Underdeveloped mouth muscles or weak facial muscle tone are some of the causes of deviations. speech development.
Based on the position of N.A. Bernstein about the level organization of voluntary movements and actions, a number of researchers, specialists in this field (in particular, Sheremetyeva E.V.) suggested that articulation, as the highest symbolic level of voluntary movement, can be formed while maintaining all the underlying levels of voluntary movement. The peripheral part of articulation is built on top of the objective level of oral movements that fulfill life-supporting nutritional needs: sucking, biting, chewing, swallowing. Therefore, they considered it possible to evaluate the potential possibility of articulation by observing the objective level of movements of articulators - lips, tongue, lower jaw - in the process of eating and the state of facial expressions in free activity.
After analyzing the results of the study by E.V. Sheremetyeva, in the oral base of articulation, the precursors of speech underdevelopment (indicators of deviations from the normal course of speech development) at an early age were identified:
refusal of solid food: the child prefers homogeneous, well-ground masses. Often such children, so that they do not remain hungry, parents bring in kindergarten yoghurts, curds, etc. Such eating behavior can have different causes: late introduction of solid complementary foods; parents for a long time (up to a year, or even two) crushed the child's food to a homogeneous mass; maintenance of the sucking reflex (breastfeeding) up to two, two and a half years; violation of the innervation of the mandibular muscles;
difficulties in the process of chewing and, as a result, spitting out, which is associated with a violation of the innervation of the corresponding muscle groups. With such a decrease in physical activity, the muscles that lift and hold the lower jaw and the muscles of the tongue weaken;
general amimia in the process of eating: the child sits for a very long time over a plate or with a piece in his hand, then slowly brings the spoon to his mouth or bites off, starts chewing lazily (lack of pleasure “written” on the face from the process of eating);
often liquid food or liquid is spilled due to the insufficient formation of the lip grip: the child does not sufficiently capture the edge of the spoon, cup with the lower lip (liquid spills) or captures pieces of food from the spoon directly with the teeth. They say about such people: "Eats not neatly." In reality, the innervation of the labial muscles and, as a result, their strength, dexterity and coordination are disturbed.
an increase in the threshold of receptive sensitivity of the skin around the lips, which also indicates a violation of the innervation of the corresponding muscle groups: the child drinks kefir or jelly, the remnants of which, due to insufficient automation of object movement, remain around the lips. He does not try to reduce the irritation from the remnants of the liquid in any way. They say about such children: "Very untidy."
If the perceiving sensitivity of the perilabial space is preserved, and the innervation of the lingual muscles is impaired, then under similar conditions the following is observed:
the absence of circular licking movements of the tongue when a thick drink or liquid porridge gets on the lips or near-lip space: in such cases, the child wipes the upper lip with improvised means;
pulling the back of the tongue up with an unexpressed tip of the tongue in similar conditions;
reduction of irritation of the skin surface of the lips with the help of the lower lip or other means;
raising the tip of the tongue to the level of the corner of the lips when trying to lick the upper lip.
In general, in the chewing muscles, there is a limitation of the mobility of the lower jaw; slight or fairly pronounced displacement of the lower jaw to the side at rest, during chewing and during articulation; in the pathology of the masticatory muscle tone, there is a decrease in the intensity and volume of masticatory movements, discoordination of the movements of the lower jaw during articulation; violation of the process of biting off a piece (which can also be complicated by anomalies of the dentoalveolar system); synkinesis is revealed in the motility of the lower jaw during tongue movements (especially when raising the tongue to the upper lip or pulling it to the chin).
E.G. Chigintseva is also noted for features in the lingual muscles: pathological conditions of muscle tone are observed, which in some cases are accompanied by structural features of the tongue (with spasticity, the tongue is more often massive, drawn in a lump deep into the oral cavity or elongated with a “sting”, this can be combined with a shortening of the frenulum, represented by in the form of a dense cord; with hypotension, the tongue is in most cases thin, flaccid, flattened at the bottom of the oral cavity, which can be complicated by shortening of the sublingual fold, which looks thin and translucent); there are violations of the position of the tongue (at rest and during movement) in the form of deviation to the side, protrusion of the tongue from the mouth, laying the tongue between the teeth; a slight or rather pronounced limitation of the mobility of the lingual muscles is revealed; hyperkinesis, tremor, fibrillar twitching of the tongue; increase or decrease in the pharyngeal reflex. In the muscles of the soft palate, there is a sagging of the palatine curtain (with hypotension); deviation of the uvula (uvula of the soft palate) from the midline. In the autonomic nervous system, there are mainly mosaic disorders in the form of easily occurring spasms of the face (redness or blanching), cyanosis of the tongue, hypersalivation (intense salivation, which can be constant or intensify under certain conditions).
