Requirements for conducting a speech pathology examination. Stages of speech therapy examination
Logopedic examination
The speech therapy examination should be based on the general principles and methods of pedagogical examination: it must be comprehensive, holistic and dynamic, but at the same time it must have its own specific content aimed at analyzing speech disorders.
Each speech disorder is characterized by its own set of symptoms, and some of them turn out to be the main primary for each disorder, core, while others are only additional and only arising from the main defect, i.e. secondary.
The methodology and techniques for conducting the survey should be subject to the specifics of its content.
The complexity, integrity and dynamism of the survey are ensured by the fact that all aspects of speech and all its components are examined, moreover, against the background of the entire personality of the subject, taking into account the data of his development - both general and speech - from an early age.
The logopedic examination includes the following items:
1. Name, surname, age, nationality.
2. Complaints of parents, educators, teachers.
3. Data of early development: a) general (briefly); b) speech (in detail, by periods).
4. Brief description of the child at the present time.
5. Hearing.
6. Vision.
7. The reaction of the child to his speech difficulties.
8. Intelligence.
9. The structure of the organs of articulation, their mobility.
10. Speech: a) impressive; b) expressive - from the point of view of phonetics, vocabulary, grammatical structure; whether he owns a broken speech; c) writing - reading and writing.
11. Conclusion.
The first three points are filled in from the words of the mother, educator, teacher accompanying the child, and on the basis of the documentation submitted. In cases of appeal by an adult, these sections are filled in according to the words of the applicant.
A brief description can be formulated from the words of the parents (caregiver, teacher), can be presented by the children's institution that sends the child. It is desirable that it contains information about what the child is interested in, how he reacts to his speech difficulties.
It is desirable to fill in the data of the examination of hearing and vision on the basis of the certificates submitted by the otolaryngologist and the eye doctor. If there are no specialists, then the speech therapist must himself check the hearing and vision and establish (by questioning) at what age the subject had a deviation from the norm.
The state of intelligence is the main factor in the analysis of speech disorders. It is important to find out what is in the foreground: a severe speech disorder that delays the overall development of the child, or mental retardation that delays and distorts speech development.
The speech therapist receives data on the structure of the organs of articulation on the basis of an examination of the oral cavity. He sets the mobility of the articulatory apparatus by offering the child to make the main movements of each of the organs (lips, tongue, soft palate), while noting the freedom and speed of movement, its smoothness and uniformity of movement of the right and left sides (tongue, lips, soft palate), and also ease of transition from one movement to another.
First of all, a speech therapist must identify the level of development of the child's intellect and analyze his speech in detail. To clarify these issues, there are special techniques.
The survey begins with a conversation. The topic for conversation and the manual that the speech therapist will use, he thinks over and selects in advance, taking into account the age of the child.
During the conversation, the speech therapist tries to establish contact with the subject, and also reveals how the child understands his speech, whether he uses the phrase, whether he pronounces the sounds correctly. Establishing contact and the conversation itself help the speech therapist get an idea about the general mental and speech development of the child, about some features of his personality.
Another methodological method of examination will be the active observation of the speech therapist for the child in the course of his activities, which is organized by the speech therapist, offering him various material (toys, pictures) and setting him various tasks of the game and curriculum. Tasks related to the processes of abstraction and generalization are of great importance:
1) decompose a series of sequential pictures, interconnected by a certain content, in the order of the sequence of depicted actions or events; 2) classify objects (shown in the pictures) into groups: dishes, furniture, toys, vegetables, fruits, etc.; the pictures laid out on the table depicting objects belonging to different groups need to be sorted, explain why they are combined into one group, and then name the objects in one word.
You can also use a simpler classification technique, which is called "The Fourth Extra": out of the four proposed pictures, one of which does not fit the rest, you need to select and explain why it does not fit. Board games are also used, for example, the loto "Who needs what?", Or pictures with the question: "Who is missing something?"
In both classification tasks, a child with a developmental disability begins to group objects according to a random, unimportant feature. So, he puts the carrot and the doll in one group, because "the carrot and the doll's dress are red", or he combines the knife and bread, since bread is cut with a knife, etc.
A full understanding of speech is a necessary prerequisite for the correct use of speech and for further successful learning. Therefore, when starting to examine a child, a speech therapist studies all aspects of speech: its impressive and expressive sides.
Examining the impressive side of speech (speech understanding), the speech therapist focuses on how the child understands:
a) the names of various everyday items; b) generalizing words (clothing, dishes, furniture, fruits, vegetables, transport, etc.; c) a phrase of an everyday nature; d) a short text told or read to him. When examining speech understanding, a verbal response should not be required from the child. It is enough to get it with the help of a gesture, selection of the necessary pictures, facial expressions, individual exclamations.
When examining the expressive side of speech, a speech therapist studies: a) a dictionary; b) grammatical structure; c) sound pronunciation; d) voice, its pace and fluency.
Observing the speech of the child, the speech therapist determines the poverty or richness of his vocabulary. To determine the vocabulary, a speech therapist selects the necessary didactic material, using not only subject pictures, but also plot pictures that will allow you to name objects and their actions, quality, position in space (to identify the use of prepositions), etc.
Examining the child's dictionary, one should pay attention to the degree of mastery of the syllabic structure of the word (the presence of abbreviations of words up to the use of one syllable from the word, permutations within the word).
When examining the grammatical structure, the nature of the design of the answers, the use of the phrase (short, elementary, stereotypical or expanded, free) are revealed, special attention is paid to the correct agreement in verbal and case endings, the correct use of prepositions. For this examination, the speech therapist selects plot pictures, the answers to which require the compilation of various types of sentences: simple (The boy is walking), simple common - with the use of a direct addition (The girl is reading a book) or indirect with the use of prepositions (The book is on the table). For a deeper analysis of the grammatical structure, a speech therapist can pose additional questions to the child that require the use of singular and plural adjectives.
Analyzing the answers of children, the speech therapist pays attention to the pace of speech (too fast or too slow, monotony or expressiveness of speech), smoothness or its violation by more or less frequent and severe stammering - stuttering. When stuttering, auxiliary movements of the arms, legs, head can be noted.
To examine sound pronunciation, a speech therapist selects subject pictures so that their names include the tested sounds at the beginning, middle and end of words. If the child incorrectly pronounced the sound in the word, the speech therapist suggests pronouncing this word with this sound by imitation, and then direct and reverse syllables with this sound. The nature of the incorrect pronunciation of the sound is noted: the sound is omitted, replaced by another constantly or only in some words, distorted. If a child can pronounce both sounds in isolation, but still confuses them, you should check whether he distinguishes them by ear.
To do this, you can do the following types of work: a) repeat after the speech therapist combinations of sounds like ta-da and da-ta; b) correctly name the pictures (house, volume); c) correctly specify one
from the pictures named by the speech therapist, the names of which differ only in mixed sounds (for example, a bear - a bowl or a rat - a roof, etc.) It is possible to check the distinction of similar sounds in full if the child knows the letters and knows how to write syllables, words under dictation, phrases with the indicated sounds, since violations of oral speech (sometimes even already overcome) are reflected in one way or another in teaching literacy. Due to this, the analysis of violations of written speech allows you to more deeply identify the entire violation as a whole.
In case of difficulties in mastering literacy, it is necessary to check how the child acquires reading and writing skills in accordance with the program.
