“Accept and live life to the fullest”: advice to parents of children with disabilities

Alalia is an insufficiency (deficiency) of speech that is not associated with somatic hearing or intellectual impairments. It occurs against the background of damage to the speech lobes of the brain during childbirth or in the prenatal period.

The most severe degrees of the disease are manifested by a complete lack of speech or incoherent babbling. A mild degree of impairment is characterized by difficulties in mastering writing and reading skills, a limited vocabulary and other deviations in the use of speech structures.

Types of alalia

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

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

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

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

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

“Accept and live life to the fullest”: advice to parents of children with disabilities

A child with a disability was born into the family. The familiar world for parents is turned upside down and becomes different. People who have never encountered such a problem before sometimes do not know who to contact, where to go, and waste precious time. Chairman of the Public Council for Young Disabled People 18+ at the Department of Labor and Social Protection of the Population of the City of Moscow, expert of the Council of Trustees in the Social Sphere under the Government of the Russian Federation and Chairman of the Council of the Moscow City Association of Parents of Disabled Children (MGARDI) Yulia Igorevna Kamal answers the most important questions about what the first steps of parents should be so as not to miss the opportunity to rehabilitate their child.

— A child with a disability was born into the family. This is a lot of stress, both physical and psychological. What should a family do to avoid missing out on time and the opportunity for recovery? Where to turn for help first?

— The fact is that it is extremely rare that disability is diagnosed in the first year of life. And here, first of all, doctors will be able to help the baby, and both social service employees and non-profit organizations, such as MGARDI and others, will be able to help the family. It is worth noting that under the word “help” lies a huge and diverse complex. And only by combining the efforts of all organizations can we count on success.

It is very important for a structure such as the Early Help Service to work in our city. So far, such a service is available only at the Scientific and Practical Center for Medical and Social Rehabilitation of Disabled People named after L. I. Shvetsova and the Butovo Center for Comprehensive Rehabilitation of Disabled People. It is very important to develop this direction; an interdisciplinary team of specialists should get involved as early as possible and help not only the child, but the whole family.

Julia Kamal. Photo: Website of the Moscow City Duma duma.mos.ru

— What social services are provided to children with disabilities free of charge? How can the state help the family?

— Support measures are very diverse. In addition to federal measures, each region implements its own regional projects. In Moscow, this means not only payments, but also on-site rehabilitation, recreation and wellness, tax breaks, free travel on public transport, financial measures of additional support and much more. Parents often contact us with this question, and we inform them about all aspects of assistance in the city. MGARDI and ROO “Contact” have been implementing the “Parental Reception” project for several years: parents of children with disabilities address their problems, and our organizations help solve them. For five years now we have been holding an annual Congress of families raising children with disabilities and young people with disabilities. At the Congress there are consultation platforms for executive authorities, where everyone can get help in solving their problem. In parallel, discussions and round tables are held where systemic problems are discussed and ways to solve them are outlined.

— You often communicate with families raising a child with a disability. From your experience, what advice could you give to families to avoid emotional burnout?

— It’s easiest to give advice, but you need to understand that everyone has their own path and their own views. In my opinion, the most important thing is to love a child, learn to understand him and enjoy any successes, even the most seemingly insignificant ones. A special child is not a reason to stop living life to the fullest. Yes, life will change, and all the good in these changes depends only on ourselves. You need to accept and live a full and happy life.

— There are rehabilitation and educational centers in Moscow. Should parents strive to send their child there or should they make every effort to ensure that he or she attends a regular school? What is the best thing to do from a physical and psychological point of view?

— You only need to strive to ensure that the child is comfortable receiving knowledge to the extent of which he is capable. And where he gets them is the parent’s choice. All children are different, some feel great in inclusion, while others are more successful in a rehabilitation center. It is important that such centers exist in Moscow. I would like this unique experience to be replicated in the regions.

— In your opinion, how important is interaction with government agencies?

— It’s very important, without this not a single project will work, not a single idea will eventually become a document. The ability to conduct a dialogue, hear, listen and look for solutions together is the main thing.

— What issues did MGARDI manage to resolve last year?

