Differential diagnosis of alalia and autism spectrum disorders in the practice of speech therapy support

What is alalia

Alalia in children is a consequence of damage that occurred during the prenatal or early period of life. Without specially developed treatment, children with this disease will not begin to speak independently.

The appearance of speech may be postponed to preschool, and in some cases to a later period. In such children, such speech delay is not associated with hearing and intellectual defects.

Attention! Alalia cannot be treated at home; to make a diagnosis and prescribe therapy, you only need to visit a specialist in person. First of all, you need to contact your local pediatrician, who will refer the child for further examination.

If correctional therapy begins after 4-5 years, secondary speech delay is possible, associated with the mental development of the child. These children have less knowledge about the world around them than their healthy peers. Alalia is characterized by violations of all aspects of speech:

• phonetic;
• lexical;
• grammatical;
• morphological;
• syntactic.

This is a systemic disorder of the speech apparatus, in which it is difficult to learn the rules of functioning of the native language. The vocabulary is poor and ungrammatical. The treatment is complex and systematic over several years. Statistically, boys suffer from it twice as often.

Alalia is a persistent, severe pathology of the speech apparatus. Children with this diagnosis have difficulty acquiring language. They do not perceive speech as a single system. There are cases when a child does not begin to speak even by school age.

Disorders associated with this disease affect the baby's speech and cognitive activity. Later, problems may arise during the formation of personality. There is often a lack of desire for development and interaction with the outside world.

Alalia is characterized by a systemic nature of speech development disorders, which affects all its components. A child with such impairments does not understand speech addressed to him; all communication is reduced to short babbling words.

In subsequent years, a poor vocabulary, agrammatism, incorrect construction of syllables, and disturbances in the pronunciation of sounds are observed. Alalia is one of the most severe speech disorders. It is impossible to solve this complex problem without the help of speech therapists and other specialists.

Alalia

Alalia is the absence or underdevelopment of speech due to organic damage to the cerebral cortex in the prenatal or early periods of a child’s development. Many scientists have noted the leading role in the occurrence of alalia of birth craniocerebral injuries and asphyxia of the newborn .

Moreover, in most cases, both injuries and asphyxia are a consequence of intrauterine pathology, causing chronic oxygen starvation of the fetus (intrauterine hypoxia). Among the etiological factors, there are also intrauterine encephalitis, meningitis, fetal intoxication, intrauterine or early intravital brain injuries, early childhood diseases with complications on the brain.

Some Western researchers emphasize the role of heredity and family predisposition in the etiology of alalia.

Alalia cannot be considered simply a temporary functional delay in speech development. With this disorder, the entire process of speech formation occurs under conditions of a pathological state of the central nervous system . A child’s speech, which occurs late, is formed on a pathological basis. Alalia is characterized by late development of speech, slow accumulation of vocabulary, disruption of the syllabic structure of words, delayed formation of phrasal speech with pronounced agrammatisms, insufficient or complete absence of the communicative function of speech. The development of the linguistic system in a child with alalia is of a specific nature, and this is reflected not so much in the quantity as in the quality of speech. With alalia, all components of speech are disrupted: the phonetic-phonemic side, the lexical-grammatical structure. Non-verbal disorders include motor, sensory and mental symptoms.

Children with motor alalia are characterized by limited and unstable attention and perception. Children seem to glance at objects, objects, pictures, without catching essential details, so subject and plot pictures for classes with children should be simple, without distracting details, clear, bright.

The question of the intelligence of children with motor alalia is resolved ambiguously. Many researchers agree that the intelligence of such children is secondarily altered due to the state of speech, and we can talk about secondary mental retardation. It should be noted that the thinking of children with motor alalia is concrete.

Alalia classification

Modern speech therapy distinguishes two forms in the classification of alalia - expressive (motor) and impressive (sensory). There is alalia that combines these two forms - sensorimotor (mixed type).

Expressive or motor – systemic underdevelopment of expressive speech of a central organic nature. This is due to the insufficient development of language operations.

Impressive or sensory alalia is a speech disorder that has a central pathogenesis. A child with this diagnosis is unable to understand speech addressed to him due to the malfunction of the speech-hearing analyzer.

Each of these types has its own treatment method. Without proper therapy, the sensory type is more dangerous for a child's development than the motor type. Based on neurophysiology, neurochemistry and psycholinguistics, methods for correcting all types of alalia have been developed. But the child’s parents must prepare themselves for long and hard work.

To make it easier to monitor speech development, speech therapists recommend a convenient and simple diary, where you should write down all the baby’s new words. You can download this questionnaire, fill it out and continue further. Be sure to take it with you to your appointment with a specialist - with its help you can quickly form a general impression of your child’s speech skills

History of the study of alalia

In the history of the study of alalia, 3 stages can be distinguished:

FIRST STAGE: Mechanistic stage.

Names: Cohen, Gutzman, Zeiman.

The etiology and symptoms of the disorders are described; the description is external in nature and does not affect the mechanisms of the defect. These authors put forward their assumptions about the causes of alalia. They said that the cause of alalia, that the cause of alalia are inflammatory processes or metabolic processes in the intrauterine or early development of the child. Cohen and Zeiman talked about heredity.

SECOND PHASE:

Since the end of the 19th century, dialectical-materialistic ideas have emerged. This stage is based on an understanding of speech as a complex multi-level process; the state of speech is compared with the neurological status of a person. Oltushevsky, Bogdanov-Berezovsky - wrote articles on alalia.

THIRD STAGE:

Stage of further development. The issue of etiology and mechanisms of alalia is deeply studied, and various concepts are developed in the interpretation of the concept. In domestic speech therapy - Khvattsev, Traugott, Orfinskaya, Levina, Sobotovich, Kovshikov, Chaladze, etc.

Currently, alalia is being studied from various perspectives: in the clinical and physiological aspect, neurological and psycho-linguistic aspects:

ANATOMICAL AND PHYSIOLOGICAL ASPECT:

It involves taking into account the localization of damage to the brain and allows us to consider the symptoms of various forms of alalia in connection with the disruption of the activity of various zones of the cortex of the brain.

NEUROLOGICAL ASPECT:

It is based on radiography, encephalography, and speaks about the severity of organic disorders.

PSYCHOLOGICAL ASPECT:

This raises the question of the relationship between speech and thinking, speech and the emotional-volitional sphere.

PSYCHO-LINGUISTIC ASPECT:

Alalia is being studied as a language disorder. It is considered from the point of view of the processes of generating a speech utterance. In children with alalia, the language stage of speech production (psycholinguistic) is impaired.

The current stage of study involves relying on all four aspects.

22. Mechanisms of alalia.

There are several approaches to understanding the mechanisms of alalia:

-sensorimotor

- psychological

- linguistic

SENSORMOTOR APPROACH.

From the point of view of the sensorimotor approach, the mechanism of alalia lies in the immaturity of the motor or sensory aspects of speech.

There are two directions:

1) Study of the immaturity of the motor side of speech. In children with alalia, in the case of organic damage to the central parts of the speech-motor apparatus, expressive speech disorders are observed. A major role is played by apraxia (impaired voluntary movements).

2) Study of the sensory side of speech. With alalia, there is an impossibility of auditory differentiation of speech sounds, which manifests itself either in underdevelopment or in a violation of phonemic perception.

PSYCHOLOGICAL APPROACH.

