characterized by frequent and repeated disturbances of speech sounds, as a result of which speech becomes pathological. Language development is within normal limits. A number of terms are used to refer to these phenomena: infant speech, babbling, dyslalia, functional speech disorders, infantile perseveration, infantile articulation, delayed speech, lisp, imprecision oral speech, lazy speech, specific speech development disorder, and sloppy speech. In most mild cases, intelligence is not severely impaired and spontaneous recovery is possible. In severe cases, speech may be completely unintelligible, requiring long-term and intensive treatment.
Definition
An articulation disorder is defined as a significant impairment in the acquisition of normal articulation of speech sounds at an appropriate age. This condition cannot be caused by a pervasive developmental disorder, mental retardation, inner speech disorder, or neurological, intellectual, or hearing impairment. A disorder manifested by frequent incorrect pronunciation of sounds, replacement or omission of them creates the impression of “infant speech”.
Below are diagnostic criteria for developmental disorder, articulation.
- A. Significant impairment of the ability to correctly use speech sounds that should have already developed at the appropriate age. For example, a three-year-old child is unable to pronounce the sounds p, b and t, and a 6-year-old child is unable to pronounce the sounds p, sh, ch, f, ts.
- B. Not associated with pervasive developmental disorder, mental retardation, hearing impairment, oral language disorder, or neurological disorder.
This disorder is not associated with any anatomical structure, auditory, physiological or neurological abnormalities. This disorder refers to a number of different articulation disorders, ranging from mild to severe forms. Speech may be completely understandable, partially understandable, or incomprehensible. Sometimes the pronunciation of only one speech sound or phoneme (the smallest volume of sound) is affected, or many speech sounds are affected.
Epidemiology
The incidence of developmental articulation disorders has been established in approximately 10% of children under 8 years of age and approximately 5% of children over 8 years of age. This disorder is 2-3 times more common in boys than in girls.
Etiology
The cause of developmental articulation disorders is unknown. It is generally believed that simple developmental delay or delay in the maturation of neurological processes, rather than organic dysfunction, underlies speech impairment.
Disproportionately high level Articulation disorders are found among children from large families and low socioeconomic classes, which may indicate one possible cause - incorrect speech at home, and reinforcement of the deficiency on the part of these families.
Constitutional factors are more than factors environment influence whether a child will or will not suffer from an articulation disorder. The high percentage of children with this disorder who have multiple relatives with similar disorders may indicate a genetic component. Poor motor coordination, poor lateralization, and right- or left-handedness have been shown to be unrelated to developmental articulation disorder.
Clinical features
In severe cases, the disorder is first recognized around 3 years of age. In less severe cases, the disorder may not be obvious until age 6. Significant features of developmental articulation disorder include articulation that is judged to be defective when compared with the speech of children of the same age and which cannot be explained by pathology of intelligence, hearing, or the physiology of speech mechanisms. In very mild cases, there may be a violation of the articulation of only one phoneme. Usually single phonemes are disrupted, those that are mastered at an older age, in the process of normal language acquisition.
The speech sounds that are most often mispronounced are the latest in the sequence of mastered sounds (r, sh, ts, zh, z, h). But in more severe cases or in young children, there may be a violation of the pronunciation of sounds such as l, b, m, t, d, n, x. The pronunciation of one or more speech sounds may be impaired, but the pronunciation of vowels is never impaired.
A child with developmental articulation disorder cannot pronounce certain phonemes correctly and may distort, substitute, or even omit phonemes that he or she cannot pronounce correctly. When skipping, the phonemes are completely absent—for example, “goy” instead of “blue.” During substitution, difficult phonemes are replaced with incorrect ones - for example, “kvolik” instead of “rabbit”. When distorted, approximately correct phonemes are selected, but their pronunciation is incorrect. Occasionally something is added to the phonemes, usually vowels.
Omissions are considered to be the most serious type of violation, substitution is the next most serious violation, and then misstatement is considered the least heavy type violations.
Gaps are most often found in the speech of young children and appear at the end of words or consonant clusters. Distortions, which are found mainly in older children, are expressed in sounds that are not part of the speech dialect. Distortions may be the last type of articulation disorder remaining in the speech of children whose articulation disorders have almost disappeared. The most common type of distortion is "lateral slip", in which the child produces sounds with a stream of air passing through the tongue, which produces a whistling effect, and also "lisp", in which the sound is formed when the tongue is very close to the roof of the mouth, which produces a hissing effect. Effect. These disturbances are often intermittent and random. A phoneme may be pronounced correctly in one situation, but incorrectly in another. Articulation disorders are especially common at the end of words, in long syntactic complexes and sentences, and during rapid speech. Omissions, distortions and substitutions also appear in normal children learning to speak; while normal children quickly correct their pronunciation, children with articulation disorder do not. Even as the child grows and develops, when the pronunciation of phonemes improves and becomes correct, this sometimes applies only to newly learned words, while previously learned incorrectly words may still be pronounced incorrectly.