To the factors influencing the formation of speech function G.V. Chirkina also refers to later CNS lesions of traumatic or infectious origin, intoxication, severe somatic infections complicated by psycho-traumatic situations (separation from the mother, pain shock), even if they were temporary, not permanent).
In a child with rhinolalia, even with a unilateral, complete or partial cleft, inhalation is carried out more actively through the cleft, i.e. through the mouth, not through the nose. A congenital cleft contributes to a "vicious adaptation", namely, the incorrect position of the tongue, its root, and only the tip of the tongue remains free, which is pulled into the middle part of the oral cavity (the root of the tongue is excessively raised upwards, covering the cleft, and at the same time the pharyngeal space). The tip of the tongue is located at the bottom of the mouth in the middle part, approximately at the level of the fifth tooth of the lower row.
The entry of food through the cleft into the nose also seems to contribute to the overdevelopment of the root of the tongue, which closes the cleft. So, in a child with a congenital cleft, the most important, most vital functions stabilize the position of the overly raised root of the tongue. As a result, the air stream, when leaving the subglottic space, is directed almost perpendicular to the palate. This makes oral exhalation difficult in the speech act and creates a nasal tone of the voice. In addition, the constant position of the raised root of the tongue inhibits the movement of the entire tongue. As a result, the implementation of the necessary movements of the tongue for articulation speech sounds rhinolalics fail; in addition, a weak expiratory stream, not entering the anterior part of the oral cavity, does not stimulate the formation of various articulatory bonds in the upper part of the speech apparatus. Both of these conditions lead to severe impairment of pronunciation. To improve the pronunciation of a particular sound, rhinolalics direct all the tension to the articulatory apparatus, thereby increasing the tension of the tongue, labial muscles, involving the muscles of the wings of the nose, and sometimes all the facial muscles.
In the process of speech dysontogenesis, adapted (compensatory) changes in the structure of the organs of articulation are formed:
high rise of the root of the tongue and its shift to the posterior zone of the oral cavity; relaxed, inactive tip of the tongue;
Insufficient participation of the lips when pronouncing labialized vowels, labial and labial and dental consonants;
Excessive tension of mimic muscles;
The occurrence of additional articulation (laryngealization) due to the participation of the walls of the pharynx.
L.P. Borsch notes that a short frenulum is a malformation, expressed by the formation of a fold of the mucous membrane, fixing the tongue sharply anteriorly, sometimes almost to the teeth. It is often detected in parents or close relatives of children, which can be considered a family feature; anomalies and occlusion are similar. When studying medical charts of the development of children with pathology of the frenulum of the tongue, the author found that in 94.7% there is a syndrome of motor disorders; in 52.7% - hip dysplasia; in 69.4% - delayed psychomotor development; in 38.4% - trauma of the cervical spine; in 8.8% - cerebral palsy.
Newborns with a short frenulum of the tongue have anxiety when feeding. It is due to difficulty in sucking, swallowing. Toddlers do not suck out the norm. The sleep of such children is superficial, intermittent, restless, they cry a lot.
If the correction is not carried out on time, then this is aggravated with age by the fact that speech is formed with deviations; the child is not understood by peers; adults, seeking the correct pronunciation of sounds, call in response negative emotions. He closes in on himself, prefers to talk less, play alone, an "inferiority complex" begins to form. This often leads to the development of bad habits. They are characterized by a decrease in the emotional-volitional sphere, mood lability. Such children are unbalanced, hyperexcitable, hardly calm down. They are very touchy, whiny, and sometimes aggressive. These children hardly come into contact, refuse to perform certain movements of the tongue at receptions.
By the beginning of schooling, speech remains fuzzy, the pronunciation of several groups of sounds is impaired. The speech is inexpressive, the intonation coloring of the voice is poor. This makes such children more vulnerable, withdrawn, although their intellectual abilities are quite developed. For the most part, these children are self-critical.
The revealed features of the oral motor basis of articulation made it possible to assume that in the absence of timely corrective assistance, at best, there will be disturbances in sound pronunciation and general blurring in the flow of speech.
