Linguistic concept of Motor (Expressive) alalia. Mechanism. (Modern theory). V.A. Kovshikov, B.M. Grinshpun, N.S. Zhukova, E.M. Mastyukova, T.B. Filicheva, T.G. Wiesel, W.K. Vorobyova

Article:

Alalia is a persistent specific speech underdevelopment caused by damage to the cortical parts of both hemispheres of the brain.
Some authors call this childhood pathology “congenital aphasia” or “developmental aphasia” by analogy with the same speech pathology in adults. There is a significant difference here - in adults, already formed speech disintegrates, and in children there is speech underdevelopment due to damage to the speech zones of the cerebral cortex (Broca's area). Similar changes occur during fetal development or early childhood. The following types of alalia are distinguished: motor, sensory and sensorimotor. Let's look at them in more detail below.

Causes of alalia

The severity of the pathology depends on the time of brain damage. The most severe damage occurs during intrauterine development, at 3–4 months of pregnancy. Causes of damage to speech areas:

• maternal intoxication;
• toxicosis of pregnancy;
• incompatibility of mother and baby by blood type and Rh factor;
• birth trauma, asphyxia during fetal development and at birth;
• neuroinfections;
• deep prematurity;
• traumatic brain injuries at an early age;
• consumption of alcohol and nicotine by a pregnant woman;
• hereditary predisposition.

The bottom line is that with organic damage to the brain, the process of maturation of nerve cells slows down. This factor helps to reduce the excitability of neurons and reduce the conductivity of nerve impulses.

Motor alalia

The fact that with motor alalia both hemispheres of the brain are affected is indicated by the following circumstance - this pathology is not compensated spontaneously, without special corrective work and medical support. The ontogenesis of the disorder involves complex encephalopathic disorders of the cerebral cortex and subcortical structures.

The disease belongs to the third group of clinical types of general speech underdevelopment and occurs in approximately 1% of preschool children and 0.6% of school-age children. An officially recorded diagnosis is the basis for disability.

Characteristic signs of alalia are underdevelopment of absolutely all aspects of speech:

• phonetics;
• vocabulary;
• syntax;
• morphology.

Motor (expressive) alalia in a child received its name because this defect is based on a deficiency in the motor part of speech. An electroencephalopathic study of children with motor alalia diagnoses local damage to the tissues of the cortex, as well as the hypothalamus, subcortical ganglia, thalamus optic, and brain stem. In most cases, dysfunction of the midbrain structures is observed.

Valery Anatolyevich Kovshikov

Valery Anatolyevich Kovshikov (1936–2000), candidate of pedagogical sciences, associate professor - this name is rightfully inscribed in large letters in the history of domestic speech therapy. Having graduated from the defectology faculty of Leningrad State Pedagogical Institute (now RGPU) named after. A.I. Herzen, V.A. Kovshikov worked for almost 40 years at the Department of Psychopathology and Speech Therapy (later - the Department of Speech Therapy) of this university.

Formation of associate professor V.A. Kovshikov was held under the guidance of leading experts in the field of correctional pedagogy - professors E.S. Ivanova, L.S. Volkova, R.I. Lala-eva, in collaboration with G.M. Sumchenko, G.A. Volkova, L.G. Paramonova and his other colleagues, who formed the scientific speech therapy school in the Northern capital of Russia. It is no coincidence that the leadership of the defectology faculty and department, and colleagues have invariably trusted V.A. for many years. Kovshikov editing collections of scientific papers on the problems of speech therapy and special pedagogy. Editing scientific publications and opposing dissertations performed by V.A. Kovshikov, have always been distinguished by their depth, integrativeness, conceptual approach, integrity and scientific foresight.

Range of scientific interests of V.A. Kovshikov in the field of theory and practice of speech therapy was quite broad and constantly deepened, especially in light of close creative cooperation with the Leningrad (St. Petersburg) Institute of Ear, Throat, Nose and Speech - one of the leading medical and defectological research centers in our country. Never breaking ties with practical (mass and special) educational institutions, Valery Anatolyevich carried out experimental research work at the base related to differential diagnostic, correctional and educational work with children of preschool and school age who have developmental problems. He paid a lot of attention to advisory and methodological work with teachers and parents of children suffering from speech, intellectual and behavioral developmental disorders.

Scientific and methodological heritage of V.A. Kovshikov compiles 70 scientific and scientific-methodological works, most of which are devoted to the problem of motor alalia. The versatility of the studied V.A. Kovshikov's theoretical and methodological issues on this problem reflect the depth of his scientific thought: mechanisms of expressive alalia, differential diagnosis of language and speech disorders, intellectual and linguistic insufficiency in the overall picture of speech dysontogenesis, individual characteristics of children with alalia, specifics of disorders of phonemic, syntactic systems of language, speech and non-speech activity - this and much more was the subject of his careful research.

V.A. Kovshikov conducted studies of normal and impaired speech and non-speech activity on the basis of linguistic, psycholinguistic and logopathopsychological methods, continuing and developing the traditions of the domestic psychological and speech therapy school (N.N. Traugott, V.K. Orfinskaya, A.A. Leontyev and etc.).

Corrective work with children suffering from alalia, V.A. Kovshikov recommended focusing on the formation of the linguistic mechanism of speech activity, using a concentric system of material distribution; Moreover, each concentration, in his opinion, should include gradually more complex material from all subsystems of the language (lexical, morphological, phonemic). V.A. Kovshikov, knowing well the domestic and foreign literature, rightly emphasized that much in the problem of alalia still remains insufficiently studied and debatable. Solving the problem of successful correction of alalia can only be successful if we use and deepen modern ideas about human speech activity.

V.A. Kovshikov also developed an original training course on the historiography of domestic speech therapy.

