In modern speech therapy, Alalia is divided into 2 main forms - Expressive (motor) Alalia and Impressive (sensory) Alalia. There is also a combination of them - sensorimotor alalia. All this is a classification of alalia.
Expressive (motor) alalia is a systemic underdevelopment of expressive speech of a central organic nature, caused by the immaturity of linguistic operations in the process of generating a speech utterance with the relative preservation of semantic and sensorimotor operations.
Impressive (sensory) alalia is a speech disorder of central origin, manifested in the child’s inability to understand spoken speech due to insufficient functioning of the speech-hearing analyzer.
All 3 forms of alalia are corrected (often to the speech norm). Recently, the humanities (studies of humans) sciences - neurophysiology, neurochemistry, neuropsychology, psycholinguistics - have received rapid development. It is the psycholinguistic approach, on the basis of which correctional techniques are created, that allows solving the problems of alalia.
Differences between sensory and motor alalia. Alalia forms.
Many parents ask speech therapists the question: “Which alalia is worse - sensory or motor?” Without treatment, the prognosis for the development of a child’s personality with SA is worse than with MA. In correctional work, the differences are as follows: with Sensory alalia, the first stages of speech therapy work on the transition from OHP 1 to OHP 2 take 2-3 times longer. But at the same time, in children with Motor alalia, subsequent correctional work takes 2-3 times longer. Read more about the differences between motor and sensory alalia
Sensorimotor alalia.
SMA is the most severe form of alalia, in which both aspects of oral speech are impaired: understanding and speaking, all the symptoms of both sensory and motor alalia are present. It is children with SMA who are most often confused with autism. Treatment of sensorimotor alalia should begin with the sensory component, because ontogenetically the child initially develops an understanding of human speech, only after which “reproduction” becomes possible. Then, having already developed an understanding (it takes me up to six months of work), I begin parallel work with the sensory and motor components. The duration of correction of SMA consists of the duration of treatment of sensory and motor alalia and takes 2 times longer.
According to my observations during speech therapy sessions:
· in non-speaking children 2-2.5 years old with sensory alalia, there are no motor (expressive) disorders (of the two dozen children with AS I studied with, there were no symptoms of motor alalia). Therefore, if a child at this age is diagnosed with SMA, in the process of correctional work the diagnosis can be refined to simple sensory alalia.
· Non-speaking children 5-6 years old were all diagnosed with Sensorimotor alalia, i.e. There were manifestations of both alalia. I have never encountered pure sensory alalia at this age. Of course, 3 dozen sensorimotor alalikov of this age is not enough compared to research at universities to claim that there is no primary SMA.
· While working on the correction of alalia in children from 2.5 to 5 years old, I noticed that the later they started, the more motor problems are identified, and the longer the speech therapy work takes. Based on the results of observations, it can be assumed that many children with SMA have a disorder of expressive (motor) speech secondary, i.e. an early start of speech therapy work will shorten its duration for this reason as well.
Expressive alalia
Expressive alalia is a language disorder that is characterized by a violation of the assimilation in the ontogenesis of expressive speech of the inventory of linguistic units and the rules of their functioning, which in the process of speech generation is manifested in the impossibility or in the disorder of the production of grammatical, lexical and phonemic operations with complete or relative preservation of semantic and motor ( articulatory) operations.
Expressive alalia is caused by organic lesions of the brain in the prenatal, natal or early postnatal periods. There is an opinion that most children with alalia have (or had in the early stages of their development) mild but multiple damage in both hemispheres of the brain.
The mechanism of alalia is still poorly understood. Representatives of different directions in the study of alalia agree that the disorder of the language mechanism is based on organic failure of the brain. At the same time, some researchers associate the disorder in the functioning of the language mechanism with pathology of motor skills, others with pathology of certain aspects of mental activity, and still others with selective failure in mastering language as a unique sign system. The last point of view is the most well-reasoned.
Alalia by a violation of all subsystems of the language: syntactic, morphological, lexical and phonemic. Typical manifestations of alalia are agrammatism, word search disorders, difficulties in “selecting” phonemes and establishing their order, and violations of the syllabic structure of words. Many children with alalia have a variety of non-linguistic disorders - neurological and psychopathological. The degree of language disorder in different children can be different and manifest itself within the boundaries from a complete (or almost complete) absence of expressive speech to minor deviations in the functioning of language subsystems: first (most severe), second (moderate) and third (mild) degrees of system impairment language (or, in the terminology of other authors, the first, second and third “levels of development (underdevelopment) of speech”).
During its development, alalia undergoes a number of quantitative and qualitative changes. Having mastered relatively simple units of language and the rules of their functioning, children for a long time experience difficulties in mastering more complex units and rules. Having mastered oral speech to a certain extent, they cannot fully master written speech for a long time.
The necessary criteria for determining expressive alalia are: 1) delay in the rate of normal language acquisition; 2) pathological development of language; 3) the presence at certain stages of ontogenesis, to varying degrees of severity, of violations of all subsystems of language; 4) preservation of hearing; 5) satisfactory understanding of spoken language accessible to a certain age.
