The basics of pronunciation of sounds, the formation of vocabulary, and familiarity with grammar occur through the process of imitating the conversation of surrounding people. If a child does not pay attention to speech addressed to him, this indicates a violation of phonemic hearing.
Diagnosing the deviation is difficult because at an early stage of development, children still speak incomprehensibly or are mostly silent. Understanding speech itself means that a person grasps the connection between the name of an object and its function or action. At an early age, the baby does not realize this. His communication with the people around him is based on imitation, the example of adults, and analysis of intonation. And this is the norm. This is how a passive accumulation of vocabulary occurs, as if in reserve. From the age of 1.5-2 years, the baby can already name objects and describe their purpose in a few words. From the age of 2-3 years, understanding of speech comes due to created situations, imagination works well.
What does speech sound like for such children?
Sometimes it seems to parents that the child understands what they are saying, but in reality this is not confirmed by anything. From the point of view of language, speech is a set of signs that have a certain meaning.
For the children we are talking about now, speech is a general noise signal to which they get used to reacting in one way or another. For example, how an animal comes running to its owner if you say his name, jingle his leash, or rattle his bowl, because he gets used to the fact that if a certain sound is heard, he will be given a treat, taken for a walk, or fed. So it is here: speech for such children is nothing more than a habitual reaction to a stimulus, and not a meaningful and voluntary perception of addressed speech.
If you pronounce a word that sounds similar but has a different meaning, the reaction to it will be the same. If an unfamiliar interlocutor appears nearby or at least the familiar wording of phrases changes, they will cause obvious confusion in the child. This phenomenon is called addressed speech recognition disorder.
In the international classification of diseases, receptive language disorder (that is, impaired understanding of spoken speech) is allocated to a separate category (F80.2) and is contrasted with autism (F84). That is, it is assumed that although receptive speech problems occur in autism, they should be distinguished from an isolated disorder of language development, called “receptive speech disorder” (apparently, the term “sensory alalia” is used by speech therapists in the post-Soviet space to designate precisely this speech disorder). The term “receptive speech” , in fact, has a broader meaning and includes any processes of perception and understanding of speech, as opposed to the concept of “expressive speech ,” that is, speaking. As is often the case in medical terminology, some confusion occurs when the name of the disorder—“receptive language disorder”—is equated with any comprehension problems that occur in various types of developmental disorders, including autism.
What significance can all of the above have for the rehabilitation of children?
- Children with autism and children with receptive language disorder have a number of similar behavioral symptoms, however, rehabilitation of children with receptive language disorder and children with autism has its own characteristics. Therefore, a correct and timely diagnosis is a necessary condition for effective corrective work. A speech therapist who suspects a child has problems understanding speech may not take into account the peculiarities of his behavior, as well as other symptoms characteristic of autistic disorders, since he is not an expert in the field of child psychiatry. Parents can spend a long time focusing their efforts exclusively on speech therapy correction, without paying attention to the formation of social skills and adaptive behavior, which are impaired in autism. In addition, the speech therapy diagnosis “sensory alalia” or “sensorimotor alalia” is psychologically easier for parents to perceive and can “lull” their vigilance regarding possible autism for a long time. Overdiagnosis causes no less harm, when one or two similar symptoms occurring in various developmental problems are an argument for making a diagnosis of autism.
RULES FOR INTERACTION WITH A PRESCHOOL CHILD WITH RECEPTIONAL SPEECH DISORDER
Carefully observe how the child reacts to addressed speech (ignores, gets lost, does not do what is asked; watches gestures and facial expressions; does not always respond to his name, “he sometimes hears, sometimes he doesn’t hear”; understands his mom). Reduce the intensity of verbal appeals to the child and observe the following rules:
- look into the child’s face and make sure that he understands that you are addressing him;
- say only what is relevant to this specific situation (for example, “we’ll eat!”);
- “discuss” information related to the child’s recent experience (“we were walking,” “we went to the store”);
— the appeal must contain the minimum number of required words;
- in the same situations, use the same wording of verbal statements (for example, “Let’s go for a walk!”, but not “We’ll go for a walk later today!”, or “Let’s go for a walk with the kids!”);
— words must be pronounced clearly, loudly enough, accentuated, but using natural intonation;
- if necessary, reinforce by pointing to an object when naming it or demonstrate an action;
— it is necessary to expand the vocabulary only with those words that denote objects and actions from the child’s real life;
— use for viewing and commenting children’s books or pictures with bright, realistic drawings, preferably reflecting the child’s visual experience;
- do not use contextual information (fairy tales, abstract texts and expressions), because Such information is almost impossible to support with additional techniques that improve understanding. For example, how can you “demonstrate” “Kolobok” to a child, explain the expression “I scraped the bottom of the barrel” or “Once upon a time”?