In order to identify the most characteristic difficulties for each subject in mastering written speech, it is necessary to check not only the writing skill, but also reading. So, with regard to reading, determine how the child reads letters, syllables or whole words, whether he correctly understands the text being read. When conducting written work, a speech therapist takes into account the correctness of copying, writing from dictation and independent writing, analysis of errors in writing (errors in spelling rules, errors that distort the structure of a word, and phonetic errors).
Material for the examination of written speech should be taken in accordance with the stage of the child's education.
The speech therapist conducts a speech examination in various activities of the child - play, study, observes him in communication with others. In this regard, it is possible to identify the characteristics of the child's personality and his behavior - active or passive, collected, organized, obedient or disorganized, spoiled, stable in the game, at work or easily distracted, courageous, easily comes into contact or fearful, shy, aware of his speech difficulties, is shy about them or treats them indifferently.
As a result, the examination becomes comprehensive, complex and dynamic and makes it possible not only to analyze speech disorders, but also to outline a plan for the most effective assistance.
To conduct the survey described, it is necessary to have at least a certain minimum of benefits, a few of the toys most beloved by children (a bear, a doll, a bus, a car, etc.), 2-3 plot pictures with a simple, understandable content, a series of sequential pictures, several series of subject pictures selected by various categories (clothes, dishes, vegetables, etc.); subject pictures, selected according to the presence of tested sounds in their names, a typesetting canvas, a cash register with letters, 2-3 different primers, books for reading grades I, II, III, such as "Little Stories" by L. N. Tolstoy, illustrated fairy tales, several games such as lotto, dominoes.
The speech therapist must take into account that failures in schooling create a sharply negative attitude in the child to all the aids used at school (primers, books for reading, etc.), and that their use during the examination may cause a refusal to complete the task. In such cases, a speech therapist should be able to use a wide variety of material: literary texts of varying difficulty, alphabetic texts, but designed in the form of cards, tablets, etc.
When examining children's institutions (kindergartens, schools), the so-called short, or indicative, examination is used. It helps to identify children in need of speech therapy. When children are included in the work, a full examination should be carried out.
During a brief examination, the child is asked to pronounce a familiar poem, a sentence in which, if possible, all the most frequently mispronounced sounds are presented, for example. An old grandmother knitted woolen stockings or a Black Puppy sat on a chain near the booth (whistling, hissing, sonorous, r, l).
Planning speech therapy work
When drawing up a plan for speech therapy work, each item of the plan must be substantiated by the survey data.
1 The speech therapist draws up a general work plan, that is, outlines the stages of work and reveals their content.
2. The next stage of work is revealed in more detail. the main sections of the work, their sequence, their relationship to each other are established
3 The forms of work in the form of a game, a lesson are determined (in connection with the age, intelligence, character, interests of the child).
4. Speech material is selected for each lesson, taking into account the general characteristics of the child, the state of his speech, the main task of each lesson
Scheme of speech therapy examination
1. The interview begins with the purpose of the visit, complaints; parents and child.
2. Familiarization with pedagogical documentation is carried out.
3. The obstetric anamnesis and anamnesis of the child's development (motor, speech, mental) are being clarified. In doing so, special attention is paid to:
Preverbal vocalizations (cooing, cooing);
The appearance and nature of babble, the first words, phrases;
The quality of the first words, phrases (the presence of violations of the syllabic structure, agrammatism, incorrect sound pronunciation).
4. An objective examination of the child is carried out.
4.1. Emotional contact is established with the child, the right relationship to the examination is created: the interests of the child, his favorite activities, games, and especially ideas about the environment are revealed.
4.2. Non-verbal functions are studied: psychomotor is studied, Ozeretsky's tests are used (counting fingers, a test for finger gnosis by imitation, by verbal instruction), the presence of perseverations, sticking, slipping, and pronounced slowness are established.
4.3. Successive abilities are being studied: repetition of a digital series in forward and reverse order, sound series in rhythm, series in sensory standards.
4.4. Subject gnosis is being studied (along the contour, along the dotted line, against a noisy background, with missing elements).
4.5. Letter gnosis and praxis are studied (along the contour, along the dotted line, against a noisy background, with missing elements)
4.6. Thinking is studied (layout of a series of plot pictures, identification of cause-and-effect relationships, determination of the level of semantic integrity of the story).
4.7. Impressive speech is studied - understanding of coherent speech, understanding of sentences, understanding of various grammatical forms (prepositional-case constructions, differentiation of singular and plural nouns, verbs, differentiation of verbs with various prefixes, etc.), understanding of words (opposite in meaning, close by value).
4.8. Phonemic processes are being studied. At the same time, the following are carried out:
♦ phonemic analysis - highlighting a sound against the background “And words, highlighting a sound from a word, determining the place of a sound in a word in relation to other sounds, determining the number of sounds in a word, differentiating sounds according to oppositions (voicedness-deafness, softness-hardness, 1 whistling- hissing, etc.);
♦ phonemic synthesis - composing words from sequentially given sounds, composing words from sounds given in a broken sequence;
♦ phonemic representations - come up with a word for a certain sound.
4.9. Expressive speech is being studied. The following are subject to verification:
♦ structure and mobility of the articulatory apparatus, oral praxis. Movement parameters are noted - tone, activity, volume of movement, accuracy of execution, duration, replacement of one movement by another, additional and unnecessary movements (synkenesias);
♦ the state of sound pronunciation - an isolated variant, in syllables: open, closed, with a confluence of consonants, in words, in speech, pronunciation of words of various syllabic structures. There is a reduction in the number of syllables, simplification of syllables, likening of syllables, rearrangement of syllables;
♦ the vocabulary of the language - the child's independent addition of thematic series, the selection of synonyms, antonyms of related words, the identification of common categorical names.
The following are noted: the correspondence of the dictionary to the age norm, the presence of verbs, adverbs, adjectives, pronouns, nouns in the dictionary, the accuracy of the use of words.
With motor alalia, note the difference between active and passive vocabulary; i
♦ grammatical structure of speech. The following are noted: the nature of the sentences used (single-word, two-word and more), the nature of the use of prepositional case constructions, the state of the function of inflection, the transformation of the singular number of nouns into the plural in the nominative case, the formation of the genitive form of nouns in the singular and plural, agreement with numerals, the state word-formation functions, the formation of nouns with the help of diminutive suffixes, the formation of adjectives (relative, qualitative, possessive), the formation of the names of baby animals, the formation of verbs with the help of prefixes.
4.10. The state of coherent speech is investigated (reproduction of a familiar fairy tale, compilation of a story based on a series of plot pictures, etc.): a logical sequence in the presentation of events is noted, the nature of agrammatism, vocabulary features are clarified.
4.11. The dynamic characteristics of speech (tempo, intonational expressiveness; the presence of scanned speech; hesitation, stumbling, stuttering) and voice features (loud, quiet, weak, hoarse, hoarse) are investigated.
5. The state of written speech is analyzed.
5.1. The skill of writing is being studied (according to the written works presented in school notebooks):
♦ skills of sound analysis and synthesis are revealed;
♦ features of sound analysis and synthesis are noted;
♦ features of auditory-speech memory are noted;
♦ auditory differentiation of phonemes is checked;
♦ checking the state of dynamic praxis;
♦ the leading hand is determined (tests of A. R. Luria for left-handedness and hidden left-handedness);
♦ different types of written activity are analyzed (copying, dictation, independent writing);
♦ handwriting features are noted;
♦ the nature of dysgraphic and spelling errors is noted.
