Mkb 10 speech. Disorders of psychological development (f80-f89). F80.8 Other speech and language developmental disorders

RCHR (Republican Center for Health Development of the Ministry of Health of the Republic of Kazakhstan)
Version: Archive - Clinical protocols of the Ministry of Health of the Republic of Kazakhstan - 2010 (Order No. 239)

Speech and language developmental disorders, unspecified (F80.9)

general information

Short description

Delay psycho speech development - a combined group, which includes mild pathologies of various etiologies of the development of the central nervous system with immaturity of emotional-volitional, cognitive and speech functions with the prospect of compensation.

Aphasia- speech disorder caused by damage to the cortical speech zones (inferior frontal gyrus or parieto-temporo-occipital regions in the dominant hemisphere); aphasia - speech disorders acquired at any age (in a child after three years of age); they are expressed in the complete or partial loss of one’s own speech or understanding of someone else’s speech.

Motor aphasia develops as a result of damage to the left hemisphere cortex in the third frontal gyrus (Broca's area). In this case, the skill of pronunciation is lost, the loss of skills of voluntary movements of the speech apparatus in the absence of paralysis.
Sensory aphasia occurs when there is a lesion in the superior temporal gyrus of the left hemisphere. With sensory aphasia, the patient hears but does not understand spoken speech. With this form of aphasia, the gnostic center of speech is affected - Wernicke's center, which in its mechanism is speech agnosia.

Protocol"Delayed psycho-speech development"

ICD code:

F80.1. Delayed psycho-speech development

Disorder expressive speech(developmental dysphasia or expressive aphasia)

F80.2. Receptive language disorder

Development related:

Dysphasia or receptive aphasia

Wernicke's aphasia

Failure to perceive words

F80.9 Developmental speech and language disorder

Classification

Delay mental development with speech impairment (L.A. Bulakhova):

1. Motor alalia.

2. Sensory alalia.

3. Dyslalia:

Mental retardation with dysgraphia;

Mental retardation with dyslexia;

Mental retardation with dyscalculia;

Mental retardation with dyspraxia;

Mental retardation due to congenital or early acquired deafness and hearing loss;

Mental retardation due to blindness or low vision.

Classification of speech disorders (L.O. Badalyan). Speech disorders:

Speech disorders associated with organic damage to the central nervous system. Depending on the level of damage to the speech system:

1. Aphasia - the collapse of all components of speech as a result of damage to the cortical speech areas.

2. Alalia - systemic underdevelopment of speech as a result of damage to cortical speech zones in the pre-speech period.

3. Dysarthria - a violation of the sound-pronunciation aspect of speech as a result of a violation of the innervation of the speech muscles. Depending on the location of the lesion, several forms of dysarthria are distinguished.

Speech disorders associated with functional changes in the central nervous system:

Stuttering;
- mutism and surdomutism.

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

Delayed speech development of various origins (prematurity, severe illness internal organs, pedagogical neglect, etc.)

Diagnostics

Diagnostic criteria

Complaints and anamnesis: delay in psycho-speech development, decreased thinking, memory, attention, disinhibition, restlessness; the perinatal anamnesis is burdened, a history of possible traumatic brain injuries and neuroinfections.

Physical examination: psycho-speech development does not correspond to the child, behavioral disturbances, inappropriate reactions.

Laboratory research: within normal limits.

Instrumental studies: EEG shows a delay in the formation of age-related cortical rhythms, diffuse changes in electrogenesis.

Indications for consultation with specialists: speech therapist, psychologist, ENT audiologist, ophthalmologist.

Minimum examination when referred to a hospital:

General analysis blood;

General urine analysis;

Feces on worm eggs.

Basic diagnostic measures:

1. General blood test.

2. General urine analysis.

4. Hearing examination.

5. ENT audiologist.

6. CT scan of the brain.

7. Speech therapist.

8. Psychologist.

9. Oculist.

Additional diagnostic measures:

1. ELISA for toxoplasmosis.

2. ELISA for cytomegalovirus.

3. Urine analysis for metabolic disorders.

4. Ultrasound of the abdominal organs.

Differential diagnosis

Diagnosis, sign	Rett syndrome	Early childhood autism	Sensory alalia	Motor alalia
Speech	Children who have reached a certain level of development of speech, communication and social adaptation lose these skills after the manifestation of the disease. According to parents, expressive and impressive speech and social skills are lost on average at the age of 4-11 months, and self-care skills - at 12-14 months.	The communicative function of speech is especially impaired, and speech development is delayed.	A sharp violation of the phonetic aspect of speech, speech is absent or limited, there are numerous errors in words, sound substitutions, echolalia.	Speech development develops with a delay, at an early age there is no babbling speech, by 2-3 years distorted words that are incomprehensible to others appear, by 4-5 years - simplified phrasal speech
Behavior	Autistic behavior, stereotypical hand movements reminiscent of squeezing, squeezing, clapping, “hand washing,” rubbing, appearing after the loss of purposeful hand movements; gait disturbances (apraxia and ataxia) that appear between the ages of 1 and 4 years	Children play alone, stereotypically, often with non-play objects, communicative behavior is impaired, stereotypical nature of games	Children are often restless and disinhibited	Self-doubt, irritability, silence
Intelligence	Up to 1 year of age, psycho-speech development corresponds to age, then there is a gradual loss of previously acquired skills. Intelligence significantly reduced	Intelligence level ranges from subnormal to normal	Impaired mental function	Mild mental retardation
Speech understanding	Speech understanding is extremely limited, profound damage to expressive and impressive speech and severe delay in psychomotor development		Children do not understand the speech of others	Children understand the speech of others

Treatment abroad

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Treatment

Treatment tactics

Treatment goals:

Activation of mental development;

Replenishment of passive and active vocabulary;

Behavior correction;

Increasing the emotional tone and mood of the child;

Self-care skills training;

Social adaptation.

Non-drug treatment:

Individual correctional classes with a speech therapist;

Classes with a psychologist;

Conductive pedagogy;

Group exercise therapy classes;

Massage of the collar area, head;

Physiotherapy - electrophoresis with aminophylline on the cervical spine, oxygen cocktail, darsonvalization of the scalp.

Drug treatment

Recently, nootropic drugs - neuroprotectors - have been widely used to improve metabolic processes in the brain. Most nootropic drugs, due to their psychostimulating effect, are prescribed in the first half of the day. The duration of nootropic treatment courses ranges from one to two to three months.

Cerebrolysin, ampoules 1 ml IM, piracetam, ampoules 5 ml 20%, ginkgo biloba (tanakan), tablets 40 mg, pyritinol hydrochloride (encephabol), dragees 100 mg, suspension - 5 ml contain 80.5 mg pyritinol (resp. 100 mg pyritinol hydrochloride).

Encephabol has a minimum of contraindications and is approved for use from the first year of life. Dosing of the suspension (containing 20 mg of encephabol in 1 ml) for children 3-5 years old with alalia, a daily dose of 200-300 mg (12-15 mg body weight) is prescribed in 2 doses - in the morning (after breakfast) and in the afternoon (after naps and afternoon tea). The duration of the course is 6-12 weeks, long-term use is advisable, which increases performance and learning ability, and improves higher mental functions.

Actovegin, ampoules 2 ml 80 mg, dragee-forte 200 mg active substance. A neurometabolic drug containing exclusively physiological components. Children are prescribed tablets-fort, taken before meals, ½ -1 tablets 2-3 times a day (depending on age and severity of symptoms of the disease), up to 17 hours. Duration of therapy is 1-2 months.

Instenon, tablets (1 tablet contains 50 mg etamivan, 20 mg hexobendine, 60 mg etophylline). Multicomponent neurometabolic drug. The daily dose is 1.5-2 tablets, prescribed in 2 doses (morning and afternoon), after meals. To avoid side effects, it is recommended to gradually increase the dose over 5-8 days. Duration of treatment is 4-6 weeks.

Angioprotectors to improve cerebral circulation: vinpocetine, cinnarizine.

B vitamins: B1, B6, B12, folic acid, aevit, neuromultivit - a special complex of B vitamins with a targeted neurotropic effect, neurobex.

Sedative therapy according to indications: Noofen, Novo-Passit.

Behavior correctors: sonapax, chlorprothixene.

Preventive actions:

Prevention of injuries;

Prevention of viral and bacterial infections.

Further management: regular classes with a speech therapist, speech pathologist, psychologist, social adaptation of the child, registration in a specialized kindergarten, passing a medical-pedagogical commission to resolve the issue of educating the child.