By the third grade, children sometimes overcome articulation disorder. However, after the fourth grade, if the deficiency has not previously been overcome, spontaneous recovery from it is unlikely, therefore it is especially important to correct the disorder before complications develop.
In most mild cases, recovery from articulation disorders is spontaneous, and is often facilitated by the child's admission to kindergarten or school. These children are fully recommended for classes with a speech therapist aimed at establishing speech sounds if they do not have spontaneous improvement by the age of six. For children with significant pronunciation disorders, with incomprehensible speech, and especially for those of them who are very worried about their defect, it is necessary to ensure an early start of classes.
Other specific developmental disorders commonly occur, including developmental expressive language disorder, developmental receptive language disorder, reading disorder, and developmental coordination disorder. There may also be functional enuresis.
Delays in language development and achievement of developmental milestones, such as saying the first word and first sentence, are also observed in some children with developmental articulation disorder, but most children begin to speak at normal ages.
Children with developmental articulation disorders may exhibit a variety of co-occurring social, emotional and behavioral nature. Approximately one-third of these children have a mental disorder, such as hyperreactivity with attention disorder, separation anxiety disorder, avoidance disorder, adjustment disorder, and depression. Those children who have severe articulation disorder or those whose disorder is chronic, without remission or recurrent, constitute a risk group for the development of mental illness.
Differential diagnosis
The differential diagnosis of developmental articulation disorder involves three stages: first, it is necessary to determine that the articulation disorder is severe enough to be considered pathological and excludes normal pronunciation disorders in young children; secondly, it should be noted that there is no physical pathology that could cause a pronunciation disorder and exclude dysarthria, hearing impairment or mental retardation; thirdly, it is necessary to establish that expressive language is expressed within normal limits and exclude developmental language disorder and pervasive developmental disorders. Approximately, we can be guided by the fact that a 3-year-old child normally correctly pronounces m.n, b, p, v, f, g, x, t, k, d;, and a normal 5-year-old child pronounces all sounds correctly.
To exclude physical factors that could cause some types of articulation disorders, it is necessary to carry out neurological, structural and audiometric examination methods.
Children with dysarthria, whose articulation disorder is caused by structural or neurological pathology, differ from children with developmental articulation disorder in that dysarthria is extremely difficult to correct, and sometimes not at all. Mindless chatter, slow and uncoordinated motor behavior, difficulty chewing and swallowing, and restricted and slow tongue protrusion and retraction are signs of dysarthria. Slow speech rate is another sign of dysarthria.
Forecast
Recovery is often spontaneous, especially in children whose articulation disorder involves only a few phonemes. Spontaneous recovery rarely occurs after the age of 8 years.
Treatment
Speech therapy treatment is considered successful for most articulation errors. Corrective classes are indicated when the child’s articulation is such that his speech is incomprehensible, when the child suffering from articulation disorders is over 6 years old, when speech difficulties clearly cause complications in dealing with peers, difficulties in learning and negatively affect the formation of one’s own image, when the disorders the articulations are so heavy that many consonants are mispronounced, and when errors involve omissions and phoneme substitutions rather than distortions.
Bibliography
Kaplan G.I., Sadok B.J. Clinical psychiatry, T. 2, – M., Medicine, 2002
Multiaxial classification of mental disorders in childhood and adolescence. Classification of mental and behavioral disorders in children and adolescents in accordance with ICD-10, - M., Smysl, Academy, 2008
Characterized by frequent and repeated disturbances in speech sounds. The child's use of sounds below the level appropriate for his mental age - that is, the child's acquisition of speech sounds is either delayed or deviated, leading to disarticulation with difficulties in understanding his speech, omissions, substitutions, distortions of speech sounds, changes depending on their combination (then says correctly, then no). Most speech sounds are acquired by 6-7 years; by 11 years all sounds should be acquired.
In most cases, nonverbal intellectual level is within normal limits.
Etiology and pathogenesis
The cause of developmental articulation disorders is unknown. Presumably, the basis of speech impairment is a delay in the development or maturation of neuronal connections and neurological processes, and not organic dysfunction. The high percentage of children with this disorder who have multiple relatives with similar disorders suggests a genetic component. With this disorder, there is no subtle differentiation of motor kinesthetic postures of the tongue, palate, lips; brain basis - activity of the postcentral parts of the left hemisphere of the brain.