Early diagnosis is based on the assessment of non-speech disorders, which include the following:
violation of the tone of the articulatory muscles (face, lips, tongue) according to the type of spasticity (increased muscle tone), hypotension (decreased tone) or dystonia (changing character of muscle tone);
limitation of mobility of the articulatory muscles (from the almost complete impossibility of articulatory movements to minor restrictions on their volume and amplitude);
violation of the act of eating: violation of the act of sucking (weakness, lethargy, inactivity, irregularity of sucking movements; leakage of milk from the nose), swallowing (choking, choking), chewing (absence or difficulty chewing solid food), biting off a piece and drinking from a cup;
hypersalivation (increased salivation): increased salivation is associated with restriction of tongue muscle movements, impaired voluntary swallowing, paresis of the labial muscles; it is often aggravated due to the weakness of kinesthetic sensations in the articulatory apparatus (the child does not feel the flow of saliva); hypersalivation can be constant or increase under certain conditions;
oral synkinesis (the child opens his mouth wide with passive and active hand movements and even when trying to perform them);
respiratory failure: infantile breathing patterns (the predominance of the abdominal type of breathing after 6 months), rapid, shallow breathing; discoordination of inhalation and exhalation (shallow inhalation, shortened weak exhalation); stridor.
During the development of speech, systemically controlled auditory-motor formations are formed, which are real, material signs of the language. For their actualization, the existence of an articulatory base and the ability to form syllables are necessary. Articulatory base - the ability to bring the organs of articulation into positions necessary for the formation, formation of sounds that are normative for given language.
In the process of mastering pronunciation skills under the control of his hearing and kinesthetic sensations, he gradually finds and retains in memory those articulation modes that provide the necessary acoustic effect that corresponds to the norm. If necessary, these articulatory positions are reproduced and fixed. When finding the correct patterns, the child must learn to distinguish between articulation patterns that are similar in the pronunciation of sounds, and develop a set of speech movements necessary for the formation of sounds.
E.F. Arkhipova, characterizing children with erased dysarthria, reveals the following pathological features in the articulatory apparatus. The paresis of the muscles of the organs of articulation is indicated, which manifest themselves as follows: the face is hypomimic, the muscles of the face are flaccid on palpation; posture closed mouth many children do not hold, tk. the lower jaw is not fixed in an elevated state due to the lethargy of the masticatory muscles; lips are flaccid, their corners are lowered; during speech, the lips remain sluggish and the necessary labialization of sounds is not produced, which worsens the prosodic side of speech. The tongue with paretic symptoms is thin, located at the bottom of the oral cavity, sluggish, the tip of the tongue is inactive. With functional loads (articulation exercises), muscle weakness increases.
L.V. Lopatina noted spasticity of the muscles of the organs of articulation, manifested in the following: the face is amimic, the muscles of the face are hard and tense on palpation. The lips of such a child are constantly in a half smile: the upper lip is pressed against the gums. During speech, the lips do not take part in the articulation of sounds. Many children who have similar symptoms do not know how to perform the "tube" articulation exercise, i.e. stretch the lips forward, etc. The tongue with a spastic symptom is often changed in shape: thick, without a pronounced tip, inactive
L.V. Lopatina points to hyperkinesis with erased dysarthria, which manifests itself in the form of tremor, tremor of the tongue and vocal cords. Tremor of the tongue manifests itself during functional tests and loads. For example, when asked to support a wide tongue on the lower lip at a count of 5-10, the tongue cannot maintain a state of rest, trembling and slight cyanosis appear (i.e. blue tip of the tongue), and in some cases the tongue is extremely restless (waves roll over the tongue in longitudinal or transverse). In this case, the child cannot keep the tongue out of the mouth. Hyperkinesis of the tongue is more often combined with increased muscle tone of the articulatory apparatus. When examining the motor function of the articulatory apparatus in children with erased dysarthria, it is noted that it is possible to perform all articulation tests, i.e. on assignment, children perform all articulatory movements - for example, puff out their cheeks, click their tongues, smile, stretch their lips, etc. When analyzing the quality of the performance of these movements, one can note: blurring, blurred articulation, weakness of muscle tension, arrhythmia, a decrease in the amplitude of movements, a short duration of holding a certain posture, a decrease in the range of movements, rapid muscle fatigue, etc. Thus, with functional loads, the quality of articulation movements sharply falls. This leads during speech to the distortion of sounds, their mixing and deterioration in general of the prosodic side of speech.
E.F. Arkhipova, L.V. Lopatin distinguish the following articulation disorders, which manifest themselves:
in the difficulties of switching from one articulation to another;
in a decrease and deterioration in the quality of articulatory movement;
in reducing the time of fixation of the articulatory form;
in reducing the number of correctly performed movements.
