To properly understand what signs indicate a delay speech development, it is necessary to know the main stages and conventional norms of speech development in young children.
The birth of a child is marked by a cry, which is the baby’s first speech reaction. A child’s cry is realized through the participation of the vocal, articulatory and respiratory sections of the speech apparatus. The time at which the cry appears (normally in the first minute), its volume and sound can tell a neonatologist a lot about the condition of the newborn. The first year of life is a preparatory (pre-speech) period, during which the child goes through the stages of babbling (from 1.5-2 months), babbling (from 4-5 months), babbling words (from 7-8.5 months). ), first words (at 9-10 months for girls, 11-12 months for boys).
Normally, at 1 year of age, a child’s active vocabulary contains approximately 10 words consisting of repeated open syllables (ma-ma, pa-pa, ba-ba, dyad-dya); in the passive dictionary - about 200 words (usually the names of everyday objects and actions). Until a certain time, the passive vocabulary (the number of words whose meaning the child understands) greatly exceeds the active vocabulary (the number of spoken words). At approximately 1.6 - 1.8 months. The so-called “lexical explosion” begins when words from the child’s passive vocabulary suddenly flow into the active vocabulary. For some children, the period of passive speech can last up to 2 years, but in general their speech and mental development proceeds normally. The transition to active speech in such children often occurs suddenly and soon they not only catch up with their peers who spoke early, but also surpass them in speech development.
Researchers believe that the transition to phrasal speech is possible when a child’s active vocabulary contains at least 40–60 words. Therefore, by the age of 2, simple two-word sentences appear in the child’s speech, and the active vocabulary grows to 50-100 words. By the age of 2.5 years, the child begins to construct detailed sentences of 3-4 words. In the period from 3 to 4 years, the child masters some grammatical forms, speaks in sentences united by meaning (coherent speech is formed); actively uses pronouns, adjectives, adverbs; masters grammatical categories (changing words according to numbers and genders). Vocabulary increases from 500-800 words at 3 years to 1000-1500 words at 4 years.
Experts allow deviations from the normative framework in terms of speech development by 2-3 months in girls, and by 4-5 months in boys. Only a specialist (pediatrician, pediatric neurologist, speech therapist) who has the opportunity to observe the child over time can correctly assess whether the delay in the appearance of active speech is a delay in speech development or an individual characteristic.
Thus, signs of delayed speech development at different stages of speech ontogenesis may be:
abnormal course of the pre-speech period (low activity of humming and babbling, soundlessness, similar vocalizations).
lack of reaction to sound and speech in a child aged 1 year.
inactive attempts to repeat other people's words (echolalia) in a child aged 1.5 years.
inability to perform a simple task (action, demonstration) by ear at 1.5-2 years of age.
absence of independent words at the age of 2 years.
inability to combine words into simple phrases at the age of 2.5-3 years.
complete absence of his own speech at 3 years old (the child uses in speech only memorized phrases from books, cartoons, etc.).
the child’s predominant use of non-verbal means of communication (facial expressions, gestures), etc.
For quotation: Zavadenko N.N., Suvorinova N.Yu. Speech development delays in children: causes, diagnosis and treatment // RMJ. 2016. No. 6. pp. 362-366
The article is devoted to the causes, diagnosis and treatment of speech delay in children
For citation. Zavadenko N.N., Suvorinova N.Yu. Speech development delays in children: causes, diagnosis and treatment // RMJ. 2016. No. 6. pp. 362–366.
Speech development delays usually mean a lag in speech formation from age standards in children under the age of 3–4 years. Meanwhile, this formulation implies a wide range of speech development disorders that have different causes.
The period from the first year of life to 3–5 years is decisive for the formation of speech. At this time, the brain and its functions intensively develop. Any disturbances in speech development are a reason for immediate contact with specialists - a doctor (pediatrician, child neurologist, ENT doctor, child psychiatrist), speech therapist, psychologist. This is all the more important because it is in the first years of life that deviations in the development of brain functions, including speech, are best amenable to correction.
Speech and its functions. Speech is a special and most perfect form of communication, inherent only to humans. In progress verbal communication(communication) people exchange thoughts and interact with each other. Speech is an important means of communication between a child and the world around him. The communicative function of speech contributes to the development of communication skills with peers, develops the ability to play together, which is invaluable for the formation of adequate behavior, the emotional-volitional sphere and personality of the child. The cognitive function of speech is closely related to the communicative function. The regulatory function of speech is formed already in the early stages of child development. However, the adult’s word becomes a true regulator of the child’s activity and behavior only by the age of 4–5, when the child’s semantic side of speech is already significantly developed. The formation of the regulatory function of speech is closely related to the development of internal speech, purposeful behavior, and the ability for programmed intellectual activity.
