Diagnosis F 80 Specific disorders of speech and language development (disease treatment)

For every person, speech is the most important means of communication. The formation of oral speech begins from the earliest periods of a child’s development and includes several stages: from screams and babble to conscious self-expression using various linguistic techniques.

There are such concepts as oral, written, impressive and expressive speech. They characterize the processes of understanding, perceiving and reproducing speech sounds, the formation of phrases that will be spoken or written in the future, as well as the correct arrangement of words in sentences.

Oral and written forms of speech: concept and meaning

Oral expressive speech actively involves the organs of articulation (tongue, palate, teeth, lips). But, by and large, the physical reproduction of sounds is only a consequence of brain activity. Any word, sentence or phrase first represents an idea or image. After their complete formation occurs, the brain sends a signal (order) to the speech apparatus.

Written speech and its types directly depend on how developed the oral form of speech is, since, in essence, it is a visualization of the same signals that the brain dictates. However, the peculiarities of written speech allow a person to more carefully and accurately select words, improve a sentence and correct what was written earlier.

Thanks to this, written speech becomes more literate and correct compared to oral speech. While for oral speech the important indicators are voice timbre, speed of conversation, clarity of sound, intelligibility, written speech is characterized by the clarity of handwriting, its legibility, as well as the arrangement of letters and words in relation to each other.

By studying the processes of oral and written speech, specialists form a general understanding of a person’s condition, possible disorders of his health, as well as their causes. Speech function disorders can be detected both in children with a speech apparatus that has not yet fully formed, and in adults who have suffered a stroke or suffer from other diseases. In the latter case, speech may be fully or partially restored.

Main reasons

Children's age is sensitive to various kinds of influences. Severe pregnancy, childbirth, illness and head injuries will negatively affect its development.

In recent years, the number of children with such pathologies has only been growing. Experts attribute this to various reasons. Some believe environmental degradation plays a role. Others highlight the main risk factors:

• chronic diseases of the father and mother;
• age of women in labor;
• bad habits (alcohol, drugs, smoking);
• trauma during childbirth.

There are also so-called social factors. An increase in the number of smartphones, tablets, 24-hour television. Many cartoons and games for children with advertising easily attract the attention of the baby. Therefore, they lose the need to study and interact with the outside world.

In many cartoons, acid colors and shrill mechanical voices predominate - all this quickly captures the child and his attention. After which he is of little interest in the ordinary speech of an adult.

When communicating with other children and adults, he looks at the face and unconsciously tries to repeat the movements of the organs of articulation. Without such visual contact, it will be difficult for him to make sounds.

Impressive and expressive speech: what is it?

Impressive speech is a mental process that accompanies the understanding of various types of speech (written and oral). Recognition of speech sounds and their perception is a complex mechanism. The most actively involved in it are:

• sensory speech area in the cerebral cortex, also called Wernicke's area;
• auditory analyzer.

Impaired functioning of the latter provokes changes in impressive speech. An example is the impressive speech of deaf people, which is based on recognizing spoken words by lip movements. At the same time, the basis of their written impressive speech is the tactile perception of three-dimensional symbols (dots).

Schematically, Wernicke's area can be described as a kind of card index containing sound images of all words acquired by a person. Throughout his life, a person refers to this data, replenishes and corrects it. As a result of damage to the zone, the sound images of words stored there are destroyed. The result of this process is the inability to recognize the meaning of spoken or written words. Even with excellent hearing, a person does not understand what is being said (or written) to him.

Expressive speech and its types are the process of pronouncing sounds, which can be contrasted with impressive speech (their perception).

Disorders

Expressive and impressive speech in speech therapy, namely the level of its development in a particular young patient, determines the direction of additional classes designed to adapt the child to age-related psychological and physiological changes. For the convenience of providing assistance to children, speech therapists decided to classify speech disorders into subtypes.

Having different views on the course of therapy, specialists have so far failed to come to a common decision. Despite the presence of many options, the most popular of them is the classification of L. O. Badalyan.

Associated with serious disturbances in the functioning of the central nervous system

According to Badalyan, it is advisable to classify lesions of the child’s nervous system at the stage of intrauterine development or after the birth of a child into several forms.

For example:

Associated with minor changes in the functioning of the central nervous system

Forms of speech disorder arising due to functional deformations of the central nervous system are:

• stuttering (when voicing one word, the child repeats the same compound syllable several times);
• mutism (the child does not respond to requests from other people and does not react to what is happening);
• surdomutism (the child is unable not only to perceive information by ear, but also to reproduce it independently).

Associated with deviations in the structure of the organs of the articulatory apparatus

The forms of speech disorders provoked by the imperfect structure of the organs of articulation are considered to be:

• mechanical dyslalia (the child does not pronounce sounds or deliberately distorts them due to the lack of physical ability to pronounce them correctly, for example, in the presence of a short frenulum of the tongue);

• rhinolalia (the child does not pronounce nasal sounds due to the incorrect structure of the ENT organs).

Various origins

Speech therapists include speech disorders of various origins as delays in the development of a child’s speech for non-physiological reasons:

• birth as a result of premature birth;
• the presence of serious diseases of the internal systems of the body;
• incorrect form of education and general development.

The process of forming expressive speech

Starting from the first months of life, the child learns to perceive words addressed to him. Directly expressive speech, that is, the formation of a plan, inner speech and pronunciation of sounds, develops as follows:

1. Screams.
2. Booming.
3. The first syllables are like a type of humming.
4. Babble.
5. Simple words.
6. Words related to the adult vocabulary.