It should be noted that expressive alalia can manifest itself in children with severe neurological and psychopathological disorders (for example, in children with cerebral palsy, in oligophrenic children, etc.). These variants of alalia are specific, have not yet been well studied and are difficult to diagnose. A very large number of different terms are used to refer to alalia, which reflects different ideas about it and insufficient knowledge of its etiology, mechanism and dynamics. The most common terms are “alalia idiopathic” (congenital), “hearing muteness”, “aphasia” (“dysphasia”), “developmental aphasia” (“ontogenetic aphasia”), “speech development delay” and “constitutional delay”, “general underdevelopment speech", "impaired language acquisition", "language inability". Examples of rarely used and uninformative terms: “muteness”, “congenital alogy”, “non-speaking children”, “children with severe (profound) speech impairments”. These terms carry an uncertain meaning and many fundamentally different forms of speech disorders can be subsumed under them.
Of the existing terms that best meet the requirements for a term as an element of the language of science, and which to a greater extent reflect the specifics of the designated object, are, from our point of view, the terms “alalia” and “developmental aphasia” (otherwise “ontogenetic aphasia"). Of the two terms used to designate the form of alalia, in which auditory perception and speech understanding are preserved, but expression and speaking are impaired, namely, from the terms “motor” and “expressive,” the latter seems more successful, since it captures the typical for This form of pathology of speech activity is a disorder of linguistic (speech) expression and at the same time the rigid attachment of this disorder to its mechanism, about which very little is still known, is removed.
Due to the fact that different authors put different content into the concept of expressive alalia and sometimes define the boundaries of alalia very broadly (i.e., they consider various variants of language development disorders to be alalia), there is currently no convincing statistical data on its distribution. However, the available data are scarce and contradictory.
If you still try to summarize them and find the average indicators, then with certain reservations we can assume that alalia is observed in 0.1% of the population. Moreover, this figure varies depending on age. Thus, among preschool children, those suffering from alalia account for approximately 1.0%. Among children of primary school age - 0.6%, middle and older - 0.2%. In relation to all forms of pathology of speech activity in all age groups, alalia is 0.5%, in children - approximately 4.0%. Alalia is more common in males; The ratio of the incidence of alalia between the sexes is 2:1. According to clinical observations, compared to impressive (sensory) alalia, expressive alalia is much more common (there are no exact statistics).
CLASSIFICATIONS OF ALALIA V.A. KOVSHIKOVA, B. F. SOBOTOVICH
CLASSIFICATIONS OF ALALIA V.A. KOVSHIKOVA, B. F. SOBOTOVICH.
Psycholinguistic classification by E.F. Sobotovich:
Kovshikov.
Selection criterion: Analyzes the disorder taking into account the psycholinguistic structure and mechanisms of speech activity.
Distinguished forms: 1) Alalia, with predominant violations of the paradigmatic assimilation;
2) Alalia, with predominant disturbances in the acquisition of syntagmatic systems of language.
Brief description of the forms of alalia (main symptoms): 1) Alalia, with predominant violations of the paradigmatic assimilation. The system of relations (primarily oppositions) into which homogeneous elements of language, units of the same order, of the same level enter, is disrupted, that is, the internal structure of the language system is disrupted.
2) Alalia, with predominant disturbances in the acquisition of syntagmatic systems of language. The syntagmatic system, which reflects the patterns of compatibility of language signs when constructing speech utterances, is disrupted. Children with this form do not learn or have difficulty mastering the system of rules, norms for the compatibility of language elements (both homogeneous and heterogeneous), on the basis of which the formation and formulation of speech utterances is carried out in accordance with the norms of their native language.
Sobotovich.
Isolation criterion: According to the pathogenetic principle, revealing the mechanism of the disorder.
Distinguished forms: 1) Impressive (sensory) alalia; 2) Expressive (motor) alalia.
Brief description of the forms of alalia (main symptoms): 1) Impressive (sensory) alalia .
If the child has normal hearing, he does not understand speech addressed to him, which means he does not speak.
Symptoms: impaired phonemic hearing, poor attention and memory for oral speech (does not develop due to lack of understanding of verbal speech). The result is vagueness and instability of phonemic patterns. Sensory alaliks have hearing impairment to one degree or another, which makes it difficult to perceive spoken speech. 2) Expressive (motor) alalia is a language disorder characterized by a violation of the acquisition of linguistic units and the rules of their functioning, which is manifested in the impossibility of grammatical, lexical and phonemic operations with the relative preservation of semantic and articulatory operations. The child begins to understand someone else’s speech in a timely manner, but does not speak himself. There is often a misunderstanding of difficult words and phrases, complex sentences. The enrichment of expressive speech is limited, because they talk to him little, believing that speech is inaccessible to him. Motor speech imitation is especially severely impaired (they cannot repeat words that they have already learned to speak).
Symptoms of motor alalia
With any type of alalia, vocabulary is the first to suffer. A child 3 years old and older retains forms of speech communication that his peers have long left in the past - syllables and even babble. Motor alalia manifests itself primarily in communications. Children with this disorder communicate mainly through facial expressions and gestures. They use no more than 10-40 words in which sounds are pronounced incorrectly, and replace complex sounds with simple ones. They construct their sentences incorrectly, preferring short, choppy ones. In addition to speech symptoms, it is important to pay attention to the accompanying ones. This:
- inability to maintain concentration for a long time;
- difficulty maintaining balance due to problems with gross motor skills;
- Poorly developed self-care skills due to deficits in fine motor skills.
Motor development disorders can manifest themselves in other ways. If violations of fine motor skills manifest themselves not only in everyday life, but also in play activities, this is a serious signal. The same applies to gross motor skills (aka coordination of movements). Assess how the child walks and runs, and whether he can play with the ball. If you feel like something is wrong, you need to discuss it with a specialist, even if your speech is fine.