5.2. Reading skill is being studied:
♦ the ability to correctly show block and capital letters is revealed;
♦ the ability to correctly name letters is noted;
♦ the ability to read syllables, words, sentences, text is revealed and the nature of the mistakes made (substitutions, distortions, omissions, permutations of letters, semantic substitutions) is noted;
♦ the nature of reading is noted (letter-by-letter, syllable-by-syllable, continuous, expressive);
♦ reading comprehension is revealed;
♦ the child's attitude to reading is noted (likes or does not like to read independently).
6. A speech therapy conclusion is drawn up (speech diagnosis: the degree and nature of the violation of oral and written speech.
At what age can logo-diagnostics be carried out?
A speech therapy examination of a child is extremely necessary to determine the level of his speech development. Diagnosis can be carried out starting from one and a half years: the earlier purposeful work with the child begins, the more complete and effective the correction and compensation of disorders can be, and in some cases it is possible to prevent secondary developmental disorders (for example, mental retardation).
In our center, you can be diagnosed 1 year before the child enters school. Speech therapists will be able to establish the level of development of your child's speech, its compliance with age norms and contribute to further improvement.
You are certainly interested in your child's school success. But not always a cute, obedient preschooler copes with school problems. Requirements for the child, for his speech, behavior at school are changing dramatically. Many difficulties can be avoided if you turn to specialists in a timely manner. We can help you with this. Parents of schoolchildren often contact us. Their children have had difficulty learning to read and write, and their grades are not encouraging at all. Most likely, the child needs the help of a speech therapist, and the examination should not be delayed (screening of violations of the letter can be carried out by a specialist in school notebooks). See section "School difficulties" - article "Strange" writing errors)
When diagnosing, the specialists of our center use various methods of examining a child, depending on his age and individual characteristics.
Every day, children come to our Center with a request for diagnostics coming from various children's institutions that are faced with the problem of an increase in the contingent of children with signs of mental retardation in terms of readiness for schooling, difficulties in adapting to new school conditions, and difficulties in mastering the school curriculum.
Recently, there has been an increase in the number of children with minimal brain dysfunctions, which lead to impaired development of higher mental functions, including speech. Diagnostic examination of such children presents certain difficulties, because this contingent of children has not only speech, but communicative and emotional-volitional disorders of varying severity.
Therefore, speech therapists in their work use complex diagnostics developed on the basis of:
Thus, a diagnostic study, on the one hand, allows you to determine the violation or lack of formation of functional systems, including speech, and thereby approach the cause of the difficulties experienced by the child, and on the other hand, complex diagnostics helps to determine special corrective teaching methods that can help overcome these difficulties.
Of particular importance are complex diagnostic methods in the study of disorders and deviations in the development of higher mental functions in children:
- Oral and written speech
- Features of the processes of perception
- attention
- memory
- Thinking
- Spatial imagination.
- "General diagnostics" (memory, attention, counting, thinking, emotions).
- "Speech diagnostics" (oral speech, reading, writing, auditory-speech memory).
A comprehensive examination, covering both the speech and non-speech capabilities of the child, allows for high-quality functional diagnostics and the development of an effective correction strategy.
What is included in a speech pathology examination?
- Diagnostics (about 1 hour)
- Parent consultation
- Registration of a speech therapy conclusion
- Discussion with parents of an individual program for accompanying a child
How is logopedic diagnosis carried out?
The speech therapist examines the state of the child's speech in the following areas:- speaking side,
- phonemic processes (hearing and perception, sound analysis and synthesis),
- dictionary,
- grammatical structure of speech,
- connected speech,
- articulatory motility (mobility of the organs of speech),
- fine motor skills of hands,
- reading and writing status of schoolchildren.
Before the diagnosis, the speech therapist will offer you to fill out an anamnesis - a questionnaire in which parents describe the main points in the development of the child, starting from birth, the conditions of his life. You can fill in an anamnesis by coming to our center for diagnostics. All the data obtained helps the speech therapist to understand the cause of the violation and plan his work in such a way as to help the child as much as possible.
After the diagnosis, the speech therapist will recommend the necessary program for the development of your child, taking into account his speech, age and individual psychophysiological characteristics.
What documents do you need to bring with you to the examination?
- direction from school.
- Characteristics for a child from a class teacher.
- References from specialists: psychoneurologist (required), ophthalmologist, ENT.
- Notebooks with a large amount of written work of the student (on the Russian language, natural history, mathematics, singing, etc.)
The speech therapy examination protocol includes the following items:
- First name, last name, age, date of birth, home address, school, class.
- The patronymic names of the parents, who they work for, what are the names of other family members living with the child.
- Complaints of parents, characteristics of educators or teachers.
- Data of early development: a) general (briefly); b) speech (in detail, by periods).
- The structure of the organs of articulation, their mobility.
- Speech: a) impressive (understanding of speech); b) expressive (ownership of one's own speech) - from the point of view of phonetics, vocabulary, grammatical structure; story, retelling.
- The state of verbal intelligence.
- Reading and writing skills.
Approximate types of speech therapy examination tasks
On examination overall development of the child need to find out:- whether the child understands the speech addressed to him;
- what speech means he uses in communication;
- imitates the speech of an adult;
- how he answers questions (in monosyllables or in extended phrases);
- uses facial expressions, gestures.
Nominative vocabulary survey
Survey of grammatical categories
Connected speech survey
- What is your name?
- How old are you?
- Who else lives with you at home?
- What is your favorite toy?
- Who did you make friends with in kindergarten?
Drawing up a story based on a plot picture, or a series of pictures.
Reading and writing survey
- Reading the text in accordance with age norms.
- Retelling what was read, understanding the hidden meaning (what the fable teaches).
- Dictation letter.
- Writing a small text with an open end and completing it with 2-3 sentences (from grade 3).
Speech therapy examination at an early age is necessary to determine the level of speech development of the child. A comprehensive diagnosis of a speech therapist helps to notice pathologies in time that affect the speech center. Such a measure is needed both to identify the cause of violations and to select the best methods for solving the problem.
The first visit to a speech therapist is recommended at the age of 3-4 years, when the child is about to start kindergarten. In some cases, a visit to the doctor is made earlier, when parents notice persistent speech disorders. It may also be necessary to diagnose a speech therapist at school when the problem is just beginning to be detected in the learning process.
At the first appointment, the doctor will offer to fill out a questionnaire, which indicates the important points in the development of the child. The information obtained will help the speech therapist to plan the work correctly and select an individual program.
During a general examination, the doctor finds out the following points:
- level of knowledge of geometric shapes, colors, parameters of objects;
- the ability to navigate in space and time;
- knowledge of simple mathematical concepts;
- state of fine motor skills;
- ability to classify.
The examination of speech development includes an assessment of the child's understanding when they are addressed to him, finding out what speech means he uses, whether he imitates adults, how he answers questions. The doctor asks to name and show the object, part of the body, animal, describe something in one word.
When examining coherent speech, the doctor asks the child's name, the names of parents, sisters, brothers, with whom he lives, what is his favorite toy. Then he will need to tell a story, make sentences using pictures and key words.
When should you show your child to a speech pathologist?