Speech development disorders affect the overall development of children’s personality, their intellectual growth and behavior, and make it difficult to learn and communicate with others.
Forms of speech development disorders. Specific language development disorders include those disorders in which normal language development is affected in the early stages. According to the ICD-10 classification, these include developmental disorders expressive speech(F80.1) and receptive speech (F80.2). In this case, disturbances appear without a previous period of normal speech development. Specific speech development disorders are the most widespread disorders of neuropsychic development; their frequency of occurrence in the child population is 5–10%.
Alalia(according to modern international classifications - “dysphasia” or “developmental dysphasia”) is a systemic underdevelopment of speech, it is based on an insufficient level of development of the speech centers of the cerebral cortex, which can be congenital or acquired in the early stages of ontogenesis, in the pre-speech period. In this case, first of all, children’s ability to speak suffers; expressive speech is characterized by significant deviations, while speech understanding can vary, but, by definition, is much better developed. The most common variants (expressive and mixed expressive-receptive disorders) are manifested by a significant delay in the development of expressive speech compared to the development of understanding. Due to difficulties in organizing speech movements and their coordination, independent speech does not develop for a long time or remains at the level individual sounds and words. Speech is slow, poor, vocabulary is limited. There are many slips of the tongue (paraphasias), permutations, and perseverations in speech. Growing up, children understand these mistakes and try to correct them.
IN modern literature Both terms “specific language development disorders” and “developmental dysphasia” are used, but they refer to the same group of pediatric patients. But “developmental dysphasia” is considered a more accurate formulation of the diagnosis, since this term reflects both the neurological and developmental aspects of this disorder.
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 made only after 3–4 years. With aphasia, there is a complete or partial loss of the ability to speak or understand someone else's speech.
Dysarthria– 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 in the central nervous system (CNS), several variants of dysarthria are distinguished: pseudobulbar, bulbar, subcortical, cerebellar.
Depending on the leading violations underlying speech disorders in children, L.O. Badalyan proposed the following clinical classification.
I. Speech disorders associated with organic damage to the central nervous system. Depending on the level of damage, they are divided into the following forms:
1. Aphasia - the collapse of all components of speech as a result of damage to the cortical speech areas.
2. Alalia is a systemic underdevelopment of speech as a result of damage to the cortical speech zones in the pre-speech period.
3. Dysarthria - 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.
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. Speech development delays of various origins (prematurity, severe illness internal organs, pedagogical neglect, etc.).
In domestic psychological and pedagogical classification alalia (dysphasia), along with other clinical forms of speech retardation in children, is considered from the perspective of general speech underdevelopment (GSD). This classification is based on the principle “from particular to general”. OHP is heterogeneous in terms of development mechanisms and can be observed when various forms ah disorders of oral speech (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 in varying degrees: from the absence of speech or its babbling state to extensive speech, but with elements of phonetic and lexico-grammatical underdevelopment.
The three levels of OHP differ as follows: 1st – absence of common speech (“speechless children”), 2nd – the beginnings of common speech and 3rd – extensive speech with elements of underdevelopment in the entire speech system. The development of ideas about OSD is focused on creating correction methods for groups of children with similar manifestations of various forms of 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 a qualitatively more high levels speech development.
However, the primary mechanisms of ANR cannot be elucidated without conducting 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 part of cases of OSD are associated with developmental dysphasia (alalia).
For normal speech development it is necessary so that the brain, and especially the cortex of its cerebral hemispheres, 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.
Causes of speech retardation there may be pathology during pregnancy and childbirth, dysfunction of the articulatory apparatus, damage to the hearing organ, a general lag in mental development 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 represent the most 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 lack of response to sound signals and inability to imitate sounds, and in an older child – excessive use of gestures and close observation of lip movements talking 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 in a child with isolated speech delay, it is necessary to conduct 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.
The causes of delayed speech development in a child may be autism or general mental retardation, which is characterized by uniform incomplete formation of all higher mental functions and intellectual abilities. To clarify the diagnosis, an in-depth examination is carried out by a pediatric psychoneurologist.