Essential medications:

1. Actovegin, ampoules 2 ml 80 mg

2. Vinpocetine (Cavinton), tablets 5 mg

3. Piracetam, ampoules 5 ml 20%

4. Piracetam, tablets 0.2 and 0.4

5. Pyridoxine hydrochloride, ampoules, 1 ml 5%

6. Pyritinol (encephabol), tablets 100 mg, suspension (5 ml = 80.0 pyritinol)

7. Thiamine chloride, ampoules 5%, 1 ml

8. Folic acid, tablets 0.001

9. Cerebrolysin, ampoules 1 ml

10. Cyanocobalamin, ampoules 1 ml, 200 mcg and 500 mcg

Additional medications:

1. Aevit, capsules

2. Actovegin, tablets 200 mg

3. Glycine, tablets 0.1

4. Hopanthenic acid (pantocalcin), tablets 0.25

5. Instenon, tablets

6. Magnesium lactate + pyridoxine hydrochloride, magnesium B6 tablets

7. Neuromultivit, tablets

8. Neurobex, tablets

9. Novo-passit, tablets, solution

10. Noofen, tablets 0.25

11. Thioridazine (sonapax), tablets 10 mg

12. Chlorprithixene, 15 mg

13. Cinnarizine, tablets 25 mg

Performance indicators:

1. Improving attention, memory, performance.

2. Replenishment of passive and active vocabulary.

3. Increased emotional and mental tone.

Hospitalization

Indications for hospitalization (planned): delayed psycho-speech development from birth or acquired, emotional-volitional disorders, general speech underdevelopment, loss of pronunciation and speech understanding skills.

Information

Sources and literature

Protocols for diagnosis and treatment of diseases of the Ministry of Health of the Republic of Kazakhstan (Order No. 239 of 04/07/2010)
1. Perinatal pathology. Edited by M.Ya. Studenikina. Moscow 1984 Yu.A. Yakunin. Diseases of the nervous system in newborns and young children. Moscow 1979 Directory of a child psychiatrist and neurologist. Edited by L.A. Bulakhova. Kyiv 1997 L.O. Badalyan. Child neurology. Moscow 1998 L.O. Badalyan. Neurology. Moscow 1982 N.N. Zavadenko. Nootropic drugs in the practice of pediatricians and child neurologists. Guidelines. Moscow 2003 L.Z. Kazantseva. Rett syndrome in children. Moscow 1998

Information

List of developers:

№	Developer	Place of work	Job title
	Kadyrzhanova Galiya Baekenovna		Head of department
	Serova Tatyana Konstantinovna	RDKB "Aksai", psychoneurological department No. 1	Head of department
	Mukhambetova Gulnara Amerzaevna	Department of Nervous Diseases, KazNMU	Assistant, Candidate of Medical Sciences
	Balbaeva Ayim Sergazievna	RDKB "Aksai", psychoneurological department No. 3	Neuropathologist

Attached files

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Cipher	Decoding
Methodological recommendations for the use of the International Statistical Classification of Diseases and Related Health Problems, tenth revision in the diagnostic activities of centers of correctional and developmental training and rehabilitation / Ministry of Education Rep. Belarus. – Minsk, 2002.	Models of diagnosis and treatment of mental and behavioral disorders: Order of the Ministry of Health of the Russian Federation dated August 6, 1999 No. 311 // Speech therapist. – 2004. - No. 4. Speech therapist. – 2005. - No. 1. Speech therapist. – 2005. - No. 3.
F80 - specific developmental disorders of speech and language
F80.0–specific disorders speech articulation	dyslalia	dyslalia
F80.1–expressive language disorder	motor alalia	1. delays (impairments) of speech development, manifested in general speech underdevelopment (GSD) of levels I – III; 2.motor alalia; 3. motor aphasia.
F80.2 – receptive speech disorder	sensory alalia	1. sensory agnosia (verbal deafness); 2. sensory alalia; 3. sensory aphasia.
F80.3 – acquired aphasia and epilepsy	childhood aphasia
F80.9 – speech and language developmental disorders, unspecified	uncomplicated variant of ANR, ANR of unknown pathogenesis
F80.81–speech development delays caused by social deprivation		1. delayed speech development due to pedagogical neglect; 2. physiological delay in speech development.
F81–specific developmental disorders of school skills
F81.0 – specific reading disorder	dyslexia, incl. in combination with dysgraphia	dyslexia
F81.1 – specific spelling disorder	dysgraphia	dysgraphia
F81.2–specific counting disorder	dyscalculia	dyscalculia

F98.5–stuttering (stammering)	stuttering	stuttering
F98.6–excited speech	tachylalia

R47.0–aphasia	aphasia
R47.1–dysarthria, anarthria	dysarthria, anarthria
R49.0 – dysphonia	dysphonia
R49.1–aphonia	aphonia
R49.2 – open and closed nasality	open and closed rhinolalia

Classification of speech underdevelopment in children (according to A.N. Kornev):

Principles for constructing the classification:

Clinical and pathogenetic principle

Multidimensional approach to diagnosis

Multidisciplinary approach

System-functional approach

A. Clinical-pathogenetic axis

1. Primary speech underdevelopment (PSD)

1.1.Partial commissioning

a) functional dyslalia

b) articulatory dyspraxia

Dysphonetic form

Dysphonological form

Dynamic form

c) developmental dysarthria

d) rhinolalia

e) dysgrammatism

1.2. Total PNR

Alalic variant of the disorder (“mixed”)

a) motor alalia

b) sensory alalia

2. Secondary speech underdevelopment (SSD)

2.1. Due to mental retardation

2.2. Due to hearing loss

2.3. Due to mental deprivation

3. Speech underdevelopment of mixed origin

3.1. Paraallic variant of total speech underdevelopment (TSD)

3.2. Clinical forms with a complex type of disorder (“mixed”)

B. Neuropsychological axis (syndromes and mechanisms of impairment)

1. Neurological level syndromes

Syndromes of central polymorphic total disorder of sound pronunciation of organic origin (developmental dysarthria syndromes)

2. Gnostic-praxic level syndromes

2.1. Syndrome of functional disorders of certain phonetic characteristics of speech sounds (dyslalia)

2.2. Syndromes of central polymorphic selective disorders of sound pronunciation (articulatory dyspraxia syndromes)

Dysphonetic articulatory dyspraxia syndrome

Dysphonological articulatory dyspraxia syndrome

Dynamic articulatory dyspraxia syndrome

Syndrome of delayed lexical-grammatical development

3. Language level syndromes

3.1. Expressive phonological underdevelopment syndrome (as part of motor alalia)

3.2. Impressive phonological underdevelopment syndrome (as part of sensory alalia)

3.3. Syndromes of lexico-grammatical underdevelopment

a) with a predominance of violations of paradigmatic operations (morphological dysgrammatism)

b) with a predominance of violation of syntagmatic operations (syntactic dysgrammatism)

4. Disorders with a mixed mechanism (gnostic-praxic and linguistic levels)

4.1. Verbal dyspraxia syndrome

4.2. Impressive dysgrammatism syndrome

4.3. Polymorphic expressive dysgrammatism syndrome

4.4. Syndrome of immature phonemic representations and metalinguistic skills

B. Psychopathological axis (leading psychopathological syndrome)

1. Syndromes of mental infantilism

2. Neurosis-like syndromes

3. Psychoorganic syndrome

D. Etiological axis

1. Constitutional (hereditary) form of HP

2. Somatogenic form of HP

3. Cerebral-organic form of HP

4. Form of NR of mixed origin

5. Deprivation-psychogenic form of HP

D. Functional axis (degree of maladjustment)

1. Severity of speech disorders

I degree – mild violations

III degree – violations of moderate severity

III degree – severe violations

2. Degrees of severity of socio-psychological maladjustment

a) mild b) moderate c) severe

Methodological recommendations for the use of the International Statistical Classification of Diseases and Related Health Problems, tenth revision in the diagnostic activities of centers of correctional and developmental training and rehabilitation / Ministry of Education Rep. Belarus. – Minsk, 2002.

Lopatina L.V. Methodological recommendations for diagnosing speech disorders in children of preschool and school age // Logopedic diagnostics and correction of speech disorders in children: collection. method. rec. – SPb., M.: SAGA: FORUM, 2006. – P. 4 – 36.

Lalaeva R.I. Methodological recommendations for speech therapy diagnostics // Diagnosis of speech disorders in children and organization speech therapy work in a preschool setting educational institution: Sat. method. recommendations / Comp. V.P. Balobanova and others - St. Petersburg: Publishing house "CHILDHOOD-PRESS", 2000. - P. 5–14.

Prishchepova I.V. Speech therapy work on the formation of prerequisites for the acquisition of spelling skills in junior schoolchildren with general speech underdevelopment. Author's abstract. dis. ...cand. ped. Sciences: 13.00.03 / Russian. state ped. univ. – L., 1993. – 16 p.

Kornev A.N. Reading and writing disorders in children: Educational method. allowance. – St. Petersburg: Publishing House “MiM”, 1997. – 286 p.