Research by L.V. Lopatina et al. revealed disorders in the innervation of the mimic muscles in children: the presence of smoothness of the nasolabial folds, asymmetry of the lips, difficulties in raising the eyebrows, closing the eyes. Along with this, the characteristic symptoms for children with erased dysarthria are: difficulty switching from one movement to another, reduced range of motion of the lips and tongue; lip movements are not performed in full, are approximate, there are difficulties in stretching the lips. When performing exercises for the tongue, selective weakness of some muscles of the tongue, inaccuracy of movements, difficulties in spreading the tongue, lifting and holding the tongue up, tremor of the tip of the tongue are noted; in some children - a slowdown in the pace of movements when the task is repeated.
Many children have: rapid fatigue, increased salivation, the presence of hyperkinesis of the facial muscles and lingual muscles. In some cases, a language deviation (deviation) is detected.
Features of mimic muscles and articulatory motility in children with dysarthria indicate neurological microsymptoms and are associated with paresis of the hypoglossal and facial nerves. These violations are most often not detected initially by a neurologist and can only be established in the process of a thorough speech therapy examination and dynamic monitoring in the course of corrective speech therapy work. A more in-depth neurological examination reveals a mosaic of symptoms of the facial, glossopharyngeal, and hypoglossal nerves, which determines the characteristics and diversity of phonetic disorders in children. So, in cases of predominant damage to the facial and hypoglossal nerves, articulation disorders of sounds are observed, due to the inferior activity of the labial muscles and muscles of the tongue. Thus, the nature of speech disorders depends on the state of the neuromuscular apparatus of the organs of articulation.
In order for a person's speech to be articulate and understandable, the movements of the speech organs must be regular, accurate and automated. In other words necessary condition the implementation of the phonetic design of speech is a well-developed motor skills of the articulatory apparatus.
When pronouncing various sounds, the speech organs occupy a strictly defined position. But since in speech sounds are not pronounced in isolation, but together, smoothly following one after another, the organs of the articulatory apparatus quickly move from one position to another. A clear pronunciation of sounds, words, phrases is possible only if the organs of the speech apparatus are sufficiently mobile, their ability to quickly reorganize and work clearly, strictly coordinated, and differentiated. Which implies accuracy, smoothness, ease of movement of the articulatory apparatus, pace and stability of movement.
Thus, impaired motor abilities of the articulatory apparatus is one of the causes of deviations in the speech development of young children. An analysis of studies on the state of articulation in young children with speech development deviations allowed us to identify the following features:
There is insufficient mobility of the muscles of the tongue, lips, lower jaw;
Features of articulation are manifested in the difficulties of switching from one articulation posture to another, in the difficulty of maintaining an articulation posture;
It is possible to study the state of articulation of young children by observing the child's eating behavior.
Conclusions on Chapter I
The development of articulation is an important component of normal speech development. Articulation is the work of the speech organs (articulatory apparatus) when pronouncing syllables, words, phrases; this is the coordination of the action of the speech organs when pronouncing speech sounds, which is carried out by the speech zones of the cortex and subcortical formations of the brain. When pronouncing a certain sound, auditory and kinesthetic, or speech-motor control is realized.
In order for speech to be articulate and understandable, the movements of the speech organs must be regular, accurate and automated. In other words, a necessary condition for the implementation of the phonetic design of speech is a well-developed motor skills of the articulatory apparatus. The articulatory apparatus is an anatomical and physiological system of organs, including the larynx, vocal folds, tongue, soft and hard palate, teeth of the upper and lower jaws, lips, nasopharynx and resonator cavities involved in the generation of speech and voice sounds. Any violations in the structure of the articulation apparatus of a congenital or early acquired nature (under the age of 7 years) invariably entail difficulties in the formation and development of speech.
All movements of the organs of articulation are determined by the work of the motor analyzer. Its function is the perception, analysis and synthesis of stimuli that go to the cortex from the movement of the organs of speech. In the motor speech zone, a complex and subtle differentiation of speech movements occurs, the organization of their sequence.
In ontogenesis, the process of development of articulation is formed sequentially: cry, cooing, early babbling; late babble; first words, phrases; further fine differentiation of articulatory structures.
Eating behavior is one of the indicators of the development of articulation. If a child prefers soft food to solid food, the organs of articulation are not sufficiently mobile during meals, then this indicates an underdevelopment of the muscles of the mouth and lips.