The earliest reason to visit a speech therapist will be the absence of cooing in infants up to a year old. The strategy of waiting until the child "talks" will be wrong, because the older he gets, the more difficult it is to solve the existing problem.
The following violations will also be a reason to contact a specialist:
- by the age of three, the child cannot correctly build phrases;
- does not master the grammatical structure until the age of five;
- the child began to speak, but then became completely silent;
- Poorly pronounces certain sounds.
In addition, the diagnosis of readiness for school by a speech therapist will help parents to engage in the proper development of the baby. The specialist will tell you what to focus on, how to conduct classes, how to interest the child in improving speech.
Stages of examination by a speech therapist
Examination of children by a speech therapist consists of several stages:
- Supervision of the child during the game, communication with parents.
- Evaluation of the manifestation of interest in the surrounding people and objects.
- Attention, the ability to concentrate, as a child perceives loud sounds and whispers.
- Evaluation of observation - matching pictures, objects, recognizing colors.
- The study of the level of intellectual development - the ability to count, distinguish objects by basic features, navigate in space.
- States of speech and general motor skills.
- The ability to understand speech and pronounce - repetition of sentences, understanding the story, performing light assignments, making sentences.
In some cases, several visits to a specialist are required so that he can verify the presence of violations or confirm their absence.
They will be carried out according to the scheme drawn up after the initial survey and forecast.
Preparing your child for a visit to the doctor
A visit to a specialist can alarm the child, then he will close and will not make contact, which is extremely important for diagnosis. Some children may react negatively to a visit to a speech therapist, even with a correct explanation of the purpose of the visit, arguing that they have no problems and they already know how to “beautifully” talk, and then it is very difficult to convince them.
- tell the child who a speech therapist is, explaining to him as an adult;
- show a video where a speech therapist works with a child;
- very small to say that you are going to get acquainted and play.
The speech therapist starts the first appointment in the form of a game, because the child feels comfortable. If you hide from him the purpose of the visit to a specialist, he will be excited, and then it will be more difficult to get in touch with him.
Types and methods of diagnostics of a speech therapist
Methods for diagnosing children under 2 years of age without intellectual and hearing impairment:
- Understanding the names of objects Several toys are laid out in front of the child, the speech therapist asks to show each of them in turn.
- Understanding actions. The speech therapist asks to perform a certain task - feed the doll, put the bear to sleep.
- Group orientation. The child is asked to point to an object located in the room, to find something or to approach something.
- active speech. The child plays freely, during which the speech therapist observes his emotions, pronounced sounds, words.
Methods for diagnosing a child by a speech therapist under the age of 3 years:
- Understanding of speech, prepositions. The task is given - to put the toy “under”, “near”, to step over “through”, to stand “in front of” something.
- Understanding prefix relationships. An order is given to “close”, “deploy”, “open”, “take away”.
- auditory attention. The ability to distinguish words similar in sound - "moustache-ears", "mouse-bear" is determined.
- active speech. The speech therapist conducts a free conversation with the child, expecting to hear a complex subordinate clause.
What might be the results
The results of a speech therapy examination contain information about the pace, rhythm, intonation of the voice, and breathing patterns. The speech therapist makes notes about the state of the sound-voice structure of phrases and individual words, impressive and expressive speech, vocabulary, and voice motor skills.
A speech pathologist can identify speech disorders such as:
- tongue-tied tongue or dysalgia - distortion, replacement of sounds, their mixing or absence;
- rhinolalia - a violation of sound pronunciation and timbre of the voice due to defects in the speech apparatus, the child is nasal, distorts sounds, speaks monotonously;
- dysarthria - there is a consequence of damage to the central nervous system, when the movements and strength of the organs of speech are disturbed, it is difficult for the child to control the language;
- alalia - partial or complete absence of speech while maintaining normal hearing, the child tries to contact parents and people around him, doing this with facial expressions and gestures;
- delayed speech development - occurs with violations of the physical and mental state, often observed in children from dysfunctional families;
- logoneurosis is stuttering, when a child stretches out sounds, repeats consonants, stops in mid-sentence, the exact reasons have not yet been clarified, but the psycho-emotional state plays a big role;
- dyslexia and dysphagia - the inability to master reading and writing with normal intellectual development, the child sees other letters, he makes many mistakes in writing.
If a defect is found, it is necessary to determine the root cause so that work with a speech therapist is aimed at eliminating it. When there is a suspicion of damage to the nervous system, the doctor sends for examination to other specialists - a neurologist, psychologist, defectologist. The final conclusion is made by a speech therapist after receiving answers to all the questions posed.
"Technology of speech therapy examination
preschool children"
Purpose of speech therapy examination:
determination of ways and means of correctional and developmental work and opportunities for teaching a child on the basis of identifying violations in his speech sphere.
Tasks:
1) identifying the features of speech development for subsequent consideration when planning and conducting the educational process;
2) identifying negative trends in development to determine the need for further in-depth study;
3) identification of changes in speech activity to determine the effectiveness of pedagogical activity.
Gribova O. E.
identifies 5 stages of speech therapy examination.
Stage 1. Approximate.
Stage 2. Diagnostic.
Stage 3. Analytical.
Stage 4. Prognostic.
Stage 5 Informing parents.
(1991) identified the following stages of speech therapy examination of preschool children:
Stage 1. Orientation stage;
Stage 2. Differentiation stage;
Stage 3. Main;
Stage 4. Final (clarifying stage).
Consider the stages of speech therapy examining which offers
Gribova O. E.
I stage. Approximate.
Tasks of the first stage:
Collection of anamnestic data;
Clarification of the request of parents;
Identification of preliminary data on the individual typological characteristics of the child.
Solving these problems makes it possible to form a package of diagnostic materials adequate to the age and speech capabilities, as well as to the interests of the child. .
Activities:
Study of medical and pedagogical documentation;
Studying the work of the child;
Interview with parents.
Study of medical and pedagogical documentation.
Medical records include :
Medical record of the child;
Extracts from specialists;
Expert opinions.
Pedagogical documentation includes :
Pedagogical characteristics;
Logopedic characteristics;
Psychological characteristic.
Studying the work of the child .
This type of documentation includes:
drawings;
Creative crafts.
Interview with parents.
It is most rational to start a conversation with parents by identifying the parents' request or parents' complaints about the child's speech.
Filling out the questionnaire by parents (mother or father);
II stage. Diagnostic.
The diagnostic stage is the actual procedure for examining the child's speech. At the same time, the interaction between the speech therapist and the child is aimed at clarifying the following points:
What language means have been formed by the time of the survey;
What language means are not formed by the time of the survey;
The nature of the unformed language means.
Thus, we, as speech therapists, will be concerned not only with the shortcomings that the child has in speech, but also with how language means have been formed by the time of the examination.
In addition, we must consider:
In what types of speech activity are shortcomings manifested (speaking, listening);
What factors influence the manifestations of a speech defect.
Methods of speech therapy examination :
* pedagogical experiment;
* conversation with the child;
* supervision of the child;
* the game.
The nature of the didactic material in each case will depend on:
From the age of the child(the smaller the child, the more real and realistic the objects presented to the child should be);
From the level of development of speech(the lower the level of development of the child's speech, the more realistic and real the presented material should be );
From the level of mental development of the child;
From the level of education of the child (the material presented must be sufficiently mastered not by memorization by the child ).
Examination of children of different age groups and different degrees of learning will be built in different ways. However, there aregeneral principles and approaches determining the sequence of the survey.