Lalaeva R.I. Methodological recommendations for speech therapy diagnostics // // Diagnosis of speech disorders in children and organization of speech therapy work in a preschool educational institution: Sat. method. recommendations / Comp. V.P. Balobanova and others - St. Petersburg: Publishing house "CHILDHOOD-PRESS", 2000. - P. 5–14.

Lalaeva R.I. Problems of speech therapy diagnostics // Speech therapy today. – 2007. - No. 3. – P. 37 – 43.

A.N. Kornev Fundamentals of speech pathology in childhood: clinical and psychological aspects. St. Petersburg, 2006.

Introduction. Speech formation is one of the main characteristics general development child. For the development of speech, it is necessary that the brain and especially the cortex of its cerebral hemispheres reach a certain maturity, the articulatory apparatus is formed, and hearing is preserved. Another important condition – [! ] a complete speech environment from the first days of a child’s life.

The speech function has two important components: the perception of speech sounds (impressive or receptive speech), for which Wernicke's center is responsible (located in the auditory cortex of the temporal lobe), and the reproduction of sounds, words, phrases (expressive speech) - the 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 are localized in the dominant cerebral hemisphere: the left in right-handed people and the right in left-handed people.

Delayed speech development[SRR] (or speech acquisition later than normal) is a systemic underdevelopment of speech, which is based on an insufficient level of development of the speech centers of the cerebral cortex. According to modern international classifications FDD is defined as “dysphasia” or “developmental dysphasia” (in modern literature The term “specific speech development disorders” is also used). There is also “dysarthria” - a disorder of the sound-pronunciation side of speech as a result of a violation of the innervation of the speech muscles (read also the article “On the classifications of speech disorders in childhood” Stepanenko D.G., Sagutdinova E.Sh.; Government agency Healthcare of the Sverdlovsk Region, Children's Clinical Hospital for Rehabilitation Treatment, Scientific and Practical Center "Bonum", Regional Children's Center for Speech Pathology (electronic scientific journal "System Integration in Healthcare" No. 2, 2010) [read]).

Stages of speech development. At 1 - 1.5 months. The first hum of individual vowel sounds appears at 2 - 3 months. Consonants are added to the walk, at 4 months. the singing becomes complex (pipe). At 7 - 8.5 months. the child begins to babble (pronunciation of individual syllables like ba-ba), and at the end of this period modulated babbling appears, i.e. variation in intonation. At 8.5 - 9.5 months. the child pleases those around him with the words ma-ma, pa-pa, am-am. But he cannot give them meaning or correlate them with specific individuals. At 12 months the child can already relate the words ma-ma, pa-pa with specific people. At 13 - 15 months. the child pronounces 5-6 simple words, but those around him understand no more than 20% of the child’s babble. By 18 months onomatopoeic words appear (muttering with lips, imitating the sound of a car, aw-aw, etc.). At 18 - 21 months. there are attempts to pronounce simple phrases like give-give, go-go, mom, give. At 22 - 24 months. understanding appears plural form And singular, the stage of asking “what is this?” begins. In the third year of life, cases and multi-word sentences appear in speech, and subordinate clauses are used. Speech includes pronouns and conjunctions. At 4 - 5 years old, monologues and long phrases appear. In the future, other things being equal, speech development depends on the cultural level of the family and activities with the child.

The reasons for the delay in speech development may be pathology during pregnancy and childbirth (most often the neurological status of these children is due to the following diagnoses: minimal cerebral dysfunction, perinatal encephalopathy), dysfunction of the articulatory apparatus, damage to the hearing organ, 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 have suffered serious illnesses at an early age, those who are weakened, or those who receive malnutrition. Less commonly, the cause of delayed speech development in children is autism or general mental retardation.

Early organic damage to the central nervous system in connection with the pathology of pregnancy and childbirth is traditionally considered as the main cause of retardation in speech development. However, in last years The attention of specialists is also drawn to the role of hereditary factors in the formation of speech development disorders. The role of hereditary predisposition is confirmed by the frequency of intrafamilial speech development disorders. In clinical practice, to identify a hereditary predisposition to speech development disorders, it is recommended to conduct a genealogical study in order to clarify information about the patients’ relatives, namely, about the characteristics of their development in childhood, the presence of indications of delays and other speech development disorders. The conclusion about a hereditary predisposition is considered valid when oral speech disorders are detected in childhood in one or more of the child’s closest relatives (father, mother, siblings).

Signs of trouble in speech formation . Children who do not try to speak at the age of 2 - 2.5 years should be 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 - if the child does not understand frequently used words and does not imitate speech sounds, does not respond to addressed speech, and resorts only to crying to attract attention to himself; in the second year - if there is no interest in speech activity, there is no increase in the volume of passive and active vocabulary, phrases, an inability to understand the simplest questions and show an image in a picture is detected. In the 3rd to 4th year of life, the following signs should cause particular concern. The child does not turn to adults with questions or for help, and does not use speech. Vocabulary is limited; he cannot name objects known to him. Doesn't answer simple questions. The child’s speech is incomprehensible to others, and he tries to supplement it with gestures, or shows indifference to whether other people understand him. The child has no desire to repeat words and phrases after adults, or he does it reluctantly.

It is well known that correctional assistance provided during a sensitive age period for speech formation is effective - from 2.5 to 4 - 5 years, when the active development of speech function is underway. However, the earlier trouble is noticed in the development of a child’s speech, and the sooner specialists begin working with him, the better the results achieved will be, because the reserve capabilities of the child’s brain are highest in the first years of life.

The main directions of correction for speech development disorders in children are speech therapy, psychological-pedagogical, psychotherapeutic assistance to the child and his family, as well as drug treatment (in the form of repeated courses of nootropic drugs). Of particular importance when organizing assistance to such children is the complexity of the impact and continuity of work with children by specialists in various fields (doctors, speech therapists, psychologists, teachers). It is important that the joint efforts of specialists be aimed at the early identification and correction of disorders in the formation of oral and written speech in children. Planning and implementation of corrective measures, including drug therapy, should be carried out according to individual plans...

Read more about mental retardation in the article “Retarded speech development in the practice of a pediatrician and child neurologist” by N.N. Zavadenko, I.O. Shchederkina, A.N. Zavadenko, E.V. Kozlova, K.A. Orlova, L.A. Davydova, M.M. Doronicheva, A.A. Shadrova; Russian National Research medical University them. N.I. Pirogov, Moscow; Morozov Children's City Clinical Hospital, Moscow, Russian Federation(magazine “Issues of Modern Pediatrics” No. 1, 2015) [read];

and:

in the article “Delayed speech development in children: an introduction to terminology” by M.Yu. Bobylova, T.E. Braudo, M.V. Kazakova, I.V. Vinyarskaya; LLC Institute of Child Neurology and Epilepsy named after. St. Luke", Russia, Moscow; Federal State Budgetary Institution "Rehabilitation Center (for children with hearing impairment)" of the Russian Ministry of Health, Moscow; FGBNU " Science Center mental health"; Russia Moscow; Federal State Institution "Scientific Center for Children's Health" of the Ministry of Health of Russia, Moscow (Russian Journal of Child Neurology, No. 1, 2017) [read];

in the article “Ontogenesis of speech development” by T.E. Braudo, M.Yu. Bobylova, M.V. Kazakova; Federal State Budgetary Institution "Rehabilitation Center (for children with hearing impairment)" of the Russian Ministry of Health; LLC Institute of Child Neurology and Epilepsy named after. St. Luke", Russia, Moscow; Federal State Budgetary Institution "Research Center for Mental Health", Russia, Moscow (Russian Journal of Child Neurology, No. 3, 2016) [read];

in the article “Motor and sensory alalia: difficulties of diagnosis” by M.Yu. Bobylova, A.A. Kapustina, T.A. Braudo, M.O. Abramov, N.I. Klepikov, E.V. Panfilova; LLC Institute of Pediatric and Adult Neurology and Epilepsy named after. St. Luke", Moscow; GBOU Education Center No. 1601 named after. Hero of the Soviet Union E.K. Lyutikova", Moscow; OOO " Child Center“Development Plus”, Moscow (Russian Journal of Child Neurology, No. 4, 2017) [read]

WHAT PARENTS OF NON-SPEAKING CHILDREN SHOULD KNOW (article “Consulting parents of non-speaking children” by Tarakanova O.N.; Center for Psychological and Pedagogical Correction and Rehabilitation “Peasant Outpost”, Moscow; magazine “Training and Education: Methods and Practice” No. 18, 2015) [read]

© Laesus De Liro

The disorders included in this block have common features: a) onset is required 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 impairments of neurological or speech mechanisms, sensory deficits, mental retardation, or factors environment. Specific speech and language development disorders are often accompanied by related problems, such as difficulties with reading, spelling and pronunciation of words, 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

A disorder in which the main feature is a significant decrease in the development of motor coordination and which cannot be explained solely by ordinary intellectual retardation or by 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:

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.