Deviations in speech development at an early age are an underdevelopment of the cognitive and linguistic components of speech development, due to a violation of psychophysiological prerequisites and / or inconsistency of microsocial conditions with the child's capabilities. It manifests itself in the difficulties of forming the initial children's vocabulary and phrasal speech. It can be an independent speech pathology or a part in the structure of any form of deviant development.
The study of the state of articulation in young children with deviations in speech development is possible with the organization of observation of the child's eating behavior.
It is characterized by frequent and repetitive disturbance of speech sounds, as a result of which speech becomes pathological. Development in the field of language is within the normal range. A number of terms are used to refer to these phenomena: infantile speech, babble, dyslalia, functional speech disorders, infantile perseveration, infantile articulation, delayed speech, lisping, inaccurate speech, lazy speech, a specific developmental speech disorder, and sloppy speech. In most mild cases, the intellect is not severely impaired and spontaneous recovery is possible. In severe cases, there may be completely incomprehensible speech, which requires long and intensive treatment.
Definition
Articulation disorder is defined as a significant impairment in the acquisition of normal articulation of speech sounds at an appropriate age. This condition cannot be due to pervasive developmental disorder, mental retardation, impaired internal speech mechanisms, or neurological, intellectual or hearing impairments. A disorder manifested by frequent mispronunciation of sounds, substitution or omission of them gives the impression of "infant speech".
The following are diagnostic criteria for a developmental disorder, articulation.
- A. Significant impairment of the ability to correctly use speech sounds that should have already developed at an appropriate age. For example, a three-year-old child has an inability to pronounce the sounds p, b and t, and a 6-year-old child has an inability to pronounce the sounds r, w, h, f, c.
- B. Not associated with pervasive developmental disorder, mental retardation, hearing impairment, speech mechanism disorder, or neurological disorder.
This disorder is not associated with any anatomical structures, auditory, physiological or neurological disorders. This disorder belongs to various violations articulations varying from mild to severe forms. Speech can be fully intelligible, partially intelligible, or incomprehensible. Sometimes the pronunciation of only one speech sound or phoneme (the smallest volume of sound) is disturbed, or many speech sounds are affected.
Epidemiology
The incidence of articulation disorders has been established in approximately 10% of children under 8 years of age and in approximately 5% of children over 8 years of age. This disorder is 2-3 times more common in boys than girls.
Etiology
The cause of developmental articulation disorders is unknown. It is generally believed that a simple developmental delay or delay in the maturation of neurological processes, rather than an organic dysfunction, underlies the speech disorder.
A disproportionately high level of articulation disorders is found among children from large families and low socioeconomic classes, which may indicate one of the possible causes - incorrect speech at home, and reinforcement of the disadvantage on the part of these families.
Constitutional factors are more than factors environment have an impact on whether a child will or will not suffer from an articulation disorder. A high percentage of children with this disorder, who have many relatives with similar disorders, may indicate the presence of a genetic component. As shown, bad motor coordination, poor lateralization, and right- or left-handedness are not related to developmental articulation disorder.
Clinical features
In severe cases, this disorder is recognized for the first time around the age of 3 years. In less severe cases, the disorder may not be apparent until 6 years of age. Significant features of developmental articulation disorder include articulation that is judged to be defective when compared with the speech of children of the same age and that cannot be explained by pathology of intelligence, hearing, or the physiology of speech mechanisms. In very mild cases, there may be a violation of the articulation of only one phoneme. Usually single phonemes are violated, those that are mastered at an older age, in the process of normal language acquisition.
Speech sounds, which are most often mispronounced, are the latest in the sequence of mastered sounds (r, w, c, g, h, h). But in more severe cases or in young children, there may be a violation of the pronunciation of sounds such as l, b, m, t, d, n, x. The pronunciation of one or more speech sounds may be impaired, but the pronunciation of vowels is never impaired.
A child with an articulation disorder cannot pronounce certain phonemes correctly and may distort, replace, or even skip phonemes that he cannot pronounce correctly. When omitted, phonemes are completely absent - for example, "gooy" instead of "blue". During substitution, difficult phonemes are replaced with incorrect ones, for example, "kwolic" instead of "rabbit". When distorted, approximately correct phonemes are selected, but their pronunciation is incorrect. Occasionally something is added to the phonemes, usually vowels.
Omissions are considered to be the most severe type of impairment, replacement is the next most severe impairment, and then distortion follows as the least severe type of impairment.