1.Principle of individual and differentiated approach suggests that the selection of tasks, their formulation and filling with verbal and non-verbal material should be correlated with the level of the child's real psychoverbal development and take into account the specifics of his social environment and personal development.
2. It is rational to conduct research in the direction from general to particular . First, the specialist identifies problems in the development of the child's speech, and then these problems are examined more closely, subjected to quantitative and qualitative analysis.
3. Within each type of testing, the presentation of the material is given from complex to simple. This allows the child to complete each test successfully, which creates additional motivation and a positive emotional state, which, in turn, increases the productivity and duration of the examination.With a standard approach, when each test becomes more complicated as the child is tested, the child is doomed in most cases to "rest" on failure, which causes a feeling of negativity, a feeling of the inevitability of error, and this to a large extent provokes a decrease in interest in the material presented and a deterioration in the achievements demonstrated.
4. From productive types of speech activity - to receptive ones. Based on this principle, first of all, such types of speech activity as speaking are examined.
5. It is logical to first investigate the volume and nature of the use of language and speech units, and only if there are difficulties in using them, proceed to identifying the features of using them in liabilities.Thus, the sequence of the procedure can be formulated as from expressive language competence to impressive. Such an approach will reduce the time and effort spent on the survey, make the survey of an impressive language stock targeted.
Survey directions:
The state of coherent speech;
The state of the vocabulary;
The state of the grammatical structure of speech;
The state of sound pronunciation;
Examination of the syllabic structure of the word;
The state of the articulatory apparatus;
Survey of phonemic perception;
III stage. Analytical.
task the analytical stage is the interpretation of the data obtained and the completion of the speech card, which is a mandatory reporting document for a speech therapist, regardless of his place of work.
The speech map usually contains sections :
Passport part, including the age of the child at the time of the examination;
Anamnestic data;
Data on the physical and mental health of the child;
Section on the characteristics of speech;
speech therapy conclusion.
IV stage.Prognostic.
At this stage, based on the results of the examination of a preschooler, a speech therapist determines the forecast for the further development of the child, the main directions of corrective work with him, and an individual work plan is drawn up.
Forms of implementation of individual routes :
Individual lessons according to an individual plan;
Group classes according to a specific correctional program;
Classes in a group of small occupancy;
Integrated classes in interaction with specialists of preschool educational institutions;
Classes at home with parents with the advisory support of specialists from preschool educational institutions.
Speech therapy conclusion, areas of correctional work and its organizational forms should be communicated to parents and discussed with them at the 5th stage of the survey .
V stage. Informational.
Informing parents is a delicate and difficult stage of examining a child.
It is conducted in the form of a conversation with parents in the absence of a child.
Requirements for informing parents:
The conversation with parents should be based on the terminology available to them;
The conversation should take into account the parent's feelings of love for the child;
The conversation should be built in a constructive direction in order to find allies in the person of the parents.
Consider the stages offered to usG.V. Chirkina and T.B. Filicheva .
I stage. Estimated(where parents are interviewed, special documentation is studied, a conversation with a child ).
II stage. Differentiation stageincluding examination of cognitive and sensory processes in order to distinguish children with primary speech pathology from similar conditions caused by hearing or intelligence impairment .
III stage. Basic.Examination of all components of the language system:
sound pronunciation,
The structures of the articulatory apparatus,
respiratory function,
the prosodic side of speech,
phonemic perception,
understanding words,
Understanding the sentences
Understanding grammatical forms
vocabulary,
The grammatical structure of the language
Skills for constructing sentences
grammatical changes of words in a sentence,
Grammar at the morphological level,
Connected speech.
IV stage. Final (clarifying).Including dynamic observation of the child in conditions of special education and upbringing .
Literature sources used:
1. Gribova O.E. Technology of organization of speech therapy examination. Toolkit. - M.: Iris-press, 2005. - 96 p.
2. Rossiyskaya E.N., Garanina L.A. Pronunciation side of speech: Practical course. - M.: ARKTI, 2003. - 104 p.
3.http://logoportal.ru/logopedicheskie-tehnologii/.html
Question 2. Principles and content of a speech therapy examination of school-age children.
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1 question. Biological and social causes of speech disorders
Speech disorders- a collective term for denoting deviations from the speech norm adopted in a given language environment, completely or partially preventing speech communication and limiting the possibilities of a person's social adaptation. As a rule, they are caused by deviations in the psychophysiological mechanism of speech, do not correspond to the age norm, cannot be overcome on their own and can affect mental development. For their designation, specialists use various, not always interchangeable terms - speech disorders, speech defects, speech defects, speech underdevelopment, speech pathology, speech deviations.
Among the causes of speech disorders, there are biological and social risk factors. Biological causes development of speech disorders are pathogenic factors affecting mainly during fetal development and childbirth (fetal hypoxia, birth trauma, etc.), as well as in the first months of life after birth (brain infections, trauma, etc.). Speech disorders, arising under the influence of any pathogenic factor, do not disappear by themselves, and without specially organized corrective speech therapy work, they can adversely affect the entire further development of the child. In this regard, it is necessary to distinguish between pathological speech disorders and possible speech deviations from the norm caused by age-related features of speech formation or environmental conditions (socio-psychological factors).
Socio-psychological factors risk associated mainly with mental deprivation of children. A negative impact on speech development can be exerted by the need for a child of primary preschool age to learn two language systems at the same time, excessive stimulation of the child's speech development, an inadequate type of upbringing of the child, pedagogical neglect, i.e. lack of due attention to the development of the child's speech, speech defects of others. As a result of these causes, the child may experience developmental disorders of various aspects of speech.
Term "etiology"- Greek and means the doctrine of causes (etio- the reason logos- science, teaching). The problem of causality has long attracted the attention of mankind. The development of etiology as a doctrine of causes is closely related to the general scientific progress of a number of medical and natural disciplines. The concept of "etiology" is a philosophical category, so its connection with the development of philosophy is obvious.
A great contribution to the solution of this problem was made by the studies of the largest Russian pathophysiologist I. V. Davydovsky, who wrote: “Any true meaning goes back to causes, that is, to the concepts of causality and determinism. These are two related, but different concepts, interpreting, on the one hand, about causality, i.e., about causal relationships (this is precisely the meaning of the concept of "etiology"), on the other hand, about the knowledge of the essence, phenomenon, i.e. . regularities that underlie it (determinism in the proper sense of the word).
The problem of the etiology of speech disorders has gone through the same path of historical development as the general doctrine of the causes of disease states.
Even in ancient times, the Greek philosopher and physician Hippocrates (460-377 BC) saw the cause of a number of speech disorders, in particular stuttering, in brain damage.
Another Greek philosopher Aristotle (384-322 BC), linking the processes of speech formation with the anatomical structure of the peripheral speech apparatus, saw the causes of speech disorders in violations of the latter.
Thus, already in the studies of ancient scientists, there were two directions in understanding the causes of speech disorders. The first of them, coming from Hippocrates, gave the leading role in the occurrence of speech disorders to brain lesions; the second, originating from Aristotle, is disorders of the peripheral speech apparatus. At subsequent stages of studying the causes of speech disorders, these two points of view were preserved.