Development related:

physiological disorder

Babbling [children's form of speech]

aphasia NOS (R47.0)
apraxia (R48.2)
due to:
- hearing loss (H90-H91)
- expressive type (F80.1)
- receptive type (F80.2)

Excluded:

dysphasia and aphasia:
- NOS (R47.0)
selective mutism (F94.0)

Development related:

Wernicke's aphasia

Excluded:

autism (F84.0-F84.1)
dysphasia and aphasia:
- NOS (R47.0)
selective mutism (F94.0)
mental retardation (F70-F79)

Excluded: aphasia:

NOS (R47.0)
for autism (F84.0-F84.1)

Codification of speech disorders in ICD-10

Classification of speech underdevelopment in children (according to A.N. Kornev):

Principles for constructing the classification:

Multidimensional approach to diagnosis

A. Clinical-pathogenetic axis

1. Primary speech underdevelopment (PSD)

a) functional dyslalia

b) articulatory dyspraxia

c) developmental dysarthria

1.2. Total PNR

Alalic variant of the disorder (“mixed”)

a) motor alalia

b) sensory alalia

2. Secondary speech underdevelopment (SSD)

2.1. Due to mental retardation

2.2. Due to hearing loss

2.3. Due to mental deprivation

3. Speech underdevelopment of mixed origin

3.1. Paraallic variant of total speech underdevelopment (TSD)

3.2. Clinical forms with a complex type of disorder (“mixed”)

B. Neuropsychological axis (syndromes and mechanisms of impairment)

1. Neurological level syndromes

Syndromes of central polymorphic total disorder of sound pronunciation of organic origin (developmental dysarthria syndromes)

2. Gnostic-praxic level syndromes

2.1. Syndrome of functional disorders of certain phonetic characteristics of speech sounds (dyslalia)

2.2. Syndromes of central polymorphic selective disorders of sound pronunciation (articulatory dyspraxia syndromes)

Dysphonetic articulatory dyspraxia syndrome

Dysphonological articulatory dyspraxia syndrome

Dynamic articulatory dyspraxia syndrome

Syndrome of delayed lexical-grammatical development

3. Language level syndromes

3.1. Expressive phonological underdevelopment syndrome (as part of motor alalia)

3.2. Impressive phonological underdevelopment syndrome (as part of sensory alalia)

3.3. Syndromes of lexico-grammatical underdevelopment

a) with a predominance of violations of paradigmatic operations (morphological dysgrammatism)

b) with a predominance of violation of syntagmatic operations (syntactic dysgrammatism)

4. Disorders with a mixed mechanism (gnostic-praxic and linguistic levels)

4.1. Verbal dyspraxia syndrome

4.2. Impressive dysgrammatism syndrome

4.3. Polymorphic expressive dysgrammatism syndrome

4.4. Syndrome of immature phonemic representations and metalinguistic skills

B. Psychopathological axis (leading psychopathological syndrome)

1. Syndromes of mental infantilism

2. Neurosis-like syndromes

3. Psychoorganic syndrome

1. Constitutional (hereditary) form of HP

2. Somatogenic form of HP

3. Cerebral-organic form of HP

4. Form of NR of mixed origin

5. Deprivation-psychogenic form of HP

D. Functional axis (degree of maladjustment)

1. Severity of speech disorders

I degree – mild violations

III degree – violations of moderate severity

III degree – severe violations

2. Degrees of severity of socio-psychological maladjustment

a) mild b) moderate c) severe

Lalaeva R.I. Methodological recommendations for speech therapy diagnostics // Diagnosis of speech disorders in children and organization of speech therapy work in a preschool educational institution: Sat. method. recommendations / Comp. V.P. Balobanova and others - St. Petersburg: Publishing house "CHILDHOOD-PRESS", 2000. - P. 5–14.

Prishchepova I.V. Speech therapy work on the formation of prerequisites for the acquisition of spelling skills in primary schoolchildren with general speech underdevelopment. Author's abstract. dis. ...cand. ped. Sciences: 13.00.03 / Russian. state ped. univ. – L., 1993. – 16 p.

Kornev A.N. Reading and writing disorders in children: Educational method. allowance. – St. Petersburg: Publishing House “MiM”, 1997. – 286 p.

Lalaeva R.I. Problems of speech therapy diagnostics // Speech therapy today. – 2007. - No. 3. – P. 37 – 43.

A.N. Kornev Fundamentals of speech pathology in childhood: clinical and psychological aspects. St. Petersburg, 2006.

Specific developmental disorders of speech and language

Disorders in which normal language acquisition is impaired early in development. These conditions are not directly related to neurological or speech disorders, 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.

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

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:
- NOS (R47.0)
- 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

Excluded:

acquired aphasia in epilepsy [Landau-Klefner] (F80.3)
autism (F84.0-F84.1)
dysphasia and aphasia:
- NOS (R47.0)
- 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)

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.

Excluded: aphasia:

NOS (R47.0)
for autism (F84.0-F84.1)
due to disintegrative disorders of childhood (F84.2-F84.3)

ICD 10 dyslalia

Disorders of psychological (mental) development

Disorders included in category F80 - F89 have the following characteristics:

a) the onset is obligatory in infancy or childhood;

b) damage or delay in the development of functions closely related to the biological maturation of the central nervous system;

c) constant course, without remissions or relapses, characteristic of many mental disorders.

In most cases, the functions affected include speech, visuospatial skills, and/or motor coordination. A characteristic feature of the damage is a tendency to progressively decrease as children get older (although milder deficits often persist into adulthood). Typically, developmental delay or damage appears as early as it can be detected, without a preceding period of normal development. Most of these conditions are observed in boys several times more often than in girls.

Developmental disorders are characterized by a family history of similar or related disorders, and there is evidence to suggest that genetic factors play an important role in the etiology of many (but not all) cases. Environmental factors often influence impaired developmental functions, but in most cases they are not of primary importance. However, although there is usually no significant disagreement in the overall conceptualization of disorders under this heading, in most cases the etiology is unknown, and uncertainty remains regarding the boundaries and specific subgroups of developmental disorders. Moreover, there are two types of conditions included in this section, which do not fully meet the broad conceptual definition given above. First, these are disorders in which there was an undoubted phase of previous normal development, such as disintegrative disorder of childhood, Landau-Klef syndrome.

nera, some cases of autism. These conditions are included here because

that although their beginnings are different, their characteristic features and course

have many similarities with the group of developmental disorders; in addition, it is unknown whether they differ etiologically. Second, there are disorders primarily defined as abnormalities rather than delays in the development of function; this is especially applicable to autism. Autistic disorders are included in this section because, although defined as disabilities, some degree of developmental delay is almost always found. Additionally, there is overlap with other developmental disorders both in the sense characteristic features individual cases, and in a similar group.

/F80/ Specific developmental disorders of speech and language

These are disorders in which normal speech development is disrupted in the early stages. The conditions cannot be explained by neurological or speech pathology, sensory damage, mental retardation or environmental factors. The child may be more able to communicate or understand in certain, well-known situations than in others, but language ability is always impaired.

As with other developmental disorders, the first difficulty in diagnosis relates to differentiation from normal developmental patterns. Normal children vary considerably in the age at which they first acquire spoken language and in the rate at which speech skills are firmly acquired. Such normal variations in the timing of language acquisition are of little or non-clinical significance, since most late talkers continue to develop quite normally. Children with specific speech and language developmental disorders differ sharply from them, although most of of these ultimately reaches a normal level of development of speech skills. They have many associated problems. Delayed speech development is often accompanied by difficulties in reading and writing, disturbances in interpersonal relationships, and emotional and behavioral disorders. Therefore, early and thorough diagnosis of specific speech development disorders

very important. There is no clearly defined demarcation from extreme

variants of the norm, but for judging a clinically significant disorder

Four main criteria are used: severity; flow; type; and related problems.

How general rule, speech delay can be considered pathological when it is severe enough to be a two standard deviation delay. In most cases of this level of severity, there are associated problems. However, in older children, the level of severity in statistical terms has less diagnostic value, since there is a natural tendency for steady improvement. In this situation, current is a useful indicator. If the current level of impairment is relatively mild, but there is nonetheless a history of severe impairment, then it is more likely that the current functioning represents a consequence of significant impairment rather than a variant of the norm. It is necessary to pay attention to the type of speech functioning; if the type of disorder is pathological (that is, abnormal and not simply a variant corresponding to an earlier phase of development) or if the child's speech contains qualitatively pathological features, then a clinically significant disorder is likely. Moreover, if delays in some specific aspects of language development are accompanied by deficits in school skills (such as specific delays in reading and writing), disturbances in interpersonal relationships, and/or emotional or behavioral disorders, then it is unlikely that this is a normal variant.