Prevalence
The incidence of articulation development disorders has been established in 10% of children under 8 years of age and in 5% of children over 8 years of age. This disorder occurs 2-3 times more often in boys than in girls.
Clinic
An essential feature is an articulation defect, with a persistent inability to apply speech sounds at expected developmental levels, including omissions, substitutions, and distortion of phonemes. This disorder cannot be caused by structural or neurological pathology and is accompanied by normal language development.
In more severe cases, the disorder is recognized at around 3 years of age. In milder cases, clinical manifestations may not be recognized for up to 6 years. The essential features of speech articulation disorder are an impairment in the child's acquisition of speech sounds, resulting in disarticulation with difficulty for others to understand his speech. Speech may be assessed as defective when compared with the speech of children of the same age and which cannot be explained by pathology of intelligence, hearing or the physiology of speech mechanisms. The pronunciation of speech sounds, which appear most late in ontogenesis, is often impaired, but the pronunciation of vowel sounds is never impaired. The most severe type of violation is omission of sounds. Substitutions and distortions are a less severe type of violation. Children with developmental articulation disorder may exhibit co-occurring social, emotional, and behavioral disorders. 1/3 of these children have a mental disorder.
Differential diagnosis
Includes three stages:
1. Determining the severity of articulation disorder.
2. Exclusion of physical pathology that could cause pronunciation problems, dysarthria, hearing impairment or mental retardation.
3. Exclusion of developmental disorder of expressive speech, general developmental disorder.
For articulation disorders caused by structural or neurological pathology (dysarthria) characterized by low speech rate, uncoordinated motor behavior, disorders of autonomic functions, for example, chewing, sucking. Pathology of the lips, tongue, palate, and muscle weakness are possible. The disorder affects all phonemes, including vowels.
Therapy
Speech therapy is most successful for most articulation errors.
Drug treatment is indicated in the presence of concomitant emotional and behavioral problems.
Expressive language disorder (F80.1).
Severe language impairment that cannot be explained by mental retardation, inadequate learning, and is not associated with a pervasive developmental disorder, hearing impairment, or neurological disorder. This is a specific developmental disorder in which the child's ability to use expressive spoken language is markedly below the level appropriate for his mental age. Speech understanding is within normal limits.
Etiology and pathogenesis
The cause of expressive language disorder is unknown. Minimal brain dysfunction or delayed formation of functional neuronal systems have been suggested as possible causes. A family history indicates that this disorder is genetically determined. The neuropsychological mechanism of the disorder may be associated with a kinetic component, with an interest in the process of the premotor parts of the brain or posterior frontal structures; with unformed nominative function of speech or unformed spatial representation of speech (temporo-parietal sections and the area of the parieto-temporo-occipital chiasm) subject to normal left hemisphere localization of speech centers and dysfunction in the left hemisphere.
Prevalence
The incidence of expressive language disorders ranges from 3 to 10% in children school age. It is 2-3 times more common in boys than in girls. More common among children with a family history of articulation disorders or other developmental disorders.
Clinic
Severe forms of the disorder usually appear before age 3. The absence of individual word formations by age 2 and simple sentences and phrases by age 3 is a sign of delay. Later disorders - limited vocabulary development, use of a small set of template words, difficulties in choosing synonyms, abbreviated pronunciation, immature sentence structure, syntactic errors, omission of verbal endings, prefixes, incorrect use of prepositions, pronouns, conjugations, inflections of verbs, nouns. Lack of fluency in presentation, lack of consistency in presentation and retelling. Understanding speech is not difficult. Characterized by adequate use of non-verbal cues, gestures, and the desire to communicate. Articulation is usually immature. There may be compensatory emotional reactions in relationships with peers, behavioral disorders, and inattention. Developmental coordination disorder and functional enuresis are often associated disorders.
Diagnostics
Indicators of expressive speech are significantly lower than indicators obtained for nonverbal intellectual abilities (nonverbal part of the Wechsler test).
The disorder significantly interferes with school success and Everyday life requiring verbal expression.
Not associated with pervasive developmental disorders, hearing impairment, or neurological disorder.
A specific developmental disorder in which the child's use of speech sounds is below the level appropriate for his mental age, but in which there is normal level speech skills. A diagnosis can only be made when the severity of the articulation disorder is outside the range of normal variations appropriate to the child's mental age; nonverbal intellectual level within normal limits; expressive and receptive speech skills within normal limits; articulation pathology cannot be explained by a sensory, anatomical or neurotic abnormality; Not correct pronunciation is undoubtedly anomalous, based on the characteristics of speech use in the subcultural conditions in which the child finds himself.