Ideas about the etiology of speech disorders at all stages, the study of this problem reflect the understanding of their essence, as well as the general methodological directions of a certain era and authors. Despite the fact that the role of brain damage in the etiology of speech disorders was suggested as early as four centuries BC. e. Hippocrates, a truly scientific confirmation of it was given only in 1861, when the French physician Paul Broca showed the presence in the brain of a field specifically related to speech, and associated the loss of speech with its defeat. In 1874, a similar discovery was made by Wernicke: a connection was established between understanding and the preservation of a certain area of the cerebral cortex. Since that time, the connection of speech disorders with morphological changes in certain parts of the cerebral cortex has become proven.
The most intensive questions of the etiology of speech disorders began to be developed from the 20s of this century. During these years, domestic researchers made the first attempts to classify speech disorders depending on the causes of their occurrence. So, S. M. Dobrogaev (1922) singled out “diseases of higher nervous activity”, pathological changes in the anatomical speech apparatus, lack of education in childhood, as well as “general neuropathic conditions of the body” among the causes of speech disorders.
M. E. Khvattsev for the first time divided all the causes of speech disorders into external and internal, emphasizing their close interaction. He also singled out organic (anatomical, physiological, morphological), functional (psychogenic), socio-psychological and neuropsychiatric causes.
To organic causes were attributed to underdevelopment and brain damage in the prenatal period, at the time of childbirth or after birth, as well as various organic disorders of the peripheral organs of speech. They singled out organic central (brain lesions) and organic peripheral causes (lesion of the organ of hearing, cleft palate and other morphological changes in the articulatory apparatus). Functional reasons M. E. Khvattsev explained by the teachings of IP Pavlov about violations of the correlation between the processes of excitation and inhibition in the central nervous system. He emphasized the interaction of organic and functional, central and peripheral causes. To neuropsychiatric reasons he attributed mental retardation, impaired memory, attention and other disorders of mental functions.
M. E. Khvattsev assigned an important role to socio-psychological reasons, understanding under them various adverse environmental influences. Thus, he was the first to substantiate the understanding of the etiology of speech disorders on the basis of a dialectical approach to assessing causal relationships in speech pathology.
Great achievements in the field of biology, embryology, theoretical medicine over the past decades, advances in medical genetics, immunology and other disciplines have made it possible to deepen our understanding of the etiology of speech disorders and show the significance exogenous(external) and endogenous(internal) hazards in their occurrence. It is important not only to single out organic (central and peripheral), as well as functional causes of speech disorders, but also to imagine the mechanism of speech disorders under the influence of certain adverse effects on the child's body. This is necessary both for the development of adequate ways and methods for correcting speech disorders, and for their prognosis and prevention.
The cause of speech disorders is understood as the impact on the body of an external or internal harmful factor or their interaction, which determine the specifics of a speech disorder and without which the latter cannot occur.
The question of the role of external and internal factors in the etiology of speech disorders is one of the sections of the general problem of causality. A close relationship has been established between these factors in the occurrence of speech pathology and in the formation of its clinical picture.
In the occurrence of speech disorders, social conditions and factors that contribute to or prevent the occurrence of speech disorders play an important role. For example, when a child develops stuttering, mental trauma is seen as an external cause. Favorable conditions for the onset of stuttering can be the somatic weakness of the child, his neuropathic constitution (increased neuropsychic excitability), the residual effects of an early organic lesion of the central nervous system, age, etc. In different cases, the same factor can play the role of either conditions or the reasons. So, in the above example, the child's age as favorable for the onset of stuttering (the stage of the most intensive development of speech) in combination with constitutional increased neuropsychic excitability can cause stuttering.
The basis for studying the etiology of speech disorders is the evolutionary-dynamic approach and the principle of the dialectical unity of the biological and social in the process of the formation of the psyche. In this aspect, the development of the child's speech activity is determined by the degree of maturity of his central nervous system and largely depends on the characteristics of the child's interaction with the outside world.
The concept of the development of the psyche, developed by L. S. Vygotsky, forms the methodological basis for studying the causes of speech development disorders in childhood. Emphasizing the connection of mental development with the influence of the environment, he introduced the concept of the social situation of development. It is a combination of internal development processes and external conditions that are specific to each age stage.
The maturation of the speech functional system is based on afferentation, i.e., the receipt from the outside world through various analyzers, primarily the auditory analyzer, of various signals, and above all - speech. The source of auditory afferentation is an adult who communicates with a child. In this regard, the role of the speech environment and speech communication is very large, and their insufficiency can be one of the main reasons that disrupt the formation of speech.
Young children brought up in an environment with a limited or defective speech environment (deaf and mute parents or parents with speech defects, prolonged hospitalization, limited social contacts due to various serious illnesses, for example, children with cerebral palsy) lag behind in speech development.
For the normal speech development of a child, communication must be meaningful, take place against an emotionally positive background and encourage him to respond. It is not enough for him just to hear sounds (radio, tape recorder, TV), first of all, direct communication with adults is necessary on the basis of the leading form of activity characteristic of this age stage. An important stimulus for the development of speech is a change in the forms of communication between a child and an adult. Thus, the replacement of emotional communication, characteristic of the first year of life, with object-effective communication at the age of 2-3 years is a powerful stimulus for the development of his speech. If this change in the nature of communication between an adult and a child does not occur, then a lag in the development of speech may occur.
A prerequisite for the development of speech is the child's accumulation of impressions in the process of his object-playing activity, which create the basis for mastering the meanings of words and forming their connection with the images of objects in the surrounding reality.
The development of the child's speech is delayed under adverse external conditions: the absence of an emotionally positive environment, an extremely noisy environment.
Speech develops by imitation, so some speech disorders (unclear pronunciation, stuttering, impaired speech tempo, etc.) may be based on imitation.
Speech disorders often occur with various mental traumas (fear, feelings of separation from loved ones, a long-term traumatic situation in the family, etc.). This delays the development of speech, and in some cases, especially with acute mental trauma, causes psychogenic speech disorders in the child: mutism, neurotic stuttering. These speech disorders, according to the classification of M. E. Khvattsev, can conditionally be classified as functional.
Functional speech disorders also include disorders associated with adverse effects on the child's body: general physical weakness, immaturity due to prematurity or intrauterine pathology, diseases of internal organs, rickets, metabolic disorders.
Thus, any general or neuropsychiatric disease of a child in the first years of life is usually accompanied by a violation of speech development.
Hence, it is legitimate to distinguish between defects in formation and defects in formed speech, considering the age of three as their conditional subdivision.
When evaluating speech disorders in children, it is important to take into account the so-called critical periods, when the most intensive development of certain parts of the speech system occurs, in connection with which there is an increased vulnerability of the nervous mechanisms of speech activity and the risk of violations of its function even when exposed to minor exogenous hazards. In these cases, a critical period in the development of speech is a predisposing condition for the emergence of speech disorders.
There are three critical periods in the development of speech function. The first (1-2 years of life), when the prerequisites for speech are formed and speech development begins, the foundations of communicative behavior are formed and the need for communication becomes its driving force. At this age, the most intensive development of cortical speech zones occurs, in particular Broca's zone, the critical period of which is considered to be the child's age of 14-18 months. Any, even seemingly insignificant, unfavorable factors operating in this period may affect the development of the child's speech.