On the other hand, it is necessary to distinguish tempo delay in speech development, caused by a lack of stimulation of speech development under the influence of unfavorable social factors (insufficient communication and education). A child’s speech is not an innate ability; it is formed under the influence of the speech of adults and largely depends on sufficient speech practice, a normal speech environment, and on upbringing and training, which begin from the first days of a child’s life. The social environment stimulates speech development and provides a speech pattern. It is known that in families with poor speech impulses, children begin to speak late and speak little. A delay in speech development may be accompanied by a general lack of development, while the natural intellectual and speech abilities of these children correspond to the norm.
Neurobiological factors in the pathogenesis of speech development disorders. Perinatal pathology of the central nervous system plays a significant role in the formation speech disorders in children. This is due to the fact that it is in the perinatal period that the most important events, having a direct and indirect impact on the processes of structural and functional organization CNS. Taking this into account, it is advisable to identify risk groups for disorders of psycho-speech development already in the 1st year of life. The high-risk group should include children who, in the first 3 months. life as a result of the examination, structural changes in the central nervous system were revealed, premature infants (especially with extremely low body weight), children with analyzer disorders (auditory and visual), insufficiency of cranial nerve functions (in particular V, VII, IX, X, XII), children with a delay in the reduction of unconditioned automatisms, long-lasting disorders of muscle tone.
In premature newborns, especially those with a short gestation period, an important period of development of the central nervous system (interneuronal organization and intensive myelination) occurs not in utero, but in difficult conditions postnatal adaptation. The duration of this period can vary from 2–3 weeks. up to 2–3 months, and this period is often accompanied by the development of various infectious and somatic complications, which serves as an additional factor causing disturbances in psychomotor and speech development in immature and premature children. One of the main consequences of prematurity – hearing loss – plays a negative role. Studies have shown that approximately half of very premature babies have delayed speech development, and in school age– learning difficulties, problems with reading and writing, concentration and behavior control.
IN last years The role of genetic factors in the formation of speech development disorders has also been confirmed.
Development of speech skills is normal. For timely and accurate diagnosis of speech disorders in children, it is necessary to take into account the patterns of normal speech development. Children pronounce their first words by the end of the first year of life, but they begin to train their speech apparatus much earlier, from the first months of life, so the age of up to one year is a preparatory period in the development of speech. The sequence in the development of pre-speech reactions is shown in Table 1.
So, in the first year of life, the child’s speech apparatus is preparing to pronounce sounds. Humming, “flute”, babbling, modulated babbling are a kind of game for the baby and give the child pleasure; for many minutes he can repeat the same sound, training in a similar way in the articulation of speech sounds. At the same time, the active formation of speech understanding occurs.
An important indicator of speech development up to one and a half to two years is not so much the pronunciation itself, but the understanding of addressed speech (receptive speech). The child must listen carefully and with interest to adults, understand speech addressed to him well, recognize the names of many objects and pictures, and follow simple everyday requests and instructions. In the second year of life, words and sound combinations already become a means of verbal communication, that is, expressive speech is formed.
Main indicators of normal speech development from 1 year to 4 years:
The appearance of clear, meaningful speech (words) – 9–18 months.
At first (up to one and a half years), the child mainly learns to understand speech, and from 1.5–2 years, he quickly develops active speech and his vocabulary grows. The number of words that the baby understands (passive vocabulary) is still greater than the number of words that he can pronounce (active vocabulary).
The appearance of phrases of 2 words – 1.5–2 years, of 3 words – 2–2.5 years, of 4 or more words – 3–4 years.
Volume of active dictionary:
– by the age of 1.5 years, children pronounce 5–20 words,
– 2 years – up to 150–300 words,
– 3 years – up to 800–1000 words,
– 4 years old – up to 2000 words.
Early signs of trouble in speech formation. Children who do not try to speak at 2–2.5 years should be a cause for concern. However, parents may notice certain prerequisites for problems in speech development earlier. In the first year of life, one should be alarmed by the absence or weak expression at appropriate times of humming, babbling, first words, reaction to adult speech and interest in it; at one year - the child does not understand frequently used words and does not imitate speech sounds, does not respond to speech addressed to him, and resorts only to crying to attract attention to himself; in the second year - lack of interest in speech activity, replenishment of passive and active vocabulary, the appearance of phrases, inability to understand the simplest questions and show an image in a picture.
At 3–4 years of life, signs of dysfunctional speech formation should cause high alertness in comparison with the normal characteristics of its development, which are given in Table 2.