Originated at the beginning of the 20th century. Disorders of mental activity, the uniqueness of the emotional-volitional sphere, and intellectual impairments are studied in children with alalia. Clinical material has accumulated on disturbances in children with alalia of visual perception, memory, and attention. Some scientists say that this is the cause of alalia.

Disadvantages of these approaches:

— External manifestations of articulation disorders and non-speech disorders are taken as the essence of alalia, but the internal nature remains undisclosed.

— The unique structure of non-speech and speech mental processes is not taken into account; cause-and-effect relationships are established between them.

— The complex organization of language in which semantic, syntactic, morphological, lexical and phonetic operations interact is not taken into account.

LANGUAGE APPROACH.

Underdevelopment of speech is associated with the immaturity of language operations in the processes of speech production and perception. Proponents of this approach say that the mechanism of alalia lies in a disorder in the implementation of language operations. Language is a unique system that can be disrupted regardless of the state of other systems, which is what is observed with alalia.

Supporters of this approach (Mastyukova, Zhukova, Filicheva, Vorobyova, Sobotovich, Kovshikov, etc.) see the task of logo work in the formation of ideas about the patterns of language functioning.

Currently, researchers rely on an integrated approach to understanding the mechanisms of alalia. When studying children with alalia, all points of view are considered. Although the linguistic approach is dominant, other points of view should not be excluded.

What is sensory alalia

Sensory (impressive) alalia is a severe form of speech development, in which both understanding and speaking suffer, and a number of symptoms of the motor type of the disease are observed. According to medical statistics, in the total number of children suffering from problems with the speech apparatus, the motor type accounts for 90% of cases, while the sensory type accounts for only the remaining 10%.

Sensory alalia is a violation of a child’s understanding of the speech of others. Expressive speech (the ability to speak coherently) cannot develop in a child under such circumstances. Some believe that sensory alalia is an inability to speak due to a violation of the articulatory apparatus. However, the speech impairment here is secondary, that is, due to a lack of understanding of the speech of others, due to problems with phonemic hearing.

A child with good hearing cannot put into words the sounds that he hears from adults or pronounces himself. Therefore, he is unable to reproduce them.

With this type, damage or underdevelopment of the speech-hearing analyzer is observed. This leads to serious disruptions in analytical and synthetic activities. The sounds that the child hears are not different to him. He is unable to recognize words or even individual sounds or syllables.

Causes of sensory alalia

This disorder is caused by lesions of the brain, namely certain zones located in the cortical part of it, which are responsible for the speech apparatus, speech analysis, and understanding of sounds. The main factors that can lead to this are:

1. Fetal pathologies that appear during pregnancy. Gestation can be complicated by hypoxia, infections, and malnutrition. Disturbances in the development of the fetal central nervous system may occur when consuming alcohol or drugs.
2. Disturbance of the central nervous system during childbirth. The fetus can suffer damage to the nervous system if the obstetrician acts incorrectly. During childbirth, the baby may suffer a head injury.
3. Diseases in the postnatal period. They can occur in the first years of the baby.

There are other reasons that can also cause such a speech disorder. Diagnosis can only be made after a comprehensive examination of the child. The baby should be examined by a speech therapist, pediatrician, neurologist, child psychologist, and otolaryngologist.

How to identify sensory alalia

To assess the state of the brain of a child who is suspected of having alalia, it is necessary to conduct an MRI of the brain and an EEG. All these research methods are absolutely harmless to the child and do not pose any health hazard.

It is necessary to clearly distinguish between sensory alalia and possible hearing loss. This should be done by a qualified otolaryngologist. To do this, he performs audiometry and otoscopy. Diagnostics should also determine the severity of existing disorders.

What are the symptoms of sensory alalia?

With this disorder, the understanding of speech addressed to the baby primarily suffers. He is unable to understand what is being said to him. When severe, the child shows complete indifference to surrounding sounds, regardless of the nature of their origin. Such children are unable to distinguish speech from other sounds and do not respond to their name. With a mild degree, the child can understand some everyday words.

A child suffering from this speech disorder has high speech activity, but it consists of simple (babbling) sounds and interjections. The meaning of this stream of sounds and words is incomprehensible to the people around. The child’s speech is more like a “word salad.”

One of the distinctive signs of the sensory type of the disease is pronounced echolalia - the repetition of individual sounds without understanding their meaning. It is difficult or even impossible for a child with such a speech disorder to repeat words spoken by an adult. The child is not able to correlate the word and the object it means.

Alaliks are characterized by a large number of speech errors. They indicate phonetic insufficiency, which is manifested by incorrect placement of stress, omission of sounds or their replacement with others. The child cannot control his own speech and makes mistakes in it.

Alalia and aphasia

Alalia is a complete or partial absence of speech in the presence of sufficient intellectual capabilities, hearing acuity and speech motor organs for the development of speech.
Aphasia is the loss of existing speech while maintaining the peripheral speech organs. Alalia based on underdevelopment, destruction or inhibition of the speech systems of the cerebral cortex before the formation of more or less stable speech (up to the age of three), as a result of which the formation of temporary conditioned connections in the second signaling system is impossible or difficult. This delays speech development. Disruption of normal brain activity is caused by a variety of reasons: prenatal, natural and intravital (illness, bruises, nervous shock). Prof. N.I. Krasnogorsky notes the influence of digestive and nutritional disorders on the development of children's speech. Alaliki, left to their own devices, sometimes begin to speak babblingly only at the age of 8-10 and, without training in special institutions, remain with defective speech for the rest of their lives.

Among alaliks there are children who, to a limited extent, understand the speech of others, but do not speak ( motor alalia ). In such children, the formation of conditioned connections is disrupted, mainly in the motor (kinesthetic) speech systems of the cerebral cortex. But since the auditory-speech analyzer is directly connected with the speech-motor analyzer, the understanding of speech in motor alaliks is sharply limited: they understand only specific things, mainly from the area of ​​household use or kindergarten. Other alaliks do not understand speech at all, and therefore do not speak, although their ability to form sounds is sufficiently preserved in the form of mechanical repetition. The misunderstanding in this case is based on acoustic agnosia (phonemic hearing is impaired): The child hears speech, but does not understand it. There is no connection between the first and second signaling systems. This is a sensory (sensitive) alalia.

There are no pure forms of alalia: in some, sensory impairments predominate, in others, motor impairments predominate. This connection is explained by the holistic functioning of our brain. As a rule, alaliki very rarely enter kindergartens; by this time their speech usually begins to develop slowly. But even at the age of five or six, their speech is agrammatic, consisting of an extremely limited, predominantly babbling vocabulary of an everyday nature. Motor alaliks speak slowly, heavily, with difficulty, they squeeze the words out of themselves with effort. Speech is characterized by rearrangement of sounds and syllables and contamination. Alaliki do not want to speak in the motor form due to the difficulty of the act of pronunciation, partly due to a limited understanding of speech, in the sensory form - due to a lack of understanding of speech. This makes it difficult for them to learn normal speech.

Aphasia differs from alalia in that it always occurs in a child as a result of organic damage to certain areas of the cerebral cortex (pathological “foci”), moreover, during the period of more or less developed speech, at the age of no earlier than 2.5-3 years. Along with organic lesions, under their influence, inhibited foci appear in the speech systems. When disinhibition occurs, their speech is restored to one degree or another (often without special training).