The second difficulty in diagnosis relates to differentiation from mental retardation or global developmental delay. Since intellectual development includes verbal skills, it is likely that if a child's IQ is significantly below average, then his speech development will also be below average. A diagnosis of a specific developmental disorder suggests that the specific delay is significantly out of proportion with the overall level of cognitive functioning. Accordingly, when speech delay is part of a general mental retardation or general developmental delay, the condition cannot be coded as F80.-. Mental retardation coding F70 - F79 should be used. However, mental retardation is characterized by a combination with uneven

loss of intellectual productivity, especially with a language impairment that is usually more severe than a delay in nonverbal skills. When this discrepancy manifests itself to such a marked degree that it becomes apparent in the child's daily functioning, the specific language impairment should be coded in addition to the mental retardation category (F70 -

The third difficulty concerns differentiation from secondary disorders due to severe deafness or certain specific neurological or other anatomical disorders. Severe deafness in early childhood virtually always leads to a noticeable delay and distortion of speech development; such conditions should not be included here as they are a direct consequence of hearing loss. However, often more serious disturbances in the development of receptive speech are accompanied by partial selective hearing damage (especially high-tone frequencies). These disorders should be excluded from F80 - F89 if the severity of the hearing impairment significantly explains the speech delay, but included if partial hearing loss is only a complicating factor and not the direct cause.

However, a strictly defined distinction cannot be made. A similar principle applies to neurological pathology and anatomical defects. Thus, articulation pathology due to cleft palate or dysarthria due to cerebral palsy should be excluded from this section. On the other hand, the presence of mild neurological symptoms that would not cause speech delay is not grounds for exclusion.

F80.0 Specific speech articulation 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.

The age at which a child acquires speech sounds and the order in which they develop are subject to considerable individual variation.

Normal development. At the age of 4 years, errors in the production of speech sounds are common, but the child can easily be understood strangers. Most speech sounds are acquired by the age of 6-7 years. Although difficulties may remain in certain sound combinations, they do not lead to communication problems. By age, almost all speech sounds should be acquired.

Pathological development. Occurs when a child's acquisition of speech sounds is delayed and/or deviated, resulting in: disarticulation with associated difficulty for others to understand his speech; omissions, distortions or substitutions of speech sounds; changes in the pronunciation of sounds depending on their combination (that is, in some words the child can pronounce phonemes correctly, but not in others).

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; incorrect pronunciation is undoubtedly anomalous, based on the characteristics of speech use in the subcultural conditions in which the child finds himself.

Developmental physiological disorder;

Developmental articulation disorder;

Functional articulation disorder;

Babbling (children's form of speech);

Phonological developmental disorder.

Aphasia NOS (R47.0);

Articulation disorders combined with a developmental disorder of expressive speech (F80.1);

Articulation disorders combined with a disorder of receptive speech development (F80.2);

Cleft palate and other anatomical abnormalities of oral structures involved in speech functioning (Q35 - Q38);

Articulation disorder due to hearing loss (H90 - H91);

Articulation disorder due to mental retardation (F70 - F79).

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.

Although there is considerable interindividual variation in normal language development, the absence of single words or word-related language units by 2 years, or simple expressions or two-word phrases by 3 years, should be considered significant signs of delay. Late impairments include: limited vocabulary development; overuse of a small set of common words; difficulties in choosing suitable words and substitute words; abbreviated pronunciation; immature sentence structure; syntactic errors, especially omissions of word endings or prefixes; incorrect use or absence of grammatical features such as prepositions, pronouns, and conjugations or inflections of verbs and nouns. Overgeneralization of rules may occur,

as well as lack of fluency in sentences and difficulty in establishing

consistency when retelling past events.

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). The use of nonverbal cues (such as smiles and gestures) and "inner" speech reflected in imagination or role-play is relatively intact; the ability to communicate socially without words is relatively intact. The child will strive to communicate, despite the speech impairment, and to compensate for the lack of speech with gestures, facial expressions or non-speech vocalizations. However, co-occurring disturbances in peer relationships, emotional disturbances, behavioral disturbances and/or hyperactivity and inattention are common. In a minority of cases, there may be associated partial (often selective) hearing loss, but this should not be so severe as to lead to speech delay. Inadequate conversational engagement or more general environmental deprivation may play an important or contributing role in the genesis of impaired expressive language development. In this case, the environmental causative factor should be noted through the appropriate second code from Class XXI of ICD-10. Impaired spoken language becomes evident from infancy without any long, distinct phase of normal speech use. However, it is not uncommon to see the use of a few isolated words appear normal at first, followed 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. In this regard, in such patients, the subheading “Other non-psychotic disorders caused by damage and dysfunction of the brain” should be used as the first code.

brain or somatic disease" (F06.82х). The sixth character is placed in

depending on the etiology of the disease. Structure of speech disorders

indicated by the second code R47.0.

Delayed speech development according to the type of general speech underdevelopment (GSD) level I - III;

Developmental dysphasia of expressive type;

Developmental aphasia of expressive type.

Developmental dysphasia, receptive type (F80.2);

Developmental aphasia, receptive type (F80.2);

Pervasive developmental disorders (F84.-);

General disorders of psychological (mental) development (F84.-);

Selective mutism (F94.0);

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.

Inability to respond to familiar names (in the absence of nonverbal cues) from the first birthday; inability to identify

learn at least a few common items by 18 months, or

inability to follow simple instructions by age 2

should be accepted as significant signs of speech delay

development. Late impairments include: inability to understand

grammatical structures (negations, questions, comparisons, etc.), lack of understanding of more subtle aspects of speech (tone of voice, gestures, etc.).

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 most high level concomitant socio-emotional-behavioural disorders. These disorders do not have any specific manifestations, but hyperactivity and inattention, social inappropriateness and isolation from peers, anxiety, sensitivity or excessive shyness are quite 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. However, they differ from autistic children, usually showing normal social interaction, normal role-playing games, normal calling to parents for comfort, nearly normal use of gestures, and only mild impairment of nonverbal communication. It is not uncommon to have some degree of high-pitched hearing loss, but the degree of deafness is not sufficient to cause speech impairment.

Similar speech disorders of the receptive (sensory) type are observed in adults, which are always accompanied by a mental disorder and are organically caused. In this regard, in such patients, the subheading “Other non-psychotic disorders due to brain damage and dysfunction or somatic illness” (F06.82x) should be used as the first code. The sixth character is placed depending on the etiology of the disease. The structure of speech disorders is indicated by the second code R47.0.

Developmental receptive dysphasia;

Developmental receptive aphasia;

Congenital auditory immunity;

Wernicke's developmental aphasia.

Acquired aphasia with epilepsy (Landau-Klefner syndrome) (F80.3x);

Autism (F84.0х, F84.1х);

Selective mutism (F94.0);

Mental retardation (F70 - F79);

Speech delay due to deafness (H90 - H91);

Dysphasia and aphasia of the expressive type (F80.1);

Organically caused speech disorders of the expressive type in adults (F06.82x with the second code R47.0);

Organically caused speech disorders of the receptive type in adults (F06.82x with the second code R47.0);

Dysphasia and aphasia NOS (R47.0).

/F80.З/ Acquired aphasia with epilepsy

A disorder in which a child, having previously normal speech development, loses both receptive and expressive language skills, while general intelligence is preserved; the onset of the disorder is accompanied by paroxysmal pathology on the EEG (almost always in the temporal lobes, usually bilaterally, but often with wider disturbances) and in most cases epileptic seizures. Onset is typical between 3 and 7 years of age but may occur earlier or later in childhood. In a quarter of cases, speech loss occurs gradually over several months, but more often there is a sudden loss of speech.

forged over several days or weeks. Time connection between

the onset of seizures and loss of speech is quite variable, one of

these signs may precede another by several months and

up to 2 years. It is very typical that receptive language impairment is quite

profound, often with difficulty in auditory understanding when the condition first appears. Some children become mute, others are limited to jargon-like sounds, although some show milder deficits in fluency, and speech production is often accompanied by articulation disorders. In a small number of cases, voice quality is impaired with loss of normal modulations. Sometimes speech functions appear in waves in the early phases of the disorder. Behavioral and emotional disturbances are common in the first months after the onset of speech loss, but tend to improve as children acquire some means of communication.

The etiology of the condition is unknown, but clinical data suggest the possibility of an inflammatory encephalitic process. The course of the condition is completely different; 2/3 of children retain a more or less serious receptive speech defect, and about 1/3 completely recover.

Acquired aphasia due to brain injury, tumor or other known disease process (F06.82x);

Aphasia NOS (R47.0);

Aphasia due to disintegrative disorders of childhood (F84.2 - F84.3);

Aphasia in autism (F84.0х, F84.1х).