The lack of assistance at an early age for children with speech underdevelopment leads to a number of consequences: communication disorders and the resulting difficulties of adaptation in the children's team and contacts with other people, immaturity in the emotional sphere and behavior, insufficient cognitive activity. This is confirmed by the data of our study to assess the indicators of age-related development of children with dysphasia.
We examined 120 patients aged from 3 to 4.5 years (89 boys and 31 girls) with developmental dysphasia - a disorder of the development of expressive speech (F80.1 according to ICD-10) and a picture of level 1-2 ODD according to psychological pedagogical classification. Children whose speech development delay was caused by hearing loss, mental retardation, autism, severe somatic pathology, malnutrition, as well as the influence of unfavorable social factors (insufficient communication and education) were excluded from the study group.
We studied indicators of age-related development using the Developmental Profile 3 (DP-3) methodology in five areas: motor skills, adaptive behavior, social-emotional sphere, cognitive sphere, speech and communication abilities.
A structured interview form was used, conducted by a specialist with parents. Based on the data obtained, it was determined what age the child’s development corresponds to in each of the areas and at what age interval he lags behind the normal indicators for his calendar age.
When studying the anamnesis, many parents indicated that already at an early age they paid attention to the absence or limitation of babbling in children. Parents noted silence and emphasized that the child understood everything, but did not want to speak. Instead of speech, facial expressions and gestures developed, which children used selectively in emotionally charged situations. The first words and phrases appeared late. Parents noted that, apart from speech delays, in general the children were developing normally. The children had a poor active vocabulary and used babbling words, onomatopoeia, and sound complexes. There were many reservations in the speech, which the children paid attention to and tried to correct what was said incorrectly. At the time of the examination, the volume of the active vocabulary (stock of spoken words) in children with level 1 SLD did not exceed 15–20 words, and with level 2 SLD – 20–50 words.
Table 3 presents the results of the examination, showing at what age interval there was a lag from normal indicators in three groups of children with developmental dysphasia, divided by age: (1) from 3 years 0 months. up to 3 years 5 months; (2) from 3 years 6 months. up to 3 years 11 months; (3) from 4 years 0 months. up to 4 years 5 months
It seems logical that the most significant lag was in the formation of speech and communication abilities, but at the same time the degree of this lag increased - from 17.3 ± 0.4 months. in the 1st group to 21.2±0.8 in the 2nd and 27.3±0.5 months. in the 3rd group. Along with the increase in the severity of differences from healthy peers in speech development, the lag in all other areas not only persisted, but also increased with each six-month age period. This indicates, on the one hand, the significant influence of speech on other areas of the child’s development, and on the other, the close interconnection and inseparability of various aspects individual development.
The main directions of complex therapy with developmental dysphasia in children are: speech therapy work, psychological and pedagogical correctional measures, psychotherapeutic assistance to the child and his family, drug treatment. Since developmental dysphasia is a 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 assistance is based on the ontogenetic principle, taking into account the patterns and sequence of speech formation in children. In addition, it is individual, differentiated, depending on a number of factors: the leading mechanisms and symptoms of speech disorders, the structure of the speech defect, age and individual characteristics child. Speech therapy and psychological-pedagogical correctional activities are targeted, complex organized process which is carried out over a long period of time and systematically. Under these conditions, correctional work gives most children with developmental dysphasia the means sufficient for verbal communication.
The most complete correction of speech development disorders is facilitated by the timely use of nootropic drugs. Their prescription is justified based on the main effects of this group of drugs: nootropic, stimulating, neurotrophic, neurometabolic, neuroprotective. One of these drugs is acetylaminosuccinic acid (Cogitum).
Cogitum is an adaptogenic and general tonic that normalizes nervous regulation processes and has immunostimulating activity. Cogitum contains acetylaminosuccinic acid (in the form of dipotassium salt of acetylaminosuccinate) - a synthetic analogue of aspartic acid - nonessential amino acid, contained mainly in the tissues of the central nervous system.
For pediatricians and pediatric neurologists, such properties of aspartic acid are important, such as participation in DNA and RNA synthesis, influence on increasing physical activity and endurance, normalization of the balance between the processes of excitation and inhibition in the central nervous system, immunomodulatory effect (acceleration of antibody formation processes). Aspartic acid is involved in a number of metabolic processes, in particular, it regulates carbohydrate metabolism by stimulating the transformation of carbohydrates into glucose and the subsequent creation of glycogen reserves; along with glycine and glutamic acid, aspartic acid serves as a neurotransmitter in the central nervous system, stabilizes nervous regulation processes and has psychostimulating activity. In neuropediatric practice, the drug has been used for many years for indications such as delayed psychomotor and speech development, consequences of perinatal lesions of the central nervous system, neuroinfections and traumatic brain injuries, cerebrasthenic and astheno-neurotic syndromes.
