregnancy, childbirth, illness and head injuries will negatively affect its development.

In recent years, the number of children with such pathologies has only been growing. Experts attribute this to various reasons. Some believe environmental degradation plays a role. Others highlight the main risk factors:

• chronic diseases of the father and mother;
• age of women in labor;
• bad habits (alcohol, drugs, smoking);
• trauma during childbirth.

There are also so-called social factors. An increase in the number of smartphones, tablets, 24-hour television. Many cartoons and games for children with advertising easily attract the attention of the baby. Therefore, they lose the need to study and interact with the outside world.

In many cartoons, acid colors and shrill mechanical voices predominate - all this quickly captures the child and his attention. After which he is of little interest in the ordinary speech of an adult.

When communicating with other children and adults, he looks at the face and unconsciously tries to repeat the movements of the organs of articulation. Without such visual contact, it will be difficult for him to make sounds.

Treatment

Corrective and developmental classes should begin immediately after the diagnosis of the disorder is established. Classes consist of behaviorally reinforced exercises and hands-on mastery of phonemes (blocks of sounds), vocabulary, and sentence construction. Typically, such classes are conducted by a speech therapist or speech pathologist. Psychotherapy is not usually prescribed unless a child with a language disorder shows evidence of a secondary or co-occurring behavioral or emotional disorder.

Diagnostics

It is important to show a child with any speech disorders to a pediatrician: he will examine him, ask the parent questions and refer him to more specialized specialists : a pediatric neurologist, otolaryngologist, speech therapist, psychologist.

The main purpose of the examination is to determine the causes of the disorder, distinguish it from similar disorders and determine the optimal treatment tactics.

The diagnostic process consists of:

1. General examination. Specialists talk with parents, study the anamnesis, find out whether there were any violations during the process of bearing the child and during childbirth. Reflexes are also tested. After this, the child is sent for additional examinations, the list of which depends on the conclusions of specialists. As a rule, this list includes electroencephalography, MRI or CT scan of the brain.
2. Examination by a speech therapist. The speech therapist determines how deep the speech disorders are using tests, talks with the child, notices how well he controls his own articulatory apparatus, how he uses words and constructs sentences.
3. Diagnostics of the mental sphere. Checks are carried out by a child psychologist in the form of a game. He monitors the child’s behavior and communicates with him. The child also undergoes tests that determine the degree of development of his cognitive abilities and intelligence quotient.

After a comprehensive examination, a diagnosis is made. The sooner correction of the disorder is started, the more favorable the prognosis will be.

Speech understanding period

The period of speech understanding begins at 9 months. The baby uses sentence words that acquire meaning and become a component of thinking, as well as onomatopoeic words, for example aw-aw, meow. By the end of the child’s first year of life, his vocabulary is formed, which by this time numbers about 10 words. Usually there is a doubling of the same syllable with stress on the first (pa-pa, ma-ma, ba-ba, dyad-dya, etc.). When trying to pronounce words with different syllables, children replace sounds, omit some of them or mix them, which is explained insufficiency of auditory perception and immaturity of articulatory patterns. By this time, children are pronouncing the phonemes that they hear in the speech of adults and in their own babbling and humming sounds.

Speech development disorders in children and their correction

Speech formation is one of the main characteristics of a child’s overall development. Normally developing children have good abilities to master their native language. Speech becomes an important means of communication between the child and the world around him, the most perfect form of communication inherent only to humans. But since speech is a special higher mental function provided by the brain, any deviations in its development should be noticed in time. For normal speech formation, it is necessary that the cerebral cortex reaches a certain maturity, the articulatory apparatus is formed, and hearing is preserved. Another indispensable condition is a complete speech environment from the first days of a child’s life. The main indicators of speech development from 1 year to 6 years are given in Table 1.

Speech is one of the complex higher mental functions and has two important components:

• perception of speech sounds, for which Wernicke's center is responsible (located in the auditory cortex of the temporal lobe);
• reproduction of sounds, words, phrases is a speech motor function, which is provided by Broca's center (located in the lower parts of the frontal lobe, in close proximity to the projection in the cortex of the muscles involved in speech).