The second critical period (3 years), when coherent speech develops intensively, there is a transition from situational speech to contextual speech, which requires great coordination in the work of the central nervous system (motor speech mechanism, attention, memory, arbitrariness, etc.). Some mismatch in the work of the central nervous system, in neuroendocrine and vascular regulation leads to a change in behavior, stubbornness, negativism, etc. All this determines the greater vulnerability of the speech system. Stuttering, mutism, lag of speech development may occur. The child refuses verbal communication, there is a protest reaction to the excessive demands of adults.
The stuttering that occurs at this stage may be due to age-related uneven maturation of individual parts of the speech functional system and various mental functions. They are sometimes referred to in the literature as evolutionary, i.e. associated with the age phase of development: for example, "evolutionary stuttering".
Third critical period(6-7 years) - the beginning of the development of written speech. The load on the central nervous system of the child increases. When increased requirements are presented, “breakdowns” of nervous activity can occur with the onset of stuttering.
Any violations of the speech function that the child has during these critical periods manifest themselves most strongly, in addition, new speech disorders may occur. A speech therapist should be well aware of the critical periods in the development of a child's speech and take them into account in his work.
Critical periods of speech development play a role predisposing conditions, they can have both independent significance and be combined with other adverse factors - genetic, general weakness of the child, dysfunction of the nervous system, etc.
The dynamics of the age-related development of speech in the first years of life varies significantly depending on the genotype of the organism and the influence of the environment on it. For the development of the speech functional system, normal maturation and functioning of the central nervous system are necessary.
plays an important role in the development of speech disorders exogenous organic factors. This group of reasons, according to the classification of M. E. Khvattsev, can be attributed to the group organic centerpieces, with brain damage, and organic peripheral, if, under the influence of various unfavorable intrauterine factors, the morphological development of the peripheral speech apparatus is disturbed.
Under the exogenous-organic factors understand the various adverse effects (infections, injuries, intoxication, etc.) on the central nervous system of the child and on his body as a whole. Depending on the time of exposure to these factors, there are intrauterine pathology, or prenatal (exposure during fetal development); birth injury(catal pathology) and exposure to various harmful factors after birth (postnatal pathology). Intrauterine pathology is often combined with damage to the child's nervous system during childbirth. This combination in modern medical literature is denoted by the term "perinatal pathology". Such lesions of the nervous system unite various pathological conditions caused by the impact on the fetus of harmful factors in the prenatal period, during childbirth and in the first days after birth. Perinatal pathology can be caused by diseases of the mother during pregnancy, infections, intoxications, toxicosis of pregnancy, as well as a variety of obstetric pathologies (narrow pelvis, protracted or rapid labor, premature discharge of water, cord entanglement, abnormal presentation of the fetus, etc.). Obstetric manipulations are also important, which can damage the fetal nervous system.
The leading place in the perinatal pathology of the nervous system is occupied by asphyxia and birth trauma.
The occurrence of intracranial birth trauma and asphyxia (oxygen starvation of the fetus at the time of birth) is facilitated by a violation of intrauterine development of the fetus. Birth trauma and asphyxia exacerbate fetal brain development disorders that occurred in utero. Birth trauma leads to intracranial hemorrhage and death of nerve cells. intracranial hemorrhage can also capture the speech zones of the cerebral cortex, which entails various speech disorders of cortical genesis (alalia). In premature babies, intracranial hemorrhages occur most easily as a result of the weakness of their vascular walls.
With the localization of brain damage in the area of structures that provide the speech-motor mechanism of speech, there are predominant violations of its sound-producing side - dysarthria.
In the etiology of speech disorders in children, a certain role may play immunological incompatibility of maternal and fetal blood(by Rh factor, ABO system and other erythrocyte antigens). Rhesus or group antibodies, penetrating the placenta, cause the breakdown of fetal red blood cells. As a result, a substance toxic to the central nervous system is released from erythrocytes - indirect bilirubin. Under its influence, the subcortical parts of the brain, the auditory nuclei are affected, which leads to specific violations of the sound-producing side of speech in combination with hearing impairments.
At intrauterine brain injury most severe speech disorders combined, as a rule, with other polymorphic developmental defects (hearing, vision, musculoskeletal system, intelligence). They can be observed when a pregnant woman becomes ill with rubella, cytomegaly, toxoplasmosis and other viral infections. At the same time, the severity of speech disorders and other developmental defects largely depends on the time of brain damage in the prenatal period. The most severe damage occurs in the first trimester of pregnancy, as well as during the entire period of embryogenesis, i.e. from 4 weeks to 4 months of pregnancy.
Pathological effects in the late stages of pregnancy usually do not cause severe malformations, but lead to a delay in the maturation of the nervous system, to a violation of the myelination of its structures.
In children with anomalies and malformations of the brain, multiple, so-called dysembryogenetic stigmas in the form of asymmetry of the skull, anomalies of the palate(high "Gothic" palate, flattened palate, split lip), defects in the development of the upper jaw, aplasia of the lower jaw, micrognathia, prognathia and others. An example of speech disorders that occur under the influence of adverse factors on a developing fetus can be open rhinolalia, due to congenital cleft palate.
Infectious and somatic diseases of the mother during pregnancy can lead to uteroplacental circulation disorders, nutritional disorders and oxygen starvation of the fetus. If chronic oxygen starvation of the fetus is not pronounced, it may not disturb, but somewhat slow down the rate of fetal maturation. As a result, during a full-term pregnancy, a child is born immature, with a weakened nervous system, the processes of myelination of the nervous system are slowed down, the differentiation of nerve cells and their axons is impaired, and the formation of interneuronal connections of the brain is difficult. These factors also influence the formation of speech activity.
Violations of intrauterine development of the fetus - embryopathies- may occur in connection with viral diseases, medication, ionizing radiation, vibration, alcoholism and smoking during pregnancy. The adverse effect of alcohol and nicotine on offspring has been noted for a long time.
Recently, the clinical picture of oligophrenia of alcoholic-embryopathic origin, combined with speech disorders, has been studied, and the influence of chronic alcoholism on the occurrence of various speech defects has been shown. An alcoholic embryopathic syndrome is described, including a lag in physical, speech and mental development, and craniofacial deformities.
With alcoholic embryopathic syndrome, mild hearing impairments were noted, which also adversely affects the development of the child's speech.
With parental alcoholism, there is a higher incidence of fetal death in the prenatal and perinatal periods, prematurity, intrauterine and intranatal asphyxia, as well as higher morbidity and mortality in children in the first years of life.
In the preschool and school period, these children draw attention to themselves with general physical weakness, mental retardation with manifestations of general underdevelopment of speech, motor disinhibition, impaired active attention, visual and auditory perception. They combine increased distractibility with low cognitive activity, personal immaturity, and learning difficulties. Currently, many works are devoted to the adverse effects of smoking on the reproductive function of women, as well as on the course of pregnancy and childbirth. The relationship of smoking with prematurity, lagging behind children in physical and mental development is shown.
A combination of a number of unfavorable factors that act during its intrauterine development (the combination of alcoholism and smoking with toxicosis of pregnancy, with various chronic and acute viral diseases of the mother, etc.) has a particularly harmful effect on the development of the fetus.
Toxicosis of pregnancy, prematurity, short-term asphyxia during childbirth cause mild minimal organic brain damage (children with minimal brain dysfunction - MMD). They are characterized by lack of attention, memory, motor disorders, disinhibition, various speech disorders.
At present, with mild cerebral insufficiency, a special type of mental dysontogenesis is distinguished, which is based on the superior age-related immaturity of individual higher cortical functions. It causes a kind of lag in the development of speech and uneven mental development, which determine the specific difficulties in teaching these children.