Release form. Oral solution in ampoules of 10 ml. 1 ml of the drug contains 25 mg of acetyl-aminosuccinic (aspartic) acid, and 1 ampoule (10 ml) – 250 mg. The composition of the drug includes: fructose (levulose) - 1.0 g, methyl parahydroxybenzoate (methyl-n-hydroxybenzoate) - 0.015 g, aromatics (banana flavor) - 0.007 g, distilled water - up to 10 ml per 1 ampoule. The drug does not contain crystalline sugar or its synthetic substitutes, therefore it is not contraindicated in diabetes mellitus.
Dosage regimens. The drug is given orally undiluted or with a small amount of liquid. For children aged 7–10 years, it is recommended to take 1 ampoule (250 mg) orally in the morning, for children over 10 years old – 1–2 ampoules (250–500 mg) in the morning. For patients from 1 year to 7 years, the dose is determined by the doctor individually. In our experience, it is preferable for children under 7 years of age to take 5 ml (1/2 ampoule) 1 or 2 times a day. The duration of treatment is usually 2–4 weeks. For a single dose, the drug is prescribed in the morning, for a double dose, the second dose is prescribed no later than 16–17 hours. Before prescribing Cogitum, it is necessary to obtain written informed consent from parents/legal representatives for treating a child with acetylaminosuccinic acid, indicating that they are familiar with the indications, contraindications and side effects and do not object to prescribing the drug to a child.
Side effects. Although hypersensitivity reactions (allergic reactions) to individual components of the drug are possible, they are rare. There are no reports of drug overdoses in the literature.
If necessary, children with delays in speech development may be prescribed repeated courses of treatment with nootropic drugs. An open controlled study confirmed clinical effectiveness for developmental dysphasia in children aged 3 years to 4 years 11 months. two-month therapeutic courses of hopantenic acid, pyritinol and a drug containing a complex of peptides obtained from pig brain. To objectively assess the effectiveness of the therapy, parents are recommended to monitor the growth of vocabulary, improvement in the pronunciation of sounds and words, and the emergence of new phrases in the child’s speech. It is advisable to record the results of these observations in the form of special diary entries, which will be discussed with specialists during repeat visits to them. Constant contact with specialists (doctor and speech therapist), conducting consultations over time - important condition the success of the treatment.
Literature
1. Kornev A.N. Fundamentals of speech pathology in childhood: clinical and psychological aspects. St. Petersburg: Rech, 2006. 380 p.
2. Nyokiktien Ch. Child behavioral neurology. T. 2. M.: Terevinf, 2010. 336 p.
3. ICD-10 – International Classification of Diseases (10th revision). Classification of mental and behavioral disorders. Research diagnostic criteria. St. Petersburg, 1994. 208 p.
4. Aicardi J., Bax M., Gillberg K. Diseases nervous system in children. Per. from English edited by A.A. Skoromets. M.: Panfilov Publishing House, BINOM, 2013. 1036 p.
5. Beesems M.A.G. Developmental Dysphasia. Theory Diagnosis and Treatment. Amsterdam: Developmental Dysphasia Foundation, 2007. 11 p.
6. Badalyan L.O. Child neurology. M.: MEDpress-inform, 2010. 608 p.
7. Volkova L.S., Shakhovskaya S.N. Speech therapy. 5th ed., M.: Vlados, 2009. 703 p.
8. Sapozhnikov Ya.M., Cherkasova E.L., Minasyan V.S., Mkhitaryan A.S. Speech disorders in children // Pediatrics. Journal named after G.N. Speransky. 2013. T. 92. No. 4. pp. 82–87.
9. Simashkova N.V. Autism spectrum disorders. Scientific and practical guide. M.: Author's Academy, 2013. 264 p.
10. Asmolova G.A., Zavadenko A.N., Zavadenko N.N., Kozlova E.V., Medvedev M.I., Rogatkin S.O., Volodin N.N., Shklovsky V.M. Early diagnosis of speech development disorders. Features of speech development in children with consequences of perinatal pathology of the nervous system. Method. recommendations, M.: Union of Pediatricians of Russia, Ros. assoc. specialists in perinatal medicine, 2014. 57 p.