F80.31 Psychotic variant of the course of acquired aphasia with epilepsy (Landau-Klefner syndrome)

F80.32 Non-psychotic variant of acquired aphasia with epilepsy (Landau-Klefner syndrome)

F80.39 Unspecified by type of acquired aphasia with epilepsy (Landau-Klefner syndrome)

/F80.8/ Other developmental disorders of speech and language

F80.81 Delayed speech development due to social deprivation

This group is represented by speech disorders, delayed formation of higher mental functions, which are caused by social deprivation or pedagogical neglect. The clinical picture is manifested in limited vocabulary, unformed phrasal speech, etc.

Delayed speech development due to pedagogical neglect;

Physiological delay in speech development.

F80.82 Speech development delays, combined

with delayed intellectual development and specific

learning skills disorders

In patients in this group, speech disorders are manifested by limited grammatical vocabulary, difficulties in making statements and the semantic design of these statements. Intellectual disability or cognitive impairment manifests itself in difficulties in ab-

structural-logical thinking, low level of cognitive ability, attention and memory disorders. In these cases, it is necessary to use the second code from the categories F70.xx - F79.xx or F81.x.

F80.88 Other developmental disorders of speech and language

F80.9 Speech and language developmental disorders, unspecified

This category should be avoided as much as possible and used only for unspecified disorders in which there is significant impairment in language development that cannot be explained by mental retardation or neurological, sensory, or physical abnormalities directly affecting speech.

Speech disorder NOS;

Speech disorder NOS.

/F81/ Specific developmental disorders of learning skills

The concept of specific developmental disorders of school skills is directly reminiscent of the concept of specific disorders of language development (see F80.-), and here there are the same problems in their definition and measurement. These are disorders in which normal skill acquisition is disrupted from the early stages of development. They do not result from a lack of educational opportunity or from any previous brain injury or illness. Rather, the disorders are thought to arise from impairments in the processing of cognitive information, which largely results from biological dysfunction. As with most other developmental disorders, this

The condition is significantly more common in boys than in girls.

Five types of difficulties arise in diagnosis. First, there is the need to differentiate disorders from normal schooling options. The problem here is the same as for speech disorders and the same criteria are proposed for judging the pathology of the condition (with the necessary modification, which is associated with the assessment not of speech, but of school achievements). Secondly, this is the need to take into account the dynamics of development. This is important for 2 reasons:

a) severity: a 1-year delay in reading at 7 years has a completely different meaning than a 1-year delay at 14 years;

b) change in the type of manifestations: usually, speech delay in the preschool years in spoken language disappears, but is replaced by a specific reading delay, which, in turn, decreases in adolescence, and the main problem in adolescence is severe disorder spelling; the condition is the same in all respects, but the manifestations change as one grows older; the diagnostic criterion must take into account this developmental dynamics.

The third difficulty is that school skills must be taught and learned; they are not only a function of biological maturation. It is inevitable that children's level of skill acquisition will depend on family circumstances and schooling, as well as on their individual characteristics character. Unfortunately, there is no direct and unambiguous way to differentiate school difficulties caused by a lack of adequate experience from those caused by certain individual impairments. There is good evidence to suggest that this difference has actual reality and clinical force, but diagnosis is difficult in individual cases. Fourth, although research evidence suggests an underlying cognitive processing pathology, it is not easy to differentiate in a given child what is causing reading difficulties from what is associated with poor reading skills. The difficulty arises from evidence that reading impairment can arise from more than one type of cognitive pathology. Fifthly,

uncertainty remains regarding the optimal subdivision

specific developmental disorders of school skills.

Children learn to read, write, spell, and improve arithmetic when they are exposed to these activities at home and at school. Countries vary widely in the age at which formal schooling begins, in the curricula of schooling, and therefore in the skills children are expected to have acquired at different ages. This discrepancy is greatest during the period of children’s education in elementary or primary school(that is, up to 11 years old) and complicates the problem of developing current definitions of impaired school skills that have transnational adequacy.

However, within all educational systems it is clear that within each age group of schoolchildren there is variation in school achievement and some children show deficiencies in specific aspects of skills relative to their general level intellectual functioning.

Specific Disorders of School Skills (SDSD) encompass groups of disorders characterized by specific and significant deficits in the learning of school skills. These learning disabilities are not a direct consequence of other conditions (such as mental retardation, gross neurological defects, uncorrected visual or auditory damage, or emotional disturbances), although they may occur as comorbidities. SDD often occurs in association with other clinical syndromes (such as attention deficit disorder or conduct disorder) or other developmental disorders such as specific motor development disorder or specific language development disorder.

The etiology of SRRHS is unknown, but there is an assumption of a leading role biological factors, which interact with non-biological factors (such as the availability of learning opportunities and the quality of learning) to produce the condition. Although these disorders are associated with biological maturation, this does not mean that children with such disorders are

are simply at a lower level of the normal continuum and, therefore, will “catch up” with their peers over time. In many cases, signs of these disorders can continue into adolescence and persist into adulthood. However, a necessary diagnostic feature is that the disorders appear in certain forms during the early periods of schooling. Children may lag behind in their school improvement even at a later stage of their education (due to lack of interest in learning; poor educational program; emotional disturbances; increase or changes in task requirements, etc.), however, such problems are not included in the concept of SRRSHN.

There are several basic requirements for diagnosing any of the specific developmental disorders of school skills. First, there must be a clinically significant degree of impairment in any particular school skill. This can be judged: on the basis of severity, determined by school performance, that is, such a degree of impairment that could occur in less than 3% of the population of school-age children; by previous developmental disorders, that is, delay or deviation in development in the preschool years, most often in speech; for related problems (such as inattention, hyperactivity, emotional or behavioral disturbances); by type of disorder (that is, the presence of qualitative impairments that are not usually part of normal development); and by response to therapy (i.e., school difficulties do not immediately improve with increased help at home and/or school).

Secondly, the disorder must be specific in the sense that it cannot be explained solely by mental retardation or a less pronounced decline in general intellectual level. Since IQ and school achievement do not run directly in parallel, this determination can only be made on the basis of individually administered standardized tests of learning and IQ that are culturally appropriate and appropriate. educational system. Such tests should be used in conjunction with statistical tables with data on the average expected level of mastery of school material at a certain coefficient.

rate of mental development at a given age. This last requirement is necessary because of the importance of the effect of statistical regression: a diagnosis based on subtracting school age from the child's mental age is seriously misleading. However, in normal clinical practice these requirements will not be met in most cases. So the clinical guidance is simply that the level school knowledge the child must be significantly lower than expected for a child of the same mental age.

Third, the impairment must be developmental in the sense that it must be present from the early years of education rather than acquired later in the course of education. Information about the child’s school success should confirm this.

Fourthly, there must be no external factors that can be considered as the cause of school difficulties. As stated above, in general, the diagnosis of SSD should be based on positive evidence of a clinically significant impairment in the assimilation of school material in combination with internal factors in the child’s development. However, in order to learn effectively, children must have adequate learning opportunities. Accordingly, if it is clear that poor school achievement is directly attributable to very long periods of non-attendance without homeschooling or grossly inadequate instruction, then these violations should not be coded here. Frequent absence from school or interruptions in education due to changes in school are usually not sufficient to lead to school delay to the extent required for a diagnosis of SRS. However, poor school performance may complicate the problem, in which case school factors should be coded using code X from ICD-10 Class XXI.

Fifthly, specific disorders in the development of school skills should not be directly caused by uncorrected visual or auditory disorders.

It is clinically important to differentiate between SRSNs that occur in the absence of any diagnosable neurological disorder,

and SRRSN secondary to certain neurological conditions such as

cerebral paralysis. In practice, this differentiation is often very

difficult to do (due to the uncertain meaning of multiple

"soft" neurological signs), and the research results are not

give a clear criterion for differentiation either in the clinical picture or in

dynamics of SRRS depending on the presence or absence of neurological dysfunction. Accordingly, although it does not constitute a diagnostic criterion, it is necessary that the presence of any associated disorder be coded separately in the appropriate neurological section of the classification.

Specific reading disorder (dyslexia);

Specific impairment of writing skills;

Specific impairment of arithmetic skills (dyscalculia);

Mixed school skills disorder (learning difficulties).

F81.0 Specific reading disorder

The main feature is a specific and significant impairment in the development of reading skills that cannot be explained solely by mental age, problems with visual acuity, or inadequate schooling. Reading comprehension skills and performance on tasks that require reading may be impaired. Spelling difficulties are often combined with specific disorder reading difficulties and often remain in adolescence, even after some progress has been made in reading. Children with specific reading disorder often have a history of specific language development disorders, and comprehensive examination of language functioning at this time often reveals ongoing mild impairments in addition to lack of achievement in theoretical subjects. In addition to academic failure, poor school attendance and problems in social adjustment, especially in elementary or high school. The condition is found in all known linguistic cultures, but it is unclear how often the disorder is due to speech or script.