Both speech centers in right-handers are located in the left hemisphere of the brain (Fig. 1), and in left-handers, on the contrary, in the right. In accordance with this, a distinction is made between impressive speech (the process of listening to speech, understanding the meaning and content of a speech utterance) and expressive speech (the process of speaking using language).

During speech development, children must master several subsystems of their native language. The first of these is phonetics, the system of speech sounds. Any language is based on a certain signal or phonemic feature, changing which changes the meaning of the word. This signal, semantically distinctive feature forms the basis of the sound units of language - phonemes (from the Greek phonema - “speech sound”). There are 42 phonemes in the Russian language, including 6 vowels and 36 consonants. The main semantic distinctive features include sonority and dullness (was-dust, house-volume, guest-bone), hardness and softness (dust-dust), stressed and unstressed (za'mok-zamo'k).

In addition, language is an ordered system in which all parts of speech are interconnected according to certain rules. The set of these rules makes up grammar, thanks to which words are formed into complete semantic units. Syntax sets the rules for combining words in a sentence, semantics explains the meaning of individual words and phrases, and pragmatics sets the social rules that dictate what, how, when, and to whom to speak. In the process of speech development, children master these laws of their native language (J. Butterworth, M. Harris, 2000).

The reasons for the delay in speech development may be pathology during pregnancy and childbirth, dysfunction of the articulatory apparatus, damage to the organ of hearing, a general lag in the mental development of the child, the influence of heredity and unfavorable social factors (insufficient communication and education). Difficulties in mastering speech are also typical for children with signs of retarded physical development, those who suffered serious illnesses at an early age, those who are weakened, or those who receive malnutrition.

Hearing impairment is a common cause of isolated speech delay. It is known that even moderately pronounced and gradually developing hearing loss can lead to delays in speech development. Signs of hearing loss in a baby include a lack of response to sound signals and an inability to imitate sounds, while in an older child there is excessive use of gestures and close observation of the movements of the lips of speaking people. However, the assessment of hearing based on the study of behavioral reactions is insufficient and is subjective. Therefore, if partial or complete hearing loss is suspected, a child with isolated speech delay should undergo an audiological examination. The method of recording auditory evoked potentials also provides reliable results. The sooner hearing defects are detected, the sooner it will be possible to begin appropriate corrective work with the baby or equip him with a hearing aid.

Less commonly, a delay in speech development is associated with a child having autism or a general mental retardation. In such cases, an in-depth psychoneurological examination is indicated.

Classifications of speech development disorders in children

Diagnosis of speech development disorders requires the participation of not only doctors, but also speech therapists, psychologists, and special education specialists in helping the child. To date, no unified classification of speech disorders in children has been developed. Depending on the leading disorders underlying speech disorders in children, L. O. Badalyan (1986, 2000) proposed the classification below.

I. Speech disorders associated with organic damage to the central nervous system (CNS). Depending on the level of damage to the speech system, they are divided into the following forms.

• Aphasia is the collapse of all components of speech as a result of damage to the cortical speech areas.
• Alalia is a systemic underdevelopment of speech as a result of damage to the cortical speech zones in the pre-speech period.
• Dysarthria is a violation of the sound pronunciation side of speech as a result of a violation of the innervation of the speech muscles. Depending on the location of the lesion, several variants of dysarthria are distinguished: pseudobulbar, bulbar, subcortical, cerebellar.

II. Speech disorders associated with functional changes in the central nervous system (stuttering, mutism and surdomutism).

III. Speech disorders associated with defects in the structure of the articulatory apparatus (mechanical dyslalia, rhinolalia).

IV. Delays in speech development of various origins (prematurity, severe diseases of internal organs, pedagogical neglect, etc.).

