Characterized by frequent and repeated disturbances in speech sounds. The child's use of sounds below the level appropriate for his mental age - that is, the child's acquisition of speech sounds is either delayed or deviated, leading to disarticulation with difficulties in understanding his speech, omissions, substitutions, distortions of speech sounds, changes depending on their combination (then says correctly, then no). Most speech sounds are acquired by 6-7 years; by 11 years all sounds should be acquired.
In most cases, nonverbal intellectual level is within normal limits.
Etiology and pathogenesis
The cause of developmental articulation disorders is unknown. Presumably, the basis of speech impairment is a delay in the development or maturation of neuronal connections and neurological processes, and not organic dysfunction. The high percentage of children with this disorder who have multiple relatives with similar disorders suggests a genetic component. With this disorder, there is no subtle differentiation of motor kinesthetic postures of the tongue, palate, lips; brain basis - activity of the postcentral parts of the left hemisphere of the brain.
Prevalence
The incidence of articulation development disorders has been established in 10% of children under 8 years of age and in 5% of children over 8 years of age. This disorder occurs 2-3 times more often in boys than in girls.
Clinic
An essential feature is an articulation defect, with a persistent inability to apply speech sounds at expected developmental levels, including omissions, substitutions, and distortion of phonemes. This disorder cannot be caused by structural or neurological pathology and is accompanied by normal language development.
In more severe cases, the disorder is recognized at around 3 years of age. In milder cases, clinical manifestations may not be recognized for up to 6 years. The essential features of speech articulation disorder are an impairment in the child's acquisition of speech sounds, resulting in disarticulation with difficulty for others to understand his speech. Speech may be assessed as defective when compared with the speech of children of the same age and which cannot be explained by pathology of intelligence, hearing or the physiology of speech mechanisms. The pronunciation of speech sounds, which appear most late in ontogenesis, is often impaired, but the pronunciation of vowel sounds is never impaired. Most heavy type violations - missing sounds. Substitutions and distortions are a less severe type of violation. Children with developmental articulation disorder may exhibit comorbid social, emotional, and behavioral nature. 1/3 of these children have a mental disorder.
Differential diagnosis
Includes three stages:
1. Determining the severity of articulation disorder.
2. Exclusion of physical pathology that could cause pronunciation problems, dysarthria, hearing impairment or mental retardation.
3. Rule out developmental disorder expressive speech, pervasive developmental disorder.
For articulation disorders caused by structural or neurological pathology (dysarthria) characterized by low speech rate, uncoordinated motor behavior, disorders of autonomic functions, for example, chewing, sucking. Pathology of the lips, tongue, palate, and muscle weakness are possible. The disorder affects all phonemes, including vowels.
Therapy
Speech therapy is most successful for most articulation errors.
Drug treatment is indicated in the presence of concomitant emotional and behavioral problems.
Expressive language disorder (F80.1).
Severe language impairment that cannot be explained by mental retardation, inadequate learning, and is not associated with a pervasive developmental disorder, hearing impairment, or neurological disorder. This is a specific developmental disorder in which the child's ability to use expressive spoken language is markedly below the level appropriate for his mental age. Speech understanding is within normal limits.
Etiology and pathogenesis
The cause of expressive language disorder is unknown. Minimal brain dysfunction or delayed formation of functional neuronal systems have been suggested as possible causes. A family history indicates that this disorder is genetically determined. The neuropsychological mechanism of the disorder may be associated with a kinetic component, with an interest in the process of the premotor parts of the brain or posterior frontal structures; with unformed nominative function of speech or unformed spatial representation of speech (temporo-parietal sections and the area of the parieto-temporo-occipital chiasm) subject to normal left hemisphere localization of speech centers and dysfunction in the left hemisphere.
Prevalence
The incidence of expressive language disorders ranges from 3 to 10% in children school age. It is 2-3 times more common in boys than in girls. More common among children with a family history of articulation disorders or other developmental disorders.
Clinic
Severe forms of the disorder usually appear before age 3. The absence of individual word formations by age 2 and simple sentences and phrases by age 3 is a sign of delay. Later disorders - limited vocabulary development, use of a small set of template words, difficulties in choosing synonyms, abbreviated pronunciation, immature sentence structure, syntactic errors, omission of verbal endings, prefixes, incorrect use of prepositions, pronouns, conjugations, inflections of verbs, nouns. Lack of fluency in presentation, lack of consistency in presentation and retelling. Understanding speech is not difficult. Characterized by adequate use of non-verbal cues, gestures, and the desire to communicate. Articulation is usually immature. There may be compensatory emotional reactions in relationships with peers, behavioral disorders, and inattention. Developmental coordination disorder and functional enuresis are often associated disorders.
Diagnostics
Indicators of expressive speech are significantly lower than indicators obtained for nonverbal intellectual abilities (nonverbal part of the Wechsler test).
The disorder significantly interferes with school success and Everyday life requiring verbal expression.
Not associated with pervasive developmental disorders, hearing impairment, or neurological disorder.