There are also manifestations of motor alalia in the psycho-emotional sphere. In order for a non-specialist to notice or suspect them, it is important to observe the child’s interactions with peers and compare reactions to different situations. Of course, all children are different. You should think about a visit to a neurologist if you notice neurotic symptoms (unreasonable whims, night terrors, uncontrolled movements, etc.); lagging behind peers in the emotional-volitional sphere; difficulties with understanding the surrounding world; the desire to do without verbal communication (logophobia), up to the lack of response to direct appeals.
Sometimes motor alaliks have high speech activity. In such cases, anxiety and neuroticism are extremely pronounced.
What do Soviet scientists say about motor alalia?
Valery Anatolyevich. Kovshikov wrote 70 scientific papers, most of which are devoted to the problem of motor alalia. One of the founders of the language concept.
V.A. Kovshikov conducted studies of normal and impaired speech and non-speech activity on the basis of linguistic, psycholinguistic and logopathopsychological methods, continuing and developing the traditions of the domestic psychological and speech therapy school (N.N. Traugott, V.K. Orfinskaya, A.A. Leontyev, Grinshpun B.M. et al.).
FLOW
Expressive alalia is not a static, but a dynamic disorder, which undergoes a number of significant changes during its development. All children, to one degree or another, spontaneously acquire language, despite a significant delay in the timing of its acquisition and pathological development. In the process of special education of children in preschool and school institutions, the language in the structural, structural-functional and communicative aspects is enriched and gradually approaches the norm.
Let us note the main patterns of language genesis in children with alalia.
As our research has shown (V.A. Kovshikov, 1983), the development of the sound sign system in the first - preverbal - period in children with alalia does not have any significant differences from the norm, either in structural-functional or communicative terms. In them, as in normally developing individuals, nonverbal vocalizations (screaming, crying, grunting, humming, whining, screaming, babbling, laughing, pseudo-word sounds and muttering) are involved in the formation of intonation and the prerequisites for the semantic and syntactic aspects of expressive speech. A whole series of semantic functions are formed (emotive, appellative, voluntative, regulative, relative, etc.) and a large number of meanings that make up unique semantic fields (fields of asthenic and sthenic emotions, fields of actions, relationships, etc.), as well as initial semantic-syntactic structures (“subject-action”, “object-action”, “subject-adverbial place”, etc.), which probably serve as matrices for verbal syntax.
Disruption of the development of the sound sign system in children with alalia occurs in the second - verbal - period during the mastery of verbal, linguistic signs, which, unlike the previous, non-verbal signs, have a special structure and functioning. Therefore, children cannot or find it difficult to realize their prerequisites for expressive speech in a new language form.
The genesis of language in children with alalia and in normally developing children has similar and fundamentally different features.
The similarity lies in the fact that both children go from the development of semantic functions and unique meanings, expressed by nonverbal vocalizations, to the linguistic (verbal) form of expression of these functions and meanings. For both of them, the expression of the semantic component of utterances dominates over the formal for a long time, which is especially pronounced in the early stages of language acquisition. Both of them have a certain sequence in the formation of the structural and functional side of language: the immutability of the linguistic form - its partial (mostly incorrect) change - overgeneralization and irregularity of the learned forms - the correct form.
Along with the similarities, there are significant differences. In children with alalia, the timing of the appearance of linguistic units (words, sounds, inflections, etc.) and especially the rules of their functioning are significantly behind the norm; The development of the mechanism of expressive speech in preschool age, as a rule, does not reach the norm. Until 2-3 years of age, most children with alalia either do not use verbal speech at all, or their speech has an extremely limited number of words, which are usually defective in sound and syllabic structure and which do not enter into syntactic connections with each other; If, nevertheless, the desire for connections is manifested, then their expression is abnormal: incorrect word order, lack of inflections, etc. In some children, this condition drags on for longer periods (sometimes up to the age of 4-5 years).
Children with alalia are characterized not only by a significant delay in the development of the mechanism of expressive speech, but also by its pathological development.
Thus, the volume of linguistic units related to all subsystems of the language is usually limited. The order of appearance of many units (phonemes, inflections, syntactic constructions, etc.) is different than in children with normal speech development. For example, some stops ([t], [t'], [k']) often appear earlier than some sonorants ([m]), the affricate [h] often precedes the appearance of sibilants, etc.
Children with alalia typically use language forms that are not typical for children with normal development: the use of syntactic constructions and inflections that is not normal for the norm, phoneme substitutions that are unusual for the norm, etc.
For example, replacing the genitive case with the dative (hat for the boy /boy/), the accusative with the prepositional (found a mushroom /mushroom/), the instrumental with the genitive (dig with a scoop/scoop/), etc.; the sound [w] is replaced not only by the sounds [t], [t'], [c], [c'], which is typical for the norm, but also by the sounds [h] [bump - chishka], [sch] (coils - coils ), [f] (hat - fapka), [x] (ball - harik), [d] (fur coat - oak); the sounds [v], [v'] are replaced not only by the sounds [b], [b' ], but also on [l'] (broom - lenik), [d] (girl - grandfather), [j] (mittens - yarezki) and even on the sound [r] (sofa - diran)
The communicative function of speech also differs. Children with alalia avoid communicating through speech in many situations. They often develop verbal negativism.
The development of the mechanism of expressive speech in children with alalia is characterized by a discrepancy between the violation of this mechanism and the complete or relative preservation of other speech and non-speech mechanisms of activity. These include: impressive speech, articulation, which potentially allows children to carry out a speech act, non-verbal sign systems used in speech activity (intonation, non-verbal vocalizations, “sound gestures”, onomatopoeia, facial-gestural speech), the ability to establish correct relationships between phenomena reality in a non-verbal, objective-practical form (“non-verbal thinking”).