In aphasia, motor and sensory forms also differ. Sensory aphasia should not be confused with the speech of the hard of hearing, with which young children have many external similarities. In aphasia, the higher analysis and synthesis of auditory-verbal stimuli reaching the brain is impaired. Therefore, it is impossible to form speech stereotypes from them either for pronouncing or understanding speech. Speech in aphasics develops slowly and with great difficulty, words are poorly remembered and sharply distorted, and are often grasped by guesswork. Only in rare cases does it develop to normal.

In children who are hard of hearing, the central end of the auditory-speech analyzer is preserved, and the lack of their speech mainly depends on the fact that higher analysis and synthesis process the inferior auditory-speech stimuli that come to their disposal. Speech development in them proceeds incomparably faster and more often reaches the norm than in aphasics.

A significant difference between an aphasic, predominantly motor, and an alalik is the preservation (in unadvanced cases) of the desire to speak; some words and phrases from previous speech remain. This facilitates the restoration and further development of speech. A big obstacle to the mastery of speech by alaliks and aphasics around them is poor memorization and rapid forgetting of words and phrases, i.e. difficulty and fragility of closures in defective speech systems of the cerebral cortex.

Khvattsev M. E.

How to correct sensory alalia

It is necessary to correct sensory alalia only using an integrated approach. It consists of:

• medications prescribed by a neurologist;
• neurocorrection;
• classes with a speech pathologist;
• classes with a speech therapist;
• working with a child psychologist;
• physiotherapy, occupational therapy;
• special speech therapy massage.

Comprehensive assistance

Doctors prescribe nootropic drugs, neuropeptides, neuroprotectors, vitamins. These drugs have a positive effect on the central nervous system as a whole. Additional measures may include massages, exercise therapy, and medicinal baths.

Logotherapy

The goal here is the formation of auditory perception, the development of the ability to analyze the speech and words of others. In the first stages, the baby’s chaotic speech slows down, his perseverance and attentiveness increase.

Neuropsychological correction

Here, the development of deficit functions and thinking occurs, the baby’s memory improves, and activity appears in exploring the world around them. All these treatment components are selected and prescribed by specialists, taking into account age, severity of the disease, causes and a number of other physiological characteristics. A prerequisite for successful therapy is training with a speech pathologist.

Corrective measures can be selected only after a comprehensive diagnosis. The outcome of therapy depends on the timing of detection of this speech disorder. The optimal age when it is desirable to begin correction is considered to be 2-3 years.

Treatment prognosis and preventive measures

The prognosis of the result is determined by how early the problem was identified and only the doctor who is caring for the baby can talk about it. Logotherapy will help only if the entire plan of correctional work, consisting of a medical as well as a psychological component, is followed.

Timely initiation of therapy and strictly observed correction make it possible to smooth out disorders of the speech apparatus and prevent deviations in the future.

In case of late application, the likelihood of receiving a fully formed speech is sharply reduced. In the absence of corrective measures, speech delay can lead to poor socialization of the baby. As a result, psychological disorders may appear. Measures to prevent sensory alalia are carried out during pregnancy, and then at an early age of the baby.

Differences between sensory alalia and the motor type of speech impairment

Auditory attention with this disorder is reduced or completely absent. The speech of adults is perceived indistinctly, as a set of chaotic sounds. Therefore, there is no desire to imitate, repeat words, syllables, sounds.

Children with sensory alalia have increased speech activity. This distinguishes them from children with a motor type of speech disorder. Children with a sensory type talk a lot, maintaining the correct intonation.

In this case, the speech motor analyzer is not damaged. However, the speech of such children is unstable in sound composition. It contains many isolated fragments of words and meaningless phrases. Such speech is incomprehensible to others. In some cases, echolalia is observed - repetition of individual words and sounds without understanding their meanings.

Often the correlation between heard and spoken words is not formed. The name cannot be assigned to a specific item. Children with normal development of the speech apparatus remember the name of an object after 3-5 repetitions.

For alaliq with a sensory type of disease, this requires a minimum of 25-30 repetitions. The child cannot repeat the word spoken by the parent. Adults regard this as stubbornness on the part of the child.

The degree of impairment of understanding may vary. There may be a complete misunderstanding of speech, or a misunderstanding of individual sounds and words. Understanding speech is situational. One phrase can be understood in different ways.

Sensory alalia is increased speech activity with low understanding of it by others. The baby has poor control over his own speech. Symptoms of sensory alalia:

• high excitability;
• poor behavior control;
• secondary delay in intellectual development.

Children suffering from this disorder have difficulty interacting with other people. It is difficult to influence them with words and beliefs, it is difficult for them to explain something. These factors explain the baby's uncontrollability.

It is typical for a sensory type that even specialists can often confuse it with autism. In the professional circle of speech therapists, there is an opinion to replace the term “sensory alalia” with “sensory disintegration.” Therapy for this disease begins with the sensory component. This is dictated by the fact that the child first begins to develop an understanding of speech, and only after that does the ability to pronounce sounds and words appear.

Alalia. Speech disorders of cortical origin

Nadezhda Kuzmina

Alalia. Speech disorders of cortical origin

Alalia (reason, structure, types)

such as alalia , which is expressed in the absence or underdevelopment of speech due to organic damage to the speech areas of the brain in the prenatal period or the early period of child development. A significant contribution to the study alalia was made by G. Gutzman, A. Liebmann, and at a later time M. E. Khvattsev, R. E. Levina and other researchers.

The works of various authors present the features of speech development and the structure of the defect in alalia based on the use of various criteria - physiological, clinical, psychological, linguistic, etc. Various forms of alalia . Alalia is not just a temporary functional delay in speech development. The entire process of speech takes place under conditions of a pathological state of the central nervous system.

K. P. Becker and M. Sovak identify components in the picture of speech underdevelopment that are associated with the predominance of biological, social reasons or their combinations.

With alalia , there are speech and non-speech symptoms, between which there are complex indirect relationships. In the symptoms of disorders in alalia disorders are predominant .

Alalia is a systemic underdevelopment of speech , in which all components of speech are disrupted - the phonetic-phonemic side, the lexical-grammatical structure. Among non-speech disorders, the symptoms of alalia include motor , sensory, and psychopathological symptoms.

During the long period of study of alalia , different assumptions were made about the causes of its occurrence. Thus, R. Cohen, A. Gutsman and others argued that the leading cause of this disorder is inflammatory or nutritional-trophic metabolic pathological processes occurring in the prenatal or early period of child development.

A. Treitel considered alalia to be a consequence of lack of attention and memory. A. Liebmann associated speech deficiency in alalia with intellectual deficiency. V. A. Kovshikov and others noted the leading role in the occurrence of alalia - traumatic brain injuries and asphyxia of newborns.

Among the etiological factors, intrauterine encephalitis, unfavorable developmental conditions, fetal intoxication, congenital complications, intrauterine or early lifetime brain injuries, diseases of early childhood with complications on the brain, etc. are also distinguished. According to the observations of S. S. Korsakov and N. I. Krasnogorsky, alalia is a consequence of a somatic disease that causes depletion of the central nervous system, primarily malnutrition.