A specific developmental disorder in which the child's use of speech sounds is below the level appropriate for his mental age, but in which there is normal level speech skills. A diagnosis can only be made when the severity of the articulation disorder is outside the range of normal variations appropriate to the child's mental age; nonverbal intellectual level within normal limits; expressive and receptive speech skills within normal limits; articulation pathology cannot be explained by a sensory, anatomical or neurotic abnormality; incorrect pronunciation is undoubtedly anomalous, based on the characteristics of speech use in the subcultural conditions in which the child finds himself.
Included:
Developmental physiological disorder;
Developmental articulation disorder;
Functional articulation disorder;
Babbling (children's form of speech);
Dyslalia (tongue-tied);
Phonological developmental disorder.
F80.1. Expressive language disorder
A specific developmental disorder in which a child's ability to use expressive spoken language is markedly below the level appropriate for his mental age, although speech comprehension is within normal limits. There may or may not be articulation disorders.
Often, a lack of spoken language is accompanied by a delay or disturbance in verbal and audio pronunciation. The diagnosis should be made only when the severity of the delay in expressive language development exceeds the normal range for the child's mental age; Receptive language skills are within normal limits for the child's mental age (although they may often be slightly below average). Impaired spoken language becomes evident from infancy without any long, distinct phase of normal speech use. However, it is not uncommon to encounter the initially apparently normal use of several individual words, accompanied by speech regression or lack of progress. Often similar expressive speech disorders are observed in adults; they are always accompanied by a mental disorder and are organically caused.
Included:
Motor alalia;
Delays speech development by type of general speech underdevelopment (GSD) levels I-III;
Developmental dysphasia of expressive type;
Developmental aphasia of expressive type.
F80.2. Receptive language disorder
A specific developmental disorder in which the child's understanding of speech is below the level appropriate for his mental age. In all cases, expansive speech is also noticeably impaired and a defect in verbal-sound pronunciation is not uncommon.
A diagnosis can only be made when the severity of the delay in receptive language development is beyond normal variations for the child's mental age and when criteria for pervasive developmental disorder are not met. In almost all cases, the development of expressive speech is also seriously delayed, and violations of verbal-sound pronunciation are common. Of all the variants of specific speech development disorders, this variant has the highest level of concomitant socio-emotional-behavioral disorders. These disorders do not have any specific manifestations, but hyperactivity and inattention, social inattention
ability and isolation from peers, anxiety, sensitivity or excessive shyness are common. Children with more severe forms of receptive language impairment may experience quite significant delays in social development; imitative speech is possible with a lack of understanding of its meaning and a limitation of interests may appear. Similar speech disorders of the receptive (sensory) type are observed in adults, which are always accompanied by a mental disorder and are organically caused.
The structure of speech disorders is indicated by the second code R47.0.
Included:
Developmental receptive dysphasia;
Developmental receptive aphasia;
Lack of perception of words;
Verbal deafness;
Sensory agnosia;
Sensory alalia;
Congenital auditory immunity;
Wernicke's developmental aphasia.
The basis of this pathology is the delay psychological development, caused by intellectual deficit and insufficient educational work on the child’s speech skills.
The clinical picture of the disease is characterized by incorrect, distorted reproduction of phonemes, especially in newly acquired words, in complex sentences and during rapid speech. The severity of specific speech articulation disorders depends on the number of distorted phonemes.
As a rule, phonemes that are mastered at later stages of speech development are predominantly distorted, normally by the age of 4 (z, l, r, f, h, w).
Distorted reproduction is caused by the incorrect position of the tongue when “pronouncing” phonemes, which can result in whistling or “hissing”.
According to Yu.V. Popov and V.D. Vida (2000), the prevalence of the disorder is about 10% among children under the age of 8 years and about 5% over the age of 8 years, and in boys this disorder occurs 2-3 times more often than in girls, without a significant difference in severity of the disease.
Correct correctional work with such children for approximately 1 year leads to the complete disappearance of speech articulation disorders, however, to maintain a positive effect, further constant and daily work of others (parents, teachers, educators) on the child’s speech skills is necessary.
Expressive speech disorder.
This syndrome is based on a selective delay in the development of expressive speech while maintaining (in accordance with age) speech understanding and nonverbal intelligence. The clinical picture of the disease is characterized by the inability to repeat simple words and sentences. At the same time, children try to cover up their shortcomings with a variety of gestures and facial expressions, maintaining conversational contact with their gaze for a long time. By about 4 years of age, a child can reproduce short phrases However, when learning new words, old ones are often forgotten.
The beginning of school age is critical for a child, when “fixation” on his own defect complicates his learning and adaptation in everyday life, reduces the level of self-esteem, often leading to functional enuresis (bedwetting) and a number of behavioral disorders (depression or aggression, etc.) . All of the above is reflected fully and on the full spectrum of the child’s intellectual development (decreased attention, memory, impairment of the operational side of thinking, etc.).
The disease is more common in boys than girls.
The prognosis is generally favorable and depends on the time of initiation of therapy, correctional work and motivating the child to participate in the recovery process.