The mechanism of language in children with alalia has been tuned for a long time to the primacy (superiority) of content to the detriment of linguistic form: sufficiently developed content (which can be judged by the non-speech activity of children and by their use of non-verbal language means in communication) is often expressed by rudimentary and defective verbal means. Of the formal linguistic means, many children over the course of a number of years have access only to those that constitute the “lowest” level of language (intonation, non-verbal vocalizations, “sound gestures”, onomatopoeia, facial-gestural speech), or the simplest means belonging to its “highest” level. level (one-word and two-word sentences, elementary syntactic connections, simple (contrasting) phonemic oppositions, “universal” syllable structure (SG), etc.).
Failure to assimilate changes in the form of language is a leading indicator of a disorder in the development of the language mechanism in children with alalia. While mastering over time a certain (sometimes relatively large) set of language units (phonemes, morphemes, words, syntactic structures), they do not master the operational rules of their functioning in the language mechanism or they master only the easiest rules to master, characteristic of the initial stages of the verbal period of normal speech development, and for a long time do not move on to other, more complex rules, at the same time using their own, defective rules. In other words, children with alalia “do not know” how to properly operate with the inventory of linguistic units they have (as we were able to verify in numerous examples, considering the mechanism of azalea; see above).
At all stages of development of verbal speech, children with alalia constantly experience alternating difficulties in operating with the structural components of language subsystems. Having partially overcome difficulties in any subsystem (for example, lexical or phonemic), they, as a rule, continue to experience difficulties in other subsystems (for example, morphological or syntactic). Overcoming difficulties at a “lower” level of organization of a particular subsystem, they often continue to experience increasing difficulties at a “higher,” complex level of its organization. For example, children can learn many syntactic structures of a sentence, but not the syntactic structure of a text. This pattern is also visible in the relationship between the development of oral and written speech systems. Many children, having satisfactorily mastered oral speech, often have great difficulty mastering the initial skills of reading and writing, and dyslexic and dysgraphic errors appear in their written speech for a long time; when dysgraphic errors partially or even completely disappear, children continue to find it difficult to express the content in writing, which is especially pronounced when independently constructing detailed texts.
The named patterns of language development in children with alalia show that its development follows a pathological type and is characterized mainly by non-assimilation and defective use of the rules for the functioning of language operations.
Typically, at the age of 3-4 years (sometimes earlier), children begin to attend specialized preschool institutions (speech therapy kindergartens, speech therapy rooms at clinics, etc.), where they receive medical and pedagogical work aimed at overcoming language and non-linguistic disorders.
In the course of this work, many children make noticeable progress. The structural and functional side of language and the communicative function of speech are formed to a certain extent, cognitive processes are improved, the range of knowledge is expanded, children master the rudiments of literacy, positive changes occur in the emotional-volitional sphere and in personality traits, in particular, speech negativism disappears or is smoothed out. However, linguistic and non-linguistic symptoms, although not as pronounced as before, continue to exist, and in some children even new ones are added to them. This is stuttering and stumbling, or a disturbance in the rhythm of speech that resembles stumbling.
Authors writing about these disorders in children with alalia believe that their occurrence is associated with articulatory difficulties that children begin to experience during the period of speech emergence when pronouncing complex sound complexes. This hypothesis has not been investigated. Another assumption can be made: stuttering occurs as a result of a violation of the construction and implementation of a motor program, but this violation, in turn, is caused by a violation of other programs included in the language process (lexical, syntactic, etc.). Of course, this assumption also needs experimental verification.
Most children, due to language and non-linguistic disorders, cannot enroll in a comprehensive school and therefore begin their education at a school for children with severe speech impairments. Only a few begin to study at a comprehensive school; usually they continue to work with them to overcome the residual effects of alalia at the speech therapy center.
Many children studying in a special school experience difficulties in mastering program material, mainly in the Russian language. Nevertheless, almost everyone completes their studies and masters the knowledge of 8 grades of secondary school. Linguistic and non-linguistic disorders are largely overcome, so that after leaving school, symptoms manifest themselves in a mild degree and are often discovered only during a special study.
The prognosis should be determined after assessing a set of factors. It is better if the child has the following indicators:
1) non-linguistic disorders are not expressed harshly (intelligence for age, behavior without pathology)
2) the microsocial environment is favorable (either a specialized kindergarten for children with STD, or parents, grandparents, etc., observing the language regime)
3) there is a need for speech (joint work of a speech therapist and parents to prevent or overcome speech negativism)
4) at least elementary syntagmatic relations in syntax are developed (presence of a sentence)
5) there are predicative words (verbs)
6) medical and pedagogical influence on the child is carried out at the early stages of his life (early examination by an ENT doctor, neurologist, early start of speech therapy work).
The prognosis is often worse if these indicators have negative characteristics and appear in combination.”
Valery Anatolyevich Kovshikov
Valery Anatolyevich Kovshikov (1936–2000), candidate of pedagogical sciences, associate professor - this name is rightfully inscribed in large letters in the history of domestic speech therapy. Having graduated from the defectology faculty of Leningrad State Pedagogical Institute (now RGPU) named after. A.I. Herzen, V.A. Kovshikov worked for almost 40 years at the Department of Psychopathology and Speech Therapy (later - the Department of Speech Therapy) of this university.