The child's reading performance should be significantly below the level expected based on the child's age, general intelligence and school performance. Productivity is best assessed through individually administered standardized tests of accuracy and reading comprehension. The exact nature of the reading problem depends on the expected reading level and on the language and font. However, in the early stages of alphabetic learning, there may be difficulty in reciting the alphabet or categorizing sounds (despite normal hearing acuity). Later there may be errors in oral reading skills, such as:

a) omissions, replacements, distortions or additions of words or parts of words;

b) slow reading pace;

c) attempts to start reading again, prolonged hesitations or “losing space” in the text and inaccuracies in expressions;

d) rearrangement of words in a sentence or letters in words.

There may also be a lack of understanding of what is being read, for example:

e) inability to remember facts from reading;

f) inability to draw conclusions or conclusions from the essence of what was read;

g) answer questions about the story read using general knowledge rather than information from a specific story.

Typically, in later childhood and adulthood, spelling difficulties become more profound than reading deficits. Spelling disorders often involve phonetic errors, and it appears that reading and spelling problems may result in part from impairments in phonological analysis. Little is known about the nature and frequency of spelling errors in children who must read non-phonetic languages, and little is known about the types of errors in non-alphabetic text.

Specific disorders of reading skills are usually preceded by disorders of speech development. In other cases, the child may be experiencing normal language development milestones for age, but may still have difficulty processing auditory information, resulting in problems with sound categorization, rhyming, and possibly deficits in speech sound discrimination, auditory sequential memory, and auditory association. In some cases, there may also be problems in processing visual information (such as distinguishing letters); however, they are common among children who are just beginning to learn to read, and therefore are not causally related to poor reading. Attention disorders combined with increased activity and impulsivity are also common. The specific type of developmental disorder in the preschool period varies greatly from child to child, as does its severity, but such disorders are common (but not obligatory).

Also typical in school age are concomitant emotional and/or behavioral disorders. Emotional disorders are more common in the early school years, but conduct disorders and hyperactivity disorders are more likely in late childhood and adolescence. Also often noted low self-esteem and problems of school adaptation and relationships with peers.

Specific reading delay;

Read in reverse order;

Dyslexia due to impaired phonemic and grammatical analysis;

Spelling disorders combined with reading disorder.

Alexia BDU (R48.0);

Dyslexia NOS (R48.0);

Secondary reading difficulties in persons with emotional disorders (F93.x);

Spelling disorders not associated with reading difficulties

F81.1 Specific spelling disorder

This is a disorder in which main feature- a specific and significant impairment in the development of spelling skills in the absence of a previous specific disorder of reading skills and which is not explained solely by low mental age, problems with visual acuity and inadequate schooling. Both the ability to spell words orally and to write words correctly are impaired. Children whose problems consist solely of poor handwriting should not be included here; but in some cases, spelling difficulties may be related to writing problems. In contrast to the characteristics typically found in specific reading disorder, writing errors tend to be primarily phonetically correct.

The child's spelling performance should be well below the level expected based on his or her age, general intelligence, and academic performance. This is best assessed using individually administered standardized spelling tests. The child's reading skills (both accuracy and comprehension) should be within normal limits and there should be no history of significant reading difficulties. Difficulties in spelling should not be due primarily to

due to grossly inadequate training or defects in visual, auditory

or neurological functions. Also they cannot be purchased

due to any neurological mental or other

Although it is known that “pure” spelling disorder is differentiated from reading disorders comorbid with spelling difficulties, little is known regarding the antecedents, dynamics, correlates, and outcome of specific spelling disorders.

Specific delay in mastering spelling skills (without reading disorder);

Specific spelling delay.

Spelling difficulties combined with reading disorder (F81.0);

Dyspraxic dysgraphia (F82);

Difficulty in spelling, determined mainly by inadequate training (Z55.8);

Agraphia NOS (R48.8);

Acquired spelling disorder (R48.8).

F81.2 Specific arithmetic disorder

This disorder involves a specific impairment of numeracy skills that cannot be explained solely by general mental underdevelopment or grossly inadequate learning. The deficit concerns basic computational skills of addition, subtraction, multiplication, and division (preferred to more abstract mathematical skills, including

algebra, trigonometry, geometry or calculus).

A child's arithmetic performance should be significantly below the level expected for his or her age, general intelligence, and academic performance. This is best assessed on the basis of individually administered standardized numeracy tests. Reading and spelling skills must be within the normal range corresponding to his mental age, assessed by individually selected adequate standardized tests. Difficulties in arithmetic must not be due primarily to grossly inadequate learning, defects in vision, hearing or neurological function, and must not be acquired as a result of any neurological, mental or other disorder.

Numeracy disorders are less well studied than reading disorders, and knowledge about the disorder's antecedents, dynamics, correlates, and outcome is quite limited. However, it has been suggested that, unlike many children with reading disorders, auditory-perceptual and verbal skills tend to be within normal limits, whereas visuospatial and visual-perceptual skills tend to be impaired. Some children have co-occurring socio-emotional-behavioural problems, but little is known about their characteristics or frequency. It has been suggested that difficulties in social interaction may be particularly common.

Arithmetic difficulties that are noted usually vary, but may include: insufficient understanding of the concepts underlying arithmetic operations; lack of understanding of mathematical terms or symbols; non-recognition of numeric characters; difficulty performing standard arithmetic operations; difficulty in understanding which numbers related to a given arithmetic operation should be used; difficulty in mastering the ordinal order of numbers or in mastering decimals or signs during calculations; poor spatial organization of arithmetic calculations; failure to learn the multiplication tables satisfactorily.

Developmental numeracy disorder;

Dyscalculia caused by a violation of higher mental functions;

Developmental specific numeracy disorder;

Developmental Gerstmann syndrome;

Arithmetic difficulties combined with reading or spelling impairments (F81.3);

Arithmetic difficulties due to inadequate training

Acalculia NOS (R48.8);

Acquired counting disorder (acalculia) (R48.8).

F81.3 Mixed learning disorder

This is a poorly defined, underdeveloped (but necessary) residual category of disorders in which both arithmetic and reading or spelling skills are significantly impaired, but in which the impairment cannot be directly explained by general mental retardation or inadequate learning. This should apply to all disorders that meet the criteria for

F81.2 and either F81.0 or F81.1.

Specific reading disorder (F81.0);

Specific spelling disorder (F81.1);

Specific numeracy disorder (F81.2).

F81.8 Other developmental disorders of learning skills

Developmental expressive writing disorder.

F81.9 Developmental disorder of learning skills, unspecified

This category should be avoided as much as possible and used only for unspecified disorders in which there is a significant learning disability that cannot be directly explained by mental retardation, visual acuity problems, or inadequate learning.

Inability to acquire knowledge NOS;

Learning disability NOS;

Learning disorder NOS.

F82 Specific developmental disorders of motor function

This is a disorder in which the main feature is a severe impairment in the development of motor coordination that cannot be explained by general intellectual disability or any specific congenital or acquired neurological disorder (other than what is suspected of coordination disorders). It is typical for motor clumsiness to be associated with some degree of impairment in performance on visuospatial cognitive tasks.

The child’s motor coordination during fine or large motor tests should be significantly below the level corresponding to his age and general intelligence. It is better to evaluate this on the basis of

new individually administered standardized tests of fine or

rough motor coordination. Difficulties in coordination must be present early in development (that is, they must not represent an acquired disability) and must not be directly caused by any visual or hearing impairment or any diagnosable neurological disorder.

The degree of impairment of fine or gross motor coordination varies considerably, and the specific types of motor incompetence vary with age. Motor developmental milestones may be delayed, and some associated speech difficulties (especially those involving articulation) may be noted. Small child may be clumsy in its normal gait and is slow to learn to run, jump, climb up and down stairs. You may have difficulty tying shoe laces, buttoning and unfastening buttons, and throwing and catching a ball. The child may be generally clumsy with fine and/or large movements - prone to dropping things, tripping, hitting obstacles, and having poor handwriting. Drawing skills are typically poor, and children with this disorder often perform poorly on tasks involving compound picture puzzles, construction toys, building models, ball games, and drawing (map comprehension).

In most cases, careful clinical examination will reveal marked neurodevelopmental immaturity, particularly choreiform or mirror movements of the limbs and other associated motor symptoms, as well as signs of poor fine or gross motor coordination (usually described as "soft" neurological signs in young children ). Tendon reflexes may be increased or decreased on both sides, but not asymmetrically.

Some children may have school difficulties, sometimes quite serious; In some cases, socio-emotional-behavioral problems are comorbid, but little is known about their frequency or characteristics.

There is no diagnosable neurological disorder (such as cerebral palsy or muscular dystrophy). However, in some cases there is a history of perinatal complications.

abnormalities such as very low birth weight or significant

Infantile clumsiness syndrome is often diagnosed as “minimal brain dysfunction,” but this term is not recommended because it has so many different and conflicting meanings.