Receptive language disorder.
The basis of this pathology is the delay in the formation of the ability to understand spoken speech with complete preservation of expressive speech and non-verbal intelligence.
Mild forms manifest as delayed understanding complex sentences, and heavy ones - even simple words and phrases.
Outwardly, children with receptive speech disorder resemble deaf people, but when observing them, it turns out that they adequately respond to all auditory stimuli except speech.
Most patients lack musical hearing and the ability to recognize the source of sound.
This speech defect makes it difficult for the child to learn and acquire everyday life skills, which also affects his intellectual development (decreased analytical and synthetic activity).
The prognosis is favorable only in mild cases of the disorder. Patients with moderate and severe forms of the disease require daily complex drug therapy (stimulation of speech centers) and psychological and pedagogical correction under the dynamic supervision of a doctor, speech therapist and psychologist.
Acquired aphasia with epilepsy (Landau-Kleffner syndrome). The clinical picture of the syndrome is similar to the clinical picture of receptive speech disorder, but differs in that the onset of acquired aphasia with epilepsy is preceded by a period of relatively normal psychological development with paroxysmal EEG abnormalities in the temporal regions and epileptic seizures.
Characteristic feature syndrome is normal speech development until loss of speech.
Patients with Landau-Kleffner syndrome should be observed by a neurologist, psychiatrist, psychologist and speech therapist.
Other speech and language developmental disorders. Speech development delays caused by deprivation. TO This pathology includes speech disorders and delayed formation of higher brain functions due to social deprivation or pedagogical neglect. The clinical picture is characterized by poorly formed phrasal speech, limited vocabulary, and mild cognitive impairment in the form of a decrease in the level of generalization or distortion of the generalization process.
The group of specific disorders of speech and language development (dyslalia) is represented by disorders in which the leading symptom is a violation of sound pronunciation with normal hearing and normal innervation of the speech apparatus.
Epidemiology
The incidence of articulation disorders has been established in 10% of children under 8 years of age and in 5% of children over 8 years of age. It occurs 2-3 times more often in boys than in girls.
Classification
Functional dyslalia - defects in the reproduction of speech sounds in the absence of organic disorders1 in the structure of the articulatory apparatus.
Mechanical dyslalia is a violation of sound pronunciation caused by anatomical defects of the peripheral speech apparatus (bad bite, thick tongue, short bridle and so on.).
Causes and pathogenesis of dyslalia
The cause of articulation disorders is not fully known. Presumably, the basis of the disorders is a delay in the maturation of neuronal connections, caused by organic damage to the speech zones of the cortex. There is data on significant role genetic factors. An unfavorable social environment and imitation of incorrect speech patterns have a certain significance.
Symptoms of dyslalia
Articulation disorders are expressed in a persistent inability to use speech sounds in accordance with the expected level of development, including incorrect production. omissions, replacements with incorrect ones or insertion of extra phonemes.
The basis of the articulation defect is the inability to voluntarily accept and maintain certain positions of the tongue, palate, lips necessary for pronouncing sounds. The intellectual and mental development of children corresponds to their age. You can observe concomitant disorders in the form of disturbances of attention, behavior and other phenomena.
Differential diagnosis
Identification of anatomical defects that could cause a pronunciation disorder, which requires consultation with an orthodontist.
Differentiation from secondary disorders caused by deafness is based on data from an audiometric study and the presence of qualitative pathological signs of speech pathology.
Differentiation from articulation disorders caused by neurological pathology (dysarthria) is based on the following signs:
- Dysarthria is characterized by low speech speed and the presence of disorders of chewing and sucking functions;
- the disorder affects all phonemes, including vowels.
IN in doubtful cases To carry out differential diagnosis and establish the anatomical focus of the lesion, instrumental studies are carried out: EEG, echoencephalography (EchoEG), MRI of the brain, CT of the brain.
Mental disorders are mainly accompanied by obsession, asthenic syndrome, depression, manic states, senestopathies, hypochondriacal syndrome, hallucinations, delusional disorders, catatonic syndromes, dementia and stupefaction syndromes. The clinical picture and symptoms usually depend on the factors that provoked the mental disorder, as well as on the forms, stages and types of disorders mental development. Children with such pathologies, as a rule, are characterized by emotional instability. They are characterized by increased fatigue, mood swings, feelings of fear, mannerisms, uncertainty, fussiness, familiarity, undifferentiated use of words, small vocabulary, difficulty in voluntarily using words, increased vegetative and general excitability, sleep disturbances, and gastrointestinal disorders. Disorders of mental development in children mainly manifest themselves in the form of distortions (autism), psychopathy, lack of self-determination, damage to personal development, problems with cognition and the impossibility of mental development. These disorders are most often associated with brain dysfunction and usually begin to appear in early childhood. Also, NPD in children may be accompanied by impatience, impaired attention, lack of concentration, hyperactive behavior (many movements of arms and legs, spinning in place), quiet speech, reduced memory capacity, low speed of memorization, low productivity, etc.