Formation of associate professor V.A. Kovshikov was held under the guidance of leading experts in the field of correctional pedagogy - professors E.S. Ivanova, L.S. Volkova, R.I. Lala-eva, in collaboration with G.M. Sumchenko, G.A. Volkova, L.G. Paramonova and his other colleagues, who formed the scientific speech therapy school in the Northern capital of Russia. It is no coincidence that the leadership of the defectology faculty and department, and colleagues have invariably trusted V.A. for many years. Kovshikov editing collections of scientific papers on the problems of speech therapy and special pedagogy. Editing scientific publications and opposing dissertations performed by V.A. Kovshikov, have always been distinguished by their depth, integrativeness, conceptual approach, integrity and scientific foresight.
Range of scientific interests of V.A. Kovshikov in the field of theory and practice of speech therapy was quite broad and constantly deepened, especially in light of close creative cooperation with the Leningrad (St. Petersburg) Institute of Ear, Throat, Nose and Speech - one of the leading medical and defectological research centers in our country. Never breaking ties with practical (mass and special) educational institutions, Valery Anatolyevich carried out experimental research work at the base related to differential diagnostic, correctional and educational work with children of preschool and school age who have developmental problems. He paid a lot of attention to advisory and methodological work with teachers and parents of children suffering from speech, intellectual and behavioral developmental disorders.
Scientific and methodological heritage of V.A. Kovshikov compiles 70 scientific and scientific-methodological works, most of which are devoted to the problem of motor alalia. The versatility of the studied V.A. Kovshikov's theoretical and methodological issues on this problem reflect the depth of his scientific thought: mechanisms of expressive alalia, differential diagnosis of language and speech disorders, intellectual and linguistic insufficiency in the overall picture of speech dysontogenesis, individual characteristics of children with alalia, specifics of disorders of phonemic, syntactic systems of language, speech and non-speech activity - this and much more was the subject of his careful research.
V.A. Kovshikov conducted studies of normal and impaired speech and non-speech activity on the basis of linguistic, psycholinguistic and logopathopsychological methods, continuing and developing the traditions of the domestic psychological and speech therapy school (N.N. Traugott, V.K. Orfinskaya, A.A. Leontyev and etc.).
Corrective work with children suffering from alalia, V.A. Kovshikov recommended focusing on the formation of the linguistic mechanism of speech activity, using a concentric system of material distribution; Moreover, each concentration, in his opinion, should include gradually more complex material from all subsystems of the language (lexical, morphological, phonemic). V.A. Kovshikov, knowing well the domestic and foreign literature, rightly emphasized that much in the problem of alalia still remains insufficiently studied and debatable. Solving the problem of successful correction of alalia can only be successful if we use and deepen modern ideas about human speech activity.
V.A. Kovshikov also developed an original training course on the historiography of domestic speech therapy.
V.A. Kovshikov was, in the true sense of the word, a socially active person, took a direct part in cultural and educational events, devoted a lot of time to engaging students and research work, and was attentive and very interested in students’ mastery of professional skills. The scientist’s ideas were embodied and developed in theses and master’s theses of his students, many of whom became leading experts in the field of correctional pedagogy. All of them remember with gratitude and great warmth their teacher, his bright, interesting lectures, polemical scientific and methodological discussions, originality of judgments, persuasiveness and evidence of scientific argumentation, his sincere devotion to the “cause of speech therapy.”
V.A. Kovshikov, a talented teacher and scientist, made a significant contribution to the development of the theory and practice of speech therapy, to the system of training and advanced training of defectological personnel.
He passed away in the prime of his creative powers, without having time to defend his doctoral dissertation, without completing work with several of his students, without finishing another book. Students, colleagues and friends keep V.A. Blessed memory of Kovshikov.
Alalia is the absence or underdevelopment of speech due to organic damage to the speech areas of the cerebral cortex in the prenatal or early period of speech development.
The causes of alalia are varied. M.V. Bogdanov-Berezovsky, N.N. Traugott point to inflammatory or nutritional-trophic metabolic pathological processes occurring in the prenatal or early period of child development. E. Freshels, Yu. A. Florenskaya about children suffering from severe rickets or who have suffered severe diseases of the upper respiratory tract (whooping cough). N. I. Krasnogorsky speaks about severe cases associated with Z.R.R., associated with lack of nutrition and sleep in the first months of life.
With alalia, various degrees of severity are observed: from relatively mild forms, in which speech develops, although slowly and distorted, from about 3-4 years, to severe ones, when the child does not use speech even at 10-12 years. Later, with systematic and special help they master speech, but it is very defective and poor.
Alalia (according to M.E. Khvattsev) is the muteness of children who speak indistinctly, if they have insufficient intelligence, elementary hearing and articulatory apparatus for the development of speech. The child is silent or makes inarticulate sounds and sound combinations. Sometimes he pronounces words that are incomprehensible to others, echolalia is observed. The phonetics, vocabulary and syntax of an 8-10 year old alalia copy the speech of 2-3 year old children. Typical for the initial stage of alalia is silence and reluctance to speak. Such inhibition is caused by the poverty of the speech process, severe mental experiences of one’s inferiority.
There are two main forms of alalia: motor and sensory. The most common is mixed sensorimotor alalia. R.E. Levin identifies 3 forms of alalia (psychological classification):
-Children with insufficient acoustic perception - do not distinguish the sound stream, do not understand, do not speak (sensory defect)
-Children with insufficiency of acoustic perception – insufficient visual perception. There is no impairment of physiological vision, but subtle visual differentiations are not formed. Notes insufficiency of optical-spatial perceptions, they do not distinguish shape, size, color, because The cells of the cerebral cortex in the parietal-occipital regions are not developed.