In domestic speech therapy, two classifications of speech disorders are used: clinical-pedagogical and psychological-pedagogical (L. S. Volkova, S. N. Shakhovskaya et al., 1999). These classifications, although they consider the same phenomena from different points of view, do not contradict, but complement one another and are focused on solving different problems of a single, but multifaceted process of correction of speech development disorders. It should be noted that both classifications relate to primary speech underdevelopment in children, i.e. to those cases when speech development disorders are observed with intact hearing and normal intelligence.

The clinical and pedagogical classification is based on the principle “from general to specific”, focused on detailing the types and forms of speech disorders, developing a differentiated approach to overcoming them (L. S. Volkova, S. N. Shakhovskaya et al., 1999). Disorders of the development of oral speech are divided into two types: phonation (external) design of the utterance, which are called disorders of the pronunciation side of speech, and structural-semantic (internal) design of the utterance.

Violations of phonation registration of utterances include:

• Dysphonia (aphonia) is a disorder (or absence) of phonation due to pathological changes in the vocal apparatus; Dysphonia manifests itself in disturbances in the strength, pitch and timbre of the voice.
• Bradylalia is a pathologically slow rate of speech, manifested in the slow implementation of the articulatory speech program.
• Tahilalia is a pathologically accelerated rate of speech, manifested in the accelerated implementation of the articulatory speech program.
• Stuttering is a violation of the tempo-rhythmic organization of speech, caused by the convulsive state of the muscles of the speech apparatus.
• Dyslalia is a violation of sound pronunciation with normal hearing and intact innervation of the speech apparatus (synonyms: sound pronunciation defects, phonetic defects, phoneme pronunciation defects).

In the psycholinguistic aspect, pronunciation disorders can arise due to three main reasons: deficiencies in the operations of discrimination and recognition of phonemes (perception defects); unformed operations of selection and implementation of pronounced sounds; violation of the conditions for the realization of sounds in case of anatomical defects of the speech apparatus.

In most children, sound pronunciation reaches the language norm by 4–5 years. Most often, speech defects are caused by the fact that the child’s articulatory base has not been fully formed (the entire set of articulatory positions necessary to pronounce sounds has not been mastered) or the articulatory positions have not been formed correctly, as a result of which distorted sounds are produced.

• Rhinolalia is a violation of voice timbre and sound pronunciation caused by anatomical and physiological defects of the speech apparatus. With rhinolalia, distorted pronunciation of all speech sounds is observed, and not individual ones, as with dyslalia.
• Dysarthria is a violation of the sound pronunciation side of speech, caused by organic damage to the central nervous system and disorders of the innervation of the speech apparatus.

Violations of the structural-semantic (internal) design of a statement include two subtypes.

• Alalia is the absence or underdevelopment of speech due to damage to the speech areas of the cerebral cortex in the prenatal or early (pre-speech) period of a child’s development (synonyms: dysphasia, early childhood aphasia, developmental dysphasia).
• Aphasia is a complete or partial loss of speech caused by local lesions of the speech areas of the cerebral cortex (as a result of traumatic brain injury, cerebrovascular accidents, neuroinfections and other diseases accompanied by damage to the central nervous system).

The psychological and pedagogical classification (L. S. Volkova, S. N. Shakhovskaya et al., 1999) is built on the opposite principle - “from the particular to the general.” This approach is focused on speech therapy intervention as a pedagogical process, the development of speech therapy correction methods for working with a group of children (study group, class). For this purpose, the general manifestations of various forms of speech disorders are determined. In accordance with this classification, speech disorders are divided into two groups: impairment of means of communication and impairments in the use of means of communication. Communication disorders include phonetic-phonemic underdevelopment and general speech underdevelopment (GSD).

Phonetic-phonemic underdevelopment of speech is a violation of the processes of formation of the pronunciation system of the native language in children with various speech disorders due to defects in the perception and pronunciation of phonemes. The following main manifestations of this condition are identified (T. B. Filicheva et al., 1989).