V.A. Kovshikov was, in the true sense of the word, a socially active person, took a direct part in cultural and educational events, devoted a lot of time to engaging students and research work, and was attentive and very interested in students’ mastery of professional skills. The scientist’s ideas were embodied and developed in theses and master’s theses of his students, many of whom became leading experts in the field of correctional pedagogy. All of them remember with gratitude and great warmth their teacher, his bright, interesting lectures, polemical scientific and methodological discussions, originality of judgments, persuasiveness and evidence of scientific argumentation, his sincere devotion to the “cause of speech therapy.”

V.A. Kovshikov, a talented teacher and scientist, made a significant contribution to the development of the theory and practice of speech therapy, to the system of training and advanced training of defectological personnel.

He passed away in the prime of his creative powers, without having time to defend his doctoral dissertation, without completing work with several of his students, without finishing another book. Students, colleagues and friends keep V.A. Blessed memory of Kovshikov.

Alalia is the absence or underdevelopment of speech due to organic damage to the speech areas of the cerebral cortex in the prenatal or early period of speech development.

The causes of alalia are varied. M.V. Bogdanov-Berezovsky, N.N. Traugott point to inflammatory or nutritional-trophic metabolic pathological processes occurring in the prenatal or early period of child development. E. Freshels, Yu. A. Florenskaya about children suffering from severe rickets or who have suffered severe diseases of the upper respiratory tract (whooping cough). N. I. Krasnogorsky speaks about severe cases associated with Z.R.R., associated with lack of nutrition and sleep in the first months of life.

With alalia, various degrees of severity are observed: from relatively mild forms, in which speech develops, although slowly and distorted, from about 3-4 years, to severe ones, when the child does not use speech even at 10-12 years. Later, with systematic and special help they master speech, but it is very defective and poor.

Alalia (according to M.E. Khvattsev) is the muteness of children who speak indistinctly, if they have insufficient intelligence, elementary hearing and articulatory apparatus for the development of speech. The child is silent or makes inarticulate sounds and sound combinations. Sometimes he pronounces words that are incomprehensible to others, echolalia is observed. The phonetics, vocabulary and syntax of an 8-10 year old alalia copy the speech of 2-3 year old children. Typical for the initial stage of alalia is silence and reluctance to speak. Such inhibition is caused by the poverty of the speech process, severe mental experiences of one’s inferiority.

There are two main forms of alalia: motor and sensory. The most common is mixed sensorimotor alalia. R.E. Levin identifies 3 forms of alalia (psychological classification):

-Children with insufficient acoustic perception - do not distinguish the sound stream, do not understand, do not speak (sensory defect)

-Children with insufficiency of acoustic perception – insufficient visual perception. There is no impairment of physiological vision, but subtle visual differentiations are not formed. Notes insufficiency of optical-spatial perceptions, they do not distinguish shape, size, color, because The cells of the cerebral cortex in the parietal-occipital regions are not developed.

-Children with insufficient mental activity. Children may be closer to normal in intelligence, but their mental activity is impaired (they cannot plan, switchability suffers, there are disturbances in all types of activities, children are passive, slow.)

R.E Levin does not distinguish motor alalia.

Other researchers (S.S. Lyapidevsky, N.N. Traugott) insist on motor alalia, noting that motor alalia is based on a violation of speech motor analyzers.

Brain damage is caused by brain damage, intrauterine ecephalitis, sometimes a complication after meningitis, unfavorable intrauterine developmental conditions, difficult childbirth, brain injuries, childhood diseases with complications on the brain. The earlier the disease occurs, the more extensive the speech impairment, because all further development of the brain proceeds abnormally (myelination of nerve fibers is delayed)

Sensory alalia.

If the child has normal hearing, he does not understand speech addressed to him, which means he does not speak. Cause: injuries and diseases of the brain (auditory-speech differentiations in the acoustic apparatus, in the temporal region did not develop subtly enough) Symptoms of sensory alalia: impaired phonemic hearing, poor attention and memory for oral speech (do not develop due to lack of understanding of verbal speech) B The result is vagueness and instability of phonemic patterns. Sensory alalitics have hearing impairment to one degree or another, which makes it difficult to perceive spoken speech. Sensory alaliks are easier than motor ones to imitate sounds and words and pronounce them more often. Sometimes speech arises spontaneously, although without awareness of its content.

Motor alalia.

This is a systemic underdevelopment of expressive speech of a central organic nature due to the underdevelopment, immaturity of linguistic concepts, the process of generating speech utterances with the relative preservation of semantic and sensorimotor operations. Motor alalik begins to understand other people's speech in a timely manner, but does not speak himself. There is often a misunderstanding of difficult words and phrases, complex sentences. The enrichment of expressive speech is limited, because they talk to him little, believing that speech is inaccessible to him. Motor speech imitation is especially severely impaired (they cannot repeat words that they have already learned to speak)

Symptoms of motor alalia:

Severe impairment of imitation of oral speech (lack of articulatory speech)

Repetition of the same sound, syllable is normal (a-a-a, bo-bo-bo), but the sound combinations are broken (instead of “au” he repeats “uu, ua”)

The more developed facial-gestural speech, the longer the indication of motor alalia, because verbal thinking is relatively intact.

Causes of motor alalia:

Congenital or acquired inferiority and abnormal development of speech motor systems due to damage by disease, physical trauma, intoxication or due to delayed development of differentiation in the motor centers of the speech motor zone of the cerebral cortex (Brocca's area).

Difficulties in independently pronouncing sounds are explained by the weakness of traces from the reproduction of sounds in the speech motor system of the brain or the weakness of the connections of this system with others (acoustic, optical).

Alalik's speech

:

Speech is simplified according to the type of speech of small children (mo-milk)

Repeats syllables, but cannot merge them into words. Often there are omissions and rearrangements.