-Children with insufficient mental activity. Children may be closer to normal in intelligence, but their mental activity is impaired (they cannot plan, switchability suffers, there are disturbances in all types of activities, children are passive, slow.)
R.E Levin does not distinguish motor alalia.
Other researchers (S.S. Lyapidevsky, N.N. Traugott) insist on motor alalia, noting that motor alalia is based on a violation of speech motor analyzers.
Brain damage is caused by brain damage, intrauterine ecephalitis, sometimes a complication after meningitis, unfavorable intrauterine developmental conditions, difficult childbirth, brain injuries, childhood diseases with complications on the brain. The earlier the disease occurs, the more extensive the speech impairment, because all further development of the brain proceeds abnormally (myelination of nerve fibers is delayed)
Sensory alalia.
If the child has normal hearing, he does not understand speech addressed to him, which means he does not speak. Cause: injuries and diseases of the brain (auditory-speech differentiations in the acoustic apparatus, in the temporal region did not develop subtly enough) Symptoms of sensory alalia: impaired phonemic hearing, poor attention and memory for oral speech (do not develop due to lack of understanding of verbal speech) B The result is vagueness and instability of phonemic patterns. Sensory alalitics have hearing impairment to one degree or another, which makes it difficult to perceive spoken speech. Sensory alaliks are easier than motor ones to imitate sounds and words and pronounce them more often. Sometimes speech arises spontaneously, although without awareness of its content.
Motor alalia.
This is a systemic underdevelopment of expressive speech of a central organic nature due to the underdevelopment, immaturity of linguistic concepts, the process of generating speech utterances with the relative preservation of semantic and sensorimotor operations. Motor alalik begins to understand other people's speech in a timely manner, but does not speak himself. There is often a misunderstanding of difficult words and phrases, complex sentences. The enrichment of expressive speech is limited, because they talk to him little, believing that speech is inaccessible to him. Motor speech imitation is especially severely impaired (they cannot repeat words that they have already learned to speak)
Symptoms of motor alalia:
Severe impairment of imitation of oral speech (lack of articulatory speech)
Repetition of the same sound, syllable is normal (a-a-a, bo-bo-bo), but the sound combinations are broken (instead of “au” he repeats “uu, ua”)
The more developed facial-gestural speech, the longer the indication of motor alalia, because verbal thinking is relatively intact.
Causes of motor alalia:
Congenital or acquired inferiority and abnormal development of speech motor systems due to damage by disease, physical trauma, intoxication or due to delayed development of differentiation in the motor centers of the speech motor zone of the cerebral cortex (Brocca's area).
Difficulties in independently pronouncing sounds are explained by the weakness of traces from the reproduction of sounds in the speech motor system of the brain or the weakness of the connections of this system with others (acoustic, optical).
Alalik's speech
:
Speech is simplified according to the type of speech of small children (mo-milk)
Repeats syllables, but cannot merge them into words. Often there are omissions and rearrangements.
A peculiar stuttering is noted as a stage of speech development: it occurs either simultaneously with the appearance of speech, or later when mastering a phrase. Sometimes the stuttering goes away, sometimes it remains.
There are frequent sharp violations of the melody of speech, tempo, rhythm, chanting with prolonged syllables or abrupt pronunciation of words in a sentence.
Phonemic and grammatical disorders, tongue-tiedness, nasality.
Loss of understanding is secondary in nature. This occurs as a result of: lack of habit of listening, rapid fatigue, and lack of habit of listening to complex speech.
The presence of a kind of expressive speech: alalik always says something, but does not know how to use the learned words in the right case, the word is reproduced based on the object, and not on memory.
Alalik's personality.
More often they are psychophysically inferior. Due to damage to the central nervous system, deprivation of the possibility of normal communication, difficulties in the speech act, negative personality traits develop: agitation, short temper, sudden mood swings, touchiness, tearfulness, stubbornness, inactivity in movements and thinking. Negativity is typical. Extraverbal disorders: disorders of attention, memory, thinking.
Formation of expressive speech of alalik .
The formation of speech is caused by a violation of the analytical-synthetic activity of the speech motor analyzer. These violations can be of a different nature:
Kinetic oral apraxia: difficulties in the formation and consolidation of articulatory structures, and subsequently in the motor differentiation of sounds.
Difficulty switching from one movement to another.
Difficulties in mastering the sequence of these movements to reproduce words / motor patterns /.
The development of the main leading component - the active vocabulary - is delayed. It turns out to be poor, insufficient, and distorted.
The phonetic side of speech also lingers.
The grammatical structure is formed distortedly.
Formation of impressive speech.
Impressive speech suffers secondarily and to a lesser extent in its development. Characteristic is a decrease in speech stimulus or speech negativism.
Diagnostic differences between alalia and similar conditions.
Difference between alalik and deaf-mute:
Presence of modulated screaming and babbling with intonations.
At the age of 1-3 months, reaction to sound.
Emerging kinesthetic (gestural) speech accompanied by screaming.
The expression of the eyes is lively, the face is expressive.
The difference between an alalik and a child with hearing loss:
Normal or slightly reduced hearing.
A ringing voice (muffled for those with hearing loss).
Complete absence of speech (in the case of the hard of hearing – babbling or distorted speech).
Alalik does not repeat words (a hard-of-hearing child repeats).