• Undifferentiated pronunciation of pairs or groups of sounds. In these cases, the same sound can serve as a substitute for two or even three other sounds for the child. For example, the soft sound t' is pronounced instead of the sounds s', ch, sh: “tyumka” (bag), “tyaska” (cup), “hoe” (hat).
• Replacing some sounds with others. Sounds that are difficult to pronounce are replaced by easier ones, which are characteristic of the early period of speech development. For example, the sound l is used instead of the sound r , the sound f - instead of w . In some children, a whole group of whistling and hissing sounds can be replaced by the sounds t and d : “tobacco” (dog).
• Mixing sounds. This phenomenon is characterized by the unstable use of a number of sounds in different words. A child can use sounds correctly in some words, but in others, replace them with similar ones in articulation or acoustic characteristics. So, a child, able to pronounce the sounds r , l or s in isolation, in speech utterances says, for example: “The carpenter is planing a board” instead of “The carpenter is planing a board.”

Such violations indicate underdevelopment of phonemic hearing (the ability to distinguish phonemes), which is confirmed during the examination. Underdevelopment of phonemic hearing prevents the full implementation of sound analysis of words. That is why, by school age, this group of children has insufficient prerequisites for learning to write and read.

OSD includes various complex speech disorders, in which the formation of all components of the speech system related to the sound and semantic side suffers. By OHP we understand the impaired formation of all components of the speech system in their unity (sound structure, phonemic processes, vocabulary, grammatical structure, semantic aspects of speech) in children with normal hearing and initially preserved intelligence.

OHP is heterogeneous in its developmental mechanisms and can be observed in various forms of oral speech disorders (alalia, dysarthria, etc.). Common signs include a late onset of speech development, a poor vocabulary, agrammatisms, pronunciation defects, and phoneme formation defects. Underdevelopment can be expressed to varying degrees: from the absence of speech or its babbling state to extensive speech, but with elements of phonetic and lexico-grammatical underdevelopment. Depending on the degree of impairment in the formation of means of communication, ONR is divided into three levels. According to R. E. Levina (1968), these levels of speech underdevelopment are designated as:

• lack of common speech (so-called “speechless children”);
• the beginnings of common speech;
• developed speech with elements of underdevelopment in the entire speech system.

Thus, the development of ideas about OSD in children is focused on the development of correction methods for groups of children with similar manifestations of various forms of speech disorders. It is necessary to take into account that ONR can be observed with various lesions of the central nervous system and deviations in the structure and functions of the articulatory apparatus (R. E. Levina, 1968; L. S. Volkova, S. N. Shakhovskaya et al., 1999), i.e. e. for various clinical forms of oral speech disorders. The concept of ONR reflects the close relationship of all components of speech during its abnormal development, but at the same time emphasizes the possibility of overcoming this lag and moving to qualitatively higher levels of speech development.

However, the primary mechanisms of ANR cannot be elucidated without a neurological examination, one of the important tasks of which is to determine the location of the lesion in the nervous system, i.e., making a topical diagnosis. At the same time, diagnostics is aimed at identifying the main disrupted links in the development and implementation of speech processes, on the basis of which the form of speech disorders is determined. There is no doubt that when using the clinical classification of speech development disorders in children, a significant proportion of cases of OHP turn out to be associated with alalia. At the same time, damage to various zones of the cerebral cortex in the pre-speech period entails a certain originality in the formation of alalia symptoms.

Alalia is one of the most severe speech development disorders. Alalia is a systemic underdevelopment of speech of central origin. The insufficient level of development of the speech centers of the cerebral cortex, which underlies alalia, can be congenital or acquired in the early stages of ontogenesis, in the pre-speech period. The cause of alalia may be early organic damage to the central nervous system due to the pathology of pregnancy and childbirth. In recent years, special attention of researchers has been drawn to the role of hereditary factors in the formation of both speech abilities and various speech development disorders, including alalia.