11. Zavadenko N.N., Efimov M.S., Zavadenko A.N., Shchederkina I.O., Davydova L.A., Doronicheva M.M. Disorders of neuropsychic development in premature infants with low and extremely low birth weight // Pediatrics. Journal named after G.N. Speransky. 2015. T. 94. No. 5. pp. 143–149.
12. Zavadenko N.N., Kozlova E.V. Assessment of development indicators in children with dysphasia (alalia) and comprehensive correction of their disorders. Doctor.ru / Neurology Psychiatry. 2014. T. 94. No. 6. pp. 12–16.
13. Alpern G.D. Developmental Profile 3, DP-3 Manual. Western Psychological Services, Los Angeles, 2009. 195 p.
14. Studenikin V.M., Balkanskaya S.V., Shelkovsky V.I. On the use of acetylaminosuccinic acid in neuropediatrics. Issues of modern pediatrics. 2008. T. 7. No. 3. P. 91–94.
15. Zavadenko N.N., Kozlova E.V. Drug therapy of developmental dysphasia in children with nootropic drugs // Questions of practical pediatrics. 2013. T. 8. No. 5. pp. 24–28.
Delayed psycho-speech development is a disease that is characterized by a disruption in the rate of mental development of a child. In most cases, this disease is caused by abnormalities in the development of the nervous system, in particular the brain. The latter may be due to a number of etiological factors, and the incorrect lifestyle of parents is no exception. By international classification diseases of the tenth revision (ICD-10) this pathology is assigned code F80. Whether it is possible to completely cure this disease, only a doctor can say after examining the patient. The sooner this disorder is diagnosed, the greater the child’s chances of recovery.
It should be noted that severe delay in psychospeech development is most often diagnosed in children after 5 years of age. This is due to the fact that at this age the child begins to actively communicate with others and must adapt socially. Therefore, it is very important to promptly pay attention to all problems in the baby’s development.
Etiology
Clinicians note that delayed psychospeech development is almost never an independent disease. In the majority of cases, this is a consequence of pathological processes in the central nervous system, in particular the brain.
In general, there are diseases that can lead to the development of this disorder:
- infectious diseases that affect the brain, nervous system (one of the most common is);
- (oxygen starvation of the fetus);
- congenital pathologies of the central nervous system;
- leukodystrophy;
- pathologies of cerebral vessels and liquor dynamics;
- mental illness.
Predisposing factors for the development of this disorder in children include:
- infectious diseases of the mother during pregnancy;
- incorrect lifestyle of the expectant mother while carrying a child - smoking, drinking alcohol, taking drugs, nervous experiences, stress;
- injuries to the child during childbirth, difficult pregnancy;
- severe illnesses suffered by the child at an early age (up to 2–3 years);
- difficult psycho-emotional situation in the family;
- severe psychological trauma;
- genetic, chromosomal diseases that lead to inhibition of development;
- improper upbringing of a child - excessive care or, on the contrary, rough treatment, moral and physical violence of the child.
It should be understood that ZPRD itself is a consequence of certain pathological processes or psychiatric diseases. Therefore, the root cause must be eliminated initially.
Symptoms
In most cases, disturbances in speech and mental development are clearly visible in children aged 4–5 years. The following signs may indicate speech development disorders:
- lack of response to sounds and calls under the age of one year;
- inactive attempts to repeat words or individual letters under the age of 1.5 years;
- the child does not pronounce words independently, cannot perform a simple action at the age of 2–2.5 years;
- at the age of 2.5–3.5 years, the child cannot meaningfully connect words into whole phrases;
- distortion of the articulation of some sounds;
- speech inactivity;
- almost complete absence of own speech, starting from the age of three. The baby can only repeat memorized phrases without meaning, which he most often hears in his environment.
On the part of mental disorder, the following general clinical picture may appear:
- auditory perception is less developed than visual perception;
- it is difficult for a child to explain what he wants, he has difficulty forming holistic images;
- the child has difficulty concentrating on certain objects or situations;
- syndrome may be present;
- patchy memorization of material;
- visual-figurative memory prevails over verbal;
- low mental activity;
- a child cannot draw his own conclusion, build a simple logical chain, or explain what he said without the help of an adult;
- (impaired written speech);
- affective reactions;
- infantilism;
- sudden change of mood;
- emotional instability;
- motor awkwardness, lack of coordination of movements.