ALALIA
Alalia is a profound immaturity of speech function, caused by organic damage to the speech areas of the cerebral cortex. With alalia, speech underdevelopment is systemic in nature, that is, there is a violation of all its components - phonetic-phonemic and lexical-grammatical. Unlike aphasia, in which there is a loss of previously present speech, alalia is characterized by an initial absence or sharp limitation of expressive or impressive speech. Thus, alalia is spoken of if organic damage to the speech centers occurred in the prenatal, intranatal or early (up to 3 years) period of the child’s development.
Alalia is diagnosed in approximately 1% of preschool children and 0.6-0.2% of school-age children; Moreover, this speech disorder occurs 2 times more often in boys. Alalia is a clinical diagnosis, which in speech therapy corresponds to the speech conclusion ONR (general speech underdevelopment).
Causes of alalia
The factors leading to alalia are diverse and can act during different periods of early ontogenesis. Thus, in the antenatal period, organic damage to the speech centers of the cerebral cortex can be caused by fetal hypoxia, intrauterine infection (TORCH syndrome), the threat of spontaneous abortion, toxicosis, falls of a pregnant woman with injury to the fetus, chronic somatic diseases of the expectant mother (arterial hypotension or hypertension, heart or pulmonary failure).
The natural outcome of a complicated pregnancy is complications of childbirth and perinatal pathology. Alalia may be a consequence of asphyxia of newborns, prematurity, intracranial birth trauma during premature, rapid or prolonged labor, or the use of instrumental obstetric aids.
Among the etiopathogenetic factors of alalia that affect the first years of a child’s life, one should highlight encephalitis, meningitis, head injury, and somatic diseases leading to depletion of the central nervous system (hypotrophy). Some researchers point to a hereditary, family predisposition to alalia. Frequent and prolonged illnesses of children in the first years of life (ARI, pneumonia, endocrinopathies, rickets, etc.), operations under general anesthesia, unfavorable social conditions (pedagogical neglect, hospitalism syndrome, deficiency of speech contacts) aggravate the effect of the leading causes of alalia.
As a rule, the history of children with alalia reveals the participation of not one, but a whole complex of factors leading to minimal brain dysfunction - MMD.
Organic damage to the brain causes a slowdown in the maturation of nerve cells, which remain at the stage of young immature neuroblasts. This is accompanied by a decrease in the excitability of neurons, inertia of the main nervous processes, and functional exhaustion of brain cells. Damages to the cerebral cortex in alalia are mild, but multiple and bilateral, which limits the independent compensatory capabilities of speech development.
Alalia classification
Over many years of studying the problem, many classifications of alalia have been proposed depending on the mechanisms, manifestations and severity of speech underdevelopment. Currently, speech therapy uses the classification of alalia according to V.A. Kovshikov, according to which they distinguish:
- expressive
(motor) alalia
- impressive
(sensory) alalia
- mixed
(sensorimotor or motosensory alalia with a predominance of impaired development of impressive or expressive speech)
The occurrence of the motor form of alalia is based on early organic damage to the cortical part of the speech motor analyzer. In this case, the child does not develop his own speech, but his understanding of someone else’s speech remains intact. Depending on the damaged area, afferent motor and efferent motor alalia are distinguished. With afferent motor alalia, damage to the postcentral gyrus (lower parietal parts of the left hemisphere) occurs, which is accompanied by kinesthetic articulatory apraxia. Efferent motor alalia occurs with damage to the premotor cortex (Broca's center, the posterior third of the inferior frontal gyrus) and is expressed in kinetic articulatory apraxia.
Sensory alalia occurs when the cortical part of the speech-hearing analyzer (Wernicke's center, the posterior third of the superior temporal gyrus) is damaged. In this case, the higher cortical analysis and synthesis of speech sounds is disrupted and, despite intact physical hearing, the child does not understand the speech of others.
Symptoms of motor alalia
With motor alalia, characteristic non-speech (neurological, psychological) and speech manifestations occur.
Neurological symptoms in motor alalia are represented primarily by movement disorders: awkwardness, lack of coordination of movements, poor development of motor skills of the fingers. Children have difficulty mastering self-care skills (buttoning buttons, tying shoes, etc.) and performing fine motor operations (folding mosaics, puzzles, etc.).
Considering the psychological characteristics of children with motor alalia, one cannot help but note impairments in memory (especially auditory-verbal), attention, perception, and emotional-volitional sphere. Based on their behavioral characteristics, children with motor alalia can be hyperactive, disinhibited, or sedentary and inhibited. Most children with motor alalia have reduced performance, high fatigue, and speech negativism. Intellectual development in alalik children suffers secondarily due to speech insufficiency. As speech develops, intellectual impairments are gradually compensated.
With motor alalia, there is a pronounced dissociation between the state of impressive and expressive speech, i.e., speech understanding remains relatively intact, but the child’s own speech develops with gross deviations or does not develop at all. All stages of the development of speech skills (humbling, babbling, babbling monologue, words, phrases, contextual speech) occur with a delay, and the speech reactions themselves are significantly reduced.
Despite the fact that a child with afferent motor alalia is potentially able to perform any articulatory movements (unlike dysarthria), sound pronunciation is grossly impaired. In this case, persistent substitutions and confusions of articulatory disputable phonemes arise, which leads to the impossibility of reproducing or repeating the sound image of a word.
With efferent motor alalia, the leading speech defect is the inability to perform a series of successive articulatory movements, which is accompanied by a gross distortion of the syllabic structure of the word. The lack of formation of a dynamic speech stereotype can lead to the appearance of stuttering against the background of motor alalia.