Complete or partial loss of speech caused by local lesions of the speech areas of the cerebral cortex is called aphasia. Aphasia is the decay of already formed speech functions, so this diagnosis is given only to children over 3–4 years old. With aphasia, there is a complete or partial loss of the ability to understand spoken speech or speak, that is, to use words and phrases to express one’s thoughts. Aphasia is caused by damage to the speech centers in the cortex of the dominant hemisphere (for right-handers - left, for left-handers - right) in the absence of disturbances in the articulatory apparatus and hearing.

In cases of lesions of the speech centers in children under the age of 3–4 years, speech usually develops, but with a pronounced lag. Domestic experts refer to this condition as alalia. The international term “dysphasia” or “developmental dysphasia” is more accurate. Similar to aphasia in adults, motor and sensory alalia (dysphasia) are distinguished.

Motor alalia (dysphasia) is a systemic underdevelopment of expressive speech of central origin. The child has disturbances in articulatory praxis and the organization of speech movements, therefore speech development is delayed. There is a search for articulation, an inability to perform certain articulatory movements and their sequences. The child cannot find the correct sequence of sounds in a word, words in a phrase, and cannot switch from one word to another. This leads to an abundance of errors, permutations, and perseverations in speech (multiple repetition of the same syllable or word). As a result, in a child with motor alalia, with good hearing and sufficient understanding of speech, in the absence of paresis of the articulatory muscles, independent speech does not develop for a long time, or it remains at the level of individual sounds and words.

Already at an early age, attention is drawn to the absence or limitation of babbling. Parents note silence, emphasize that the child understands everything, but does not want to speak. Instead of speech, facial expressions and gestures develop, which children use selectively in emotionally charged situations.

The first words and phrases appear late. Parents note that, in addition to speech delays, in general, children develop normally. As their vocabulary increases, the difficulties children have in mastering word structure become more noticeable. Speech is slow. There are many slips of speech in the speech stream, which children pay attention to and try to correct what was said incorrectly - especially as they develop. Examples of word distortions: button - “kubyka”, “puzyka”, “puzuvisa”, “kubiska”; February - “Fral”, “Viral”, “Faral”.

Vocabulary is formed slowly, distorted, and incorrect use of words is common. Substitutions of words based on external signs of an object or action are typical: washes-washes, ax-hammer, cup-glass, etc. Children do not know how to use synonyms, antonyms, and generalizing words. The stock of adjectives and adverbs is narrow and monotonous.

The vocabulary is poor, limited to everyday topics. The child cannot explain the meaning of words and does not know how to use word formation. In their statements, children find it difficult to coordinate words, use gender and numerical endings, and do not use prepositions and conjunctions. Their phrases consist of unchangeable words (“Book, Tanya!” and a gesture of request), which makes them understandable only in a certain situation. The number and order of words in the sentences are disturbed; the child responds with one or two words (mainly nominative sentences-nouns in the correct or distorted case version) in combination with a gesture. In case of alalia, the lack of formation of the sentence structure is a consequence of the immaturity of internal speech operations - choosing a word and constructing a plan of utterance.

There is a systematic underdevelopment of all aspects and functions of speech. There are difficulties in constructing phrases, mastering grammatical structure, insufficient development of imitative activity (including imitative speech) and all forms of voluntary speech. Children are not able to gradually transfer familiar words from a passive to an active vocabulary.

With little speech activity, the child’s general cognitive activity suffers. Speech during alalia is not a full-fledged means of communication, organization of behavior and individual development. Intellectual deficiency and a limited supply of knowledge, observed in many children with alalia at different age periods, are therefore secondary in nature.

In some cases, children with alalia develop pathological personality traits and neurotic character traits. As a reaction to speech impairment, they experience isolation, negativism, self-doubt, tension, increased irritability, touchiness, and a tendency to cry. Some children use speech only in emotionally charged situations. The fear of making a mistake and causing ridicule from others leads to the fact that they try to get around speech difficulties, refuse verbal communication, and are more willing to use gestures. Speech disability “excludes” the child from the children’s group and, with age, increasingly traumatizes his psyche.