Omissions are most commonly found in speech in young children and appear at the end of words or consonant clusters. Distortions, which are found mainly in older children, are expressed in sounds that are not part of the speech dialect. Distortions may be the last type of articulation disorder preserved in the speech of children whose articulation disorders have almost disappeared. The most common type of distortion is "lateral escape" in which the child utters sounds with airflow passing through the tongue, producing a whistling effect, and "lisping", in which the sound is formed by placing the tongue very close to the palate, producing a hissing sound. Effect. These disturbances are often intermittent and random. A phoneme can be pronounced correctly in one situation and incorrectly in another. Articulation disorders are especially common at the end of words, in long syntactic complexes and sentences, and during fast speech. Omissions, distortions and substitutions also appear in normal children learning to speak, while normal children quickly correct their pronunciation, children with articulation developmental disorder do not. Even as the child grows and develops, when the pronunciation of phonemes improves and becomes correct, this sometimes only applies to newly learned words, while words previously learned incorrectly may still be pronounced with an error.
By the third grade, children sometimes overcome articulation disorder. However, after the fourth grade, if the deficiency has not been overcome previously, spontaneous recovery from it is unlikely, so it is especially important to correct the disorder before complications develop.
In most mild cases, recovery from developmental articulation disorders is spontaneous and is often facilitated by the child's entry into kindergarten or school. These children are fully shown to speech therapy sessions aimed at staging speech sounds if they do not have spontaneous improvement by the age of six. For children with significant pronunciation disorders, with incomprehensible speech, and especially for those of them who are very worried about their defect, it is necessary to ensure an early start to classes.
Other specific developmental disorders usually occur, including developmental expressive language disorder, receptive language developmental disorder, reading disorder, and developmental coordination disorder. There may also be functional enuresis.
A delay in speech development, reaching a certain milestone in this development, for example, pronouncing the first word and first sentence, is also noted in some children with an articulation disorder, but most children begin to speak at a normal age.
Children with developmental articulation disorder may present with many comorbid social, emotional, and behavioral disorders. Approximately 1/3 of these children have a psychiatric disorder, such as hyperreactivity with attention disorder, separation anxiety disorder, avoidance disorder, adjustment disorder, and depression. or those with a chronic, non-remitting, or recurrent disorder are at risk for developing mental illness.
Differential Diagnosis
The differential diagnosis of developmental articulation disorder includes three stages: first, it must be determined that the articulation disorder is severe enough to be considered pathological and rules out normal speech impairment in young children; secondly, it should be noted that there is no physical pathology that could cause a violation of pronunciation and exclude dysarthria, hearing impairment or mental retardation; thirdly, it is necessary to establish that the expressive language is expressed within the normal range and exclude language development disorder and pervasive developmental disorders. Approximately, one can be guided by the fact that a 3-year-old child normally correctly pronounces m.
To exclude physical factors that could cause some types of articulation disorders, it is necessary to produce neurological, structural and audiometric methods of examination.
Children with dysarthria, whose articulation disorder is due to a structural or neurological pathology, differ from children with developmental articulation disorder in that dysarthria is extremely difficult to correct, and sometimes not at all. Mindless chatter, slow and uncoordinated motor behavior, impaired chewing and swallowing, as well as tight and slow protrusion and retraction of the tongue are signs of dysarthria. Slow speech speed is another sign of dysarthria.
Forecast
Recovery is often spontaneous, especially in children whose articulation disorder includes only a few phonemes. Spontaneous recovery rarely occurs after the age of 8 years.
Treatment
Speech therapy correction is considered successful for most articulation errors. Correctional classes are indicated when the child’s articulation is such that his speech is incomprehensible, when the child suffering from articulation is older than 6 years, when speech difficulties clearly cause complications in dealing with peers, learning difficulties and negatively affect the formation of one’s own image, when articulation disorders are so are heavy, that many consonants are mispronounced, and where errors include omissions and phoneme substitutions rather than distortions.
Bibliography
Kaplan G.I., Sadok B.J. Clinical psychiatry, T. 2, - M., Medicine, 2002
Multiaxial classification of mental disorders in childhood and adolescence. Classification of mental and behavioral disorders in children and adolescents in accordance with the ICD-10, - M., Smysl, Academy, 2008
A comment. The inspection is divided into several stages. These include clarification of complaints, clarification of the history of the present disease, the characteristics of the patient's life.
2.2 Physical examination.
A consultation with a neurologist is recommended.Recommendation strength level A, evidence level I.