- do not leave the child near the switched-on TV, as he will simply repeat in the future the fragments from films and commercials he has heard and “imprinted” without understanding their meaning, which will make it difficult to work with him to improve his understanding of speech.
- Helping a child with receptive speech impairment should be woven into the daily life of the family. The daily routine should be organized in accordance with age standards (sleep time, meals, etc.) and be stable from day to day. This mode is the basis for the child’s feeling of safety and predictability of events, which is extremely important for adaptation in case of speech understanding disorders. Each event or action of the daily routine should be accompanied by the same speech commentary (its volume and content depend on the degree of impairment of understanding - the more pronounced the problem, the more concise). Of particular importance is the formation of an understanding of simple requests and appeals: “give me...”; help your child express his desire (“Mom, give me some water”, “I’m thirsty”). When speaking for him, demonstrate how this should be done using other family members (“Dad, give me bread!”, “Here, Mom, bread!”); It is necessary to constantly support the child, help, show patience, and in no case should you scold the child for the wrong reaction to verbal requests.
When a diagnosis of receptive speech disorder is made at an early age and adequate correctional support is provided, in most cases the problem can be compensated for until complete recovery.
Why doesn't the child understand speech?
Children with impaired speech recognition resemble children with diagnosed autism spectrum disorder (ASD) in their behavior. Since they do not understand spoken speech, it turns out that they grow up, as it were, in a speech vacuum. Their speech does not develop at all, because children learn to speak by imitating adults, but how to do this if speech sounds are perceived as general noise?!
This seriously affects the overall development of the child. Emotional and communicative aspects, mental development, and behavior suffer. Such children are usually hyperactive, their mood often changes, and they do not know how to control their emotions. All this happens due to the fact that they do not even have internal speech, although it is present, for example, with motor alalia.
Features of speech formation in children with mental retardation
The development of speech characteristics in mentally retarded children is characterized by a significant delay in speech development and underdevelopment of all components. The formation of speech skills in such children occurs with great delay and abnormalities. All aspects suffer, and the most damaged is semantics.
Psychological and pedagogical characteristics of children with mental retardation
Mental retardation is not classified as a specific condition or disease. Such children are characterized by significant deviations in the development of motor skills. They begin to walk, sit, stand much later, the child’s ability to get acquainted with surrounding objects and navigate in space decreases, and they also begin to respond to words and requests very late.
On a note! Memory, thinking, and speech skills develop with large deviations. Indecision and lack of emotionality are noticeable in actions.
Features of speech
The speech development of mentally retarded children occurs in a unique way and with great delays. They come into emotional contact with relatives late and not as actively as ordinary children. Many mentally retarded children speak their first words at age 3. As a result of the delay, children interact poorly with adults and peers.
Phonetic and intonation-expressive aspects of speech
A common speech disorder among children with mental retardation is erased dysarthria. This deviation manifests itself in disorders of the phonetic and intonation-expressive components. At the same time, children experience illegibility, slurredness and lack of emotional picture.
Improving intonation expressiveness
Features of the dictionary and speech regulation of children’s activities
In mentally retarded children, speech is considered as a special type of activity and cognitive process. Speech deficiencies in such children are very common, so it needs to be developed systematically.
On a note! It is important to understand all the features of the dictionary and correctly regulate speech activity, as well as what type of reading is typical for children with speech impairments.
Endogenous and exogenous causes of underdevelopment
Endogenous or exogenous factors lead to disturbances in the mental or physical development of children.
Endogenous diseases include certain diseases, both hereditary and acquired. Exogenous causes include injuries, poisoning and infectious diseases of the mother during pregnancy, as well as malnutrition and Rh conflict.g
If signs indicating a delay in speech development appear, you must immediately seek help. Only in this case can the deviation be compensated for as quickly as possible.
After making a diagnosis and prescribing treatment, you must follow all recommendations and be sure to supplement the work of the defectologist with medication and physiotherapeutic treatment. In combination, all of the above activities will help correct the situation and allow the child to fully use their own capabilities.
Why does a child hear but not understand speech?
Infants under one year of age first develop the ability to perceive sounds made by objects and animals; they are called non-speech. Children distinguish their volume, rhythm, tonality, melody, and also determine their source. The temporal cortex of the right hemisphere of the brain is responsible for this. This lays a kind of foundation for understanding speech sounds, which have a specific meaning that does not depend on intonation and source. Therefore, it is very important that infants hear as many different sounds around them as possible. As a result, the baby develops onomatopoeia, a precursor to speech.