A peculiar stuttering is noted as a stage of speech development: it occurs either simultaneously with the appearance of speech, or later when mastering a phrase. Sometimes the stuttering goes away, sometimes it remains.

There are frequent sharp violations of the melody of speech, tempo, rhythm, chanting with prolonged syllables or abrupt pronunciation of words in a sentence.

Phonemic and grammatical disorders, tongue-tiedness, nasality.

Loss of understanding is secondary in nature. This occurs as a result of: lack of habit of listening, rapid fatigue, and lack of habit of listening to complex speech.

The presence of a kind of expressive speech: alalik always says something, but does not know how to use the learned words in the right case, the word is reproduced based on the object, and not on memory.

Alalik's personality.

More often they are psychophysically inferior. Due to damage to the central nervous system, deprivation of the possibility of normal communication, difficulties in the speech act, negative personality traits develop: agitation, short temper, sudden mood swings, touchiness, tearfulness, stubbornness, inactivity in movements and thinking. Negativity is typical. Extraverbal disorders: disorders of attention, memory, thinking.

Formation of expressive speech of alalik .

The formation of speech is caused by a violation of the analytical-synthetic activity of the speech motor analyzer. These violations can be of a different nature:

Kinetic oral apraxia: difficulties in the formation and consolidation of articulatory structures, and subsequently in the motor differentiation of sounds.

Difficulty switching from one movement to another.

Difficulties in mastering the sequence of these movements to reproduce words / motor patterns /.

The development of the main leading component - the active vocabulary - is delayed. It turns out to be poor, insufficient, and distorted.

The phonetic side of speech also lingers.

The grammatical structure is formed distortedly.

Formation of impressive speech.

Impressive speech suffers secondarily and to a lesser extent in its development. Characteristic is a decrease in speech stimulus or speech negativism.

Diagnostic differences between alalia and similar conditions.

Difference between alalik and deaf-mute:

Presence of modulated screaming and babbling with intonations.

At the age of 1-3 months, reaction to sound.

Emerging kinesthetic (gestural) speech accompanied by screaming.

The expression of the eyes is lively, the face is expressive.

The difference between an alalik and a child with hearing loss:

Normal or slightly reduced hearing.

A ringing voice (muffled for those with hearing loss).

Complete absence of speech (in the case of the hard of hearing – babbling or distorted speech).

Alalik does not repeat words (a hard-of-hearing child repeats).

ALALIA

Alalia is a profound immaturity of speech function, caused by organic damage to the speech areas of the cerebral cortex. With alalia, speech underdevelopment is systemic in nature, that is, there is a violation of all its components - phonetic-phonemic and lexical-grammatical. Unlike aphasia, in which there is a loss of previously present speech, alalia is characterized by an initial absence or sharp limitation of expressive or impressive speech. Thus, alalia is spoken of if organic damage to the speech centers occurred in the prenatal, intranatal or early (up to 3 years) period of the child’s development.

Alalia is diagnosed in approximately 1% of preschool children and 0.6-0.2% of school-age children; Moreover, this speech disorder occurs 2 times more often in boys. Alalia is a clinical diagnosis, which in speech therapy corresponds to the speech conclusion ONR (general speech underdevelopment).

Causes of alalia

The factors leading to alalia are diverse and can act during different periods of early ontogenesis. Thus, in the antenatal period, organic damage to the speech centers of the cerebral cortex can be caused by fetal hypoxia, intrauterine infection (TORCH syndrome), the threat of spontaneous abortion, toxicosis, falls of a pregnant woman with injury to the fetus, chronic somatic diseases of the expectant mother (arterial hypotension or hypertension, heart or pulmonary failure).

The natural outcome of a complicated pregnancy is complications of childbirth and perinatal pathology. Alalia may be a consequence of asphyxia of newborns, prematurity, intracranial birth trauma during premature, rapid or prolonged labor, or the use of instrumental obstetric aids.

Among the etiopathogenetic factors of alalia that affect the first years of a child’s life, one should highlight encephalitis, meningitis, head injury, and somatic diseases leading to depletion of the central nervous system (hypotrophy). Some researchers point to a hereditary, family predisposition to alalia. Frequent and prolonged illnesses of children in the first years of life (ARI, pneumonia, endocrinopathies, rickets, etc.), operations under general anesthesia, unfavorable social conditions (pedagogical neglect, hospitalism syndrome, deficiency of speech contacts) aggravate the effect of the leading causes of alalia.

As a rule, the history of children with alalia reveals the participation of not one, but a whole complex of factors leading to minimal brain dysfunction - MMD.

Organic damage to the brain causes a slowdown in the maturation of nerve cells, which remain at the stage of young immature neuroblasts. This is accompanied by a decrease in the excitability of neurons, inertia of the main nervous processes, and functional exhaustion of brain cells. Damages to the cerebral cortex in alalia are mild, but multiple and bilateral, which limits the independent compensatory capabilities of speech development.

Alalia classification

Over many years of studying the problem, many classifications of alalia have been proposed depending on the mechanisms, manifestations and severity of speech underdevelopment. Currently, speech therapy uses the classification of alalia according to V.A. Kovshikov, according to which they distinguish:

• expressive

  (motor) alalia

• impressive

  (sensory) alalia

• mixed

  (sensorimotor or motosensory alalia with a predominance of impaired development of impressive or expressive speech)

The occurrence of the motor form of alalia is based on early organic damage to the cortical part of the speech motor analyzer. In this case, the child does not develop his own speech, but his understanding of someone else’s speech remains intact. Depending on the damaged area, afferent motor and efferent motor alalia are distinguished. With afferent motor alalia, damage to the postcentral gyrus (lower parietal parts of the left hemisphere) occurs, which is accompanied by kinesthetic articulatory apraxia. Efferent motor alalia occurs with damage to the premotor cortex (Broca's center, the posterior third of the inferior frontal gyrus) and is expressed in kinetic articulatory apraxia.