Alalia is heterogeneous in its mechanisms, manifestations and severity of speech (language)

underdevelopment.
Due to the fact that different criteria are used as the basis for distinguishing forms, there are different classifications of alalia (R. E. Levina, V. K. Orfinskaya, A. Liebmann, V. A. Kovshikova, but despite this, all forms are reduced to two - motor and sensory forms of alalia . Motor alalia is a complex complex of speech and non-speech symptoms. In the structure of a speech defect, the leading one is language impairment Speech underdevelopment is systemic in nature, covering all its components - phonetic-phonemic and lexical-grammatical aspects. Also neurological symptoms of varying severity are observed. The main symptom of sensory alalia is a violation of speech understanding due to disruption of the speech-auditory analyzer, which occurs when the temporal lobe of the dominant hemisphere is predominantly damaged. The speech of a child with sensory alalia can be characterized as increased speech activity against the background of decreased attention to the speech of others and lack of control over one's speech.
Alalia is one of the most complex speech disorders . Despite numerous studies, it is not sufficiently studied. reliable statistical information on the prevalence of alalia . The most complex and controversial issue is the mechanisms of alalia - sensorimotor , psychological and linguistic concepts interpret it differently. Underdevelopment of speech in alalia is systemic in nature; imperfection of all operations in the process of generating a speech utterance is noted.

Thus, the theoretical data on the problem of alalia are multifaceted and contradictory . Speech, as a complex functional system, has a dynamic localization, and different brain structures involved in speech activity enter into constantly changing connections with each other. The speech process, complexly organized and multimodal in its structure, is not reduced solely to the motor level. For children with alalia , not only delays in the development of expressive speech , but also the pathological course of this development.

To summarize, it should be noted that as the child grows and develops, the range of traumatic situations that can become the cause or conditions for the occurrence of a speech disorder expands significantly due to the increasing importance of environmental influences. These are conflictual relationships with peers and significant adults (parents, educators, etc., excessive punishment, experiencing a situation of fear, the birth of another child in the absence of readiness to take the position of an elder.

During the period of speech must be protected from being in conflict situations, that is, the socio-psychological environment must be organized for the child in a special way: exclusion of traumatic situations, a favorable social development situation, exclusion of the influence of exogenous factors, and so on. The most important means of mental development is play as the leading type of activity in early childhood. The child should have a variety of sets of toys for independent use: games for the development of fine motor skills, for the development of attention and perception ( various mosaics, boards, construction sets, etc.)

. Naturally, the adult must initially act as a play partner - telling and guiding the child. It is necessary to create a certain gaming context. The inclusion of didactic games that promote the child’s sensory development also has a beneficial effect on the development of the child as a whole, forms concepts, develops the ability to learn, improves speech articulation and speech in general.

List of used literature

1. Arkin E. A. Child in preschool years / E. A. Arkin. - M.: Education, 1968.- 248 p.

2. Volkovskaya T. N. Comparative study of the characteristics of mental and speech activity of preschool children with mental retardation and general speech underdevelopment / T. N. Volkovskaya // Journal “Speech Pediatrics”. - 2005. - No. 2 (8)

.

3. Goykhman O. Ya. Fundamentals of speech communication. Textbook for university students / Nadeyka T. M., O. Ya. Goikhman, T. M. Nadeyka. – M.: INFRA-M, 1997.-272s

4. Kataeva L. I. Study of cognitive processes of preschool age / L. I. Kataeva. – M.: KomPuls, 1994. – 37 p.

5. Lobacheva E. L. Medical, psychological and pedagogical rehabilitation of children of primary school age with neurological symptoms and developmental delays / E. L. Lobacheva // Journal “Psychologist in kindergarten”. - 2000. - No. 4.

6. Child. Early detection of deviations in speech and their overcoming / Ed. Yu. F. Garkushi. – 2nd ed., rev. – M.: Publishing house of the Moscow Psychological and Social Institute; Voronezh: Publishing house NPO “MODEK”, 2003. – 288 p. (Series “Library of a practicing teacher”)

7. Reader. Children with developmental disorders . Textbook for students and students of special faculties / comp. V. M. Astapov. – M.: International Pedagogical Academy, 1995.- 264 p.

8. Elkonin D. B. Child psychology: Textbook. aid for students Higher Textbook Establishments / ed. -composition B. D. Elkonin. – M.: Publishing House

, 2004. – 384 p.

What is motor alalia

Motor alalia - or expressive in other words - is due to the fact that it is associated with motor (movement) disorders. The main problems in speech development are poor mastery of language operations and insufficient vocabulary. For example, motor alalia in a 3-year-old child is expressed in the inability to express his thoughts, words, and individual sounds. It is difficult for him to form words, phrases and use them correctly.

Such children have normal mobility of the organs responsible for speech. But there is difficulty in motor skills and abilities. A child can lick ice cream with his tongue, but cannot lift his tongue up at the request of an adult or parent.

Understanding the speech of others, the baby is powerless in reproducing his native language. The delay affects exclusively the speech apparatus. If there is a long-term delay, secondary mental retardation may appear. This is smoothed out with the formation of speech and its development, complication.

A characteristic symptom of the motor type of alalia is the inability to repeat speech heard from adults. In particularly difficult situations, the child cannot repeat even the simplest sounds, such as “AU”, “BA”, “PA”, although he understands the spoken speech of adults. The more complex the syllable, the more difficult it is to repeat. Children suffering from such speech disorders usually have neurological or mental disorders.

Neurological symptoms may include awkwardness, poor coordination, and lack of physical activity. Poor fine motor skills of the fingers may be observed - it is difficult to fasten buttons or tie shoelaces.

Children with motor alalia find it difficult to play with other children. It is difficult for them to jump well, play ball and do other movements that are easy for healthy children.

In some cases, the opposite effect may be observed, that is, increased activity. It depends on the location of the brain lesion. In this case, children may be hyperactive, easily excitable, and excessively fussy, but at the same time they get tired quickly.

Mental disorders with motor alalia

Deviations in the emotional-volitional sphere may be observed. This manifests itself in excessive touchiness, a tendency to violent reactions, frequent tears, hysterics, and reluctance to have contacts and communication with other people. Such symptoms can be expressed in:

• memory impairment;
• poor concentration;
• slow development of thought processes;
• visuospatial disorders;

Children with motor alalia have difficulty concentrating on any activity or object. They are very quickly distracted by other unimportant objects or events. It is extremely difficult to interest such a child in anything. It is difficult for such children to remember rhymes, numbers, and names of the days of the week.

Types of alalia

Alalia can be expressed in different forms, each of which has its own characteristics depending on the defect and specific manifestations:

1. Expressive (motor) alalia is diagnosed when there is an organic lesion in the speech motor analyzer section. Characterized by a delay in the development of speech function or its stop at any stage, while the understanding of the words of others does not suffer. With this type of alalia, the child has difficulties in expressive speech, grammar, and a poor vocabulary. Depending on which area was affected, subspecies are distinguished:

• afferent - appears if the lower parietal parts of the brain are affected, the method of manifestation is incorrect or difficult articulation;
• efferent - characteristic of damage to the premotor cortex, which leads to disruption of the syllabic structure of words.

1. Impressive (sensory) alalia - appears after lesions of the speech-hearing analyzer. Disturbances in the perception of sound are characteristic when the auditory analyzer is healthy (the child does not understand the meaning of the words addressed to him). It looks like a gap between the meaning and sound of words.
2. Mixed (sensorimotor) alalia - occurs with a combination of organic disorders of the auditory and motor areas. The severity of the defect in these areas can be different, that is, motor defects can be severe, and sensory ones can be mild, or vice versa. It is precisely because of the multiplicity of options and combined symptoms that this type of alalia is considered the most severe speech defect, both from the point of view of diagnosis and correction.