Included:
Developmental physiological disorder;
Developmental articulation disorder;
Functional articulation disorder;
Babbling (children's form of speech);
Dyslalia (tongue-tied);
Phonological developmental disorder.
F80.1. Expressive language disorder
A specific developmental disorder in which a child's ability to use expressive spoken language is markedly below the level appropriate for his mental age, although speech comprehension is within normal limits. There may or may not be articulation disorders.
Often, a lack of spoken language is accompanied by a delay or disturbance in verbal and audio pronunciation. The diagnosis should be made only when the severity of the delay in expressive language development exceeds the normal range for the child's mental age; Receptive language skills are within normal limits for the child's mental age (although they may often be slightly below average). Impaired spoken language becomes evident from infancy without any long, distinct phase of normal speech use. However, it is not uncommon to encounter the initially apparently normal use of several individual words, accompanied by speech regression or lack of progress. Often similar expressive speech disorders are observed in adults; they are always accompanied by a mental disorder and are organically caused.
Included:
Motor alalia;
Delays speech development by type of general speech underdevelopment (GSD) levels I-III;
Developmental dysphasia of expressive type;
Developmental aphasia of expressive type.
F80.2. Receptive language disorder
A specific developmental disorder in which the child's understanding of speech is below the level appropriate for his mental age. In all cases, expansive speech is also noticeably impaired and a defect in verbal-sound pronunciation is not uncommon.
A diagnosis can only be made when the severity of the delay in receptive language development is beyond normal variations for the child's mental age and when criteria for pervasive developmental disorder are not met. In almost all cases, the development of expressive speech is also seriously delayed, and violations of verbal-sound pronunciation are common. Of all the variants of specific speech development disorders, this variant has the highest level of concomitant socio-emotional-behavioral disorders. These disorders do not have any specific manifestations, but hyperactivity and inattention, social inattention
ability and isolation from peers, anxiety, sensitivity or excessive shyness are common. Children with more severe forms of receptive language impairment may experience quite significant delays in social development; imitative speech is possible with a lack of understanding of its meaning and a limitation of interests may appear. Similar speech disorders of the receptive (sensory) type are observed in adults, which are always accompanied by a mental disorder and are organically caused.
The structure of speech disorders is indicated by the second code R47.0.
Included:
Developmental receptive dysphasia;
Developmental receptive aphasia;
Lack of perception of words;
Verbal deafness;
Sensory agnosia;
Sensory alalia;
Congenital auditory immunity;
Wernicke's developmental aphasia.
Thanks to the ability to reproduce and understand speech, we can communicate normally with each other, exchange experiences and information, and build our lives. Therefore, any speech disorders negatively affect the quality of life. People who cannot fully express their thoughts have difficulty building a career or improving their personal life. It is better to diagnose and treat speech disorders in childhood, without waiting until such pathologies become advanced and progress into adulthood. So, the topic of our conversation today on www..
What is articulation?
By the term articulation, speech therapists mean the work of the speech apparatus, which ensures the correct creation of sound. Articulation results in distinct sounds that can be heard by the human ear.
Correct articulation ensures correct pronunciation of sounds. And an important role in this is played not by vocal connections, but by the organs of pronunciation - active or passive. The former include the tongue and lips, and the latter include the teeth, soft and hard palate, and gums.
Causes of articulation disorders
Speech articulation disorders in adults and children can be provoked by mechanical causes, which are represented by malocclusions, too short frenulum of the tongue and other pathological conditions. If the patient does not have any problems in the structure of the speech apparatus, doctors talk about a functional disorder - about incoordination of these organs.
In children, articulation disorders are usually explained by genetic predisposition, perinatal pathologies and minimal organic lesions of the speech cortex. Also, such problems can be provoked by an unfavorable social environment, incorrect pronunciation of sounds in close relatives, and also bilingualism in the family. In some cases, articulation disorders appear due to physical weakness against the background of frequent infectious and chronic ailments, as well as underdevelopment of phonemic hearing.
Among other things, speech therapists claim that children cannot pronounce all sounds correctly until the age of five. This is a physiological disorder of articulation, which is a variant of the norm.
Correction of articulation disorders in children and adults
Articulation disorders require timely treatment. It is best to diagnose and eliminate them in early childhood. If you do not cope with such problems, they will remain for life.
In some cases, to successfully eliminate articulation disorders, you need to seek help from a dentist, for example, to correct a malocclusion or short bridle. The problem of a short frenulum can also be dealt with through a systematic series of exercises.