Sensory alalia occurs when the cortical part of the speech-hearing analyzer (Wernicke's center, the posterior third of the superior temporal gyrus) is damaged. In this case, the higher cortical analysis and synthesis of speech sounds is disrupted and, despite intact physical hearing, the child does not understand the speech of others.

Symptoms of motor alalia

With motor alalia, characteristic non-speech (neurological, psychological) and speech manifestations occur.

Neurological symptoms in motor alalia are represented primarily by movement disorders: awkwardness, lack of coordination of movements, poor development of motor skills of the fingers. Children have difficulty mastering self-care skills (buttoning buttons, tying shoes, etc.) and performing fine motor operations (folding mosaics, puzzles, etc.).

Considering the psychological characteristics of children with motor alalia, one cannot help but note impairments in memory (especially auditory-verbal), attention, perception, and emotional-volitional sphere. Based on their behavioral characteristics, children with motor alalia can be hyperactive, disinhibited, or sedentary and inhibited. Most children with motor alalia have reduced performance, high fatigue, and speech negativism. Intellectual development in alalik children suffers secondarily due to speech insufficiency. As speech develops, intellectual impairments are gradually compensated.

With motor alalia, there is a pronounced dissociation between the state of impressive and expressive speech, i.e., speech understanding remains relatively intact, but the child’s own speech develops with gross deviations or does not develop at all. All stages of the development of speech skills (humbling, babbling, babbling monologue, words, phrases, contextual speech) occur with a delay, and the speech reactions themselves are significantly reduced.

Despite the fact that a child with afferent motor alalia is potentially able to perform any articulatory movements (unlike dysarthria), sound pronunciation is grossly impaired. In this case, persistent substitutions and confusions of articulatory disputable phonemes arise, which leads to the impossibility of reproducing or repeating the sound image of a word.

With efferent motor alalia, the leading speech defect is the inability to perform a series of successive articulatory movements, which is accompanied by a gross distortion of the syllabic structure of the word. The lack of formation of a dynamic speech stereotype can lead to the appearance of stuttering against the background of motor alalia.

Vocabulary in motor alalia significantly lags behind the age norm. New words are difficult to learn; the active vocabulary contains mainly everyday terms. A small vocabulary causes an inaccurate understanding of the meanings of words, their inappropriate use in speech, and substitutions based on semantic and sound similarity. A characteristic feature of motor alalia is the absolute predominance of nouns in the nominative case in the vocabulary, a sharp limitation of other parts of speech, difficulties in the formation and differentiation of grammatical forms.

Phrasal speech with motor alalia is represented by simple short sentences (one- or two-part). As a consequence, with alalia there is a gross violation of the formation of coherent speech. Children cannot consistently present events, highlight the main and secondary, determine temporary connections, cause and effect, or convey the meaning of phenomena and events.

In severe forms of motor alalia, the child has only onomatopoeia and individual babbling words, which are accompanied by active facial expressions and gestures.

Symptoms of sensory alalia

With sensory alalia, the leading defect is a violation of the perception and understanding of the meaning of spoken speech. At the same time, the physical hearing of sensory alaliks is preserved, and they often suffer from hyperacusis - increased susceptibility to various sounds.

Against the background of auditory agnosia, own speech activity in children with sensory alalia is increased. However, their speech is a set of meaningless sound combinations and fragments of words, echolalia (unconscious repetition of other people's words). In general, with sensory alalia, speech is incoherent, meaningless and incomprehensible to others (logorrhea - “word salad”). In the speech of children with sensory alalia there are numerous perseverations (obsessive repetitions of sounds, syllables), syllable elision (omissions), paraphasia (sound substitutions), contamination (combining parts of different words with each other). Children with sensory alalia are not critical of their own speech; Facial expressions and gestures are widely used for communication.

In severe forms of sensory alalia, there is no understanding of speech at all; in other cases it is situational in nature. However, even if the child has access to the meaning of a phrase in a certain context, when the word form, word order in a sentence, or rate of speech change, understanding is lost. Often, children with sensory alalia are helped to understand speech by “reading the lips” of the speaker.

Insufficiency of phonemic hearing in sensory alalia leads to inability to distinguish paronymous words; unformed correlation of the audible and spoken word with a particular object or phenomenon.

Gross distortion of speech development with sensory alalia leads to secondary disorders of personality, behavior, and delayed intellectual development. The psychological characteristics of children with sensory alalia are characterized by difficulty turning on and maintaining attention, increased distractibility and exhaustion, instability of auditory perception and memory. Children with sensory alalia may experience impulsiveness, chaotic behavior or, on the contrary, inertia and isolation.

In its pure form, sensory alalia is rarely observed; Mixed sensorimotor alalia is usually found, which indicates the functional continuity of the speech-auditory and speech-motor analyzers.

Examination of children with alalia

Children with alalia need consultation with a pediatric neurologist, pediatric otolaryngologist, speech therapist, and child psychologist.

Neurological examination of children with alalia is necessary to identify and assess the nature and extent of brain damage. For this purpose, the child may be recommended EEG, echoencephalography, skull radiography, and MRI of the brain. To exclude hearing loss with sensory alalia, it is necessary to conduct otoscopy, audiometry and other studies of auditory function.

A neuropsychological examination of a child with alalia includes diagnostics of auditory-verbal memory. Speech therapy examination for alalia begins with clarifying the perinatal history and characteristics of the early development of the child. Particular attention is paid to the timing of psychomotor and speech development. Diagnostics of oral speech (impressive speech, lexico-grammatical structure, phonetic-phonemic processes, articulatory motor skills, etc.) is carried out according to the examination scheme for OHP.

Differential diagnosis of alalia is carried out with mental retardation, dysarthria, hearing loss, autism, mental retardation.