A pure type of speech disorder is quite rare. The most common form of alalia is mixed, with a predominance of one direction. In addition, determining the type of alalia is complicated by the fact that the symptoms overlap with indicators of other disorders or are accompanied by intellectual and emotional deviations.

Mixed type - sensorimotor alalia

In most cases, a mixed type of alalia is observed - sensorimotor. To understand what sensorimotor alalia is, we will describe the classic clinical picture. The child spoke late and has difficulties in forming speech. The vocabulary (both active and passive) is quite meager. Understanding of spoken speech is poor.

Social adaptation skills are impaired, which often makes it difficult to differentiate sensorimotor alalia from autism spectrum disorders. There may be a fear of loud sounds, and obsessive movements are common. But nevertheless, this type is treatable and correctable.

Sensory alalia through the eyes of a neuropsychologist

Sensory alalia is less studied compared to motor alalia. The number of children with sensory alalia is small, and differential diagnosis is quite complex. The main symptom of sensory alalia is impaired understanding of spoken speech. The main deficiency is the insufficiency of the auditory-speech analyzer.

It is important to understand that with sensory alalia the child’s hearing is preserved (or its deficiency is not decisive for the clinical picture). Therefore, when a child with mental retardation is referred for consultation, a specialist should always rule out physiological hearing disorders (children with sensory alalia and deaf children may be similar in their behavior). Scientists note that a study of the auditory analyzer in a child with sensory alalia reveals the exhaustion of this function: there is an inferiority of auditory analysis and synthesis, signals of the same frequency and volume are sometimes perceived, sometimes not perceived, signal processing is slowed down. Children show no interest in speech and are quickly distracted. Although there are children with sensory alalia who consistently show interest in music, and the impairment of auditory perception concerns only speech stimuli.

Fundamental concepts relating to alalia and aphasia were identified in the 60-70s of the 20th century, and since then nothing fundamentally new has been discovered.

Understanding of spoken speech can be impaired at different levels. Some researchers (for example, Doctor of Science, neuropsychologist T.G. Wiesel) separate auditory speech agnosia as a more elementary disorder (the secondary temporal cortex of the left hemisphere suffers and myelination of the pathways of the auditory analyzer occurs with a delay) and sensory alalia - as a linguistic disorder (associative cortex) .

At the same time, professor, neurophysiologist N.N. Traugott "admitted the possibility of identifying the cortical form of sensorineural hearing loss with sensory alalia." That is, it included auditory speech agnosia as part of sensory alalia. The same point of view was shared by the professor of the Department of Psychopathology and Speech Therapy of the Institute. Herzen V.K. Orfinskaya. Since Orfinskaya did not have time to finish her monograph, N.N. Traugott tried to popularize her research and classification, which included 12 types of aphasia and alalia. Orfinskaya's linguistic classification made it possible to divide speech disorders based on the sequence of speech formation in ontogenesis.

Depending on the mechanism of the disorder, the manifestations of sensory alalia and its degree can be different: from complete absence of speech to phrasal speech with impaired vocabulary, grammar and echolalia. According to my observations, in children with sensory alalia with a “higher” level of speech understanding impairment, when semantics is disrupted, binding the meaning of a word as a verbal shell - according to ASEP (acoustic brainstem evoked potentials) most often there will be no pronounced difficulties in transmitting the signal along the conductive ways. And in the case of a violation of a more elementary level - auditory speech agnosia - a slowdown in impulse transmission to the cortex will be visible on the ASVP.

Also, according to my observations, children with sensory alalia often have a history of asphyxia and entanglement with the umbilical cord, which probably leads to more severe damage to the nervous tissue. With motor alalia, hypoxia, venous dyshemia, increased ICP, and impaired venous outflow are more often observed. However, I am not a doctor, and these are just my subjective observations.

Neuropsychologist Alexandrova O.A.

Diagnosis of alalia

Speech therapists sometimes find it difficult to diagnose alalia. There are different ways of making a diagnosis, which are designed to complement each other:

1. History – collection of information from parents and communication with the child. Alalia can be suspected if at least three characteristic symptoms are present.
2. Differential diagnosis. It is necessary to conduct an examination with a number of specialists of a narrow profile. The otolaryngologist must rule out hearing problems, and the psychoneurologist must give his opinion on the mental state. A child psychologist should evaluate him for autism.
3. Dynamic examination. When starting correction, the speech therapist must monitor the dynamics of speech development. Based on the information received, the speech therapist can correct the previously made diagnosis.

Diagnosis using MRI and EEG is common. These studies reveal organic lesions and disorders.

Clinical picture and behavioral characteristics

In the absence of verbal communication with children or adults, the child experiences psychological discomfort. Children from a very early age use gestures to express their emotions and desires.

Gradually, they begin to connect speech to this, which becomes more complex as they grow older.

A child with alalia does not have this opportunity; it is difficult for him to explain what he wants from an adult. The degree of difficulty may vary, but there are three levels of underdevelopment of the speech apparatus:

1. Complete lack of speech.
2. There are initial signs of speech development. The baby has some words or sounds in its reserve and can make words from them, but such a reserve is extremely limited.
3. There is an extended speech with fragments of weak development of the speech system. The vocabulary in this case is large, but the words are pronounced in a distorted way, and there are defects in the pronunciation of certain sounds.

These levels are not related to the child's age. At 5 years old he can be at the first level. These impairments inevitably affect oral speech and, later, the ability to write and read.

Children have difficulty remembering letters and numbers. They confuse them, interfere with each other. This further complicates the development of speech ability. The child understands everyday speech. It is simple for him and does not require grammatical rules.

The child can understand simple requests, such as closing the door or taking a book, based on the current situation. He understands that if the door to the room is closed, and his mother suddenly spoke about it, then some manipulations need to be done with it.

Intuitively, the baby will open the door. But whether he understands exactly the meaning of words at this moment depends on the severity of the disease. At difficult stages, he may not understand at all what adults tell him.

Diagnosis, symptoms, examination of Motor alalia. Classification according to the severity of the violation.

The importance of examining children with alalia cannot be overestimated. Language symptoms of alalia in different children with Motor (expressive) alalia vary widely: from the complete absence of expressive speech or the presence in it of only single components of the language system (individual words, sounds, inflections, etc.) to minor disturbances in any one from the subsystems of the language (semantic, syntactic, morphological, lexical, phonemic). The latter is usually typical only for children of middle and high school age who “come out” or “come out” of alalia. In earlier age periods, as a rule, the entire language system is upset.

The inconstancy of the symptoms of alalia is indicative: the same linguistic unit, falling into different conditions, can be correct or incorrect. For example, in one case the child correctly names the object, say VASE, in another he calls it JAR, and in the third he does not name it at all. Or in a certain context the sound is pronounced correctly, in other contexts it is replaced, skipped, etc….

Violations of expressive (active, “spoken”) speech are obligatory and constitute the essence of MA, and only verbal speech is impaired, while other means of auditory speech are preserved, namely, melody, onomatopoeia, “sound gestures,” pseudowords (i.e., words invented children); Other non-verbal means of sound communication are also preserved: screaming, laughter, squeaking, etc.

Impressive and kinetic (gestural) speech remain unimpaired. Misunderstanding of speech occurs only if the child lacks the appropriate knowledge. Kinetic (gestural) speech is very widely used by many children with MA and to a certain extent compensates for the pathology of verbal speech.