With minimal brain dysfunction, there is a delay in the rate of development of the functional systems of the brain that require integrative activity for their implementation: speech, behavior, attention, memory, spatio-temporal representations and other higher mental functions.
Children with minimal brain dysfunction are at risk for developing speech disorders. Their timely detection and early stimulation of mental development can significantly improve the speech and mental prognosis of this category of children. A speech therapist and a speech pathologist need to know the early manifestations of the syndrome of minimal brain dysfunction.
The main manifestations of this syndrome in the first year of life are the so-called "small neurological signs": in infants, these are mild muscle tone disorders that usually do not interfere with active movements, but are persistent; unsharply expressed involuntary movements in the form of a tremor, general shudders; delayed sensorimotor development (especially hand-eye coordination); lag in the development of fine differentiated movements of the fingers, the formation of object-manipulative activity; delay in preverbal and initial verbal development. All these signs are combined with mild neurological symptoms.
Speech disorders are more common in males. Recent studies have shown a difference in the development of the right and left (speech) hemispheres (hemispheres) depending on gender. The left hemisphere performs mainly the speech function, and the right hemisphere - visual-spatial gnosis. Boys develop their right hemisphere faster than girls. In girls, on the contrary, the left hemisphere develops faster, and therefore they have earlier periods of speech development. In addition, a more pronounced interhemispheric interaction is formed earlier in girls, which contributes to better compensation for brain damage in them.
In addition, the reason that determines the predominance of speech disorders in males may be intellectual and speech disorders associated with specific changes in the structure of the X chromosome.
In the occurrence of speech disorders in children, an important role is played by early organic lesions of the brain, combined with unfavorable conditions for the upbringing and environment of the child in the first years of his life.
Of great importance is emotional deprivation (lack of emotionally positive contact with an adult).
Particular attention is paid to violations of the relationship between mother and child in the first years of life. It is known that normal preverbal development in the first year of life, which is important for the formation of speech function, is possible only with adequate interaction of the child with his mother or another person close to him.
Speech disorders can also occur as a result of the impact of various adverse factors on the child's brain and at subsequent stages of its development. The structure of these speech disorders is different depending on the time of exposure to harmfulness and localization of brain damage.
When the immature brain is damaged, there is no complete correlation between the localization, severity of the lesion, and long-term consequences in terms of speech disorders. Already almost a hundred years ago, it was shown and then confirmed by subsequent studies that congenital or early acquired damage to the left hemisphere in children does not lead so often to cortical speech disorders (alalic or aphasic, depending on whether the damage occurs in the pre-speech period or in the period already formed speech), as is the case with similar injuries in adults. It is known that skull injuries in a child with developed speech cause aphasia much less frequently than in an adult. Brain plasticity is largely determined by the immaturity of brain structures. This explains the lack of a clear correlation between the severity and localization of brain damage in a child and the incidence of speech disorders. There are indications in the literature that even complete removal of the left hemisphere in a young child may not cause specific speech disorders. This is due to the plasticity of the child's brain and the more diffuse presence of speech areas in the immature brain of the child, which are more common in both hemispheres. There is an inverse relationship between the plasticity of the nervous system and the degree of myelination of neurons: the less myelination, i.e., the less their maturity, the greater their plasticity.
This is manifested in the fact that the axon of a nerve cell, which cannot form a synapse (a special formation that communicates between nerve cells) on its damaged side, can form it in a healthy hemisphere. But on the other hand, it is possible only if the myelination of the cortical parts of the brain is not yet complete and not all synaptic formations in the healthy hemisphere have already been formed.
Unilateral damage to the cerebral cortex in a young child leads to qualitatively different disorders than in adults. If in adults aphasia usually occurs with damage to the dominant left hemisphere, then in children they often occur with bihemispheric damage, in addition, even damage to the right (usually subdominant) hemisphere can cause significant impairment of speech development.
Thus, when assessing the role of an exogenous-organic factor in the occurrence of speech disorders in childhood, it is necessary to take into account: the time, nature and localization of damage, the characteristics of the plasticity of the child's nervous system, as well as the degree of formation of speech function at the time of brain damage.
Hereditary factors also play a certain role in the etiology of speech disorders in children. Often they are predisposing conditions that are realized in speech pathology under the influence of even minor adverse effects.
In some cases, hereditary factors act as the leading causes. So, for example, the literature provides evidence that rhinolalia caused by a cleft palate in 10-30% of cases can be associated with hereditary factors (P. G. Svetlov, 1962; A. Ya. Piskunov, 1960, etc.) . According to A. E. Gutsman (1980), the frequency of hereditary forms of rhinolalia is only 1.31%.
According to S. A. Gridnev (1976), hereditary burden among stutterers is 17.5%. The role of hereditary factors in the occurrence of writing disorders (dysgraphia, dyslexia) is noted.
Hereditary factors in the occurrence of speech disorders usually act in combination with exogenous organic and social factors. They can also play a leading role in the occurrence of certain types of speech disorders, combined with general changes in the nervous system. These are speech disorders observed in chromosomal syndromes and hereditary degenerative diseases of the nervous system, which constitute a special group of so-called secondary speech disorders. Their features are determined by the disease itself.
Chromosomal syndromes (or chromosomal diseases) are congenital and usually do not have a progressive course. In almost all chromosomal syndromes, there is a lag in the physical and neuropsychic development of the child, and the development of speech is also impaired to one degree or another.
Chromosomal syndromes are divided into two groups: syndromes associated with a change in the number or structure of autosomes, and syndromes caused by changes in the sex chromosomes. The most pronounced disorders of speech development and speech disorders are observed in the first group of syndromes. They are usually combined with intellectual insufficiency, severe malformations and developmental anomalies. An example is speech disorders in Down's disease, which are found in a late manifestation with a significant underdevelopment of speech.
Particular attention in recent years around the world has attracted the problems of speech disorders in children with specific changes in the structure of the X chromosome (fragile or fragile X chromosome syndrome), which are usually combined with manifestations of varying degrees of mental retardation observed mainly in boys. Speech disorders in this syndrome are polymorphic: general speech underdevelopment, dysarthria, and sometimes stuttering. Characteristic is the accelerated rate of speech, combined with perseverations; as well as motor disinhibition, affective disorders.
Hereditary-degenerative diseases of the nervous system conditioned changes in genetic information. They are based on gene mutations, leading to a violation of the synthesis of certain structural proteins or enzymes, which causes various disorders.
Syndromes of speech disorders are observed in many hereditary metabolic diseases. The first sign of impaired neuropsychic development of a child is often various speech disorders.
Specific speech disorders are also observed with phenylketonuria- a hereditary disease caused by a violation of the metabolism of phenylalanine, and other hereditary metabolic diseases. All these speech disorders are considered as syndromes in the structure of hereditary metabolic diseases of the nervous system. Early therapeutic nutrition can largely prevent the severe course of the disease, the subsequent decline in intelligence and underdevelopment of speech.
It is important for a speech therapist to remember the possibility of such diseases, the need for their early diagnosis and treatment, it is advisable to refer children with suspicions of this pathology to medical genetic counseling.
So, etiological factors, causing speech disorders complex and polymorphic. The most common combination hereditary predisposition, unfavorable environment and damage or violations of brain maturation under the influence of various adverse factors.
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