Alalia correction

The method of corrective action for any form of alalia should be of a comprehensive psychological, medical and pedagogical nature. Children with alalia receive the necessary help in specialized preschool educational institutions, hospitals, correctional centers, and sanatoriums.

Work on speech is carried out against the background of drug therapy aimed at stimulating the maturation of brain structures; physiotherapy (laser therapy, magnetic therapy, electrophoresis, DMV, hydrotherapy, IRT, electropuncture; transcranial electrical stimulation, etc.). With alalia, it is important to work on the development of general and manual motor skills, mental functions (memory, attention, ideas, thinking).

Given the systemic nature of the disorder, speech therapy classes to correct alalia involve working on all aspects of speech. With motor alalia, the child’s speech activity is stimulated; work is underway on the formation of active and passive vocabulary, phrasal speech, and grammatical formatting of statements; development of coherent speech and sound pronunciation. Logorhythmics and speech therapy massage are included in the outline of speech therapy classes.

With sensory alalia, the tasks are to master the distinction between non-speech and speech sounds, the differentiation of words, their correlation with specific objects and actions, the understanding of phrases and speech instructions, and the grammatical structure of speech. As the vocabulary accumulates, subtle acoustic differentiations and phonemic perception are formed, the development of the child’s own speech becomes possible.

Clinical picture and behavioral characteristics of children

With motor alalia, a child may have a large passive vocabulary, but finds it difficult to name even well-known words. Children cannot repeat even simple words after an adult, despite having a developed articulatory apparatus. In words they rearrange and replace syllables, omit sounds. These substitutions are not permanent; in some circumstances, children replace syllables, in others, they replace sounds in the same word.

It is especially difficult for them to pronounce words expressing abstract concepts and generalization words. Children with alalia are aware of their shortcomings. A child with high intelligence is more critical of his speech; when communicating with others, he replaces words with facial expressions and gestures. When parents have excessive demands on pronunciation, when the speech therapist tries to “introduce” sounds, despite the fact that those around him do not understand him, he shows negativism.

The scarcity of phrasal speech is very noticeable - children speak in simple sentences or sentences consisting of only subjects. If you don’t work with your baby, he won’t be able to master the grammatical structure of speech. Children make mistakes in agreeing nouns with prepositions and use case endings incorrectly.

With age, more and more automation of speech is required, and afferent motor alalia in children only increases the child’s problems. Children suffering from this pathology are diagnosed with disorders of attention, memory, thinking, analysis and synthesis of words and phenomena, emotions, will, and behavior.

The symptoms of alalia exclude balanced behavior - it is not often found in children with this speech disorder; usually they are either inhibited or too excited. Most children have impaired fine and gross motor skills, are clumsy, and their movements are disinhibited or slow.

A child with alalia has little desire to understand the surrounding reality; he is inattentive and often distracted. Visual and auditory memory in such children is reduced; such children do not strive for intellectual activity. In the process of completing tasks, they do not strictly follow instructions and therefore often make mistakes.

Alalia

Alalia is one of the most serious speech disorders in children, which is caused by damage to the central nervous system (CNS).

There are motor and sensory alalia, although recently it has been customary to use a single conclusion: sensorimotor alalia, but highlight the predominant component - motor or sensory.

As a rule, the cause of alalia is damage to the central nervous system during the perinatal period or at the time of birth. Less common, but also possible, is the development of the disorder within a period of up to 2 years, most likely due to severe illnesses, high temperature (more than 40 degrees), mechanical injuries (falls, blows), reactions to vaccinations.

A distinction must be made between autism spectrum disorder, alalia and mutism. These are those disorders that are quite similar in their manifestations and only a comprehensive diagnosis will help to identify the root cause and correctly build a correction.

Sensory alalia

Sensory alalia manifests itself as a severe and persistent speech disorder, and sometimes its complete absence. To explain it in simple language, a child with sensory alalia does not differentiate or distinguish sounds. It can be compared that speech sounds to him like a set of incomprehensible foreign words. Often a child with alalia hears a set of sounds, but does not understand where one word ends and another begins. This is due to the fact that the area of ​​the brain responsible for analyzing and perceiving information by ear is either not formed or has focal lesions.

Sensory alalia can be confused with hearing loss, so parents should definitely get an audiogram to rule out hearing loss.

Unfortunately, children with sensory alalia face a huge number of difficulties in everyday life: it is difficult for them to communicate with peers, they do not understand what they are told, and it is difficult for them to understand instructions. It can be compared that such children seem to feel like foreigners in a foreign country. Despite the fact that they, as a rule, actively strive to communicate through facial expressions and gestures, such a disease requires a lot of attention and effort on the part of parents. You should contact a speech neurologist, receive drug therapy, and, while undergoing treatment, begin individual correctional work: a speech therapist-defectologist, a neuropsychologist are required. In addition, computer programs are also used: the biofeedback complex and the Timokko neurodynamic complex.

In the case of an independent course of the disorder - without drug therapy and neurological therapy correction - a secondary disorder of the child’s personality may occur:

• erratic behavior similar to autistic traits
• isolation;
• impulsiveness;
• severe fatigue;
• inability to maintain attention

What symptoms are characterized by sensory alalia in children?

• The problem of perception and understanding of speech addressed to a child. All the same gestures help out, as well as “lip reading,” which children often learn intuitively.
• Active and rich, but meaningless speech - a set of sounds that do not fit the context of distorted words, etc.
• Echolalia – i.e., uncontrolled repetition of words spoken by other people.
• Obsessive repetition of certain words, syllables, or even just sounds.
• Rough “alterations” of words that are almost impossible to understand.
• If a child is able to understand speech, then most often this is only possible if he follows his usual intonation and word order, otherwise he gets lost and ceases to understand even familiar phrases.
• Poor vocabulary, both active and passive.
• If sensory alalia is diagnosed by a neurologist, it is especially important to consult a speech therapist as early as possible, in the second or third year of life. At 5 years old it may be too late.