Manifestations of PDRD must be diagnosed with elements of autism. In such cases, the pathological process may be supplemented by the following autistic symptoms:
- the child is prone to attacks of aggression not only towards others, but also towards himself. In case of dissatisfaction or other provoking factors, the baby may hit, bite, or inflict other physical harm on himself;
- does not enter into emotional contact with others, including close people. In some cases, the child may not respond positively even to the parents;
- prone to stereotypical behavior - can monotonously perform the same movements or actions for a long time;
- avoids the company of peers, may become hysterical and cry when in an unfamiliar room;
- does not know how to handle a toy, may use it for other purposes, does not show interest in new toys and entertainment;
- does not understand speech addressed to him.
If you have even 1-2 of the above symptoms, you should contact medical care to a speech therapist and a child psychoneurologist. It should also be understood that the presence of some of the above-described signs does not mean that the child has SPR; however, this factor should not be excluded either. Timely diagnosis significantly increases the chances of a full recovery.
Diagnostics
In this case, consultation with a group of specialists is required - children's, children's, and. A physical examination of the patient is required, collecting not only a family history, but also a history of life and illness.
Instrumental diagnostics includes the following methods:
- duplex scanning of the arteries of the head;
- CT and MRI of the brain;
- EchoEG;
- neuropsychological testing.
Laboratory diagnostic tools, in this case, are carried out only when indicated.
Passage is also required additional methods examinations – psychodiagnostics and assessment of speech development. In this case, the following can be done:
- diagnostic speech examination;
- Denver test of psychomotor development;
- Griffiths Psychomotor Development Scale;
- diagnostics using the Bayley scale;
- early speech development scale.
It should be noted that clinical manifestations in children with delayed psycho-speech development at five years of age may be a manifestation of other diseases. Therefore, in some cases, differential diagnosis is required in order to confirm or exclude the presence of such diseases:
- Down syndrome;
- autism;
- selective mutism;
- general speech underdevelopment of levels 1–4.
Based on the examination results, doctors make a diagnosis, select the most effective treatment tactics, and give general recommendations to parents.
Treatment
Only a qualified medical specialist-psychoneurologist can tell you how to treat this disease correctly. In this case, treatment should begin as early as possible and only comprehensively.
Taking medications is kept to a minimum. Depending on the current clinical picture, the doctor may prescribe the following drugs:
- sedatives;
- nootropic;
- vitamin and mineral complex.
The basis of treatment should consist of physiotherapeutic procedures, sessions with a speech therapist and a child psychologist. Proper interaction between parents and the child is very important, so consultations with a psychologist can be carried out with the child’s relatives.
As for physiotherapeutic procedures, magnetotherapy is most often prescribed - this allows you to activate the work of the cerebral cortex.
In addition, the following may be shown:
- physical therapy - gym classes, swimming;
- art therapy;
- manual therapy courses.
Treatment can also take place at home - the doctor can prescribe a set of exercises and recommendations that parents should perform together with the child. This is the development of fine and gross motor skills, as well as educational games that are aimed at improving memory and attention.
It is important to understand that such classes must be conducted regularly and for a long time. In addition, it is very important what the psycho-emotional situation is in the child’s environment. The baby should be protected from stress, psychological pressure, emotional overload, and especially moral and physical violence.
In addition to the classes prescribed by doctors, general recommendations should be taken into account:
- the child’s nutrition should be complete, balanced, timely and regular;
- daily walks in the fresh air are required;
- active, outdoor games;
- the baby’s interaction with people around him, his social adaptation.
It should be understood that the sooner treatment for this disorder is started, the higher the chances that the child will reach the desired level of development and adapt socially. At the same time, you need to understand that treatment for this disease can last more than one year.
Prognosis and prevention
The prognosis will depend on the etiology of the disease and at what stage active treatment was started. As for prevention, the following recommendations should be highlighted:
- systematic examination by a children's speech therapist, neurologist, psychologist;
- exclusion of head and central nervous system injuries;
- timely and correct treatment of all diseases;
- conducting healthy image life during pregnancy.
If there is a family history of genetic chromosomal diseases, it is recommended to consult a geneticist before conceiving a child.
Disorders in which the normal acquisition of language skills is impaired already in the early stages of development. These conditions are not directly related to impairments of neurological or speech mechanisms, sensory deficits, mental retardation, or factors environment. Specific speech and language developmental disorders are often accompanied by related problems, such as difficulties with reading, spelling and pronunciation of words, interpersonal relationships, emotional and behavioral disorders.