— I would like to tell you something global: we have many issues that may not be important on a city scale, but on the scale of one family, on the contrary, are extremely important. Ramps, education, drug supply, legal issues: we deal with all this year-round. However, the biggest issue is the decision of the Ministry of Labor to cancel the requirement to submit electric wheelchairs and devices for medical and technical examination after the expiration of their use, as well as to confirm compliance in the case of independent purchase. Accordingly, all those who previously received a refusal due to the impossibility of submitting the above-mentioned technical means of rehabilitation for medical and technical examination due to their loss, disposal or non-compliance of the purchased product can apply again with an application for issue or compensation. Only prostheses with external energy sources remain on the list. Non-profit organizations have become involved in resolving this issue. Through joint efforts we managed to achieve this result.

— On June 8, Russia celebrated Social Worker Day. What would you like to wish to your colleagues from social protection?

— I want to wish all social workers health and happiness! May all good deeds return to them a hundredfold! Thank you for having us!

Press service of the Department of Labor and Social Protection of the Population of Moscow

Symptoms

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

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

Motor alalia is characterized by:

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

Symptoms of sensory alalia:

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

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

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

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

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

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

Medical and social examination

Speech is the highest mental function, characteristic only of humans. Speech and language developmental disorders - ICD-10 categories: F70-72; F 80.0 - .1 - 80.2; F80.81; F81.1; F98.5-98.6; R47.0-47.1; R49.0-49.1-49.2

The norm of speech refers to the generally accepted options for using language in the process of speech activity. For normal speech and its development in a child, it is necessary: ​​normal structure and function of the central nervous system and speech centers; normal condition of the organs of voice and speech formation (larynx, pharynx, oral cavity, respiratory apparatus, etc.); normal hearing, which is necessary not only for perceiving and imitating the speech of others, but also for controlling one’s own speech.

Briefly, the following types of speech can be distinguished: oral speech, among which there are sensory (impressive) speech associated with the perception and understanding of speech and motor (expressive) speech associated with the pronunciation of speech sounds by a person; written language related to writing and reading.

The following semantic concepts are distinguished in speech pathology:

1. General speech underdevelopment (GSD) is a variety of complex speech disorders in which the formation of all components of the speech system is disrupted: the sound side (phonetics) and the semantic side (vocabulary, grammar) with normal hearing and intelligence.

Degrees of severity of general speech underdevelopment (Table 83).

Level 1 OHP: complete absence of speech or the presence of only its elements (babbled words, onomatopoeia, sound complexes) at an age when speech is mostly formed in normally developing children. Understanding of the addressed speech is incomplete.

Level 2 OHP: phonetically and grammatically distorted phrase, sentences of simple construction of 2-4 words. Speech understanding is incomplete. Polymorphic disorder of sound pronunciation, the presence of a large number (16-20) unformed sounds.

Level 3 OHP: the presence of relatively developed phrasal speech with elements of lexico-grammatical and phonetic-phonemic underdevelopment. Vocabulary includes all parts of speech. Understanding of spoken speech is approaching normal. Minor impairment of sound pronunciation.

Level 4 OHP: extensive phrasal speech with minor changes in all components of the language (vocabulary, phonetics, grammar), which most often appear in the process of performing special tasks. Full understanding of the addressed speech.

Table 83

Degrees of severity of general speech underdevelopment and approximate degrees of dysfunction

Levels of general speech underdevelopment

Approximate formulations of a speech diagnosis when referred to ITU: “General speech underdevelopment (level I). Motor alalia (sensory alalia, sensorimotor alalia)"; “General speech underdevelopment (level II). Erased pseudobulbar dysarthria"; “General speech underdevelopment (III level). Exit from motor alalia.”

2. Systemic underdevelopment of speech (SSD): speech disorders in which the formation of all components of the speech system is disrupted: the sound side (phonetics) and the semantic side (vocabulary, grammar) in children with mental retardation and organic damage to the central nervous system (Table 84).

Table 84

Degrees of severity of systemic underdevelopment of speech and approximate degrees of dysfunction

Approximate formulations of a speech diagnosis when referred to an ITU: “Systemic underdevelopment of moderate speech in mental retardation. Erased form of pseudobulbar dysarthria. Complex form of dysgraphia (acoustic dysgraphia, dysgraphia due to impaired language analysis and synthesis)”, “Mild systemic speech underdevelopment with mental retardation, Mechanical dyslalia. Agrammatic dyslexia and dysgraphia.”

2. Delayed speech development - a slowdown in the normal rate of speech development of a child up to 3-4 years of age, when certain mental (memory, attention, thinking) and language functions, as well as the function of intelligence, lag behind in their development from accepted psychological norms for a given age, but intellectual the deficiency does not reach the level of dementia

3. Phonetic-phonemic underdevelopment (FFN) - this category includes children with normal physical hearing and intelligence, who have impaired pronunciation of speech and phonemic hearing, i.e. hearing, which allows you to distinguish and recognize phonemes (sounds) of your native language.

Approximate wording of a speech diagnosis when referred to an ITU: “Phonetic-phonemic speech disorder. Sensory functional dyslalia. Dysgraphia based on impaired phoneme recognition”, “Phonetic-phonemic speech disorder. Erased pseudobulbar dysarthria.”

The main speech syndromes with phonetic-phonemic speech underdevelopment: dyslalia, dysarthria, rhinolalia, voice disorders; violations of written speech.

Degrees of severity of phonetic-phonemic underdevelopment of speech: mild degree: insufficient discrimination and recognition of only those sounds whose pronunciation is impaired; medium degree: insufficient discrimination of a significant number of sounds from different phonetic groups with their pronunciation relatively formed; deep phonemic underdevelopment, when the child is practically unable to isolate them from words or determine the sequence of sounds in a word.

4.Lexico-grammatical underdevelopment of speech (LGSD): limited vocabulary, violation of the grammatical structure of speech in children with normal sound pronunciation and relatively intact phonemic processes;

5. Speech decay - loss of existing speech and communication skills due to local or diffuse brain damage.

These concepts are speech therapy terms and should be reflected in the speech therapist’s conclusion when referred to MSE (indicating their degree of severity).

After three to four years of age, it is necessary to determine the specific type of speech disorder and the structure of the speech defect in a child.

All types of speech disorders are divided into 2 main groups: oral speech disorders: disorders of phonation (external) speech: aphonia (dysphonia), bradilalia, tachylalia, stuttering, dyslalia, dysarthria, rhinolalia; violations of the structural-semantic (internal) design of speech: alalia, aphasia; disorders of written speech: dysgraphia (agraphia), dyslexia (alexia).

The main speech syndromes are:

- motor alalia - underdevelopment of expressive speech (difficulty in mastering an active vocabulary and grammatical structure of the language) with a fairly intact understanding of speech, normal hearing and primarily intact intelligence. The cause of motor alalia is damage to Broca's center (cortical end of the speech motor analyzer) and its pathways;

- sensory alalia - a violation of the understanding of speech and its phonetic side due to disruption of the central part of the speech-hearing analyzer and its pathways (Wernicke's center) with intact elementary hearing;

- aphasia - complete or partial loss of speech caused by local damage to the speech zones of the cerebral cortex as a result of brain injuries, cerebrovascular accidents (stroke), neuroinfections, space-occupying lesions and other diseases of the central nervous system; up to 3 years of age, the diagnosis of “aphasia” is not made;

- stuttering - a violation of the tempo-rhythmic organization of speech, caused by a convulsive state of the muscles of the speech apparatus (syn.: logoneurosis);

— dyslalia — a violation of sound pronunciation with normal hearing and intact innervation of the speech apparatus;

- rhinolalia - disturbances in voice timbre and sound pronunciation, caused by anatomical and physiological defects of the speech apparatus and characterized by a peculiar combination of incorrect articulation of sounds and voice disorders;

- dysarthria - a violation of the pronunciation side of speech, caused by organic damage to the central nervous system and disorders of the innervation of the speech apparatus due to damage to the cortical-nuclear connections, peripheral nerves, cranial nerves (VII, IX, X, XII pairs), cerebellum, subcortical nuclei.

Necessary data when referring to ITU: during the initial visit, data on the diagnosis in a speech hospital is desirable; upon re-application - data on outpatient and inpatient treatment for the past expert period, EPO with an assessment of the state of mental processes and, if necessary, an assessment of intelligence according to Wechsler, expert opinions: psychiatrist, pediatrician, orthopedist, neurologist, ophthalmologist, etc., a detailed report from a speech therapist indicating the speech status, diagnosis, severity of existing disorders, characteristics from the place of study, or an extract from the rehabilitation center for the disabled (defectologist's report), if necessary - a conclusion from a psychological, medical and pedagogical commission (extract or protocol) defining the type of training , form, mode and conditions; instrumental and laboratory research methods (MRI or CT of the brain, neurosonography, ultrasound of the vessels of the head and neck, EEG, etc.): necessary in the presence of a concomitant or complicating component.

Clinical-expert-functional diagnosis after examination and evaluation of clinical-expert documents consists of: a) main nosology; b) the main maladaptive syndromes of speech pathology (disorders of oral and written speech), an indication of their persistence and degree of severity; c) additional syndromes of non-speech pathology - attention deficit disorder with hyperpractice, psychoorganic syndrome, asthenic syndrome, statodynamic disorders, etc. For example: “Organic brain damage of perinatal origin with moderate attention deficit disorder, with moderate impairments of expressive speech such as pseudobulbar dysarthria and moderate impairments of written speech such as dysgraphia and dyslexia.”

Expert assessment of the main types of speech pathology: the degree of severity of violations of language and speech functions in various speech syndromes is determined by the degree of severity of general, systemic and phonetic-phonemic speech disorders.

Disability criteria: persistent moderate, severe and significant impairment of language and speech functions, leading to limited abilities to communicate and learn, determining the need for social protection of the child

A quantitative system for assessing the severity of persistent dysfunctions of a child’s body functions in percentage [1] is presented in Table 85.

Table 85

Quantitative system for assessing the severity of persistent dysfunctions of the human body in percentage

ICF domains: dysfunction: b 167 mental speech functions, b 310 voice functions, b 320 articulation functions, b 330 speech fluency and rhythm functions, structural impairment:

Recommendations for the rehabilitation of a disabled child in the IRP. Medical rehabilitation: reconstructive surgery – according to indications; restorative therapy: drug therapy of the underlying disease: pathogenetic and symptomatic - drugs that improve the metabolic processes of the cerebral cortex (nootropics, vascular drugs, vitamin therapy) in courses of 4-8 weeks in an age-appropriate dosage, behavior correctors, etc.); physiotherapeutic treatment, physical therapy, massage (including probe speech therapy); acupuncture; balneotherapy, etc. Sanatorium-resort treatment in the absence of contraindications.

[1] Quantitative assessment of language and speech disorders in children needs clarification

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Causes of alalia

Different factors contribute to the occurrence of speech disorders at different stages of life. So, in the antenatal period:

• fetal hypoxia;
• toxicosis;
• injury to the fetus due to falls or bruises of the mother;
• intrauterine infections and inflammations;
• threats of miscarriage;
• metabolic disorders during intrauterine development;
• maternal diseases of a chronic nature (heart and pulmonary failure, hypertension, etc.).

In the perinatal period:

• difficult or pathological childbirth;
• asphyxia, hypoxia of the newborn and intracranial birth injury;
• use of obstetric devices.

In the first years of life:

• brain injuries;
• inflammatory processes of the brain;
• diseases that cause depletion of the nervous system;
• frequent or prolonged somatic diseases.

In addition to biological factors, the condition is aggravated by unfavorable social conditions of the child’s development: pedagogical neglect, lack of verbal contact or its rarity. As a rule, with alalia there is not one reason that provokes an increase in the defect, but a whole complex that leads to brain dysfunction.

Diagnostic methods and treatment methods

If a child has the first signs of motor or other alalia at the age of 4, parents need to show him to the doctor as soon as possible. A disease identified in the early stages is more treatable, which means children have a greater chance of significant improvement. To make a diagnosis, you should visit several specialists at once: a neurologist, speech therapist, child psychologist.

To make an accurate diagnosis, the doctor must carefully study the medical history over a certain period of time and track changes in it. Electroencephalogram and hearing level testing are used as diagnostic methods. Such procedures are carried out several times to obtain results with the required degree of accuracy.

If pathology is detected at an early stage, the success of correcting motor alalia in a 4-year-old child depends on how to treat it. An integrated approach is extremely important:

• pharmacotherapy with medications aimed at providing adequate nutrition and oxygen saturation of brain cells, stimulating their work, increasing the ability to concentrate, and stimulating memory function;
• speech therapy massage for the purpose of developing the muscles of the articulatory apparatus, developing correct pronunciation and diction;
• physiotherapy and reflexology, promoting the development of neural connections and stimulation of blood circulation in the brain;
• visiting a speech therapist-defectologist to work with speech skills and develop higher mental functions.

Correcting the motor type of alalia takes more time than the sensory type, and also requires a systematic approach and regular practice. The result of therapy depends primarily on the degree of brain damage. For mild to moderate severity, strict adherence to medical instructions can lead to complete restoration of speech. In severe cases, there is every chance of a significant improvement in the condition.