Most children with MA have difficulty mastering written language, and they often have various forms of dyslexia and dysgraphia.

A) lexical violations.

Motor alalia is characterized by a significant discrepancy between the quantitative composition of the passive (understood) and active (pronounced) vocabulary: children understand the meanings of all or most words available for their age, but cannot find many words when updating them (using them in speech) or make peculiar errors. (see MA mechanism).

Children are better at actualizing words related to significant parts of speech (nouns, adjectives, verbs, adverbs), and worse - related to auxiliary parts (prepositions, particles).

Disturbances in the actualization (search) of words cause various forms of errors: absence of words (words are not named), their substitutions, abnormal words, blends... There are substitutions of words with facial-gestural speech, which is used very widely by many children with MA.

Features of the MA dictionary: at the 1st level of speech development (in the absence of phrasal speech), a child, having a very limited vocabulary, for example 10 everyday words, suddenly uses the rather rare word “avocado”; in independent speech it may be quite appropriate to use the names of objects, but when answering a question asked, the same words “can’t remember.”

B) syntactic violations.

All children with MA, regardless of the degree of impairment of the language system, are characterized by limitations in the use of a set of sentence types. Mostly, children use simple narrative and incentive sentences (usually uncommon). Other types of sentences are complex, with homogeneous members, etc. - are relatively rare in their speech, and in some they do not occur at all.

The number of syntactic constructions is also limited. It is often exhausted by “subject” constructions (“Children.” instead of “The children went to the forest to pick mushrooms”).

There is a tendency to place the predicate at the end of the sentence (“washes hands”, “children are sledding down the hill”) and shifts the adjective to the place after the noun (“big cube”, “blue circle”).

Necessary parts of a sentence are often missed, especially predicate verbs (“the boy is a car” instead of “the boy is rolling a car”)

Characteristic is the omission of conjunctions and prepositions. Many prepositions and conjunctions are used incorrectly (“the house goes” instead of “the house goes”).

In children with the rudiments of expressive speech, syntactic connections may be absent or extremely limited. (“Children play. Aunt. Drip-drip. Run. Girl. Cry.” - story “Naughty”).

Syntactic violations at the text level are expressed in the absence of predicate words (verbs), incorrect construction of sentences, incorrect word agreement, omissions and substitutions of words. As a result of these violations, the texts are insufficiently detailed, they contain omissions of parts of the plot, and logical connections are broken; outside the situation, the texts become incomprehensible or difficult to understand for listeners.

B) Morphological disorders.

The roots of words and the endings of the initial forms of words remain intact in the majority of children with MA; these elements can be deformed only in children with a severe disorder of the language system, which is mainly caused by phonemic disorders: cubes - “ku”, small - “ma”, sitting - “si”.

Prefixes and suffixes are more likely to be violated. Children have a very limited number of them, and many prefixes and suffixes are not used at all or are used incorrectly: drew - “drew”, “moved out” - “drove”. One of the symptoms of morphological disorders is incorrect agreement in gender and number: “red bow, red dress, red skirt, the wheel fell.”

In a number of cases, children incorrectly use plural endings and use earlier and simpler plural models: “houses”, “eyes”, “chairs” - by analogy with “cows”.

In the declension system, children correctly use the zero, initial form and some forms of the accusative and genitive cases, although the forms of the latter are often subject to violations. There is a pronounced tendency to replace the endings of oblique cases with endings of the nominative. At the same time, interchanges of the endings of a number of cases are noted (caught a beetle, a beetle; gives a rooster, a rooster).

Many agrammatical errors are also made in verb forms. Instead of the form of a definite person and number, an indefinite form is sometimes used (mom and dad drink tea, boys throw a ball).

Children with MA have very limited knowledge of word formation and, as a rule, many errors occur in the process.

The considered lexical, syntactic and morphological disorders in children with MA are not associated with pathology of thinking or other mental processes.

D) Phonemic disorders.

Children whose phonemic system is rudimentarily developed use a limited number of phonemes. Usually these are vowels and the first consonants in the genesis of child speech (P, B, M, T, D, N). The rules for operating with them are the most basic. Children with a relatively developed phonemic system have a larger number of sounds (up to whistling, hissing and even R, Rb), but the phonemic system itself is disordered, in speech “all the sounds are out of place.” At the same time, substitutions and distortions are irregular (for example, a child replaces the sound C in different words with different sounds - “(s) sled”, “(s) mamolet”, “(s) steps”, “autoboot(s)”). .

Words of different syllabic constructions are reduced to the construction “consonant + vowel” (SG) or “consonant + vowel + consonant + vowel” (CGSG); other types of syllables are very rare. Children predominantly pronounce only the stressed syllable of a word or the vowel of a stressed syllable.

Violations of the syllabic structure of a word are most often expressed in a reduction in the number of syllables. Permutations and, especially, repetitions of syllables, also due to contextual influences, occur much less frequently.

The mentioned phonemic disorders are detected to a lesser extent when pronouncing “local” words and to a greater extent when pronouncing sentences (word combinations). A “local” word may be pronounced correctly or may exhibit isolated violations, but when included in a more complex context, it, thereby experiencing an increased number of segmental and suprasegmental influences, is often subject to a greater number of diverse violations.

D). Phonetic disorders.

Many children exhibit a mild degree (the so-called “erased form”) of dysarthria. It does not represent any specificity in children with MA.

A small number of children have prosody features associated with language impairment. Due to difficulties in finding linguistic units and the rules of their functioning, stops occur, the rate of speech slows down, and sounds are drawn out.

It is very important to examine alalia at the earliest stages.

Alalia correction

Children suffering from alalia have difficulties in raising them. Some parents may treat such children unfairly. They do not understand all the problems that the baby faces along the way. It is important to realize that such children require a special approach based on calm, patience, and understanding.

If a parent notices the first symptoms of alalia, they should immediately seek help from specialists. The sooner a problem is identified, the easier it is to deal with it. Timely correction will reduce the risk of complications.

The treatment of these disorders includes various techniques and methods. There are psychological, pedagogical, and medicinal approaches. The technique of transcranial electrical stimulation has a special contribution to the restoration of speech capabilities. Correction stages based on special classes must also go through:

• gymnastics;
• Speech therapy rhythm classes (logorhythmics);
• artistic and technical classes,
• reading;
• writing classes;
• speech therapy classes;
• memory training;
• special classes aimed at attention and perception;

In special correctional centers and speech therapy schools, special medical and psychological therapies are used. The drug approach is primarily aimed at stimulating and shaping damaged brain centers. Experts note the effectiveness of some procedures:

• DMV;
• IRT;
• hydrotherapy;
• laser therapy;
• electrophoresis;
• magnetic therapy;
• electropuncture;
• transcranial electrical stimulation.

The correction program is selected individually and must take into account all the characteristics of the child. The recovery process should influence the pathology itself and its accompanying diagnoses.

Treatment of motor alalia in children

When treating, emphasis should be placed on the development of the child’s motor skills, his thinking, and his ability to remember. Since this disease has a systemic nature of occurrence, the speech therapy approach is adjusted to the full coverage of sound-letter productions, visualization, and the ability to concentrate attention on something. This should be a whole range of measures that have an impact on:

• speech stimulation;
• meaningfulness of speech;
• formation and expansion of vocabulary;
• grammatical development of speech.