Motor alalia

Motor alalia is a speech disorder characterized by underdevelopment or absence of speech with intact intelligence.

Motor alalia differs from sensory alalia in the localization of the focus in the central nervous system. In the case of motor alalia, the child's brain area responsible for speech production is affected. As the child grows older, he begins to critically perceive his speech problems and, in an attempt to avoid difficulties, learns to use gestures and facial expressions widely and colorfully.

Working with children with motor alalia, as a rule, proceeds faster and more productively than with sensory alalia.

As a rule, children with motor alalia have an extremely difficult time understanding concepts that do not have a clear visual image. For example, “green apple” is an accessible image. But a “spiritual hug” may well force a child to pause, get confused during a conversation, or even stop talking. Phrasal speech and grammatically correct sentence construction remain in their infancy without special work. The phrases are simple, “chopped”: “I’m here”, “Give me”, “This is bad.”

It is just as difficult for a child with motor alalia to learn their native language as it is for an adult to learn Chinese or Japanese characters. Another striking feature of the formation of coherent speech during alalia is repeated repetition. If a child normally remembers most words literally from the second or fourth repetition (and funny words generally from the first time), then a child with alalia may need dozens or even hundreds of repetitions for the same words. The child understands the general course of his own or someone else’s thoughts, can even speak consistently, but has difficulty identifying the main thing. All this makes it difficult to form coherent speech.

Work with alalia should be built comprehensively. At the Children's Speech Academy, we approach each child individually and use combinations of various methods, techniques and work with correctional equipment that will be effective for a particular child.

We create an individual program using the following types of assistance:

• Drug treatment prescribed by a speech-language neurologist
• Corrective work with a speech therapist-defectologist or speech therapist-psychologist, depending on the child’s characteristics
• Neuropsychological correction – classes aimed at developing interhemispheric interaction.
• Cerebellar stimulation is especially indicated in the case of a predominant motor component of alalia.
• Biofeedback complex Biofeedback is necessary for the development of the frontal lobes of the brain, which are responsible for control and self-regulation.
• Speech therapy simulator Delfa-M - for practicing correct sound pronunciation for sensory alalia, as it allows the child to hear himself through the speakers.
• Neurocorrection complex Timocco is a game version of classic neurocorrection for children with difficulty concentrating.

In a number of cases, we consider it right to stimulate the child using the intensive “Starting Speech” methodology, and then continue to work with the necessary specialists as usual.

Sensory alalia

With sensory alalia, the perception of other people's speech is impaired due to damage to the speech-hearing analyzer. Sensory alalia is very rare, perhaps due to imperfect diagnostics.

Features of the pathology:

• Many children with this pathology do not even respond to their own name and do not understand speech addressed to them.
• Children may understand individual words but lose the meaning of statements with the same words.
• In other cases, they understand the instructions for completing the task, but outside of this situation they cannot understand the task.
• Sometimes he incoherently repeats words he knows - logorrhea develops.

Information reaches children's brains in fragments, because they perceive it very poorly by ear. This results in incomprehensible, distorted speech, although the speech activity of such children is quite high.

Realizing their defect, many children become shy, although they do not lose the desire to communicate. Other alaliks are excitable and irritable, and may exhibit negativism and affective outbursts.

In some cases, a complex disorder is diagnosed - sensorimotor alalia.

CLASSIFICATIONS OF ALALIA V.A. KOVSHIKOVA, B. F. SOBOTOVICH

CLASSIFICATIONS OF ALALIA V.A. KOVSHIKOVA, B. F. SOBOTOVICH.

Psycholinguistic classification by E.F. Sobotovich:

Kovshikov.

Selection criterion: Analyzes the disorder taking into account the psycholinguistic structure and mechanisms of speech activity.

Distinguished forms: 1) Alalia, with predominant violations of the paradigmatic assimilation;

2) Alalia, with predominant disturbances in the acquisition of syntagmatic systems of language.

Brief description of the forms of alalia (main symptoms): 1) Alalia, with predominant violations of the paradigmatic assimilation. The system of relations (primarily oppositions) into which homogeneous elements of language, units of the same order, of the same level enter, is disrupted, that is, the internal structure of the language system is disrupted.

2) Alalia, with predominant disturbances in the acquisition of syntagmatic systems of language. The syntagmatic system, which reflects the patterns of compatibility of language signs when constructing speech utterances, is disrupted. Children with this form do not learn or have difficulty mastering the system of rules, norms for the compatibility of language elements (both homogeneous and heterogeneous), on the basis of which the formation and formulation of speech utterances is carried out in accordance with the norms of their native language.

Sobotovich.

Isolation criterion: According to the pathogenetic principle, revealing the mechanism of the disorder.

Distinguished forms: 1) Impressive (sensory) alalia; 2) Expressive (motor) alalia.

Brief description of the forms of alalia (main symptoms): 1) Impressive (sensory) alalia .

If the child has normal hearing, he does not understand speech addressed to him, which means he does not speak.
Symptoms: impaired phonemic hearing, poor attention and memory for oral speech (does not develop due to lack of understanding of verbal speech). The result is vagueness and instability of phonemic patterns. Sensory alaliks have hearing impairment to one degree or another, which makes it difficult to perceive spoken speech. 2) Expressive (motor) alalia is a language disorder characterized by a violation of the acquisition of linguistic units and the rules of their functioning, which is manifested in the impossibility of grammatical, lexical and phonemic operations with the relative preservation of semantic and articulatory operations. The child begins to understand someone else’s speech in a timely manner, but does not speak himself. There is often a misunderstanding of difficult words and phrases, complex sentences. The enrichment of expressive speech is limited, because they talk to him little, believing that speech is inaccessible to him. Motor speech imitation is especially severely impaired (they cannot repeat words that they have already learned to speak).

Diagnostic and treatment methods

Children with any form of alalia need the help of a speech therapist, neurologist and psychologist. Neurological diagnostics helps to identify the extent of brain damage using an electroencephalogram and MRI. To exclude hearing loss, otoscopy and audiometry are performed, and in order to differentiate the symptoms of alalia from similar symptomatic pathologies, such as delayed speech development, dysarthria, autism, speech therapists and psychologists are involved in the work of the neurologist.

Sensorimotor alalia requires speech therapy examination. The speech therapist determines the following parameters:

• level of speech understanding;
• determining the number of words in the dictionary, including all speech manifestations;
• identifying opportunities for speech imitation;
• identifying the possibility of using prepositions;
• identifying the state of the organs of articulation and sound pronunciation;
• determining the maximum volume of sentences used;
• research into the possibility of changing words by numbers.

Alalik children with minimal damage to speech development are assessed for the ability to retell a simple fairy tale and answer questions about its content, and the ability to compose a story based on a series of pictures. Diagnosis is carried out in the presence of parents, using a large amount of stimulus material (toys, pictures). The speech therapist strives to establish close contact with the child.

Correction of the defect is carried out in a complex manner. Treatment of alalia in children requires the use of medications that stimulate the maturation of brain structures:

• vitamins B5 and B12;
• Cogitum;
• Gammalon.

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To eliminate sensory and motor alalia, physiotherapy and microcurrent reflexology are prescribed. Drug treatment of motor alalia will be more effective if it is accompanied by corrective classes with a speech therapist, speech pathologist, or psychologist. Specialists work on the development of speech and other higher mental functions: attention, memory, thinking.

In modern speech therapy, Alalia is divided into 2 main forms - Expressive (motor) Alalia and Impressive (sensory) Alalia. There is also a combination of them - sensorimotor alalia. All this is a classification of alalia.

Expressive (motor) alalia is a systemic underdevelopment of expressive speech of a central organic nature, caused by the immaturity of linguistic operations in the process of generating a speech utterance with the relative preservation of semantic and sensorimotor operations.

Impressive (sensory) alalia is a speech disorder of central origin, manifested in the child’s inability to understand spoken speech due to insufficient functioning of the speech-hearing analyzer.

All 3 forms of alalia are corrected (often to the speech norm). Recently, the humanities (studies of humans) sciences - neurophysiology, neurochemistry, neuropsychology, psycholinguistics - have received rapid development. It is the psycholinguistic approach, on the basis of which correctional techniques are created, that allows solving the problems of alalia.

Differences between sensory and motor alalia. Alalia forms.

Many parents ask speech therapists the question: “Which alalia is worse - sensory or motor?” Without treatment, the prognosis for the development of a child’s personality with SA is worse than with MA. In correctional work, the differences are as follows: with Sensory alalia, the first stages of speech therapy work on the transition from OHP 1 to OHP 2 take 2-3 times longer. But at the same time, in children with Motor alalia, subsequent correctional work takes 2-3 times longer. Read more about the differences between motor and sensory alalia

Sensorimotor alalia.

SMA is the most severe form of alalia, in which both aspects of oral speech are impaired: understanding and speaking, all the symptoms of both sensory and motor alalia are present. It is children with SMA who are most often confused with autism. Treatment of sensorimotor alalia should begin with the sensory component, because ontogenetically the child initially develops an understanding of human speech, only after which “reproduction” becomes possible. Then, having already developed an understanding (it takes me up to six months of work), I begin parallel work with the sensory and motor components. The duration of correction of SMA consists of the duration of treatment of sensory and motor alalia and takes 2 times longer.

According to my observations during speech therapy sessions:

· in non-speaking children 2-2.5 years old with sensory alalia, there are no motor (expressive) disorders (of the two dozen children with AS I studied with, there were no symptoms of motor alalia). Therefore, if a child at this age is diagnosed with SMA, in the process of correctional work the diagnosis can be refined to simple sensory alalia.

· Non-speaking children 5-6 years old were all diagnosed with Sensorimotor alalia, i.e. There were manifestations of both alalia. I have never encountered pure sensory alalia at this age. Of course, 3 dozen sensorimotor alalikov of this age is not enough compared to research at universities to claim that there is no primary SMA.

· While working on the correction of alalia in children from 2.5 to 5 years old, I noticed that the later they started, the more motor problems are identified, and the longer the speech therapy work takes. Based on the results of observations, it can be assumed that many children with SMA have a disorder of expressive (motor) speech secondary, i.e. an early start of speech therapy work will shorten its duration for this reason as well.

Massage technique

When treating alalia, speech therapy massage is very effective, stimulating speech zones. A full massage cannot be performed without qualifications and the use of special probes. Under the guidance of a specialist, parents can learn the simplest techniques of massaging the face, hands, lips, tongue and carry them out at home on their own. To do this, you can use teaspoons with smooth edges and your mother’s clean, warm hands. Elements of the massage are performed 5 times, all exercises begin and end with stroking.

Sequence of massage movements:

• stroking the forehead from the center to the temples, temples clockwise using the convex side of a spoon or hands;
• the eye sockets are ironed in the same way;
• cheeks are stroked in a circle;
• then the space between the eyebrows is massaged;
• The nose is rubbed, the lip and tongue are massaged.

Hand and face massage is carried out in a warm room. The massage therapist's hands are pre-treated with an antiseptic.

By massaging a child's hands, he develops fine motor skills associated with brain function and speech. It can be performed not only with your hands, but also with rubber balls, prickly curlers, Su Jok. Hand warm-up begins with the little finger, first from its outer side. Then it is recommended to move up along the finger, gently pressing on the pads, then rubbing them. After warming up the palm, its inner side is massaged.

Corrective work of a speech therapist

The speech therapist carries out step-by-step work on the formation of oral speech. Each new stage of work is built on the basis of the achievements of the previous stage.

Sequence of training:

1. Stimulating imitative activity, expanding the volume of understood speech, forming a one-word sentence from amorphous root words.
2. The appearance of the first forms of words, teaching children the ability to construct two-word sentences, expanding the scope of understanding the speech of others.
3. Learning to construct a grammatically correct sentence of 2-3 words, reproducing 3-syllable words.
4. Constructing sentences of 3–5 words, developing the simplest skills of coherent speech, developing correct sound pronunciation.
5. Expanding the volume of sentences, teaching inflection, and the ability to construct complex sentences.

If there are no complex lesions of the cerebral cortex, at the end of the correctional work, children master grammatically correct spoken language. With any form of alalia, early literacy training is necessary, since reading and writing help consolidate the learned material and control oral speech.

Silence mode when correcting sensory alalia

The speech therapist recommends to parents how to properly organize the baby’s speech and sound modes. Temporarily, adults are asked to talk to the child as little as possible, organizing a quiet hour or a hearing rest day. During this time, it is necessary to eliminate unnecessary sounds in the children's room: a playing TV, a computer, a tablet; sometimes it is recommended to remove sounding visual stimuli (toys, books). This sound mode helps to increase children's sensitivity to sounds.

The next stage is the awakening of interest in the sounds surrounding the child, the emergence of interest in imitation and perception of one’s own speech.

In the first lessons, the speech therapist develops attention, helping the child to focus on sound stimuli, teaching him to distinguish between two or three sounding objects, for example, a pipe, a tambourine and spoons. Then he is given the opportunity to play various games that will help him develop correct, smooth, diaphragmatic breathing.

At the next stage of correction, the speech therapist’s main task is to draw the child’s attention to laughter, crying and other reactions of people around him, to develop perseverance and the ability to copy the emotional reactions of others. If he is tired, the lesson stops. For the work of a speech therapist to be successful, correction is carried out from 2.5-3 years. The specialist must systematically influence each component of speech.

Prognosis and prevention

With properly organized and carefully carried out work to correct motor alalia, it is possible to almost completely compensate for this defect by the beginning of schooling and overcome the danger of further speech and intellectual underdevelopment. But such children have a high risk of developing dysgraphia and dyslexia during their schooling. Children with complex damage to brain structures or for whom correctional work began late will not be able to overcome this pathology of speech development. Therefore, in the future they are sent to special schools to continue correctional work.

To prevent the appearance of such a complex pathology, it is necessary to carefully screen the health status of pregnant women, rationally manage childbirth, and protect children from contracting neuroinfections and injuries.

That's all. Now you know how the forms of alalia differ and how to treat it, and whether this disorder can be cured without the services of specialists.

Symptoms

A common symptom for all types of alalia is the lack of relationship between the vocabulary and effective-semantic spheres, poverty of vocabulary and tongue-tiedness. The formation of speech skills occurs with a delay; there is long-term preservation of speech patterns from previous stages (babble, monosyllabic statements, etc.).

Further detailed symptoms are based on the localization of damaged areas or influencing factors, and differ depending on the type of disorder.

Motor alalia is characterized by:

• complete absence of speech, when words are replaced by gestures and facial expressions or the earliest sound forms are used (babble, unrelated sounds, etc.);
• incorrect sound pronunciation;
• poor active vocabulary;
• ungrammatical;
• mixing sounds, syllables, replacing complex sounds;
• the conversation is built from simple sentences with a small number of words;
• poor development of both fine and gross motor skills;
• problems with coordination;
• decreased memory and absent-mindedness;
• difficulties in self-care (tying shoelaces, brushing teeth, etc.).

Symptoms of sensory alalia:

• misunderstanding of spoken speech;
• understanding the meaning of spoken speech exclusively in one context and loss of understanding when it changes;
• increased own speech activity with low meaningfulness (pronouncing sounds, individual syllables);
• frequent use of facial expressions and sounds to convey information;
• repetition of sounds and syllables;
• sound substitutions or omissions of syllables;
• increased fatigue and distractibility.

Problems in the emotional-volitional sphere with any type of alalia can manifest themselves as hyperactivity, impulsiveness or, conversely, excessive isolation and inactivity. Secondary personality changes caused by language impairment may resemble autism spectrum disorders. This may include:

• behavioral problems;
• motor disinhibition;
• impairment of communication function and ability to build relationships;
• selectivity in food;
• instability of attention and cognitive activity;
• emotional instability.

Correct diagnosis is important, since so-called combined disorders often occur. That is, the child has both speech impairment and autism spectrum disorder (ASD) due to underdevelopment of the subcortical parts of the brain.

ASD is not synonymous with autism. Autism spectrum disorders are acquired characteristics of organic origin. Their presence leads to the emergence of mixed diagnoses, in which a certain type of alalia with autistic-like features is given (or “pervasive disorder unspecified” and other formulations). In its pure form, “true autism” (Kanner syndrome, Asperger syndrome, Rett syndrome) is rare, is congenital and has a stable percentage of occurrence in populations. It is important to understand that the “autism epidemic” is precisely related to the prevalence of autism spectrum disorders, which are caused by disturbances in the functioning of the subcortical structures of the brain.

In addition to the autism spectrum, which characterizes the behavior and emotional component, in addition to alalia, one can highlight the likelihood of delayed cognitive development. Reduced cognitive functions are compensated through defectological and neurocorrection. This is due to the fact that intellectual decline is often secondary to delayed cognitive abilities and mental development. After three years, the child’s thinking and intelligence develop to a greater extent in verbal, speech form. And if by the age of 3 there is no speech, then thinking is inhibited in its development, maintaining infantile forms. Therefore, it is extremely important to carry out timely diagnosis and correction if alalia is suspected.