Child clumsiness syndrome;

Developmental coordination disorder;

Abnormalities of gait and mobility (R26.-);

Impaired coordination (R27.-);

Impaired coordination secondary to mental retardation (F70 - F79);

Impaired coordination secondary to a diagnosable neurological disorder (G00 - G99).

F83 Mixed specific disorders of psychological (mental) development

This is a poorly defined, underdeveloped (but necessary) residual group of disorders in which there is a mixture of specific disorders of language development, school skills and/or motor functions, but there is no significant predominance of any of them to establish a primary diagnosis. What these specific developmental disorders have in common is an association with some degree of general cognitive impairment, and this mixed category should only be used when there is significant overlap among the specific disorders. Therefore, this category should be used when dysfunctions meeting the criteria of two or more categories F80.-, F81.x and F82 are encountered.

/F84/ General psychological disorders

A group of disorders characterized by qualitative abnormalities in social interaction and communication and a restricted, stereotyped, repetitive pattern of interests and activities. These qualitative violations are general features individual functioning in all situations, although they may vary in degree. In most cases, development is impaired from infancy and, with only minor exceptions, appears in the first 5 years. They usually, but not always, have some degree of cognitive impairment, but the disorder is defined by behavior that is abnormal in relation to mental age (regardless of the presence or absence of mental retardation). The subdivision of this group of pervasive developmental disorders is somewhat controversial.

In some cases, the disorders are combined and are believed to be caused by certain medical conditions, among which the most common are infantile spasms, congenital rubella, tuberous sclerosis, cerebral lipidosis, and fragility of the X chromosome. However, the disorder must be diagnosed based on behavioral findings, regardless of the presence or absence of underlying medical conditions; however, any of these comorbid conditions should be coded separately. If mental retardation is present, it is important to code this separately (F70 - F79), since it is not mandatory feature general developmental disorders.

/F84.0/ Childhood autism

A pervasive developmental disorder defined by the presence of abnormal and/or disrupted development that begins before age 3 years and abnormal functioning in all three domains of social interaction, communication, and restricted, repetitive behavior. Boys develop the disorder 3-4 times more often than girls.

There is usually no previous period of undoubtedly normal development, but if there is, then anomalies are detected before the age of 3 years. There are always qualitative disturbances in social interaction. They take the form of an inadequate assessment of socio-emotional signals, which is noticeable by the lack of reactions to the emotions of other people and/or the lack of modulation of behavior in accordance with the social situation; poor use of social cues and little integration of social, emotional and communicative behavior; Particularly characteristic is the lack of socio-emotional reciprocity. Qualitative disturbances in communication are equally obligatory. They appear in the form of a lack of social use of existing speech skills; violations in role-playing and social simulation games; low synchrony and lack of reciprocity in communication; insufficient flexibility of speech expression and relative lack of creativity and imagination in thinking; lack of emotional reaction to verbal and non-verbal attempts of other people to engage in conversation; impaired use of tonality and expressiveness of the voice to modulate communication; the same absence of accompanying gestures, which have an enhancing or auxiliary value in conversational communication. This condition is also characterized by restricted, repetitive and stereotyped behaviours, interests and activities. This manifests itself as a tendency to establish rigid and routine routines in many aspects of daily life, usually in new activities as well as old habits and play activities. There may be a special attachment to unusual, often hard objects, which is most typical for early childhood. Children may insist on a special order for performing rituals of a non-functional nature; there may be a stereotypical preoccupation with dates, routes or schedules; motor stereotypies are common; characterized by a special interest in non-functional elements of objects (such as smell or tactile qualities of a surface); The child may resist changes to routines or details of his environment (such as decorations or furnishings in the home).

In addition to these specific diagnostic features, children with autism often exhibit a number of other nonspecific problems, such as

such as fears (phobias), sleep and eating disorders, outbursts of anger and aggressiveness. Self-harm (eg, wrist biting) is common, especially if there is concomitant severe mental retardation. Most children with autism lack spontaneity, initiative, and creativity in their leisure time activities, and have difficulty using their skills when making decisions. general concepts(even when performing tasks is well within their abilities). The specific manifestations of the defect characteristic of autism change as the child grows, but throughout adulthood this defect persists, manifesting itself in many ways similar type problems of socialization, communication and interests. To make a diagnosis, developmental anomalies must be noted in the first 3 years of life, but the syndrome itself can be diagnosed in all age groups.

Autism can occur at any level of mental development, but about three-quarters of cases have a distinct mental retardation.

In addition to other variants of general developmental disorder, it is important to consider: specific developmental disorder of receptive language (F80.2) with secondary socio-emotional problems; reactive attachment disorder in childhood (F94.1) or attachment disorder in childhood of the disinhibited type (F94.2); mental retardation (F70 - F79) with some associated emotional or behavioral disorders; schizophrenia (F20.-) with unusually early onset; Rett syndrome (F84.2).

Autistic psychopathy (F84.5);

F84.01 Childhood autism caused by organic brain disease

Autistic disorder caused by an organic disease of the brain.

F84.02 Childhood autism due to other causes

/F84.1/ Atypical autism

A type of pervasive developmental disorder that is distinguished from childhood autism (F84.0x) either by age of onset or by the absence of at least one of three diagnostic criteria. Thus, one or another sign of abnormal and/or impaired development first appears only after the age of 3 years; and/or there is no sufficiently distinct impairment in one or two of the three psychopathological domains required for a diagnosis of autism (namely, impairments in social interaction, communication, and restricted, stereotyped, repetitive behavior) despite characteristic abnormalities in the other domain(s). Atypical autism most often occurs in children with profound mental retardation, in whom the very low level of functioning provides little scope for the specific abnormal behavior required for a diagnosis of autism; it also occurs in individuals with severe specific receptive language development disorder. Atypical autism is therefore a condition that is significantly different from autism.

Mental retardation with autistic features;

Atypical childhood psychosis.

F84.11 Atypical autism with mental retardation

The first code is this code, and the second is the mental retardation code (F70.xx - F79.xx).

Mental retardation with autistic features.

F84.12 Atypical autism without mental retardation

Atypical childhood psychosis.

F84.2 Rett syndrome

A condition so far described only in girls, the cause of which is unknown, but which is identified on the basis of the characteristics of the onset of the course and symptomatology. In typical cases, apparently normal or nearly normal early development is followed by partial or complete loss of acquired manual skills and speech along with slowing of head growth, usually with onset between 7 and 24 months of age. Loss of intentional hand movements, handwriting stereotypies, and shortness of breath are especially common. Social and play development is delayed in the first two or three years, but there is a tendency to maintain social interest. During middle childhood, there is a tendency to develop trunk ataxia and apraxia, accompanied by scoliosis or kyphoscoliosis, and sometimes choreoathetoid movements. As a result of the condition, severe mental disability constantly develops. Epileptic seizures often occur during early or middle childhood.

The onset of the disease in most cases is between 7 and 24 months of age. The most characteristic feature is the loss of intentional hand movements and acquired fine motor manipulative skills. This is accompanied by loss, partial loss or absence of speech development; characteristic stereotypical movements of the hands are noted - painful wringing or “washing of hands”, arms are bent in front chest or chin; stereotypical wetting of hands with saliva; lack of proper chewing of food; frequent episodes of shortness of breath; There is almost always a failure to establish control over functions Bladder and intestines; Excessive drooling and tongue protrusion are common; inclusion in social life is lost. Typically, the child maintains the appearance of a "social smile", looking "behind" or "through" people, but not interacting with them socially in early childhood (although social interaction often develops later). The posture and gait are wide-legged, the muscles are hypotonic, trunk movements usually become poorly coordinated, and scoliosis or kyphoscoliosis usually develops. In adolescence and adulthood, approximately half of the cases develop special atrophies with severe motor disability. Later, rigid muscle spasticity may appear, usually more severe in the lower extremities than in the upper extremities. Most cases involve epileptic seizures, which usually involve some type of petit mal seizure and usually begin before the age of 8 years. In contrast to autism, both intentional self-harm and a set of stereotypical interests or routines are rare.

Rett syndrome is primarily differentiated on the basis of lack of purposeful runic movements, slowing of head growth, ataxia, stereotypic movements, hand washing, and lack of proper chewing. The course, expressed by a progressive deterioration in motor functions, confirms the diagnosis.

F84.3 Other disintegrative disorders of childhood

Pervasive developmental disorders (other than Rett syndrome) that are defined by a period of normal development before their onset, a distinct loss over several months of previously acquired skills in at least several areas of development, with the simultaneous appearance of characteristic abnormalities in social, communication, and behavioral functioning. There is often a prodrome of unknown illness; the child becomes wayward, irritable, anxious and hyperactive. This is followed by impoverishment, and then loss of speech, accompanied by disintegration