Multidisciplinary specialists, not just speech therapists, take part in treatment and correction. A child with alalia needs to be taught the alphabet and letters as early as possible. These skills will help to better develop memory, teach how to form words from individual sounds, and control speech.

Why does alalia occur?

Alalia can result from asphyxia of the newborn, prematurity, or birth injuries. Sometimes this disorder occurs in children after premature or prolonged labor. Provoking factors can be complications during pregnancy and childbirth, perinatal pathologies. The causes of alalia are usually:

• infectious diseases (infection occurred in utero or during childbirth);
• hypoxia;
• asphyxia;
• toxicosis;
• fetal injury (fall or blow of a pregnant woman);
• TBI during childbirth or pregnancy;
• risk of spontaneous abortion;
• a number of chronic diseases in women (heart failure, pulmonary failure, hypertension and a number of others.

Among the etiopathogenetic factors for the onset of the disease, it is necessary to highlight encephalitis, meningitis, head injuries, and a number of somatic diseases affecting the central nervous system. A number of scientists associate alalia with heredity. Alalik children are seriously different from mentally retarded children. As speech develops, their mental retardation disappears.

Home therapy for alalia

In addition to classes with specialized specialists, you can conduct additional classes at home. To get rid of the disease, the parent must focus as much as possible on his baby and help him. There are some effective methods designed specifically for patients:

• The baby must learn to understand speech by ear. The parent names the object, the child must show it. If he showed it wrong, you need to show it correctly. This exercise is repeated many times for alaliks before he understands what is required of him. Bright toys and colored figurines are suitable for such activities.
• If the vocabulary is wide, train him to pronounce the names of objects by showing them.
• You need to talk to children suffering from alalia more often. Parents' speech should be clear, correct and not too fast. With sensory alalia, words must be accompanied by a demonstration of corresponding pictures.
• Show the letters. And then say words starting with these letters. Ask your child to show the letter with which the word begins and pronounce the whole word.

Take your child a few books with bright illustrations and get him interested in reading. Tell interesting stories and show what the main characters look like. Educational games with adults can help.

Possible complications and consequences

Primary manifestations of this disease become noticeable as early as 2 years. If treatment is not taken at the right time, the disease will continue to develop further. The main complications include:

• disturbance in coordination of movements;
• high excitability;
• fine motor disorders;
• poor understanding of adult speech;
• lack of self-service;
• numerous grammatical errors in your own speech;
• mental retardation;
• communication problems.

Work with alaliks is carried out in a playful way. The patient should not experience discomfort or psychological pressure on himself. Correct correction work is the key to getting rid of problems associated with alalia. Success of therapy is likely when started early - at 3-4 years. An integrated approach is needed. With minor damage to the speech center, this pathology can be completely cured.

Prevention of alalia

This disease can be congenital or acquired. Scientists have identified certain patterns in the appearance of this serious disease. It can appear after fetal hypoxia, a number of complications during pregnancy, and early childbirth.

Prevention of natural causes is impossible or extremely difficult. The baby may suffer a head injury during childbirth. Alalia is also caused by etiopathogenetic factors. These include:

• rickets;
• viral encephalitis;
• TBI;
• malnutrition;
• meningitis;
• viral diseases and complications after them.

A number of these reasons can be completely avoided, thereby minimizing the risk of pathology. These are the following measures:

• parents should give up bad habits;
• Before planning a pregnancy, undergo all the necessary tests to identify diseases in the mother.
• During pregnancy, the mother should avoid infection with viral infections and exacerbation of chronic diseases as much as possible.
• use medications that are safe for the fetus.
• undergo all required examinations during pregnancy.
• After birth, it is necessary to talk and engage in educational games.
• If symptoms of mental or neurological disorders appear, immediately contact a speech therapist, child psychologist or neurologist.
• carry out vaccinations prescribed by doctors, including for mother.

Such preventive measures will ensure good development of the nervous system, development of speech and motor skills.

Etiology and pathogenesis of alalia

There is no consensus in the literature on the etiology (causes) of alalia and its pathogenesis (brain mechanisms).

Some authors give preference to biological factors, others - socio-psychological, others - heredity, and others believe that the hereditary factor does not play a fundamental role in the occurrence of alalia.

Causes:

Biological

Proponents of the idea that alalia is a consequence of organic brain damage consider asphyxia to be the most dangerous etiological factor.

Asphyxia as the most likely cause of the development of alalia is also pointed out by such authors as V. Gardner, E.M. Mastyukova, B.V. Lebedev, G.V. Gurovets.

The French alalia researcher J. Ajuriaguerra, in addition, believed that alalia is caused only by bilateral brain lesions, in which spontaneous compensation of defects is impossible or extremely difficult.

It should be noted, however, that, according to numerous observations of clinicians, not all children with a history of the complications listed above develop alalia.

Some children who develop normally in terms of speech have asphyxia and various bilateral brain lesions that do not negatively affect the speech mechanism.

The views of different scientists on the role of heredity in the etiology of alalia are also not the same. V.A. Kovshikov conducted a special study of this problem.

He reports that heredity occurs only in a small number of cases - approximately 16% of the total number of alaliks.

The main argument is the data he obtained that the speech development problems that parents had are not always passed on to their children.

More significant, according to the conclusions of V.A. Kovshikov from a detailed review of the literature on alalia, factors such as late birth, induced and spontaneous abortions, a history of stillbirths, pathology of pregnancy, especially severe toxicosis in the first half.

Threatened miscarriages, psychological trauma, abnormal position of the fetus, bleeding, Rh incompatibility, premature birth, rapid, protracted, dry labor, stimulation, forceps, head injuries during childbirth, asphyxia and some other circumstances are also unfavorable.

Children who are born weakened and have suffered severe brain diseases before the age of one year, and especially neuroinfections, as well as children who have received head injuries before the age of one year, are also at risk.

Socio-psychological

American psychologist V. Gardner attaches great importance in the etiology of alalia to social factors: conflictual relationships in the family, improper upbringing of children (mockery over incorrect speech, etc.).

They pay special attention to the relationship between the child and the mother. He notes that among the mothers of alaliks, neurotic, timid, and, conversely, arrogant ones are much more common than among the mothers of normally speaking children.

There are conflicting opinions regarding the stay of children in a bilingual environment. Most of the authors, for example, A.V. Yarmolenko, do not recognize that bilingualism has a harmful effect on the development of alalia. Others consider it to provoke deviations in speech development.

Different views on the mechanism of alalia

Motor concept

The first noteworthy study of alalia belongs to A. Kussmaul, who back in 1877 called it “congenital aphasia.”

A little later, in 1888 , R. Cohen designated alalia as “ideopathic deafness” or “hearing-muteness.” Despite this designation, R. Cohen is considered a supporter of the motor concept of alalia.

He believed that the main thing in alalia was the absolute inability of children to pronounce sounds and syllables, although he recognized that the brain structures that are responsible for this may not be damaged in them. According to R. Cohen, this type of speech pathology is based on discoordination in the work of individual speech zones.

A follower of R. Cohen was the German neurologist G. Gutzmann, who also proposed intensively stimulating the articulatory side of speech in alaliks.

Psychological concept

However, the motor concept of alalia has not received universal acceptance. Researchers of the late 19th century, for example, A. Liebmann, M.V. Bogdanov-Berezovsky, expressed considerations according to which alalia cannot be caused only by motor reasons.

They believed that the main factor here was the psychological factor: disturbances in thinking, emotional-volitional sphere, memory, attention, etc.