Specific speech articulation disorder
A specific developmental disorder in which a child's use of speech sounds is below age-appropriate levels, but in which language skills are normal.
Development related:
- physiological disorder
- speech articulation disorder
Dyslalia [tongue-tied]
Functional speech articulation disorder
Babbling [children's form of speech]
Excluded: insufficiency of speech articulation:
- aphasia NOS (R47.0)
- apraxia (R48.2)
- due to:
- hearing loss (H90-H91)
- mental retardation (F70-F79)
- in combination with a developmental language disorder:
- expressive type (F80.1)
- receptive type (F80.2)
Expressive language disorder
A specific developmental disorder in which a child's ability to use colloquial is at a level significantly lower than that corresponding to his age, but at which his understanding of the language does not go beyond the age norm; Articulation anomalies may not always be present.
Developmental dysphasia or expressive aphasia
Excluded:
- acquired aphasia with epilepsy [Landau-Klefner] (F80.3)
- dysphasia and aphasia:
- associated with the development of the receptive type (F80.2)
- selective mutism (F94.0)
- mental retardation (F70-F79)
- pervasive developmental disorders (F84.-)
Receptive language disorder
A developmental disorder in which a child's understanding of language is below age-appropriate levels. In this case, all aspects of language use noticeably suffer and there are deviations in the pronunciation of sounds.
Congenital hearing loss
Development related:
- dysphasia or receptive aphasia
- Wernicke's aphasia
Non-perception of words
Excluded:
- acquired aphasia in epilepsy [Landau-Klefner] (F80.3)
- autism (F84.0 -F84.1)
- dysphasia and aphasia:
- associated with the development of the expressive type (F80.1)
- selective mutism (F94.0)
- language delay due to deafness (H90-H91)
- mental retardation (F70-F79)
last modified: January 2008
Acquired aphasia with epilepsy [Landau-Klefner]
A disorder in which a child who previously had normal language development loses receptive and expressive language skills but retains general intelligence. The onset of the disorder is accompanied by paroxysmal changes in the EEG and, in most cases, epileptic seizures. The onset of the disorder usually occurs between three and seven years of age, with loss of skills occurring within a few days or weeks. The temporal relationship between the onset of seizures and loss of language skills is variable, with one preceding the other (or cycling) from several months to two years. An inflammatory process in the brain has been suggested as a possible cause of this disorder. Approximately two thirds of cases are characterized by the persistence of more or less severe deficiencies in language perception.
The disorders included in this block have common features: a) onset is obligatory in infancy or childhood; b) disruption or delay in the development of functions closely related to the biological maturation of the central nervous system; c) stable course without remissions and relapses. In most cases, speech, visuospatial skills and motor coordination are affected. Typically, a delay or impairment that appears as early as it can be reliably detected will progressively decrease as the child grows older, although milder deficits often persist into adulthood.
Disorders in which the normal acquisition of language skills is impaired already in the early stages of development. These conditions are not directly related to neurological or language impairments, sensory deficits, mental retardation, or environmental factors. Specific speech and language disorders are often accompanied by related problems, such as difficulties with reading, spelling and pronunciation of words, disturbances in interpersonal relationships, emotional and behavioral disorders.
Disorders in which normal indicators acquisition of learning skills is impaired starting from the early stages of development. This impairment is not simply a consequence of a learning disability or solely the result of mental retardation, nor is it due to a previous injury or disease of the brain.
Specific developmental disorders of motor function
Disorder, main feature which is a significant decrease in the development of motor coordination and which cannot be explained solely by ordinary intellectual retardation or any specific congenital or acquired neurological disorder. However, in most cases, a thorough clinical examination reveals signs of neurological immaturity, such as choreiform movements of the limbs in a free position, reflective movements, other signs associated with motor skills, as well as symptoms of impaired fine and gross motor coordination.
Clumsy child syndrome
Development related:
- lack of coordination
- dyspraxia
Excluded:
- gait and mobility disorders (R26.-)
- lack of coordination (R27.-)
- impaired coordination secondary to mental retardation (F70-F79)
Mixed specific psychological development disorders
This residual category contains disorders that are a combination of specific disorders of speech and language development, educational skills and motor skills, in which the defects are expressed to an equal degree, which does not allow isolating any of them as the main diagnosis. This rubric should only be used when there is a clear overlap between these specific developmental disorders. These impairments are usually, but not always, associated with some degree of general cognitive impairment. Therefore, this rubric should be used when there is a combination of dysfunctions that meet the criteria of two or more rubrics: