Specific speech articulation disorder in children treatment. Specific speech articulation disorder

Specific developmental disorder in which the child's use of speech sounds is below the level appropriate for his mental age, but in which there is a normal level of speech skills.

Diagnostic instructions:

Child acquisition age speech sounds and the order in which they develop is subject to significant individual fluctuations.

Normal development. At the age of 4 years, mistakes in pronunciation of speech sounds are common, but the child can easily be understood by strangers. Most speech sounds are acquired by the age of 6-7 years. Although difficulties in certain sound combinations may remain, they do not lead to communication problems. By the age of 11-12, almost all speech sounds should be acquired.

Pathological development. Occurs when a child's acquisition of speech sounds is delayed and / or rejected, leading to: dysarticulation with corresponding difficulties for others in understanding his speech; gaps, distortions or replacements of speech sounds; a change in the pronunciation of sounds depending on their combination, (that is, in some words the child can pronounce phonemes correctly, but in others not).

Diagnosis can only be made when the severity of the articulation disorder is outside the normal range for the child's mental age; non-verbal intellectual level within normal limits; skills of expressive and receptive speech within the normal range; articulation pathology cannot be explained by a sensory, anatomical, or neurotic abnormality; not correct pronunciation is undoubtedly anomalous, based on the characteristics of the use of speech in the subcultural conditions in which the child is.

Includes:

Developmental physiological disorder;

Developmental articulation disorder;

Functional articulation disorder;

Babbling (children's form of speech);

Dislalia (tongue-tied);

Disorder of phonological development.

Excluded:

Aphasia NOS (R47.0);

Dysarthria (R47.1);

Apraxia (R48.2);

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

Articulation disorders associated with developmental disorder of receptive speech (F80.2);

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

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

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

Other related news:

(Grammatically about a vowel): mutual, i.e. one that can be both long and short

F81.9 Developmental disorder of scholastic skills, unspecified

F81.9 Developmental disorder of schooling skills, unspecified

F82 Specific developmental disorder of motor function

Reciprocal pattern of interaction, in which an event can simultaneously be a consequence of a previous and a cause of a subsequent event.

Mental disorders are mainly accompanied by obsession, asthenic syndrome, depression, manic states, senestopathies, hypochondriac syndrome, hallucinations, delusional disorders, catatonic syndromes, dementia and confusional syndromes. The clinical picture and symptoms usually depend on the factors that provoked the mental disorder, as well as on the forms, stages and types of mental disorders. Children with similar pathologies, as a rule, are characterized by emotional instability. They are characterized by increased fatigue, mood swings, a sense of fear, demeanor, uncertainty, fussiness, familiarity, undifferentiated use of words, small vocabulary, difficulty in voluntary operation with words, increased vegetative and general excitability, sleep disturbances, gastrointestinal disorders. Disorders of mental development in children, mainly manifested in the form of distortions (autism), psychopathy, lack of self-determination, damage personal development, problems with cognition and impossibility mental development... These disorders are most often associated with dysfunction of the brain, and, as a rule, begin to manifest themselves in early childhood. Also, CPD in children can be accompanied by impatience, impaired attention, lack of concentration, hyperactive behavior (many movements of the arms and legs, rotation in place), quiet speech, reduced memory capacity, low speed of memorization, low productivity, etc.

Articulation disorders can occur due to hypofunction (weakness, decreased range of motion, slowness of movement), hyperfunction (increased muscle tone) or impaired coordination of movements of anatomical elements that provide articulation. Articulation disorders can be generalized or more specific.
- Generalized articulation disorders are articulation disorders that distort the sound of all or most of the phonemes and are observed as with lesions of the central nervous system and systemic diseases.
- Specific articulation disorders are disorders that distort the sound of certain groups of phonemes and are associated with local structural pathological processes or damage to one or more nerves.
- Articulation errors

Error options that occur during articulation include omissions, distortions, phoneme substitutions, and additional phonemes.
Articulation changes may be secondary due to neurological disorders, but may also be secondary due to structural damage to the articulation apparatus.

Common mistakes in articulation in children, it is usually considered a developmental abnormality and is not classified as a variant of dysarthria. True dysarthria can be observed in childhood(cerebral palsy, the consequences of brain injury) and in adults due to impaired control of the muscles that provide speech processes.

Violations of prosody arise due to the discoordination of the respiratory, voice-forming and articulatory components of speech and are manifested by changes in the rhythm and tempo of speech, stress and speech intonations.
- Violations of the rhythm and tempo of speech production include acceleration or deceleration, inconstancy of articulation, the presence of temporary pauses, as well as various ratios of these violations.

Violation of stress is observed in words, as well as phrases or sentences, which can lead to a change in the meaning of what is pronounced.
- Intonation errors can change the meaning of sentences (eg, are you going home. Are you going home?).
- Prosody disorders are usually associated with atactic dysarthria, hypokinetic dysarthria, and right hemispheric aprosodic dysarthria. Persons with disorders of the latter type may also note difficulty in understanding the prosodic characteristics of the speech of others.

Examination of the patient with speech disorders

Taking anamnesis:
1. The appearance of violations. When did the patient or his family first notice the changes in speech? Were there in the process age development any articulation problems?
2. The pace of development. Are your speech changes sudden or gradual? Have they been reversed, stable, or have progressed since their inception? Were there any fluctuations in the severity of violations? Were there periods of normal speech along with periods of altered speech?

3. The presence of concomitant neurological symptoms, especially those associated with damage to the upper or lower motor neurons, cranial or cervical nerves.
4. Previous neurological diagnoses and previous treatment.
5. Medical history and taking unprescribed medications.

Objective examination:

1. There are three stages of physical examination.
Stage 1. Study of samples of spontaneous speech and speech in the process of special testing.
Stage 2. Interpretation of speech samples with an assessment of the state of each element speech system, determination of the norm and pathology, as well as the nature of the existing deviations. It is recommended to study the oral cavity, oropharynx and nasopharynx, chest mobility.
Stage 3. Determination of the nature of the identified disorders, their correlation with known patterns and clinical variants of dysarthria.

2. Study of individual elements of the speech system.
- Breathing. Evaluation of the degree of fatigue when counting to 20 during one exhalation. The pitch of the voice, the volume of the speech, the length of the phrases, the clarity or explosiveness of speech should be assessed with careful listening.
- Phonation. The patient should pronounce the long vowel sound "a" as cleanly and for as long as possible. Other phonemes (such as "and") require more tension vocal cords, while the researcher should evaluate the quality of their sound, duration, pitch, sound stability and loudness. To assess the true effectiveness of the vocal cords, it is necessary to compare the retention time of the phonemes "s" and "s". With the normal functioning of the vocal cords, it is possible to keep the sound of these two consonants for the same time. If the "z" sound is noticeably shorter, there is a true decrease in vocal cord efficiency. Ask the patient to cough briefly to clarify abnormalities. In the presence of deviations, it is recommended to consult an otorhinolaryngologist or a laryngoscopic examination.
- Resonance is assessed by the patient's pronunciation of different types of phonemes. The state of the soft palate is studied when pronouncing the sound "a", which the patient must pull as long as possible, while it is necessary to note the degree of fatigue. Another technique consists in pronouncing a long "and", while the researcher covers and opens the nasal passages. At normal resonance, the sound should remain essentially unchanged.

Thanks to the ability to reproduce and understand speech, we can normally communicate with each other, exchange experiences and information, and build our lives. Therefore, any speech disorders negatively affect the quality of life. People who cannot fully express their thoughts find it difficult to build a career or improve their personal life. It is better to deal with the diagnosis and treatment of speech disorders in childhood, without waiting for such pathologies to become neglected and move into adulthood. So, the topic of our conversation today on www ..

What is articulation?

By the term articulation, speech therapists mean work speech apparatus, which ensures correct sound creation. Articulation results in a clear dismemberment of sounds that can be heard by the human ear.

Correct articulation ensures correct pronunciation of sounds. And an important role in this is played not by voice communications, but by the organs of pronunciation - active or passive. The former include the tongue and lips, and the latter include the teeth, the soft and hard palate, and the gums.

Causes of Articulation Disorders

Disorders of speech articulation in adults and children can be provoked by mechanical causes, which are represented by malocclusion, too short frenum of the tongue and other pathological conditions. If the patient does not have any problems in the structure of the speech apparatus, doctors talk about a functional disorder - about the discoordination of these organs.

In children, articulation disorders are usually explained by genetic predisposition, perinatal pathologies, and minimal organic lesions of the speech area of the cortex. Also, such problems can be triggered by an unfavorable social environment, incorrect pronunciation of sounds from close relatives, as well as bilingualism in the family. In some cases, articulation disorders appear with physical weakness against the background of frequent infectious and chronic ailments, and even with underdevelopment phonemic hearing.

Among other things, speech therapists claim that children cannot pronounce all sounds correctly until the age of five. This is a physiological disorder of articulation, which is a variant of the norm.

Correction of articulation disorders in children and adults

Articulation disorders require timely treatment. It is best to diagnose and eliminate them early in childhood. If you do not cope with such problems, they will remain for life.

In some cases, in order to successfully eliminate articulation disorders, you need to seek help from a dentist, for example, to correct a malocclusion or a short frenum. The problem of a short bridle can also be dealt with by systematically conducting a series of exercises.

If articulation disorders are caused by the discoordination of the speech organs, then this problem can be eliminated only with the help of regular sessions with a speech therapist or independent training.

Articulation exercises for children

Children should do articulation exercises in front of a mirror. You can do this starting from the age of three.

Exercises:

- "window" - the child must open his mouth wide (heat), then close it (cold);
- “we brush our teeth” the baby smiles, opening his mouth, brushing the lower and upper teeth alternately with the tip of his tongue;
- “knead the dough” the child smiles, then slaps his tongue between his teeth - “five-five-five”, then - bites the tip of the tongue with his teeth;
- "cup" - the baby smiles, opens his mouth wide, sticks out a wide tongue and forms a "cup" out of it (lifts the tip);
- "pipe" - the child must stretch forward tense lips, while closing his teeth;
- "fence" - the baby needs to smile, then expose closed teeth with tension;
- "painter" - the child smiles, opens his mouth and strokes (paints) the sky with the tip of his tongue;
- "mushrooms" - the baby needs to smile, then clap his tongue (as if riding a horse) and suck with his wide tongue to the sky;
- "kitty" - the baby smiles wider, opening his mouth. The tip of his tongue should rest against the lower teeth, while the tongue should be bent with a slide so that it rests with the tip against the lower teeth;
- "swing" - the child smiles, opens his mouth, the tip of his tongue goes first behind the upper teeth, then behind the lower teeth.

These are just a few of the articulation exercises that you can do with your child at home.

Exercises for adults

Exercises:

To develop a soft palate, yawn with your mouth closed;
- “paint” the upper arch inside the mouth with your tongue - from the soft palate to the base of the upper teeth;
- utter vowel sounds while yawning;
- imitate gargling;
- develop the lower jaw, moving it back and forth, as well as from side to side;
- lower your jaw downward with resistance;
- develop your cheeks, alternately drawing in or puffing them up;
- roll the "balloon" from cheek to cheek;
- pull in both cheeks so that a "fish mouth" is formed and move your lips;
- snort like a horse;
- Gently chew your lips;
- pull out your tongue with a sharp tip harder, then put it relaxed on your lower lip.

Violation of speech articulation in adults is also fixable as in children. Namely, the systematic performance of articulatory exercises will help get rid of articulatory disorders at different ages.

Most speech sounds are acquired by the age of 6-7 years; by the age of 11, all sounds should be acquired.

It includes three stages:

Dysarthria

Dysarthria is a disorder of the pronunciation organization of speech associated with a lesion of the central part of the speech-motor analyzer and a violation of the innervation of the muscles of the articulatory apparatus. The structure of the defect in dysarthria includes impaired speech motility, sound pronunciation, speech breathing, voice and prosodic side speech; with severe lesions, anarthria occurs. If dysarthria is suspected, neurological diagnostics (EEG, EMG, ENG, MRI of the brain, etc.), speech therapy examination, oral and written speech... Corrective work for dysarthria includes therapeutic effects (medication courses, exercise therapy, massage, FTL), speech therapy classes, articulatory gymnastics, speech therapy massage.

Dysarthria

Dysarthria is a severe speech disorder, accompanied by a disorder of articulation, phonation, speech breathing, tempo-rhythmic organization and intonation coloring of speech, as a result of which speech loses its articulation and intelligibility. Among children, the prevalence of dysarthria is 3-6%, but in last years there is a pronounced tendency towards the growth of this speech pathology. In speech therapy, dysarthria is one of the three most common forms of disorders oral speech, second only in frequency to dyslalia and ahead of alalia. Since the pathogenesis of dysarthria is based on organic lesions of the central and peripheral nervous system, this speech disorder is also being studied by specialists in the field of neurology and psychiatry.

Causes of dysarthria

Most often (in 65-85% of cases), dysarthria accompanies infantile cerebral palsy and has the same causes. In this case, organic damage to the central nervous system occurs in the intrauterine, birth or early period child development (usually up to 2 years old). The most frequent perinatal factors of dysarthria are toxicosis of pregnancy, fetal hypoxia, Rh-conflict, chronic somatic diseases mothers, pathological course of childbirth, birth trauma, birth asphyxia, kernicterus of newborns, prematurity, etc. The severity of dysarthria is closely related to the severity of movement disorders in cerebral palsy: for example, with double hemiplegia, dysarthria or anarthria is detected in almost all children.

In early childhood, damage to the central nervous system and dysarthria in a child can develop after neuroinfections (meningitis, encephalitis), purulent otitis media, hydrocephalus, traumatic brain injury, severe intoxication.

Classification of dysarthria

The neurological classification of dysarthria is based on the principle of localization and a syndromological approach. Taking into account the localization of the lesion of the speech motor apparatus, they are distinguished:

bulbar dysarthria associated with damage to the nuclei of the cranial nerves / glossopharyngeal, hypoglossal, vagus, sometimes - facial, trigeminal / in the medulla oblongata
pseudobulbar dysarthria associated with damage to the cortical-nuclear pathways
extrapyramidal (subcortical) dysarthria associated with damage to the subcortical nuclei of the brain
cerebellar dysarthria associated with damage to the cerebellum and its pathways
cortical dysarthria associated with focal lesions of the cerebral cortex.

Depending on the leading clinical syndrome in cerebral palsy, spastic-rigid, spastic-paretic, spastic-hyperkinetic, spastic-atactic, atactic-hyperkinetic dysarthria may occur.

Speech therapy classification is based on the principle of intelligibility of speech to others and includes 4 degrees of severity of dysarthria:

1 degree (erased dysarthria) - defects in sound pronunciation can only be detected by a speech therapist during a special examination.

2 degree - defects in sound pronunciation are noticeable to others, but in general the speech remains understandable.

Grade 3 - understanding the speech of a patient with dysarthria is available only to the close environment and partially to strangers.

4 degree - speech is absent or incomprehensible even to the closest people (anarthria).

Dysarthria symptoms

The speech of patients with dysarthria is slurred, indistinct, obscure ("porridge in the mouth"), which is due to insufficient innervation of the muscles of the lips, tongue, soft palate, vocal folds, larynx, respiratory muscles. Therefore, with dysarthria, a whole complex of speech and non-speech disorders develops, which constitute the essence of the defect.

Articulatory motor impairment in patients with dysarthria may manifest as spasticity, hypotension, or dystonia of the articulatory muscles. Muscle spasticity is accompanied by a constant increased tone and tension of the muscles of the lips, tongue, face, neck; tight closing of the lips, restriction of articulatory movements. With muscular hypotension, the tongue is flaccid, lies motionless at the bottom of the mouth; the lips do not close, the mouth is half-open, hypersalivation (salivation) is pronounced; due to paresis of the soft palate, a nasal tone of voice appears (nasalization). In the case of dysarthria occurring with muscular dystonia, when trying to speak, the muscle tone changes from low to increased.

Disturbances of sound pronunciation in dysarthria can be expressed to varying degrees, depending on the localization and severity of damage to the nervous system. With erased dysarthria, individual phonetic defects (distortions of sounds), "blurred" speech are observed. " With more pronounced degrees of dysarthria, there are distortions, omissions, replacements of sounds; speech becomes slow, expressionless, indistinct. The general speech activity is markedly reduced. In the most severe cases, with complete paralysis of the speech-motor muscles, the motor realization of speech becomes impossible.

Specific features of impaired sound pronunciation in dysarthria are the persistence of defects and the difficulty of overcoming them, as well as the need for more long period automation of sounds. With dysarthria, the articulation of almost all speech sounds, including vowels, is impaired. Dysarthria is characterized by interdental and lateral pronunciation of hissing and whistling sounds; voicing defects, palatalization (softening) of hard consonants.

Due to insufficient innervation of the speech muscles with dysarthria, speech breathing is disturbed: the exhalation is shortened, breathing at the time of speech becomes rapid and intermittent. Violation of the voice in dysarthria is characterized by its insufficient strength (the voice is quiet, weak, dry), a change in timbre (deafness, nasalization), melodic-intonational disorders (monotony, absence or lack of expression of vocal modulations).

In view of the inarticulateness of speech in children with dysarthria, auditory differentiation of sounds and phonemic analysis and synthesis suffer for the second time. Difficulty and insufficiency verbal communication can lead to an unformed vocabulary and grammatical structure of speech. Therefore, children with dysarthria may have phonetic-phonemic (FFN) or general speech underdevelopment (OHP) and associated corresponding types of dysgraphia.

Characteristics of clinical forms of dysarthria

Bulbar dysarthria is characterized by areflexia, amimia, disorder of sucking, swallowing of solid and liquid food, chewing, hypersalivation caused by atony of the muscles of the oral cavity. The articulation of sounds is indistinct and extremely simplified. The entire variety of consonants is reduced to a single slit sound; sounds are not differentiated among themselves. Nasalization of the timbre of the voice, dysphonia or aphonia is typical.

With pseudobulbar dysarthria, the nature of the disorders is determined by spastic paralysis and muscle hypertonia. The most clearly pseudobulbar paralysis is manifested in a violation of the movements of the tongue: great difficulties are caused by attempts to raise the tip of the tongue up, take it to the sides, and hold it in a certain position. With pseudobulbar dysarthria, it is difficult to switch from one articulatory posture to another. Typically selective violation of voluntary movements, synkinesis (friendly movements); profuse salivation, increased pharyngeal reflex, choking, dysphagia. The speech of patients with pseudobulbar dysarthria is blurry, indistinct, has a nasal tinge; the normative reproduction of sibilant and hissing sonors is grossly violated.

Subcortical dysarthria is characterized by the presence of hyperkinesis - involuntary violent muscle movements, including mimic and articulation. Hyperkinesis can occur at rest, but is usually worse when trying to speak, causing articulatory spasm. There is a violation of the timbre and strength of the voice, the prosodic side of speech; sometimes patients erupt involuntary guttural cries.

With subcortical dysarthria, the tempo of speech may be disturbed by the type of bradilalia, tachyllalia, or speech dysarrhythmia (organic stuttering). Subcortical dysarthria is often combined with pseudobulbar, bulbar and cerebellar forms.

A typical manifestation of cerebellar dysarthria is a violation of the coordination of the speech process, which results in a tremor of the tongue, jerky, chanted speech, and individual cries. Speech is slow and slurred; pronunciation of front-lingual and labial sounds is disturbed to the greatest extent. With cerebellar dysarthria, ataxia (unsteadiness of gait, imbalance, awkwardness of movements) is noted.

Cortical dysarthria in its speech manifestations resembles motor aphasia and is characterized by a violation of voluntary articulatory motor skills. Disorders of speech breathing, voice, prosodics with cortical dysarthria are absent. Taking into account the localization of the lesions, kinesthetic postcentral cortical dysarthria (afferent cortical dysarthria) and kinetic premotor cortical dysarthria (efferent cortical dysarthria) are distinguished. However, with cortical dysarthria, there is only articulatory apraxia, while with motor aphasia, not only articulation of sounds suffers, but also reading, writing, understanding speech, and the use of language.

Diagnosis of dysarthria

Examination and subsequent management of patients with dysarthria is carried out by a neurologist (pediatric neurologist) and a speech therapist. The extent of the neurologic examination depends on the anticipated clinical diagnosis. The most important diagnostic value is the data of electrophysiological studies (electroencephalography, electromyography, electroneurography), transcranial magnetic stimulation, MRI of the brain, etc.

Speech therapy examination for dysarthria includes an assessment of speech and non-speech disorders. Assessment of non-speech symptoms involves the study of the structure of the articulatory apparatus, the volume of articulatory movements, the state of the mimic and speech muscles, and the nature of breathing. The speech therapist pays special attention to the history of speech development. As part of the diagnosis of oral speech in dysarthria, a study of the pronunciation side of speech (sound pronunciation, tempo, rhythm, prosody, speech intelligibility) is carried out; synchronicity of articulation, breathing and voice production; phonemic perception, the level of development of the lexical and grammatical structure of speech. In the process of diagnosing written speech, tasks are given for copying text and writing under dictation, reading excerpts and comprehending what has been read.

Based on the results of the examination, it is necessary to distinguish between dysarthria and motor alalia, motor aphasia, dyslalia.

Correction of dysarthria

Speech therapy work to overcome dysarthria should be carried out systematically, against the background of drug therapy and rehabilitation (segmental reflex and acupressure, acupressure, exercise therapy, therapeutic baths, physiotherapy, mechanotherapy, acupuncture, hirudotherapy) prescribed by a neurologist. A good background for correctional and pedagogical classes is achieved by using unconventional forms rehabilitation treatment: dolphin therapy, sensory therapy, isotherapy, sand therapy, etc.

On the speech therapy classes for the correction of dysarthria, development is carried out fine motor skills (finger gymnastics), motility of the speech apparatus (speech therapy massage, articulatory gymnastics); physiological and speech breathing (breathing exercises), voices (orthophonic exercises); correction of the disturbed and consolidation of the correct sound pronunciation; work on the expressiveness of speech and the development of speech communication.

The order of setting and automating sounds is determined by the greatest availability of articulation patterns at the moment. The automation of sounds in dysarthria is sometimes switched to until the complete purity of their isolated pronunciation is achieved, and the process itself requires more time and perseverance than with dyslalia.

Prediction and prevention of dysarthria

Only early, systematic speech therapy work to correct dysarthria can give positive results. An important role in the success of the correctional and pedagogical influence is played by the therapy of the underlying disease, the diligence of the dysarthric patient himself and his close circle.

Under these conditions, almost complete normalization speech function can be counted in the case of erased dysarthria. Having mastered the skills of correct speech, such children can successfully learn in comprehensive school, and the necessary speech therapy assistance is received in polyclinics or at school speech centers.

In severe forms of dysarthria, only an improvement in the state of speech function is possible. The continuity of various types of speech therapy institutions is of great importance for the socialization and education of children with dysarthria: kindergartens and schools for children with severe speech disorders, speech departments of neuropsychiatric hospitals; friendly work of a speech therapist, neurologist, neuropsychiatrist, massage therapist, physiotherapy specialist.

Medical and pedagogical work on the prevention of dysarthria in children with perinatal brain damage should begin from the first months of life. Prevention of dysarthria in early childhood and adulthood consists in the prevention of neuroinfections, brain injuries, and toxic effects.

Articulation disorders in children and adults

- “we brush our teeth” the baby smiles, opening his mouth, brushing the lower and upper teeth alternately with the tip of his tongue;

- “knead the dough” the child smiles, then slaps his tongue between his teeth - “five-five-five”, then - bites the tip of the tongue with his teeth;

- "cup" - the baby smiles, opens his mouth wide, sticks out a wide tongue and forms a "cup" out of it (lifts the tip);

- "pipe" - the child must stretch forward tense lips, while closing his teeth;

- "painter" - the child smiles, opens his mouth and strokes (paints) the sky with the tip of his tongue;

- "mushrooms" - the baby needs to smile, then clap his tongue (as if riding a horse) and suck with his wide tongue to the sky;

- "kitty" - the baby smiles wider, opening his mouth. The tip of his tongue should rest against the lower teeth, while the tongue should be bent with a slide so that it rests with the tip against the lower teeth;

- "swing" - the child smiles, opens his mouth, the tip of his tongue goes first behind the upper teeth, then behind the lower teeth.

- “paint” the upper arch inside the mouth with your tongue - from the soft palate to the base of the upper teeth;

Make vowel sounds while yawning;

Simulate gargling;

Develop the lower jaw by moving it back and forth, as well as from side to side;

Lower your jaw downward with resistance;

Develop your cheeks by alternately pulling in or puffing them out;

Roll the "balloon" from cheek to cheek;

Pull in both cheeks to form a "fish mouth" and move your lips;

Snort like a horse;

Chew your lips gently;

Pull out your tongue with a sharp tip harder, then place it relaxed on your lower lip.

Specific speech articulation disorders (dyslalia) in children

A group of specific disorders of speech and language development (dyslalia) is represented by disorders in which the leading symptom is a violation of sound pronunciation with normal hearing and normal innervation of the speech apparatus.

The incidence of articulation disorders was found in 10% of children under 8 years of age and in 5% of children over 8 years of age. Boys are met 2-3 times more often than girls.

Functional dyslalia - defects in the reproduction of speech sounds in the absence of organic disorders1 in the structure of the articulatory apparatus.

Mechanical dyslalia is a violation of sound pronunciation caused by anatomical defects of the peripheral apparatus of speech (malocclusion, thick tongue, short frenulum, etc.).

Causes and pathogenesis of dyslalia

The cause of articulation disorders is not fully understood. Presumably, the disorders are based on a delay in the maturation of neuronal connections, caused by organic damage to the speech areas of the cortex. There is evidence of a significant role for genetic factors. An unfavorable social environment, imitation of incorrect speech patterns, has a certain value.

Articulation disorders are expressed in a persistent inability to apply speech sounds, including incorrect reproduction, in accordance with the expected level of development. omissions, substitutions for incorrect ones, or the insertion of unnecessary phonemes.

The defect of articulation is based on the inability to voluntarily accept and hold certain positions of the tongue, palate, lips, necessary for the pronunciation of sounds. Intellectual and mental development children are age appropriate. You can observe concomitant disorders in the form of disorders of attention, behavior and other phenomena.

Establishment of anatomical defects that could cause a violation of pronunciation, in connection with which it is necessary to consult an orthodontist.

Differentiation from secondary disorders caused by deafness is based on the data of an audiometric study and the presence of qualitative pathological signs of speech pathology.

Differentiation from articulation disorders caused by neurological pathology (dysarthria) is based on the following symptoms:

dysarthria is characterized by a low speed of speech, the presence of violations of the chewing and sucking functions;
the disorder affects all phonemes, including vowels.

In doubtful cases, instrumental studies are carried out for differential diagnosis and establishment of the anatomical focus of lesion: EEG, echoencephalography (EchoEG), MRI of the brain, CT of the brain.

Does not differ from the prevention of other types of disorders of speech development and language.

Developmental articulation disorder

characterized by frequent and repetitive disturbances in speech sounds, as a result of which speech becomes pathological. Development in the field of language within the normal range. A number of terms are used to denote these phenomena: infant speech, babbling, dyslalia, functional speech disorders, infantile perseveration, infantile articulation, delayed speech, lisping, inaccuracy of oral speech, lazy speech, specific speech development disorder, and sloppy speech. In most mild cases, intelligence is not severely impaired, and spontaneous recovery is possible. In severe cases, speech may be completely incomprehensible, which requires long and intensive treatment.

Definition

Articulation disorder is defined as a significant impairment in the mastery of normal articulation of speech sounds at an appropriate age. This condition cannot be caused by pervasive developmental disorder, mental retardation, impaired internal speech mechanisms, or neurological, intellectual and hearing impairments. A disorder manifested by frequent mispronunciation, substitution or omission of sounds creates the impression of "infant speech".

The following are diagnostic criteria for developmental articulation disorder.

A. Significant impairment of the ability to correctly use the sounds of speech, which should have already developed at the appropriate age. For example, in a three-year-old child, the inability to pronounce the sounds p, b, and t, and in a 6-year-old - p, w, h, f, c.
B. Not associated with pervasive developmental disorders, mental retardation, hearing impairment, speech disorder, or neurological disorder.

This disorder is not associated with any anatomical, auditory, physiological, or neurological abnormality. This disorder refers to a number of different articulation disorders ranging from mild to severe. Speech may be completely understandable, partially understandable, or incomprehensible. Sometimes the pronunciation of only one speech sound or phoneme is impaired (the smallest volume of sound), or many speech sounds are affected.

Epidemiology

The incidence of developmental articulation disorders is found in approximately 10% of children under 8 years of age and in approximately 5% of children over 8 years of age. This disorder is 2–3 times more common in boys than in girls.

Etiology

The cause of the developmental articulation disorder is unknown. It is generally believed that a simple developmental delay or delay in the maturation of neurological processes, rather than organic dysfunction, underlies speech impairment.

Disproportionately high level articulation disorders are found among children from large families and low socioeconomic classes, which may indicate one of the possible reasons- incorrect speech at home, and the reinforcement of the deficiency from these families.

Constitutional factors, more than environmental factors, influence whether a child will or will not suffer from an articulation disorder. A high percentage of children with this disorder, in whom many relatives have similar disorders, may indicate a genetic component. Poor motor coordination, poor lateralization, and right- or left-handedness have been shown to be unrelated to developmental articulation disorder.

Clinical features

In severe cases, this disorder is recognized for the first time around the age of 3 years. In less severe cases, the disorder may not be apparent until the age of 6. Significant features of developmental articulation disorder include articulation that is judged to be defective when compared to the speech of children of the same age and which cannot be explained by pathology of intelligence, hearing, or physiology of speech mechanisms. In very mild cases, there may be a violation of the articulation of only one phoneme. Usually single phonemes are violated, those that are mastered at an older age, in the process of normal language acquisition.

Speech sounds, which are most often incorrectly pronounced, are the latest in the sequence of sounds being mastered (p, w, c, g, h, h). But in more severe cases or in young children, there may be a violation of the pronunciation of sounds such as l, b, m, t, d, n, x. The pronunciation of one or more speech sounds may be impaired, but the pronunciation of vowels is never impaired.

A child with developmental articulation is unable to pronounce certain phonemes correctly and may distort, replace, or even skip phonemes that he cannot pronounce correctly. When skipping phonemes are completely absent - for example, "gooy" instead of "blue". When substituted, difficult phonemes are replaced with incorrect ones — for example, "kvolik" instead of "rabbit". When distorted, approximately correct phonemes are selected, but their pronunciation is incorrect. Occasionally something is added to the phonemes, usually vowels.

Gaps are most commonly found in speech in young children and appear at the end of words or consonant clusters. Distortion, which is found mainly in older children, is expressed in sounds that are not part of the speech dialect. Distortion may be the last type of articulation disorder preserved in the speech of children in whom the articulation disorder has almost disappeared. The most common type of distortion is "lateral escape", in which the child makes sounds with the air flow through the tongue, which produces a sibilant effect, as well as "lisp", in which the formation of sound occurs when the tongue is very close to the palate, which produces a hissing the effect. These violations are often fickle and accidental. A phoneme may be pronounced correctly in one situation and incorrectly in another. Articulation disorders are especially common at the end of words, in long syntactic complexes and sentences, and during rapid speech. Gaps, distortions and substitutions also appear in normal children learning to speak, if normal children quickly correct their pronunciation, children with developmental articulation disorder do not. Even as the child grows and develops, when the pronunciation of phonemes improves and becomes correct, this sometimes only applies to newly learned words, while previously learned incorrect words may still be pronounced with a mistake.

By the third grade, children sometimes overcome articulation disorder. However, after the fourth grade, if the deficiency has not been overcome earlier, spontaneous recovery from it is unlikely, therefore it is especially important to correct the disorder before complications develop.

In most mild cases, recovery from developmental articulation disorders is spontaneous, and is often facilitated by the child's admission to kindergarten or school. These children are fully shown classes with a speech therapist, aimed at setting speech sounds, if they do not have spontaneous improvement by the age of six. For children with significant pronunciation disorders, with incomprehensible speech, and especially for those of them who are greatly experiencing their defect, it is necessary to ensure an early start to classes.

Other specific developmental disorders commonly occur, including developmental speech disorder, receptive language developmental disorder, reading disorder, and developmental coordination disorder. There may also be functional bedwetting.

A delay in the development of speech, the achievement of a certain milestone in this development, for example, the pronunciation of the first word and the first sentence, is also noted in some children with developmental articulation disorders, but most children begin to speak at a normal age.

Children with developmental articulation disorders can present with many comorbid social, emotional and behavioral disorders. Approximately 1/3 of these children have mental disorders such as attention deficit hyperactivity disorder, separation anxiety disorder, avoidance disorder, adjustment disorder, and depression. Those children who have a hard time severe disorder articulations, or those in which the disorder is chronic, without remission or repeated, constitute a risk group for the development of mental illness.

Differential diagnosis

The differential diagnosis of developmental articulation disorder includes three stages: first, it is necessary to determine that the impairment of articulation is serious enough to be considered pathological, and excludes the normal impairment of pronunciation in young children; secondly, it should be noted that there is no physical pathology that could cause a violation of pronunciation and exclude dysarthria, hearing impairment or mental retardation; thirdly, it is necessary to establish that the expressive language is expressed within the normal range and to exclude the developmental disorder of the language and pervasive developmental disorders. Approximately, you can be guided by the fact that a 3-year-old child normally pronounces mn, b, p, c, f, g, x, t, k, d; and a normal 5-year-old child pronounces all sounds correctly.

To exclude physical factors that could cause some types of articulation disorders, it is necessary to perform neurological, structural and audiometric examination methods.

Children with dysarthria, in whom the disorder of articulation is due to structural or neurological pathology, differ from children with developmental articulation disorder in that dysarthria is extremely difficult to correct, and sometimes not at all. Pointless chatter, slow and uncoordinated motor behavior, impaired chewing and swallowing, as well as constrained and delayed protrusion and retraction of the tongue are signs of dysarthria. Slow speech speed is another symptom of dysarthria.

Forecast

Recovery is often spontaneous, especially in children whose articulation disorder involves only a few phonemes. Spontaneous recovery rarely occurs over the age of 8.

Treatment

Speech therapy is considered successful for most articulation errors. Correctional classes shown when the child's articulation is such that his speech is incomprehensible, when a child with articulation disorders is over 6 years old, when speech difficulties clearly cause complications in dealing with peers, learning difficulties and negatively affect the formation of his own image, when articulation disorders are so heavy, that many consonants are mispronounced, and when mistakes involve omissions and phoneme substitutions rather than distortions.

Bibliography

Kaplan G.I., Sadok B.J. Clinical Psychiatry, Vol. 2, - M., Medicine, 2002

Multiaxial classification of mental disorders in children and adolescence... Classification of mental and behavioral disorders in children and adolescents in accordance with ICD-10, - M., Smysl, Academy, 2008

What is Specific Speech Articulation Disorder -

In most cases, the non-verbal intellectual level is within the normal range.

The incidence of developmental articulation disorders was found in 10% of children under 8 years of age and in 5% of children over 8 years of age. This disorder occurs 2-3 times more often in boys than in girls.

What provokes / Causes of Specific Speech Articulation Disorder:

The cause of the developmental articulation disorder is unknown. Presumably, speech impairment is based on a delay in the development or maturation of neuronal connections and neurological processes, rather than organic dysfunction. The high percentage of children with this disorder, in whom many relatives have similar disorders, indicates a genetic component. With this disorder, there is no subtle differentiation of motor kinesthetic postures of the tongue, palate, lips; cerebral base - the activity of the postcentral parts of the left hemisphere of the brain.

Symptoms of Specific Speech Articulation Disorder:

A significant feature is a defect in articulation, with a persistent inability to apply speech sounds in accordance with the expected level of development, including omissions, substitutions and distortion of phonemes. This disorder cannot be caused by structural or neurological pathology and is accompanied by the normal development of the language sphere.

In more severe cases, the disorder is recognized around 3 years of age. In milder cases, clinical manifestations may not be recognized until 6 years of age. An essential feature of speech articulation disorder is a violation of the child's acquisition of speech sounds, leading to disarticulation with difficulties for others to understand his speech. Speech can be assessed as defective when compared with the dialect of children of the same age and which cannot be explained by the pathology of intelligence, hearing, or the physiology of speech mechanisms. The pronunciation of speech sounds, which appear most late in ontogeny, is often disturbed, but the pronunciation of vowel sounds is never disturbed. The most severe type of violation is missing sounds. Substitutions and distortions are a less severe type of violation. Children with developmental articulation disorder may present with comorbid social, emotional and behavioral disorders. One third of these children have a mental disorder.

Diagnosis of Specific Speech Articulation Disorder:

It includes three stages:

1. Isolation of the severity of the disorder of articulation.
2. Elimination of physical pathology that could cause impaired pronunciation, dysarthria, hearing impairment or mental retardation.
3. Exclusion of developmental disorder of expressive speech, general developmental disorder.

Articulation disorders caused by structural or neurological pathology (dysarthria) are characterized by low speech speed, uncoordinated motor behavior, disorders of autonomic functions, for example, chewing, sucking. Possible pathology of the lips, tongue, palate, muscle weakness. The disorder affects all phonemes, including vowels.

Treatment for Specific Speech Articulation Disorder:

Speech therapy is most successful for most articulation errors.

Drug treatment is indicated for concomitant emotional and behavioral problems.

Which doctors should you contact if you have a Specific Speech Articulation Disorder:

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Specific speech articulation disorder

What is Specific Speech Articulation Disorder

It is characterized by frequent and repetitive disturbances in speech sounds. The child's use of sounds below the level corresponding to his mental age - that is, the child's acquisition of speech sounds is either delayed or rejected, leading to disarticulation with difficulties in understanding his speech, omissions, substitutions, distortions of speech sounds, changes depending on their combination (i.e. speaks correctly, then no). Most speech sounds are acquired by the age of 6-7 years; by the age of 11, all sounds should be acquired.

In most cases, the non-verbal intellectual level is within the normal range.

What causes Specific Speech Articulation Disorder:

Symptoms of Specific Speech Articulation Disorder:

Diagnosis of Specific Speech Articulation Disorder:

It includes three stages:

1. Isolation of the severity of the disorder of articulation.

Treatment for Specific Speech Articulation Disorder:

Speech therapy is most successful for most articulation errors.

Drug treatment is indicated for concomitant emotional and behavioral problems.

F80.0. Specific speech articulation disorder

Specific developmental disorder in which the child's use of speech sounds is below the level appropriate for his mental age, but in which there is a normal level of speech skills. Diagnosis can only be made when the severity of the articulation disorder is outside the normal range for the child's mental age; non-verbal intellectual level within normal limits; skills of expressive and receptive speech within the normal range; articulation pathology cannot be explained by a sensory, anatomical, or neurotic abnormality; incorrect pronunciation is undoubtedly anomalous, based on the peculiarities of the use of speech in the subcultural conditions in which the child is.

Developmental physiological disorder;

Developmental articulation disorder;

Functional articulation disorder;

Babbling (children's form of speech);

Disorder of phonological development.

F80.1. Expressive speech disorder

Specific violation development in which the child's ability to use expressive spoken language is noticeably below the level corresponding to his mental age, although his understanding of speech is within the normal range. In this case, there may or may not be articulation disorders.

Often, the lack of spoken language is accompanied by a delay or impairment of verbal and sound pronunciation. The diagnosis should be made only when the severity of the delay in the development of expressive speech is outside the normal range for the mental age of the child; receptive language skills within normal limits for the child's mental age (although often it may be slightly below average). Colloquial speech impairment becomes apparent from infancy without any prolonged distinct phase of normal speech use. However, there is often an apparently normal use of several separate words at first, accompanied by speech regression or lack of progress. Often, such expressive speech disorders are observed in adults, they are always accompanied by a mental disorder and are organically determined.

Delays in speech development by type general underdevelopment speech (ОНР) I-III levels;

Developmental dysphasia of the expressive type;

Developmental aphasia of the expressive type.

F80.2. Disorder of receptive speech

Specific developmental disorder in which the child's understanding of speech is below the level corresponding to his mental age. In all cases, expansive speech is also noticeably impaired and a defect in verbal and sound pronunciation is not uncommon.

Diagnosis can only be made when the severity of the delay in the development of receptive speech is outside the normal range for the child's mental age and when there are no criteria for a general developmental disorder. In almost all cases, the development of expressive speech is also seriously delayed and violations of verbal and sound pronunciation are often found. Of all the variants of specific disorders of speech development, with this variant, the highest level of concomitant socio-emotional-behavioral disorders is noted. These disorders do not have any specific manifestations, but hyperactivity and inattention, social

ability and isolation from peers, anxiety, sensitivity, or excessive shyness are common. In children with more severe forms of impairment of receptive speech, there may be a rather pronounced delay in social development; imitative speech is possible with a lack of understanding of its meaning and limitation of interests may appear. Similar speech disorders of the receptive (sensory) type are observed in adults, which are always accompanied by a mental disorder and are organically conditioned.

The structure of speech disorders is indicated by the second code R47.0.

Developmental dysphasia of the receptive type;

Developmental aphasia of the receptive type;

speech articulation disorder

Universal Russian-English dictionary... Academic.ru. 2011.

See what "speech articulation disorder" is in other dictionaries:

F80.1 Expressive speech disorder In this case, there may be either ... ... Classification of mental disorders ICD-10. Clinical descriptions and diagnostic instructions. Research diagnostic criteria

Speech or Language Development Disorder - Disorders characterized primarily by severe impairments in language development or language acquisition (syntax or semantics) that cannot be explained by a general retardation of intellectual development. Most often there is a delay in development ... ... Big psychological encyclopedia

Speech violations - decomp. deviations from the norm in the process of formation of speech function, or the decay of an already established speech. NS. arise under the influence of a variety of organic and / or functional causes. character, congenital or acquired nature and associated with ... Psychology of communication. encyclopedic Dictionary

F80.0 Specific developmental disorder of speech articulation Diagnostic guidelines: Age of acquisition ... ... Classification of mental disorders ICD-10. Clinical descriptions and diagnostic instructions. Research diagnostic criteria

Aphasia in children (speech developmental disorders) is a violation of the formation of speech mechanisms in children, caused by a delay or damage to the development of speech function. It is assumed that these disorders are caused by delayed biological maturation of the brain in the prenatal period of life, ... ... Encyclopedic Dictionary of Psychology and Pedagogy

Speech disorder is the general name for various speech disorders. It is not yet clear what kind of speech disorders should be designated by this term. Some authors distinguish between functional (psychogenic) speech disorders, such as stuttering, and ... ... Encyclopedia of Psychology and Pedagogy

"F80" Specific developmental disorders of speech and language - These are disorders in which normal speech development is impaired by early stages... Conditions cannot be explained by neurological or speech pathology, sensory impairment, mental retardation, or environmental factors. Child ... ... Classification of mental disorders ICD-10. Clinical descriptions and diagnostic instructions. Research diagnostic criteria

F80.0 Specific speech articulation disorder - Note. This disorder is also called Specific Phonological Speech Disorder. A. Articulation (phonological) skills, as measured by standardized tests, are below 2 standard deviations for the child's age. B. ... ... Classification of mental disorders ICD-10. Clinical descriptions and diagnostic instructions. Research diagnostic criteria

ICD-9 Code List - This article should be wikified. Please fill it out according to the rules of article formatting. Transition table: from ICD 9 (chapter V, Mental disorders) to ICD 10 (section V, Mental disorders) (adapted Russian version) ... ... Wikipedia

Dyslalia is an articulation disorder in which the patient uses vocabulary correctly, but mispronounces some sounds (tongue-tied). Dislalia is a characteristic symptom of a speech defect acquired by children who suffer from childhood ... ... Medical terms

dysarthria is a disorder of articulation with unclear pronunciation (especially consonants), slowness and intermittent speech.