Dyslalia as a type of speech therapy defect: what causes it and how to eliminate the disorder?

Dyslalia is one of the most common forms of speech dysfunction in children of all ages. Accompanied by the inability to pronounce certain sounds. Separate combinations of these with a formally preserved ability to speak. The lexical structure does not suffer, like other formal components of correct speech. The key sign of the disorder is incorrect pronunciation of letters and reduction of sounds. According to statistics, the majority of cases occur in children aged 6 to 12 years; the disorder has no sexual preference.

Despite this statistical calculation, the deviation begins much earlier. We are talking only about cases recorded in clinical practice. In fact, many parents do not turn to a speech therapist, believing that the pathology will disappear on its own as the child grows up, which turns out to be far from the truth. Without specific correction under the control of a speech therapist, the disorder progresses, leading to problems with reading and reproducing information received by ear.

Dyslalia as a type of speech disorder occurs not only in children. Relatively mild forms are also found in adults who have not undergone specific speech correction. Classic examples are the so-called “lisp” or “burr.” Elimination in adulthood is also quite possible. Changing the production of sounds is carried out faster than in children, since the analytical component is also involved. The patient is able to comprehend the requirements, reflect on successes and, if necessary, adjust the ways to achieve the goal.

It is quite difficult to identify dyslalia when it comes to children under 6-7 years of age. Because, depending on the individual characteristics of the psyche, the formation of full-fledged speech is possible later. Both diagnosis and restoration require the work of a whole team of specialists. From a speech therapist, as a leading doctor to a neurologist, orthodontist. Because there are many possible organic reasons for the pathological development of one of the basic functions of man as a social being.

Therapy for dyslalia does not involve the use of medications or other pharmaceutical methods. The elimination is purely speech therapy, through exercises, and also surgically, if there are defects in the speech apparatus and problems with articulation. Success can be achieved in most recorded cases. Regardless of the root cause.

Causes of dyslalia

Dyslalia develops mainly as a result of underdevelopment of the speech apparatus. This may not be obvious at first glance, even to doctors. Some defects are diagnosed after the fact, only after careful, targeted examination. Others are visible to the naked eye. However, this is not the only group of reasons. Separately, we can talk about the social prerequisites for deviations in the verbal development of a child. Among the immediate provoking factors.

Pathologies of the structure of the speech apparatus

Tongue frenulum and other tongue problems

A short frenulum occurs in almost 12% of patients worldwide. And these are just the documented cases. Most likely the number is much higher. But the anatomical defect is not always so pronounced that it interferes with the normal formation of articulation and diction. These are rather extreme cases. The restoration is surgical, because in most cases it is not possible to adjust the articulation to the characteristics of the speech apparatus.

Other possibilities include a tongue that is too thick or underdeveloped. Such forms of deviations are much less common. As a rule, they are part of complex pathologies, including those of chromosomal origin. For example, within the framework of some syndromes involving general physical and mental underdevelopment. In such a situation, the pathology is of a fundamental nature; it is necessary to work in several directions at once: correction of cognitive functions, elimination of anatomical defects. Even then, no one guarantees success.

Problems with the structure of the jaw and teeth

There are many options. From too small teeth to their incorrect location. With ectopia (displacement) of the fangs relative to the upper row of teeth, speech defects that are difficult to correct are possible. Changing this state of affairs requires the participation of an orthodontist and a dentist. After training, the patient, however, has the opportunity to adjust speech activity to the characteristics of his own body.

Less obvious reasons: high or low sky

The deviation is common, found in 20% of the world's population. But, as a rule, anatomical changes are more likely to relate to errors and individual characteristics, because the problem is imaginary and does not cause any discomfort to the person.

It is found in the practice of orthodontists, maxillofacial surgeons and a group of more severe pathologies. For example, cleft palate (cleft palate), split lip (cleft lip) and some others

These conditions are controversial; practitioners are still debating which category to classify them in. Many experts insist that this is not dyslalia, but rhinolalia. The question is controversial. However, the essence remains the same. Speech, diction and articulation disorders. Without treatment, there is no point in correction, because it is basically impossible. Surgical removal of the defect is required. Complex defects also occur. Like abnormal ear formation, cleft lip, intellectual deficit in the system.

Separately, they talk about problems with bite

The correction is carried out under the supervision of an orthodontist. It is advisable to start recovery earlier. In adulthood, it is possible, but presents difficulties due to the aesthetic problems of therapy (wearing braces) and the difficulties of the rehabilitation period. It will take a lot of time, which is usually not enough even for basic things.

Social reasons

Social reasons are just as common. As experts note, one goes hand in hand with the other. Children with anatomical defects often encounter this category of provoking factors.

Mental deficit

Patients with mental retardation later acquire literate and correct oral speech skills. Within the framework of such deviations, this is considered normal. We are not always talking about a persistent deficit. Many children gradually develop and “catch up” with their peers, comparing themselves intellectually. Some diseases, such as oligophrenia (especially in the stage of imbecility or idiocy) do not acquire the ability to speak at all or are limited to individual words, sounds, mooing, and inarticulate muttering. Moronism presupposes the possibility of correcting the pathology under the supervision of a group of specialists, even in this case the chances of recovery are high.

Restraint of a child’s speech development by the environment

In the first years of life, the psyche is most susceptible to stimuli and agents of influence from the outside. These include parents, grandparents, aunts and uncles, and closest relatives. The problem is in the methods of education and human development. Babysitting and imitation of children's illiterate speech leads to a delay in verbal activity. In many cases, the child remains with his impairments until consultation with a speech therapist. Often in such families the child is left to his own devices, little is spoken to, and books are not read to him.

The development of the intellectual component is one of the key forms of education. Correction in the future is difficult, because the patient internalizes an abnormal pattern of speech activity. It is fundamentally fixed in the consciousness and subconscious. It takes several months to achieve a positive result. Perhaps more.

Weak immunity, susceptibility to infectious diseases

A clear correlation has been identified between the level of the body's defenses and the likelihood of dyslalia. It is impossible to say exactly what this is connected with. Doctors suggest that the reason is the child’s lack of social connections and contacts with the outside world. Being weakened, the patient does not go to kindergarten or attend preschool institutions. Therefore, it does not perceive speech models and does not create its own based on them. Such dyslalia is relatively easy to correct. Immunity can be considered an indirect culprit. In fact, we are talking about problems of early socialization.

Birth in a family with parents belonging to several ethnic groups and nations

When trying to teach a patient several languages, pronounced dissonance arises. Pronunciation becomes blurred, fragments from the first are woven into another language. The only way to avoid such a problem is to first teach the child to speak one language, and only then, as soon as a strong skill of expressing thoughts in a competent way is formed, begin teaching a second language. Correcting this type of dyslalia will require effort on the part of the parents themselves.

Preschool children have insufficient mobility of the speech apparatus

It is extremely rare that this is the result of organic pathologies. Usually we are talking about a banal reluctance to develop a skill. This is a feature of the patient’s psyche and character. The ideal option in this case would be to stimulate proper activity. It is better to teach speaking skills in a playful way, so that the skills are better absorbed and there is no violent element. It is better to work under the supervision of a competent speech therapist and follow all his recommendations at home.

Pedagogical neglect

This is a special case of problems in education. Inherent in dysfunctional families and more. Anomalies of diction and articulation are ignored, the child is left to his own devices and, due to his age, does not strive to change the state of affairs.

Social reasons in any case require the participation of parents in the first place. Also the immediate environment. Because the efforts of a speech therapist will not be enough if the environment persistently strives to return the patient to the original negative position.

Lesions of the hearing aid and central nervous system

Hearing problems. For example, hearing loss, a predominant loss of the ability to perceive sounds on one side

Dyslalia of this kind is always induced. The patient simply does not grasp the correct pronunciation of speech structures. Therefore, he repeats them the way he perceived them. Therapy requires restoration of the ability to hear. It is possible to use a hearing aid. Only then can speech correction begin. Usually it does not present much difficulty.

Anomalies of the central nervous system as a provocateur of the disorder are extremely rare

Usually these are reversible disorders in the cerebral cortex against the background of congenital or acquired pathologies. Encephalopathy, tumors (rarely), previous neuroinfections. In such a situation, an adult who until recently spoke normally can also become a victim of dyslalia. It will be necessary to combat organic pathology and only then can we talk about treating dyslalia itself.

CORRECTION OF SOUND PRONUNCIATION IN DYSLALIA

Speech therapy work to overcome sound pronunciation disorders is carried out in a certain sequence, step by step. Parents should also understand its general course, since their active and conscious participation in the speech therapy process significantly reduces the work time and increases its overall effectiveness.

The entire content of speech therapy work on the correction of sound pronunciation disorders can be conditionally divided into three main stages, each of which pursues a very specific goal:

1. Sound production

2. Sound automation

3. Differentiation of a newly raised sound from similar ones

Let's look at each of these stages separately.

The production of a sound (the term is somewhat “mechanistic” and does not fully correspond to the essence of the matter) refers to the very process of teaching a child the correct pronunciation of this sound. The child is taught to give his articulatory organs the position that is characteristic of normal articulation of sound, which will ensure the correctness of its sound.

A sound is “re-set” if it is completely absent from speech or replaced with another sound, as well as if there is a defect in pronunciation that cannot be partially “corrected” and brought to normal (for example, with a “burry” R or labial-dental L) . Sometimes they limit themselves to the so-called sound correction, which consists in clarifying only individual elements of its articulation, which is generally close to normal. So, for example, when pronouncing C interdentally, in order to achieve normal articulation, you only need to teach the child to hold the tip of the tongue at the lower incisors and tuck it behind the teeth (another thing is that this may require preliminary articulatory exercises or normalization of the bite). In the future we will talk only about sound production, and not about its correction.

In many cases, sound production cannot be started immediately, because the child cannot give his tongue the necessary position. Let's say we need to teach him the correct articulation of the sound R, but he cannot even raise the tip of his tongue upward, let alone the vibration itself. In such circumstances, preparatory work is necessary. It consists primarily of so-called articulatory gymnastics, the main goal of which is to develop sufficient mobility of the lips and tongue. Typically, such preparation must be carried out for motor functional and mechanical dyslalia, and especially for dysarthria, which is characterized by paresis of the articulatory muscles.

In case of polymorphic disorder of sound pronunciation, general articulatory gymnastics is performed, which includes all the basic movements of the articulatory muscles. The “generality” of the exercises is dictated by the fact that in these cases sounds from different phonetic groups are disrupted and therefore each movement is “useful”, if not for one, then for some other sounds. In addition, the very polymorphism of sound pronunciation disorders in most cases indicates an unfavorable state of speech motor skills, and therefore the need for its serious “training”.

In case of monomorphic disorders of sound pronunciation, the choice of articulatory exercises is determined by two main conditions. Firstly, it depends on the characteristics of the normal articulation of the newly acquired sound. So, for example, when developing the correct articulation of the sound P, it is important to teach the child to raise the tongue upward and develop the mobility of its tip as best as possible, but this is not at all required to produce the sound C, in which the tip of the tongue lies motionless at the lower incisors. Secondly, the choice of articulatory exercises is largely determined by the very nature of the defective sound pronunciation. For example, to develop the correct articulation of the sound L, there is no need to perform special exercises for the lips, since when pronouncing this sound they occupy a neutral position. But if we are dealing with bilabial or labiodental L, then in this case exercises for the lips are absolutely necessary: only by teaching the child to actively move his lips to the sides, we can further ensure their isolation from participation in the formation of sound, and therefore eliminate its “labial” sound.

With mechanical dyslalia, before sounds can be produced, it is often necessary to eliminate anomalies in the structure of the speech apparatus. For example, with a very short frenulum of the tongue, the production of the sound P is possible only after cutting it, or overcoming interdental sigmatism must be preceded by the elimination of an anterior open bite.

With sensory functional dyslalia, during the preparatory period, work is carried out to develop auditory differentiation of sounds, since if it is impaired, the child does not realize the incorrectness of his sound pronunciation and will not be able to control it in the future. Parental help during the preparatory period plays a very important role. It should consist of systematically performing with the child all the articulatory exercises suggested by the speech therapist, as well as exercises in auditory differentiation of sounds. To do this, you don’t need to be a specialist - you just need to get his detailed advice.

After carrying out the necessary preparatory work, they move directly to sound production. It can be done by imitation, with mechanical assistance and in a mixed way. Let's consider only the first of these methods, since the other two require special knowledge.

The method of producing sound by imitation is the easiest for both the speech therapist and the child himself, since it requires minimal effort and time. It consists in the fact that the speech therapist, in the presence of the child, clearly and clearly pronounces the desired sound. A child, hearing a sound and at the same time seeing its articulation, is often immediately able to reproduce it. If this happens, then the production of the sound can be considered complete: the child has learned to pronounce it correctly. This method of sound production can be used by parents themselves - in many cases it will “work”. Staging sounds by imitation is possible only if the child has sufficient mobility of the articulatory organs and their correct structure.

As soon as it is possible to achieve the correct sound of an isolated sound, you need to immediately move on to the next stage of sound pronunciation correction - the automation stage, that is, teaching the child to correctly pronounce the sound in coherent speech. One should not dwell on its isolated pronunciation for long, since our speech is a stream of continuous changes, and the movements of the lips and tongue when pronouncing consonants are not standard, but depend on the part of which complex of movements (that is, in which sound combinations) they are carried out. This determines the importance of incorporating the newly developed sound as quickly as possible into its most typical sound combinations. However, here we cannot go to the other extreme: move to the automation stage prematurely, that is, before obtaining the correct isolated sound. Exceptions in this regard are sometimes allowed only in cases of mechanical dyslalia and severe dysarthria. In general, at the stage of automation, in contrast to the stage of sound production, regardless of any causality of defects in sound pronunciation and any nature of their external manifestation, the work is carried out approximately the same way and in the same sequence: pronunciation of syllables, words, specially selected phrases, texts with new educated sound. This similarity of approach is explained by the fact that in all cases the child already has the correct sound, no matter how different ways and no matter how different times it was obtained.

The need to highlight a special stage of automation is due to the fact that even after mastering the normal articulation of a sound, the child, due to established habit, continues to pronounce it incorrectly in speech. After all, what is defective pronunciation of a sound? This is far from just the pronunciation of the sound. If a child replaces, for example, Ш with S in his speech, then all the stereotypes of words that include this sound are formed accordingly (SKAF instead of SHKAF, SKOLA instead of SCHOOL, SUM instead of NOISE, etc.). Naturally, immediately after sounding, he will not be able to pronounce all words with a given sound correctly.

In order to make this complex task easier for the child, sound automation is carried out gradually: first in a variety of types of syllables and sound combinations (SA, AS, ASA, STO, SKO, STR, KSY, etc.), then in individual words with different its complexity in its sound-syllable structure (SANI, JUICE, NOSE, ARGUMENT, GLASS, OSTRICH, ICICLE), then in specially selected phrases, where the automated sound is contained in each word (SALT SALT, SALT SALT), and, finally, in the texts. If the correct pronunciation of the newly introduced sound is achieved immediately in words, then automation in syllables disappears.

At this stage of work, all articulatory and acoustically close sounds are excluded from the speech material. For example, when automating the sound C, the syllables, words and phrases selected for this purpose should not contain other whistling or hissing sounds. For this reason, here you should take words like BAG, CATFISH, SCALES, SPRING, etc. and exclude words like DRYING, CANDLE, FOCK, COLD. In these cases, it is better not to use words with articulatory complex (albeit acoustically distant) sounds like R, L, since these sounds can also be pronounced defectively. Such “lightweight” speech material allows the child to focus all his attention only on the newly learned sound. It is better to immediately associate this sound with a letter so that the child develops a strong connection between the sound and the letter, which is very important for correct writing (especially if the sound was not distorted, but replaced by some other one). Exercises in the most basic sound analysis are also conducted.

The stage of sound automation can be considered complete only when the child masters the skill of correctly pronouncing a “new” sound in ordinary conversational speech. The reader has to pay special attention to this point, since many children who have already mastered the correct pronunciation of the sound do not use it in their independent speech. Most often this occurs when speech therapy classes are terminated prematurely, which happens mainly through the fault of parents. It is for this reason that adults often turn to speech therapists, since childhood they have been able to correctly pronounce this or that sound, but have never learned to use it in their speech.

Help from the parents to the speech therapist at this stage is simply irreplaceable. First, it should consist of systematically listening to all the syllables, words and phrases with an automated sound pronounced by the child in order to control the correctness of its sound. In the future, exactly the same constant control over the child’s entire speech will be necessary in ordinary life situations: an incorrectly pronounced sound must be corrected every time. This is exactly what will ensure complete automation of sound, and this will be done in the shortest possible time, which will save parents from the need to “take a long time” for their child to see a speech therapist.

In cases where the sound is distorted (and not replaced), the automation stage usually ends the work on correcting sound pronunciation. For example, if a child pronounced the sound P “kartavo” or C interdentally and did not mix these sounds with others, then there is very little likelihood that he will suddenly begin to mix them after correction. When we deal with sound substitutions, they usually make themselves felt for a long time, and special and sometimes quite lengthy work is required to completely overcome them. This is exactly what the third stage of work on correcting sound pronunciation is devoted to.

The main task of the stage of differentiation of sounds is to develop in the child a strong skill in the appropriate use of the newly taught sound in speech, without mixing it with acoustically or articulatory similar sounds. This is achieved through special exercises. The work of distinguishing mixed sounds by a child essentially begins already in the preparatory period and during the period of sound production. Even then, his attention is drawn to the different positions of the lips and tongue and to the different nature of the stream of speech exhalation when articulating the sounds he mixes (for example, S and Sh, Z and Zh). The different sounds of these sounds are also noted (Z is how a mosquito rings, Z is how a beetle buzzes).

The transition to a special stage of sound differentiation can begin only when both mixed sounds can be correctly pronounced in any sound combination, that is, when the ability to correctly pronounce the “new” sound is already sufficiently automated.

As at the previous stage, the complexity of the speech material here also increases gradually. First, the sounds mixed by the child are differentiated in a wide variety of types of syllables (SA-SHA, AS-ASH, STO-SHTO, etc.), which must be pronounced by him without any sound substitutions, then - in words (SANKY-HAT, BOWL-BEAR ), sentences (such as the widely known SASHA WALKED ON THE HIGHWAY AND SUCKED A DRYER) and connected texts, including both mixed sounds. When working with school-age children, written exercises are also necessarily used to overcome letter substitutions in writing. For preschoolers, special work is needed to prevent such substitutions. Both differentiated sounds are necessarily immediately associated with letters.

A necessary prerequisite for both preventing and overcoming letter substitutions in writing is the development in the child of the ability to accurately determine the presence of a “new” sound in a word, find its specific place in it and distinguish it from those existing in the same (or some other) sound. word with sounds similar to it. In other words, it is necessary to develop the child’s ability to perform phonemic analysis of words, which also include sounds mixed with them. Such work begins already at the automation stage, but there it is aimed at “searching” for only one newly delivered sound.

Children aged 6 years can be given tasks to isolate the sound of interest to us from the beginning and end of a word (which is the easiest to do), for example: “What is the first sound you hear in the word FISH? What is the last sound in the word CHEESE? By answering that he hears the sound R here, the child thereby isolates this sound from the general composition of the word and pronounces it in isolation. In the process of special training, more complex types of sound analysis of words can be practiced, associated with a more accurate determination of the place of sound in a word. All of the above exercises teach the child to be attentive to the sound composition of words and at the same time strengthen his skill in auditory differentiation of sounds. This is precisely what is necessary to prevent (in preschool children) or completely overcome (in school-age children) letter substitutions in writing.

The role of parents at the stage of differentiation of sounds is no less important than at the stage of automation, and it consists, firstly, in systematic monitoring of the child’s correct performance of speech therapy tasks, including written ones, and, secondly, in constant monitoring of his speech in ordinary life situations - until the sound substitutions completely disappear in it. All the necessary didactic material for automation and differentiation of sounds, located in the appropriate sequence, starting with syllables and ending with connected texts, is given in our manual “Speak and Write Correctly” mentioned in the list of references.

This is the general sequence of speech therapy work when correcting sound pronunciation defects in children. Compliance with exactly this sequence in work is mandatory, since any violation of it negatively affects the overall result and delays the work itself. So, for example, it is useless to try to immediately make a sound for a child if the state of his articulatory motor skills does not yet allow this. Or it is impossible to start automating a sound with a child who has not learned to pronounce it correctly, etc. (In many cases, parents, even before contacting a speech therapist, exercise their children in reading and memorizing poems for a certain sound in order to “correct” it, which ultimately leads to an even greater strengthening of incorrect articulation of sound).

Let us note the features of the application of the work scheme considered here for forms of sound pronunciation disorders that differ in their causality.

With sensory functional dyslalia, such features are as follows:

1. Preferential development in the preparatory period of the function of the speech-auditory analyzer compared to the speech-motor analyzer (work on auditory differentiation of sounds).

2. Paying due attention to phonemic analysis of words.

3. The obligatory presence of a stage of differentiation (in the child’s speech) of mixed sounds.

4. Purposeful work on eliminating (or preventing) letter substitutions in writing.

Overcoming motor functional dyslalia has the following features:

1. During the preparatory period, primary attention is paid to the development of the child’s articulatory motor skills, the development of sufficiently clear and coordinated articulatory movements. As for the development of auditory perception, it is important to teach the child to distinguish the correct sound from a defective sound (for example, normal P from “burry”).

2. Usually there is no need to specially highlight the 3rd stage of work - the stage of differentiation of mixed sounds.

3. There is no need for special work to overcome (or prevent) letter substitutions in writing.

For sensorimotor functional dyslalia, depending on the predominant symptoms, the work techniques used to overcome motor and sensory functional dyslalia are combined in different ways.

The main feature of overcoming mechanical dyslalia is that in most cases it is not possible to limit oneself to speech therapy assistance only, but a comprehensive medical and pedagogical intervention is necessary. Moreover, even complete elimination of an anatomical defect usually does not lead to normalization of sound pronunciation. The incorrect way of functioning becomes habitual and persists even after the anatomical defect is completely eliminated, which means that the incorrect way of articulating sounds also persists. And even more than that. If, after eliminating the anatomical defect, the old method of improper functioning of the tongue is left unchanged, then it can provoke the return of the previous “pathological form”. Often it is the secondarily impaired function of a healthy organ (in this case, the tongue) that prevents successful orthodontic treatment. For this reason, speech therapy work, and above all active articulatory gymnastics, is important in these cases not only for the correction of impaired sound pronunciation, but also for the sustainable correction of the anatomical defect itself.

As for the sequence of application of medical and speech therapy methods, it can be varied. Although from the point of view of correcting sound pronunciation it would be more expedient to first eliminate the anatomical defect, this is not always possible. For this reason, speech therapy work with a child often has to begin long before the end of orthodontic or surgical treatment, thereby facilitating its more successful completion.

The stage of sound production has the greatest complexity and originality in mechanical dyslalia. Depending on the achieved results of correction of the anatomical defect, the following two staging options may occur:

1. In the case of complete elimination of anomalies in the structure of the articulatory apparatus, sound production is carried out in the usual way, through teaching the child to give his articulatory organs the position that is necessary for normal sound articulation.

2. If it is impossible to eliminate the anatomical defect or achieve only a slight reduction in it, the speech therapist faces the difficult task of educating the correct articulation of sound given the unusual structure of the child’s articulatory apparatus. We can only talk here about the education of the so-called compensatory articulation, in which a defect in the structure of one organ is compensated by the peculiar, unusual arrangement of other articulatory organs. The main guideline here should be the correctness of the sound - you have to achieve a normal (or perhaps closer to normal) sound, while consciously going for the unusual arrangement of the articulatory organs when pronouncing the sound.

Automation of the delivered sound is carried out in the usual way. As for special work on the differentiation of sounds, in many cases with mechanical dyslalia it is not required, since distorted sounds are more often observed here than their complete replacement with other sounds.

Differences between dyslalia and other similar disorders

Dyslalia must be distinguished from dysarthria and aphasia.

Dysarthria

This is always the result of damage to cerebral structures. The result is a violation of the innervation of the speech organs. The problem lies in the lack of mobility of the tongue, lips, and the problem of coordinating their micromovements. Dyslalia is of a functional nature. Corrected by speech therapy methods. Less commonly, there is a local disorder. Anatomical problems, underdevelopment of the speech apparatus. The differences between dyslalia and dysarthria are obvious after a neurological examination. It’s impossible to tell anything specific by eye.

Aphasia

It becomes the result of generalized brain damage or dysfunction of the temporal and frontal lobes. It occurs in fundamental pathological processes such as stroke, which destroys nerve tissue and connections, neuroinfections and others. The patient loses previously acquired oral speech skills. As a rule, pathology is characteristic of older people, not children. If with dyslalia a person is able to understand the essence of the problem, and often himself recognizes its presence, aphasia makes this almost impossible. The deviation is noticeable only to others. Aphasia is the result of a previous pathology and a form of neurological deficit. This is a key feature. In addition, it is almost always accompanied by other symptoms.

This method of differentiation plays a key role in diagnosis. Because you need to find out the immediate cause of the problem and the form of deviation. Without this, there can be no effective recovery.

Forms of dyslalia, classification of pathological changes

The classification of the pathological process (relatively speaking) is carried out on several grounds. Each subdivision method is used equally often in clinical practice.

Based on the scale of speech dysfunction:

A simple form of dyslalia. Accompanied by a violation of the pronunciation of one sound or one group of sounds. For example, hissing ones, the letter “r” and others. Most common. Often patients carry the problem into adulthood and are in no hurry to part with it.
Complex dyslalia. As the name suggests, it leads to the reduction of several groups of sounds when speaking. It occurs against the background of pedagogical neglect, pronounced problems with the speech apparatus and insufficient development of the child in the intellectual sphere. The etiology of the process is more complex and it is not always possible to understand at first glance what is going on.

Based on the origin of the pathological process, the following forms of dyslalia are distinguished:

Organic. It's mechanical. It is the result of anatomical defects in the structure of the speech apparatus. Less common in the brain, with neuroinfections, tumors and other anomalies. Mechanical dyslalia is caused by problems of an organic nature; they require surgical correction. Although not always. First, conservative, speech therapy methods are used. The doctor seeks to understand whether it is possible to adapt the patient to the peculiarities of his articulation.
Functional. Becomes the result of social causes and reversible problems with the brain. The causes of functional dyslalia lie in the child’s environment. Less common in past pathologies that cause dysfunction of the central nervous system. Working with a speech therapist can change the situation dramatically. It takes from 2 months to six months or more. The question is individual.

If we talk about brain pathologies, the functional type is divided into two more subtypes:

Sensory dyslalia. The result of disruption of the speech-auditory area. Accompanied by the inability to adequately perceive spoken sounds and repeat them independently. Occurs in 45% of the total number of recorded cases.
Motor dyslalia. Accompanied by damage to the speech motor center. The coordination of movements of the lips, tongue, and speech organs in general is impaired.

Both types involve fighting the root cause and working with a speech therapist.

If we talk about functional forms in more detail, we can distinguish three more subtypes of the disorder:

Acoustic-phonemic dyslalia. Perception of similar sounds as identical. Leads to replacing one with another without understanding the difference. The disorder leads to general speech problems. She becomes incomprehensible to others.
Articulatory-phonetic form. Occurs especially often. The essence is the distortion of the pronunciation of one or several groups of sounds at once.
Phonetic form. The essence is the inability to perceive by ear the correct structure of what is being said. Within individual words. It is possible to form your own vocabulary, which is used by the child in everyday life. Therefore, the logical component does not suffer. Each time the child hears the same word, but in his own way, weaving it into the fabric of general statements. The longer such abnormal development of the speech apparatus and mental perception of verbal activity continues, the more difficult the recovery.

If we take as a basis the groups of sounds with which the patient has problems, we can name the following group of specific forms:

Rotacism (burr, in common parlance).
Sigmatism (lisp, inability to pronounce hissing sounds normally).
Lambdacism (problems with pronouncing sounds and combinations, mainly “l” or “l”).

Others are somewhat less common. The list is not exhaustive.

Based on the quantitative characteristics of the disorder, two more forms of dyslalia are distinguished as a pathological process:

Polymorphic. Accompanied by a combined deviation in speech activity. For example, rhotacism + yotism (problems with the pronunciation of “th” + sigmatism). There are many options.
Monomorphic. As the name suggests, there is a reduction in only one group of sounds. This is a classic form and also occurs in adult patients.

We can also talk about types, depending on their conditional normality:

Age-related dyslalia. Occurs in children under 3-6 years of age. Accompanied by imperfect speaking processes due to young age. The problem goes away on its own after some time.
An abnormal or pathological variety. If the deviation does not disappear on its own or, worse, worsens.

Dyslalia is most common in children. Adults suffer from it relatively rarely, because the speech apparatus, like the cerebral cortex, are already formed. At the same time, if correction is not made at the right time, the adult will retain pathological verbal habits for life. Provided that no correction is carried out. In some cases, the disorder occurs after a trauma, brain infection, or stroke. Dyslalia can also be an acquired defect. Therapy depends on the type and origin of the deficiency phenomenon.

Structure of a lesson during correction

The formation of speech motor skills consists of a set of sequential measures, the choice of which depends on each individual case of speech disorder.

The primary goal is to improve the functioning of the speech production organs, then there is a consistent adjustment of phonemic hearing and attentiveness.

Work on the correction of isolated sounds can be carried out simultaneously with recording phonemes by ear.

After successfully mastering the first stage of classes, you can move on to automating the pronunciation of syllables and short words. Later, based on the learned material, train speaking complex sound combinations in sentences.

The emergence and refinement of flaws in spontaneous dialogue speech is the final stage of linguistic training.

Breathing exercises

The basic principles of speech therapy work for dyslalia involve teaching breathing exercises aimed at deepening breathing and increasing lung volume.

An extended exhalation phase is necessary for the smooth pronunciation of long sentences and maintaining a normal respiratory rhythm.

Examples of effective training:

blow on a thread or feather, observing the correct technique - you cannot puff out your cheeks, your lips should not be too tense, make sure that the exhalation is not forced;
blow soap bubbles, trying to release air from the lungs as long as possible;
cooling a hot drink, inflating balloons;
if possible, play the harmonica, releasing air through a straw into a glass filled with water.

Techniques that develop the functioning of the respiratory system help prevent improper functioning of the articulation organs. The acquired skills need to be consolidated at home; usually, on the recommendation of a speech therapist, independent classes last 5-15 minutes three times a day or more often, but at short intervals of 2-3 minutes.

Articulation gymnastics during treatment

The ability to recognize and recognize phonemes is based on sound analysis, so first operations are performed with words that the child has learned to pronounce correctly.

After the ability to recognize phonetic units has been firmly established, you can move on to methods that develop correct pronunciation.

The process of acquiring skills should occur without coercion and consciously.

Its essence lies in a detailed explanation and demonstration by the speech therapist of how to use the articulatory apparatus to produce various sounds and their combinations.

If repetition is difficult, speech therapy probes or spatulas are used, placed under the tongue until the required form of sound is achieved.

Great importance is attached to age - therapy for preschool children is simpler than for school-age and teenage children.

The method of speech therapy for dyslalia involves 2 directions of influence: the use of general didactic principles and the development of a special approach to a small patient.

Finger gymnastics for correction and treatment

Fine motor skills training develops the area of the brain responsible for clear diction.

Therefore, speech therapy methods for dyslalia, especially the motor form, require training in fine movements of the fingers.

In children with impaired speech, there is a direct correlation with the inability to perform targeted manipulations with their fingertips: it is difficult to hold the pen, the movements of writing and coloring along the contour are imprecise and sweeping.

Classes can be entertaining, enjoyable, and exciting for children:

coloring pages with lots of small details;
modeling figures from polymer clay, plasticine;
cutting out parts, gluing appliqués;
drawing simple geometric shapes on paper.

Daily repetition of such practices will prepare your hands to hold a pen and help you develop calligraphic handwriting. The appearance of rhythmic movements also helps to improve the clarity of pronunciation.

Setting sound when eliminating a violation

The required sound is achieved using various technical methods. They include imitation of the speech therapist's speech, the use of auxiliary mechanical devices, as well as a combination of these methods.

Onomatopoeia is based on children’s conscious attempts to perform successive atriculation movements, allowing them to achieve a sound identical to the doctor. In combination with acoustic experience, visual reinforcement and exercises for tactile muscles are used.

A speech therapy probe is used to form the correct placement of the organ of articulation during the reproduction of hissing, hard, voiced consonants. Long-term training leads to independent correct pronunciation without tools.

Phoneme automation during correction

Systematic practice of all groups of sounds is necessary to produce clear, intelligible speech, and to prevent the occurrence of erroneous spelling of words under dictation.

The development of a correct lexical stereotype begins with isolated phonemes that children pronounce without errors. Later, automaticity is trained on short words and phrases.

The transition to complex speech forms is the middle stage of automatism exercises.

For oral retelling, short phrases with a clearly formulated idea are offered.

Memorizing poetry and independent narration indicate successful work. To obtain high quality diction, you can learn tongue twisters for certain sound groups.

A lasting result of correctional work for dyslalia is achieved by precise implementation of instructions by patients and parents, who would like to motivate children to frequently repeat new material for short periods of time.

Differentiation exercises during correction

The development of phonemic hearing must begin when a block of work on isolating and automating articulation has been completed. If the child has successfully mastered the skills of pronouncing letter combinations and phrases, you can begin classes aimed at recognizing similar forms of vowels and consonants.

Training tables for reading contain complexes of alternating pairs of syllables; the purpose of reading is to work out sound combinations out loud.

During auditory differentiation training, combinations of letters or words are read out that need to be found among several similar word forms.

If the child is small and does not know how to read, it is suggested to listen by ear to find cards with images of objects and animals. Their names must contain differentiable pairs of letters.

It is advisable that an adult be present during classes with a speech therapist who will repeat similar training at home.

Hearing exercises

Comprehensive training improves hearing, enhances concentration, and helps maintain it for a long period. Children 2-3 years old can be asked to guess the sound of objects they know by ear, which allows parents to show their own imagination.

To improve orientation in space, methods of guessing the source of sound with closed eyes are used. The games are aimed at improving the quality of physical perception, developing sensitivity to tempo, rhythm, and intensity of sound vibrations. Conducted in early preschool age, they prepare children for the correct perception of speech.

When treating a simple case, speech therapy lasts 2-4 months, and combined defects are eliminated after 6-12 months of regular training, attended at least 2 times a week.

Thanks to systematic repetitions of educational and entertaining exercises at home, the correction of defects is completed earlier.

Symptoms and clinical picture depending on the type of disorder

The clinic of dyslalia is represented by essentially identical manifestations, regardless of the case:

Distortion when pronouncing letters and sounds. Formally, the structure of the word is preserved. In most cases, others understand what the patient is talking about.
Replacing letters and sounds with similar ones. Voiced to voiceless (“b” to “p”) and so on. This makes it significantly more difficult for a person with dyslalia to speak and understand speech. In severe cases, the communication process is impossible at all.
Finally, there is the omission of individual letters or sounds, where they should not be reduced.

One of the following signs or several at once is observed. Depends on the type of process.

Disturbances in the speaking process lead to a whole host of problems in the socio-psychological sphere:

Lack of self-confidence, both in children and especially in adults. A person tries to talk less, not to participate in games, discussions of issues, or conversation. And then he completely withdraws into himself. Tries to leave the house less. Social isolation and lack of contacts and verbal activity lead to aggravation of the situation. Therefore, one of the main directions of treatment is based on constant communication between a person and others.
Formation of phobias. The classic version is social phobia. Fear of society in its various forms. From minimal interest groups to a group in kindergarten, a class at school, a team at work, etc.
Irritability, apathy, etc. are signs of emotional dissatisfaction and constant stress. Recovery without interaction with a speech therapist is not effective.

If a person with dyslalia is not helped in a timely manner, complications arise in other areas of speech activity.

Problems arise with the use of cases and numerals. These constructions are based on the variability of endings and the very structure of the spoken word. Written language also suffers. Although not always. A person’s grammatical structure and vocabulary may be normal or even beyond the average. Which indicates the preservation of intelligence and other higher nervous functions.

Diagnosis of dyslalia

The examination is carried out under the supervision of a group of specialists. First of all, it is recommended to contact a speech therapist. As part of the primary diagnosis, basic studies are prescribed.

The speech therapist interviews the child's parents. It is important to collect a complete life history from birth to the current day. Factors to be established: intellectual development, adherence to established development standards, nature of nutrition. If there are other children in the family, do they have problems with speaking? Also past and current illnesses. Everything is as detailed as possible. This is necessary to identify the suspected cause of the pathological process.

Oral questioning of the child himself. A series of specific tests need to be carried out. Usually the patient is given short words and needs to repeat them. If the child copes well with these tasks, they become more difficult. Longer words are offered, then whole combinations or sentences. Gradual complication makes it possible to identify at what stage the disorder begins and how pronounced it is. The gradation varies widely. This method is the most accurate. When an older patient is examined, reading skills are also checked.

Detection of problems with diction and articulation allows us only to state the fact of such. Initially, the organic nature of the pathology is assumed. Then it is necessary to examine the child or adult under the supervision of specialized specialists. These include an otolaryngologist (ENT), dentist, orthodontist, and, if necessary, a neurologist. Basic fundamental research:

Visual assessment of the oral cavity, bite, teeth and their condition.
Examination of the condition of the oropharynx and nasopharynx for organic congenital or disease-related defects.
Routine neurological examination. Testing reflexes in dyslalia allows us to identify additional symptoms that are present in most cases when the functioning of the cortex is disrupted.

What does not relate to the causes of the development of functional dyslalia presumably relates to organic factors. Instrumental diagnostics can come to the rescue:

Electroencephalography. Used to assess the functional activity of the brain. Its individual sections. Based on the nature of electrical activity, we can talk about a particular lesion, but without specifics.
When there are suspicions of anatomical defects, a general tomography of the brain is performed. Further, if necessary, targeted MRI of cerebral structures, a separate area.

In the absence of organic causes, social conditions are studied. This is where a child psychologist can come to the rescue. Pedagogical neglect and educational errors are a common cause of speech disorders.

Differential diagnosis is also carried out using instrumental methods. Through electroencephalography, MRI, CT, angiography (in adults), ultrasound of cerebral vessels and duplex scanning of the arteries of the neck.

Examination of children and adults can be time consuming. From several days to a month. The reason is not always obvious; it is possible to repeat the diagnosis in whole or in part.

Treatment of dyslalia

Therapy is challenging even for experienced professionals. There is an approximate algorithm for correcting an abnormal condition, regardless of the patient’s age.

How many stages of correction work are there for dyslalia?

There are three in total:

Preparatory. It consists in eliminating the fundamental causes of the violation; this is the basis that will allow you to achieve a high-quality result.
Formation of basic speech skills. An audit of existing skills is carried out, then new skills are introduced or those that were formed incorrectly are changed.
Communication stage. Instilling normal communication skills, taking into account the results achieved.

Treatment of the disorder and speech therapy involves a fractional division of each phase of therapy.

Preparation

Elimination of the organic cause. If there is one. Usually by surgical methods. Then specialized gymnastics and massage are prescribed. The set of exercises depends on which function is impaired. With sigmatism, the pronunciation of hissing sounds, etc. is practiced. Exercises for correction should be gentle, increasing complexity as success is achieved. This motivates the patient to continue hard work.

A separate item is speech therapy massage. It allows you to normalize blood flow and restore the mobility of the structures of the speech apparatus.

The technology of forming speech breathing is being mastered. Inhale lightly through the nose and use most of the air to form the sound.

This stage takes longer than others. This is the basis that allows you to achieve effective results.

Skill building

Involves daily repetition of exercises. There is no need to force the process. To begin with, take one sound that is difficult for the patient. Taking into account correct breathing, they begin to practice it. The methods of producing sounds depend on the specific technique; it is possible to use several, if the previous one was not successful, they resort to a new one. But the speech positions are always approximately the same. Once success is achieved, the result needs to be consolidated. Usually the task is made more difficult. They are asked to pronounce a word with the specified sound in different positions: at the beginning, in the middle, at the end. And then with several such sounds within one word. Next come phrases and sentences.

Then they move on to a new sound. In this way, the problematic verbal area is worked through. The patient simultaneously learns to distinguish between individual sounds that are similar to the ear. In children, play techniques for correcting sound pronunciation are most effective. Visually illustrated material is used, stories are told, and easy ways to train are suggested. This excludes the mental forced introduction of knowledge. The process is much faster and gives better results.

You also need to listen as much as possible. The skill of distinguishing between similar constructions and individual phonetic units is acquired with practice.

Formation of communication skills

The final phase of correction. The child or adult begins active interaction with the speech therapist and family. You need to communicate more to consolidate the acquired skills in practical speech situations. Training leads to the formation of automaticity. The patient stops thinking about how and what is pronounced and concentrates on the content, not the form.

The stages of speech therapy intervention are practiced gradually. It is necessary to complicate tasks as you complete previous ones. Forcing leads to the opposite effect.

The effectiveness of work to correct dyslalia depends on motivation and willingness to work. Therefore, when restoring verbal functions in children, play forms are practiced. It is extremely rare that an irreversible or difficult-to-reversible disorder occurs.

Features of eliminating various forms of dyslalia

Training in correct understanding of oral and written speech occurs alternately: first, children are taught to consciously analyze phonemes, then control their own pronunciation.

In case of severe disorders of phonemic perception, speech pathologists recommend eliminating speech defects while acquiring articulation skills.

The success of eliminating pathology depends on several factors:

complexity - a combination of two or more speech disorders;
individual characteristics of the child’s psyche, the ability to perceive and process new information;
regularity and correctness of the selected correction methods;
the child’s conscious desire to cooperate with the speech therapist, adequate parental support based on the doctor’s recommendations.

Depending on the form of the disorder, correctional work for dyslalia can be gradual and parallel. Incorrect pronunciation combined with listening comprehension problems can be corrected at the same time.

In a complex case with multiple symptoms, the formation of receptive skills begins with the creation of an articulatory base.

Prevention

It is enough to follow simple recommendations:

From the very first days of life, you need to talk to your child correctly and clearly. There is no verbal function yet, it is in its infancy. But it has been proven that the more you communicate with a child, the faster he begins to speak himself. Because the rudimentary function quickly becomes relevant and matures in the psyche.
It is important to speak even after the child begins to speak on his own. This is even more important. At the same time, you need to monitor the quality and purity of speech in terms of form and content. It would not be amiss to read books so that a developing person can assimilate individual speech structures, their diversity, and intonation coloring.
Under no circumstances should you lisp or deliberately distort speech, imitating the pronunciation methods of an immature person. This is detrimental to mental development and slows down the process of developing oral speech skills.
In a multilingual family, one language is first learned, then after 6-7 years, as soon as strong speech skills are formed, you can begin to learn a second language. But not together and not right away.

Dyslalia occurs in children and adults. The need to eliminate dyslalia in preschool age allows you to prevent several problems at once: poor academic performance, problems with written speech, reading, speech defects in adulthood. In addition, speech is directly related to intelligence, which also makes it important to work on speaking. The correction is carried out under the supervision of a speech therapist and, if necessary, other doctors. The prognosis is favorable in most cases.

Dyslalia examination

Diagnosis of speech with dyslalia in children begins with collecting the following data:

features of the course of pregnancy and childbirth in the mother;
a list of diseases suffered by the child;
whether there is early psychomotor and speech development;
the condition of the child’s hearing, vision and musculoskeletal system.

After collecting the necessary information, the speech therapist proceeds to study the structure and mobility of the organs of the articulatory apparatus (visual inspection and assessment of the performance of a series of imitation exercises).

Diagnostics of oral speech at the First Children's Medical Center includes examination of the state of sound pronunciation and identification of incorrectly pronounced sounds. A speech therapy examination for this speech pathology makes it possible to identify the nature of the disorder in various positions, words, phrases, and texts.