At 12-14 months, when the secondary fields of the temporal cortex of the left hemisphere begin to function, the child learns to isolate speech sounds from the general noise stream. He begins to imitate the voices that he hears from adults: these are vowels, interjections, simple words that have a specific objective meaning: “mom”, “woman”, “dad”. This stage is called the maturation of speech auditory gnosis.
Further, when the tertiary fields of the temporal cortex mature, the child begins to distinguish shades of the meaning of a word, actively replenishes his vocabulary, where words are already linked into associative series and are not strictly tied to one specific object, and polysemy appears. Thus, the child masters his native language. Only humans have tertiary fields of the temporal cortex. As you can see, each stage of the formation of speech auditory perception is the basis for the next one, and if a serious failure occurs at one of them, then the entire mechanism is disrupted.
Diagnostics show that in such children the auditory signal simply does not reach the desired part of the brain. In other words, they have mild sensorineural hearing loss, which was simply not detected immediately.
Causes
The reasons for misunderstanding of spoken speech lie in damage to the areas of the brain that are responsible for analyzing speech sounds. This area is called Wernicke's center and is located in the posterior third of the superior temporal gyrus of the left hemisphere (however, this is not the only area of the brain that is responsible for speech and its understanding). Lesions occur early in development, often during pregnancy, and are caused by:
- Intrauterine pathologies – hypoxia, hypotropia, intrauterine infections;
- Damage to the central nervous system during childbirth - operations, rapid or protracted labor, a long anhydrous period;
- Trauma and tumors in infancy.
What should parents do?
If you suspect that the child does not understand speech, you need to show him to an otolaryngologist and neurologist and undergo a series of diagnostic procedures.
- Computer audiometry (CAA) records the conductivity of the auditory signal precisely through the structures of the brain, that is, how the corresponding part of the brain reacts to sound. A regular audiogram shows only the state of physiological hearing.
- EEG (electroencephalogram) also provides up-to-date information about the functioning of the brain.
- Ultrasound scanning of the vessels of the neck and head shows the patency of blood vessels and the level of blood supply to brain cells.
It is also important to consult a psychiatrist to exclude or prevent mental disorders in the development of the baby. The level of development of the cognitive sphere and speech is assessed by a defectologist or speech therapist. Their help is required throughout the treatment. They help the child form an idea of the world around him, master his native language, and establish meaningful communication with peers and adults. Practice shows that if a violation occurred at the first and second stages of the formation of speech auditory perception, then classes using the Tomatis method are most effective.
Diagnostics
Patients with impressive speech disorders require comprehensive neurological, audiological, speech therapy, psychological and psychiatric diagnostics, consultation with relevant specialists:
- Neurological examination.
At an appointment with a neurologist, perinatal risk factors and features of early development of children are clarified; In all patients, the current neurological status is determined. To understand the etiology of speech disorders, instrumental diagnostics are prescribed: cerebral MRI scanning, MR arteriography of the brain, EEG, ultrasound scanning of the vessels of the head and neck. - Examination of auditory function.
To exclude hearing loss as the main factor in misunderstanding speech, acoustic EPs, an audiogram are examined, acoustic impedance measurements are performed, and CT scans of the temporal bones are performed. Along with an examination by an otolaryngologist, a consultation with an audiologist is carried out. - Neuropsychological testing.
Involves the study of higher mental functions (memory, perception, thinking), auditory-verbal memory. During diagnosis, attention is paid to the state of various types of gnosis and praxis. A conclusion is made about the patient's cognitive abilities. - Speech therapy examination.
When analyzing speech function, the speech therapist conducts an in-depth study of impressive speech. Evaluates the patient's understanding of situational and extra-situational questions, verbal instructions, and complex prepositional phrases. Examines phonemic awareness, meaningful reading ability, and expressive language. - Consultation with a psychiatrist.
Necessary for assessing the patient’s mental status, excluding congenital forms of MR, acquired dementia, and ASD. The methods used are conversation, observation, pathopsychological examination, neurotests.
Logotherapy
How should parents communicate with their child?
- When talking, use the simplest phrases of 2-3 words, for example, “eat porridge”, “give me your hand”, “go to bed”.
- When executing a command, first demonstrate in parallel what needs to be done so that the child connects your words with a specific action or object. When he understands it well, give up such tips.
- Talk through all your actions. For example, while eating, say “eat porridge,” etc. When using one or another object, name it several times.
It is extremely important to exclude unnecessary noise from the baby’s environment: TV, tablet, musical toys. Enter a quiet mode at home. This will awaken your child's natural interest in the world around him and its sounds.
Publication date: 03/30/2020. Last modified: 08/06/2020.