Vocabulary in motor alalia significantly lags behind the age norm. New words are difficult to learn; the active vocabulary contains mainly everyday terms. A small vocabulary causes an inaccurate understanding of the meanings of words, their inappropriate use in speech, and substitutions based on semantic and sound similarity. A characteristic feature of motor alalia is the absolute predominance of nouns in the nominative case in the vocabulary, a sharp limitation of other parts of speech, difficulties in the formation and differentiation of grammatical forms.
Phrasal speech with motor alalia is represented by simple short sentences (one- or two-part). As a consequence, with alalia there is a gross violation of the formation of coherent speech. Children cannot consistently present events, highlight the main and secondary, determine temporary connections, cause and effect, or convey the meaning of phenomena and events.
In severe forms of motor alalia, the child has only onomatopoeia and individual babbling words, which are accompanied by active facial expressions and gestures.
Symptoms of sensory alalia
With sensory alalia, the leading defect is a violation of the perception and understanding of the meaning of spoken speech. At the same time, the physical hearing of sensory alaliks is preserved, and they often suffer from hyperacusis - increased susceptibility to various sounds.
Against the background of auditory agnosia, own speech activity in children with sensory alalia is increased. However, their speech is a set of meaningless sound combinations and fragments of words, echolalia (unconscious repetition of other people's words). In general, with sensory alalia, speech is incoherent, meaningless and incomprehensible to others (logorrhea - “word salad”). In the speech of children with sensory alalia there are numerous perseverations (obsessive repetitions of sounds, syllables), syllable elision (omissions), paraphasia (sound substitutions), contamination (combining parts of different words with each other). Children with sensory alalia are not critical of their own speech; Facial expressions and gestures are widely used for communication.
In severe forms of sensory alalia, there is no understanding of speech at all; in other cases it is situational in nature. However, even if the child has access to the meaning of a phrase in a certain context, when the word form, word order in a sentence, or rate of speech change, understanding is lost. Often, children with sensory alalia are helped to understand speech by “reading the lips” of the speaker.
Insufficiency of phonemic hearing in sensory alalia leads to inability to distinguish paronymous words; unformed correlation of the audible and spoken word with a particular object or phenomenon.
Gross distortion of speech development with sensory alalia leads to secondary disorders of personality, behavior, and delayed intellectual development. The psychological characteristics of children with sensory alalia are characterized by difficulty turning on and maintaining attention, increased distractibility and exhaustion, instability of auditory perception and memory. Children with sensory alalia may experience impulsiveness, chaotic behavior or, on the contrary, inertia and isolation.
In its pure form, sensory alalia is rarely observed; Mixed sensorimotor alalia is usually found, which indicates the functional continuity of the speech-auditory and speech-motor analyzers.
Examination of children with alalia
Children with alalia need consultation with a pediatric neurologist, pediatric otolaryngologist, speech therapist, and child psychologist.
Neurological examination of children with alalia is necessary to identify and assess the nature and extent of brain damage. For this purpose, the child may be recommended EEG, echoencephalography, skull radiography, and MRI of the brain. To exclude hearing loss with sensory alalia, it is necessary to conduct otoscopy, audiometry and other studies of auditory function.
A neuropsychological examination of a child with alalia includes diagnostics of auditory-verbal memory. Speech therapy examination for alalia begins with clarifying the perinatal history and characteristics of the early development of the child. Particular attention is paid to the timing of psychomotor and speech development. Diagnostics of oral speech (impressive speech, lexico-grammatical structure, phonetic-phonemic processes, articulatory motor skills, etc.) is carried out according to the examination scheme for OHP.
Differential diagnosis of alalia is carried out with mental retardation, dysarthria, hearing loss, autism, mental retardation.
Alalia correction
The method of corrective action for any form of alalia should be of a comprehensive psychological, medical and pedagogical nature. Children with alalia receive the necessary help in specialized preschool educational institutions, hospitals, correctional centers, and sanatoriums.
Work on speech is carried out against the background of drug therapy aimed at stimulating the maturation of brain structures; physiotherapy (laser therapy, magnetic therapy, electrophoresis, DMV, hydrotherapy, IRT, electropuncture; transcranial electrical stimulation, etc.). With alalia, it is important to work on the development of general and manual motor skills, mental functions (memory, attention, ideas, thinking).
Given the systemic nature of the disorder, speech therapy classes to correct alalia involve working on all aspects of speech. With motor alalia, the child’s speech activity is stimulated; work is underway on the formation of active and passive vocabulary, phrasal speech, and grammatical formatting of statements; development of coherent speech and sound pronunciation. Logorhythmics and speech therapy massage are included in the outline of speech therapy classes.
With sensory alalia, the tasks are to master the distinction between non-speech and speech sounds, the differentiation of words, their correlation with specific objects and actions, the understanding of phrases and speech instructions, and the grammatical structure of speech. As the vocabulary accumulates, subtle acoustic differentiations and phonemic perception are formed, the development of the child’s own speech becomes possible.
How to help your baby?
Specific treatment methods and prognosis for motor alalia depend on the results of the examination. The program is always compiled individually. A mandatory part of it is classes with a speech therapist, but sessions with a psychologist, treatment of the nervous system, and neurorehabilitation may be necessary. In our center, alalia treatment is carried out comprehensively, children receive all the help that is necessary in their particular case. Our center’s specialists work with both simple cases and those in which motor alalia is combined with other developmental disorders, focusing on the best possible result for each patient.