A speech therapy examination of the child is recommended.
Recommendation strength level A, evidence level I.
A comment. A speech therapy examination should be comprehensive, holistic and dynamic, and also have its own specific content aimed at analyzing speech disorder. The complexity, integrity and dynamism of the survey are ensured by the fact that all aspects of speech and all its components are examined, moreover, against the background of the entire personality of the subject, taking into account the data of his development - both general and speech - from an early age.
It is recommended to evaluate the indicators of speech development: speech activity, sound pronunciation, understanding of addressed speech, active vocabulary, phrase expansion, lexical and grammatical structure of speech. Under speech activity implies the desire to use speech for communication, activity in the use of language means.
Recommendation strength level A, evidence level I.
A comment. The level of sound pronunciation, its compliance or degree of inconsistency with the age of the child is assessed. To assess the understanding of addressed speech, the child is offered, using only verbal instructions, to show objects in the picture, to perform certain actions, gradually complicating the tasks. If there is an understanding of speech at the everyday level, one should reveal an understanding of the meaning of prepositions, differences in time, number, and case.
The volume of the active dictionary is estimated by the number of nouns, verbs, adjectives used in speech. The wider the active vocabulary, the more signs of one object the child can name, more accurately determine the action, convey semantic shades.
The assessment of the lexical and grammatical structure of speech is carried out on the basis of the correctness of the child's use of the gender, number, case, prepositions, tenses of verbs, word formation skills. In a psychological examination, first of all, such indicators as the child's communications, emotional background, mental development (mainly non-verbal intelligence) are evaluated.
A pathopsychological (experimental psychological) study is recommended.
A comment. Pathopsychological research includes - a conversation with the patient, an experiment, observation of the patient's behavior during the study, collection and analysis of anamnesis, comparison of experimental data with the life history of the researcher. Under experiments in modern psychology refers to the use of any diagnostic procedure for modeling complete system cognitive processes, motives and personality traits.
It is recommended to consult a psychiatrist (if indicated).
Level of persuasiveness of recommendations C, level of evidence III.
Consultation with an audiologist (according to indications) is recommended.
Level of persuasiveness of recommendations B, level of evidence II.
A comment. In case of speech disorders, a comprehensive examination is necessary, including a consultation with an audiologist who evaluates hearing and identifies its problems, if necessary, audiography can be performed.
2.3 Instrumental diagnostics.
An EEG is recommended.Level of persuasiveness of recommendations B, level of evidence II.
A comment. Electroencephalography is used for all neurological, mental and speech disorders.
An MRI of the brain is recommended.
Level of persuasiveness of recommendations B, level of evidence II.
A comment. With the help of MRI, three-dimensional images of the head, skull, brain, and spine can be obtained. Magnetic resonance imaging, performed in the vascular mode, allows you to get an image of the vessels that supply the brain. MRI allows you to capture changes in the brain associated with its physiological activity. So, with the help of MRI, the position of the patient's motor, visual or speech centers of the brain, their relationship to the pathological focus - a tumor, a hematoma (the so-called functional MRI) can be determined.
2.4 Differential diagnosis.
Mental retardation.Children with SRR perform unsatisfactorily non-verbal tests and tasks, their cognitive interest and desire for communication are not sufficiently expressed, they are not active in using gestures and in maintaining games.
Autism.
Autism impairs the need for communication and the ability to social interaction, and they can also cause a violation of speech development. Speech is not used in communication purposes or underused. There is unevenness and asynchrony in the pace of speech development. Phrasal speech can be formed with a delay, often without a preceding babble period. Echolalia, cliches, use of verbs in indefinite form or in imperative mood, prolonged absence of the pronoun "I" in speech, expression, gesticulation are absent in speech, there is an inability to dialogue, children do not ask questions. Violated pronunciation of sounds, speech melody, rhythm, tempo.
Mental disorders are mainly accompanied by obsessions, asthenic syndrome, depression, manic states, senestopathies, hypochondriacal syndrome, hallucinations, delusional disorders, catatonic syndromes, dementia and confusion syndromes. The clinical picture and symptoms usually depend on the factors that provoked a 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, a sense of fear, mannerisms, uncertainty, fussiness, familiarity, undifferentiated use of words, small lexicon, difficulty in arbitrary operation of words, increased vegetative and general excitability, sleep disturbance, gastrointestinal disorders. Developmental disorders in children mainly manifest as distortions (autism), psychopathy, lack of self-determination, damage to personal development, problems with cognition and impossibility of mental development. These disorders are most often associated with dysfunction of the brain, and, as a rule, begin to manifest themselves in early childhood. Also, NPD in children can be accompanied by impatience, impaired attention, lack of concentration, hyperactive behavior (many movements of arms and legs, rotation in place), quiet speech, reduced memory capacity, low memorization speed, low productivity, etc.