Sensory alalia (dysphasia) is a systemic underdevelopment of impressive speech of central origin, caused primarily by disturbances in the auditory-speech analyzer. This leads to disorders in the analysis and synthesis of speech signals, as a result of which a connection is not formed between the sound image of a word and the object or action it denotes. The child hears but does not understand the spoken speech.

Sensory alalia is considered a less studied condition than motor alalia. Apparently, this is due to the fact that in its pure form it is much less common; its timely recognition and differential diagnosis can be quite difficult. In particular, it is always necessary to differentiate sensory alalia from hearing loss, which can interfere with normal speech development, as well as autism.

The degree of underdevelopment of the speech-hearing analyzer can be different.

In more severe cases, the child does not understand the speech of others at all, treats it as noise devoid of meaning, does not even react to his own name, and does not distinguish between the sounds of speech and noises of a non-speech nature. He is indifferent to any speech and non-speech stimuli. In other cases, he understands individual words, but loses them against the background of a detailed statement (as happens, for example, in healthy people with insufficient knowledge of a foreign language). When addressing him, the child does not catch all the words and their shades, which results in an incorrect reaction. Phonemic perception develops slowly and remains unformed for a long time. For children with sensory alalia, the situation plays a big role. Often they understand the content of statements only in a certain context and find it difficult to perceive the meaning when changing the forms and order of words, or using grammatical structures.

Often children do not perceive changes in a particular task by ear, and do not distinguish what was said in error from the correct option. Sometimes they ask to repeat the speech addressed to them and understand only what is spoken several times. Some children only understand what they can say themselves. Such pronunciation helps to improve understanding.

Children often look at the speaker's face. In this case, speech understanding improves due to the reinforcement of the auditory impression from the visual analyzer - “reading from the face” occurs. Sometimes a child understands only a certain person - a mother, a teacher - and does not understand when someone else says the same thing.

Children with sensory alalia can spontaneously repeat individual syllables, sound combinations, words and short phrases they hear, although this repetition is unstable. Imitation of speech sounds with sensory alalia is not constant and largely depends on the situation. Children are not able to form connections between an object and its name; they do not form a correspondence between the words they hear and the words they pronounce. The child's understanding of the meanings of the words he pronounces is unstable. His active vocabulary exceeds his passive one.

When pronouncing words, the child is not confident in the correctness of his own speech and looks for adequate speech movements, for example: elephant - “sleep”, “vylon”, “sylon”, “salon”. Errors in speech are qualitatively different than with motor alalia. On the one hand, diffuse undifferentiated perception of sounds leads to their incorrect pronunciation, and on the other hand, errors lead to numerous searches for the necessary kinesthesia.

Sometimes there is an incoherent reproduction of all the words known to the child - a kind of logorrhea; perseverations are noted with repetitions of a heard or spoken word or phrase (echolalia), while the words are not comprehended and not remembered.

The words contain numerous errors in stress, sound substitutions, and distortions, and with each new repetition the nature of the distortions and substitutions usually changes. The child learns new words and phrases slowly. The child's statements are imprecise and may be difficult to understand. He is not critical of his own speech. Distortions in expressive speech are caused by the inferiority of perception of one’s own speech and the speech of others.

Due to the instability of understanding the meanings of words, children, having received verbal instructions, act uncertainly, seek help, have limited opportunities for organizing role-playing games, and cannot listen for a long time when they are read or told.

In less severe forms of sensory alalia, when children have formed their own speech, they speak easily, without tension, do not think about the choice of words, the accuracy of the statement, the construction of the phrase, and do not notice the mistakes made. Children do not control their own speech; they use words and phrases that are not related to the situation and are devoid of meaning. Speech is fragmentary. Because the child's statements are inaccurate in content and erroneous in form, it is often difficult for others to understand what he is talking about. In spoken words there are many sound substitutions, omissions, perseverations, connections of parts of words with each other (contamination). In general, the speech of a child with sensory alalia can be characterized as increased speech activity against the background of impaired understanding of the speech of others and insufficient control over one’s own speech.