If articulation disorders are caused by incoordination of the speech organs, then this problem can only be eliminated with the help of regular classes with a speech therapist or independent training.
Articulation exercises for children
Children should do articulation exercises in front of a mirror. You can do this starting from the age of three.
Exercises:
- “window” - the child must open his mouth wide (heat), then close it (cold);
- “brush your teeth” the baby smiles, opens his mouth, uses the tip of his tongue to brush the lower and upper teeth alternately;
- “knead the dough” the child smiles, then slaps his tongue between his teeth - “five-five-five”, then bites the tip of the tongue with his teeth;
- “cup” - the baby smiles, opens his mouth wide, sticks out his wide tongue and forms a “cup” out of it (raises the tip);
- “pipe” - the child should stretch his tense lips forward, while closing his teeth;
- “fence” - the baby needs to smile, then expose his closed teeth with tension;
- “painter” - the child smiles, opens his mouth slightly and strokes (paints) the sky with the tip of his tongue;
- “mushrooms” - the baby needs to smile, then click his tongue (as if riding a horse) and stick his wide tongue to the palate;
- “kitty” - the baby smiles wider, opening his mouth. The tip of his tongue should rest against the lower teeth, and the tongue should be curved so that the tip rests against the lower teeth;
- “swing” - the child smiles, opens his mouth, the tip of his tongue goes behind the upper teeth, then behind the lower teeth.
These are just a few articulation exercises that can be done with your child at home.
Exercises for adults
Exercises:
To develop the soft palate, yawn with your mouth closed;
- “paint” with your tongue the upper arch inside the mouth - from the soft palate to the base of the upper teeth;
- pronounce vowel sounds while yawning;
- imitate gargling;
- develop the lower jaw by moving it back and forth, as well as from side to side;
- lower your jaws downwards with resistance;
- develop your cheeks, alternately sucking or inflating them;
- roll the “balloon” from cheek to cheek;
- pull both cheeks in so that a “fish mouth” is formed and move your lips;
- snort like a horse;
- chew your lips gently;
- extend your tongue with a sharp tip more strongly, then place it relaxed on your lower lip.
Speech articulation disorders in adults are just as correctable as in children. Namely, systematically performing articulation exercises will help get rid of articulation disorders at different ages.
This is a developmental disorder in which a child's use of speech sounds is lower than expected for his or her age, but the child's language skills are normal.
This is quite common in children younger age. It is called burr, lisp, infantile speech, babbling, dyslalia, lazy speech, sloppy speech.
In most cases, intelligence is not impaired.
In severe cases, articulation disorder is detected at the age of 3 years. In milder cases, the disorder may not be apparent until 6 years of age.
The articulation of such children differs significantly from the articulation of their peers. It is especially difficult for children to hear such sounds as “v”, “l”, “r”, “ch”, “sh”, “f”, “ts”, “b”, “t”, all or some of them. Sometimes the pronunciation of only one sound may be impaired.
A child with an articulation disorder cannot pronounce certain sounds correctly, distorts them, replaces them with others, or skips them if he cannot pronounce them correctly.
Distortion is the easiest type of articulation disorder. When distorted, the child says approximately correct sounds, but in general the pronunciation is incorrect, to make it easier to pronounce difficult sounds, the child can add vowels between consonants, for example, “palyka” instead of “stick”, “vazyal” instead of “took”.
During substitution, difficult sounds are replaced with incorrect ones, for example, “labota” instead of “work”, “holosy” instead of “good”.
The most serious articulation disorder is the omission of difficult sounds and syllables, for example, “bono” instead of “it hurts,” “gaovka” instead of “head,” “kakotik” instead of “bell.” Omissions are most often characteristic of young children.
A child's speech may be understandable, partially understandable, or incomprehensible (or understandable only to his parents). In severe cases, the child’s speech is completely incomprehensible to both parents and others and long-term treatment is required.
The incidence of this disorder in children under 8 years of age is 10%, and in children over 8 years of age - 5%. Most mild cases in children under 8 years of age recover without treatment. But in children over 8 years of age, this disorder usually does not go away on its own, and qualified treatment is required.
Although this articulation disorder is more related to speech therapy, psychiatrists often have to deal with the consequences of an untreated disorder, especially in adolescence and older age, when behavioral disorders and social maladjustment occur due to the persistence of a speech defect.
Children and adolescents may be ashamed of their shortcomings, become an object of ridicule from their peers, because of this they develop an inferiority complex, they may refuse to attend classes at school, communicate with peers and show protest reactions.
In adults, a speech defect limits their opportunities in professional activities.
Therefore, articulation disorder must be treated from an early age, when treatment is much more successful than in adults.