Articulation disorders may occur due to hypofunction (weakness, decreased range of motion, slowness of movement), hyperfunction (increased muscle tone) or impaired coordination of movements of the anatomical elements that provide articulation. Articulation disorders may be generalized or more specific.
- Generalized articulation disorders are articulation disorders that result in distortion of the sound of all or most phonemes and are observed as with lesions of the central nervous system and systemic diseases.
- Specific articulation disorders are disorders that lead to distortion of the sound of certain groups of phonemes and are associated with local structural pathological processes or damage to one or more nerves.
- Articulation errors
Error Options that occur during articulation include omissions, distortions, phoneme substitutions, and additional phonemes.
Articulation changes may be secondary to neurological disorders, but may also be secondary to structural damage to the articulatory apparatus.
Common articulation errors in children are usually considered as developmental abnormalities and are not classified as variants of dysarthria. True dysarthria can be observed in childhood (cerebral palsy, consequences of brain injury) and in adults due to impaired control of the muscles that provide speech processes.
prosody disorders arise as a result of discoordination of the respiratory, voice-forming and articulatory components of speech and are manifested by changes in the rhythm and tempo of speech, stress and speech intonations.
- Violations of the rhythm and tempo of speech products include acceleration or deceleration, inconstancy of articulation, the presence of temporary pauses, as well as various ratios of these violations.
Violation of stress is observed in words, as well as phrases or sentences, which can lead to a change in the meaning of the spoken.
- Mistakes in intonation can change the meaning of sentences (eg You are going home. Are you going home?).
- Prosody disorders are commonly associated with atactic dysarthria, hypokinetic dysarthria, and right hemispheric aprosodic dysarthria. Persons with disorders of the latter type may also note difficulty in understanding the prosodic characteristics of the speech of others.
Examination of a patient with speech disorders
Collection of anamnesis:
1. The appearance of violations. When did the patient or family first notice changes in speech? Were there any in the process age development any articulation problems?
2. The pace of development. Did the speech changes come on suddenly or gradually? Have they reversed, been stable, or have they progressed since they appeared? Were there fluctuations in the severity of violations? Were there periods of normal speech along with periods of altered speech?
3. The presence of concomitant neurological symptoms, especially those associated with damage to the upper or lower motor neurons, cranial or cervical nerves.
4. Previous neurological diagnoses and previous treatment.
5. Drug history and use of unprescribed medications.
1. There are three stages of an objective examination.
Stage 1. The study of samples of spontaneous speech and speech in the process of special testing.
Stage 2. Interpretation of speech samples with an assessment of the state of each element of the speech system, the definition of the norm and pathology, as well as the nature of the existing deviations. It is recommended to study the oral cavity, oro- and nasopharynx, chest mobility.
Stage 3. Determining the nature of the identified disorders, correlating them with known patterns and clinical variants of dysarthria.
2. The study of individual elements of the speech system.
- Breath. Assessment of the degree of fatigue when counting to 20 during one exhalation. The pitch of the voice, the volume of speech, the length of phrases, the clarity or explosiveness of speech should be assessed when listening carefully.
- Phonation. The patient should pronounce the long vowel "a" as clearly and as long as possible. Other phonemes (such as "and") require more tension on the vocal cords, and the researcher must evaluate their sound quality, duration, pitch, sound stability and loudness. To assess the true effectiveness of the vocal cords, it is necessary to compare the retention time of the phonemes "s" and "h". With the normal functioning of the vocal cords, it is possible to keep the sound of these two consonants for the same time. If the "h" sound is noticeably shorter, there is a true reduction effective work vocal cords. Ask the patient to cough briefly to clarify abnormalities. In the presence of deviations, consultation with an otorhinolaryngologist or laryngoscopy is recommended.
- Resonance is assessed by the patient's pronunciation of phonemes of various types. The state of the soft palate is studied when pronouncing the sound “a”, which the patient must pull for as long as possible, while it is necessary to note the degree of fatigue. Another technique is to pronounce a long "and", while the researcher closes and opens the nasal passages. At normal resonance, the sound should remain almost unchanged.