Sensory alalia in its pure form is relatively rare; much more often sensory deficiency accompanies motor alalia. In these cases we speak of motor alalia with a sensory component or sensorimotor alalia. The existence of mixed forms of alalia indicates the functional continuity of the speech-motor and speech-auditory analyzers. A thorough examination of a child with alalia makes it possible to clarify the nature of the disorders, establish the leading inferiority in the structure of speech disorders and determine the optimal approaches to their correction.

Treatment of speech development disorders in children

In order for assistance to a child with a delay in speech development to be effective, an integrated approach and coordinated work of different specialists (doctors, speech therapists, psychologists, teachers), as well as the active participation of parents, are necessary. It is important that these joint efforts are aimed at early detection and timely correction of speech disorders in children. The main areas of correctional work for speech development disorders in children are: speech therapy work, psychological and pedagogical correctional measures, psychotherapeutic assistance to the child and his family, as well as drug treatment.

Since alalia represents the most complex medical, psychological and pedagogical problem, the complexity of the impact and continuity of work with children by specialists of various profiles are of particular importance when organizing assistance to such children. Speech therapy and psychological-pedagogical correctional measures should be carried out over a long period of time and systematically. In the process of speech development in children with alalia, certain positive dynamics can be traced; they consistently move from one level of speech development to another, higher one. They acquire new speech skills and abilities, but often remain children with underdeveloped speech. During schooling, children experience difficulties in mastering written language skills. Therefore, along with speech therapy and psychological and pedagogical correction, children with alalia are recommended to be prescribed repeated courses of therapy with nootropic drugs.

Nootropics are a group of drugs that differ in their composition and mechanisms of action, but have a number of common properties: they have a positive effect on the higher integrative functions of the brain, improve memory, facilitate learning processes, stimulate intellectual activity, increase the brain’s resistance to damaging factors, improve cortical-subcortical connections.

Treatment of alalia is a long process, during which there is a need for repeated therapeutic courses with nootropic drugs, for example, encephabol (Fig. 2) or others (Table 2). The repeated prescription of nootropics is also due to the fact that in addition to speech disorders, many children with alalia have to overcome concomitant cognitive, motor and behavioral disorders. It is advisable to prescribe nootropic drugs in the form of monotherapy, while paying attention to the individual selection of optimal dosages and duration of treatment. In the first days of use, a gradual increase in dose is recommended. The duration of treatment courses ranges from 1 to 3 months. Most nootropic drugs are prescribed in the first half of the day.

Side effects during treatment with nootropic drugs in children are rare, they are unstable and insignificantly expressed. They often occur due to insufficiently strict parental control and inaccurate adherence to the medication regimen (taking into account a gradual increase in dose) and administration in the morning and afternoon. Possible side effects of drug therapy with nootropic drugs include: increased emotional lability, irritability, difficulty falling asleep and restless sleep. If such complaints appear, clarifications should be made to the drug prescription regimen and the dose should be slightly reduced.

In conclusion, we should once again emphasize the need for early detection, timely and comprehensive diagnosis and correction of speech development disorders in children, combining the efforts of doctors, speech therapists, teachers and psychologists.

Literature

1. Badalyan L. O. Neuropathology. M.: Academy, 2000. 382 p.
2. Butterworth J., Harris M. Principles of developmental psychology: trans. from English M.: Cogito-Center, 2000. 350 p.
3. Volkova L. S., Shakhovskaya S. N. Speech therapy. 3rd ed. M.: Vlados, 1999. 678 p.
4. Levina R. E. Fundamentals of the theory and practice of speech therapy. M.: Education, 1968. 367 p.
5. Filicheva T. B., Cheveleva N. A., Chirkina G. V. Fundamentals of speech therapy. M.: Education, 1989. 221 p.

N. N. Zavadenko, Doctor of Medical Sciences, Professor of Russian State Medical University, Moscow