A number of later researchers, following A. Kussmaul, considered alalia as an analogue of aphasia, only observed in children.

However, they had serious opponents who emphasized the fundamental difference in the mechanisms of development of aphasia and alalia. Despite these criticisms, the motor and sensory concept of alalia remained operational for a long time.

Sensory concept

At a later time, St. Petersburg neurophysiologist, psychologist, teacher N.N. Traugott, recognizing that with alalia the activity of language acquisition is always disrupted, noted that the root cause of this is the insufficiency of speech auditory gnosis.

The same point of view was expressed later, in the 60s of the 20th century , by R.E. Levina.

Mixed variants of brain mechanisms

The brain mechanisms of alalia may also be mixed. V.K. Orfinskaya allowed differences. She associated the inability of Alaliks to speak either with the presence of the phenomena of oral-articulatory apraxia, or with a deficiency of language ability and believed that there were:

a) the actual “linguistic” alalia, which consists of the inability to isolate from the speech of adults the rules of language necessary for the use of its means (phonemes, words, word forms, phrases);

b) gnostic and praxic, caused by speech auditory agnosia or articulatory apraxia.

Language concept

Currently, the priority is the “linguistic concept” of the pathogenesis of alalia. It is followed by many modern researchers of pathology of speech development: V.A. Kovshikov, N.S. Zhukova, E.M. Mastyukova, T.E. Filicheva, B.M. Grinshpun, V.K. Vorobyova, L.R. Davidovich, E.F. Sobotovich, T.G. Wiesel.

According to her, a child with alalia does not develop the “language ability” that is given to a person by nature. With both sensory and motor alalia, the child cannot master the language (its sounds, words, grammar).

At the same time, skills that do not require significant verbal accompaniment can be successfully developed (for example, the ability to draw, count, design, play various games not directly related to speech).

This is due to the fact that speech stimuli, especially with motor alalia, are perceived and inner speech is formed. It becomes the basis for mental development as a whole.

With sensory alalia, the formation of internal speech also occurs, but is reduced mainly to the visual perception of objects in the world and optical images of articulatory movements of adults.

Sensory children who do not receive timely help master non-speech skills to a lesser extent and often their mental development takes on the features of secondary mental retardation.

Neuropsychological approach

(The most likely brain mechanisms causing sensory and motor alalia)

In addition to the innate readiness for language development, primary intact intelligence, environmental stimuli that would encourage brain systems to mature, motivation for speech, it is necessary that between individual analyzers and the modalities built on them there are fully functioning pathways along which information is transmitted from one area of ​​the brain to another.

This also applies to the actual speech areas of the brain. Without communication between individual areas of the brain involved in speech acquisition, speech cannot develop.

Let us consider which intersystem connections are not formed in the first place during sensory and motor alalia from a neuropsychological point of view.

Modern neurophysiological studies (M. Kinzborn, D.A. Farber, M.M. Bezrukikh, etc.) have shown that in early speech ontogenesis the processes of left hemisphere lateralization of speech function play an important role.

Initially, the child learns non-speech noises (natural - the sound of the wind, the rustling of leaves, the sound of pouring water, thunder, as well as the “voices” of animals; object noises made by various objects - tools, musical instruments, etc.).

These acquisitions of the right hemisphere serve as the basis for the primary operations of speech development. They consist in the selection from them by the left hemisphere mechanism of signs useful for speech.

All blows, bows, hisses, whistles, growls and moos in the left hemisphere must change and turn into speech sounds, which retain a connection with the original sounds in the names themselves. This is how speech auditory gnosis is formed.

The task of extracting features useful for speech from non-speech noise turns out to be inaccessible to the most difficult alaliks.

As is known from the literature, the pre-speech period proceeds without significant deviations, i.e. the same as in speech-healthy children.

They master, according to age parameters, various pre-speech skills: movements, including rhythmic, drawing, can imitate non-speech sounds, for example, the howling of the wind, the voices of animals; perform various household operations accompanied by gestures.

However, the preparatory phase of development for speech ends with these “ancient” skills. The sounds made by the human voice remain inaccessible to them unless appropriate corrective measures are taken.

In other words, speech auditory gnosis in these children is not formed or is formed slowly, defectively

The place of primary localization of speech auditory gnosis in the brain is the left temporal lobe.

It is clear that she can start working in a timely manner only if the child has accumulated the necessary non-speech auditory base and if the pathways between the hemispheres (and, first of all, the corpus callosum) are intact.

If these conditions are not met, the child does not acquire the ability to navigate acoustic noises as speech sounds and, therefore, does not understand what adults say.

Unlike sensory alalia, in which there are no necessary connections between the right and left hemispheres of the brain, with motor alalia the pathological process is concentrated primarily in the left (speech dominant) hemisphere.

Let’s say that a child has acquired, to some extent, the ability to distinguish speech sounds and grasp their semantic roles in language, i.e. non-speech noises were transformed into speech sounds. However, in order for him to speak on his own, this is not enough; he also needs the ability to re-encode these sounds into articulatory movements

They can be approximate, undifferentiated, but precisely articulatory (speech). To do this, it is necessary that speech products perceived by ear be recoded into articulatory movements.

This , in turn, is possible only if the pathways between the sensory (temporal) and motor (premotor and postcentral) areas of the brain are complete.

The frontal lobes also play a significant role in these processes, providing not a mechanical imitation of what is heard, but meaningful speech activity. These are the most likely brain mechanisms.

Massage technique for alalia

Massage has a positive effect on the motor type of the disease. It has a number of positive effects: reduces increased muscle tone;

• coordinates the muscles of the face and tongue;

• improves articulation;

• improves tissue sensitivity;
• reduces salivation (excessive salivation, drooling).

The massage should be done with your fingers. Movements should be slow and careful. There should be at least 10 such sessions per course. The massage technique includes tapping on the lips, tongue, and inner surface of the cheeks.

You also need to carry out circular and pressing movements along the surface of the cheeks. It is worth seeking help from specialists who will prescribe a course of speech therapy massage and determine its features, frequency, and specific movements.

Corrective work of a speech therapist

All corrective work must be carried out consistently and comprehensively. Treatment is carried out in several stages of a certain sequence.

Stage one

Training in distracting noises not related to speech. This may be the sound of a bell, rattles or other objects. Sounds must have different tonality, timbre, and volume.

Stage two

Teaching individual letters and sounds. The baby must learn to understand and pronounce simple sounds consisting of individual letters, for example, “rrrrrr”.

Stage three

Learning to pronounce syllables, simple words.

Stage four

Learn to pronounce words. There is training in composing simple word combinations and phrases.

Stage five

Increasing active and passive reserve, complication of speech patterns.

Forecast for overcoming the diagnosis

The key to successful therapy is early diagnosis of the disease. Speech therapists dealing with this problem are convinced that if correction begins at the age of 3-4 years, the child has a good chance of full recovery.

The main success factors are the correctly selected course of treatment, its timeliness, and the experience of specialists conducting corrective work.

At an early age, thanks to the plasticity of the brain and nervous system, speech functions can be transferred from affected areas to other centers.

It is also worth knowing that the more damage to the speech centers, the more difficult and longer the recovery will be. Children with motor alalia have a better chance of completely eliminating the problems, although both the sensory and mixed types are more difficult to treat. At school age, such children may encounter difficulties in writing, reading, and adding numbers.