As a rule, the development of expressive speech is closely related to how and how much time parents spend communicating with their child.

Children's vocabulary size, correct sentence production, and formulation of their own thoughts are influenced by everything they hear and see around them. The formation of expressive speech occurs as a result of imitation of the actions of others and the desire to actively communicate with them. Attachment to parents and loved ones becomes the best motivation for a child, stimulating him to expand his vocabulary and emotionally charged verbal communication.

Expressive language impairment is a direct consequence of developmental disabilities, injury or illness. But most deviations from normal speech development can be corrected and regulated.

General information

In speech therapy, this disorder is identified as general speech underdevelopment (GSD). It can be on several levels. As a rule, it is advisable to talk about problems by the age of three. This is a critical period for speech development. If by this time the situation has not improved, then parents should visit specialists.

First of all, they turn to a neurologist. After which it is advisable to listen to a psychiatrist, audiologist (to determine the level of hearing) and only then a speech therapist.

Not every parent knows what exactly is considered developmental delays. By the age of one year, a child should speak 10 words. Usually they are simple “mom”, “dad”, “give”, etc. The use of onomatopoeia “ava”, “kisa”, “bibi”, etc. is allowed.

By two years, the active vocabulary already consists of 200 words, there is a simple phrase “I eat”, “give Masha”, etc. By three years the figure increases to 800 words, parts of speech, prepositions and some sounds appear.

Speech continues to develop even after three years. Therefore, if it begins to seriously lag behind the norm, it will be difficult to catch up. Problems with speech are fraught with disruption of all other mental functions:

• memory;
• thinking;
• attention, etc.

If a child at three years old has no words or only 2-3, parents should worry and start acting.

How are speech development disorders identified?

Speech therapists examine the speech function of children, conduct tests and analyze the information received. The study of expressive speech is carried out in order to identify the child’s formed grammatical structure of speech, to study vocabulary and sound pronunciation. It is for the study of sound pronunciation, its pathologies and their causes, as well as for the development of a procedure for correcting violations, that the following indicators are studied:

• Pronunciation of sounds.
• The syllabic structure of words.
• Level of phonetic perception.

When starting an examination, a qualified speech therapist clearly understands what exactly the goal is, that is, what kind of expressive speech disorder he should identify. The work of a professional includes specific knowledge about how the examination is carried out, what type of materials should be used, as well as how to formalize the results and form conclusions.

Taking into account the psychological characteristics of children whose age is preschool (up to seven years), the process of examining them often includes several stages. At each of them, special bright and attractive visual materials for the named age are used.

Sequence of the examination process

Thanks to the correct formulation of the examination process, it is possible to identify various skills and abilities by studying one type of activity. This organization allows you to fill out more than one item on the speech card at one time over a short period of time. An example is a speech therapist’s request to tell a fairy tale. The objects of his attention are:

• pronunciation of sounds;
• diction;
• skills in using the vocal apparatus;
• the type and complexity of sentences used by the child.

The information received is analyzed, summarized and entered into certain graphs of speech cards. Such examinations can be individual or carried out for several children at the same time (two or three).

The expressive side of children's speech is studied as follows:

1. Studying the volume of vocabulary.
2. Observation of word formation.
3. Study of the pronunciation of sounds.

Also of great importance is the analysis of impressive speech, which includes the study of phonemic awareness, as well as monitoring the understanding of words, sentences and text.

The influence of expressive speech delay on the development of Communication at an early age

Children with late development of independent speech, due to physiological reasons, are not accustomed to thinking logically from childhood. Without speech therapy classes at school age, they will make gross syntactic errors when writing from dictation.

There may also be problems with adequate interpretation of abstract images and concepts, which will make it difficult to build interpersonal relationships.

After the first signs of independent thinking appear, children should stimulate their cognitive interest and constantly expand their vocabulary.

If you have problems with verbal expression, it is recommended to play role-playing games together, learn basic phrases of daily etiquette, so that communication with peers is psychologically comfortable.

Causes of expressive speech disorders

It should be noted that communication between parents and children who have an expressive language disorder cannot be the cause of the disorder. It affects exclusively the pace and general nature of the development of speech skills.

No specialist can say unequivocally about the reasons leading to the occurrence of child speech disorders. There are several factors, the combination of which increases the likelihood of detecting such deviations:

1. Genetic predisposition. The presence of expressive speech disorders in one of your close relatives.
2. The kinetic component is closely related to the neuropsychological mechanism of the disorder.
3. In the vast majority of cases, impaired expressive speech is associated with insufficient formation of spatial speech (namely, the area of ​​the parietal temporo-occipital junction). This becomes possible with the left hemisphere localization of speech centers, as well as with dysfunction in the left hemisphere.
4. Insufficient development of neural connections, accompanying organic damage to the areas of the cortex responsible for speech (usually in right-handed people).
5. Unfavorable social environment: people whose level of speech development is very low. Expressive speech in children who are in constant contact with such people may have deviations.

When establishing the probable causes of speech disorders, one should not exclude the possibility of abnormalities in the functioning of the hearing aid, various mental disorders, congenital malformations of the organs of articulation and other diseases.
As has already been proven, full-fledged expressive speech can be developed only in those children who are able to correctly imitate the sounds they hear. Therefore, timely examination of hearing and speech organs is extremely important. In addition to the above, the causes may be infectious diseases, insufficient development of the brain, brain trauma, tumor processes (pressure on brain structures), hemorrhage in the brain tissue.

Speech development delays in children: causes, diagnosis and treatment

For citation.
Zavadenko N.N., Suvorinova N.Yu. Speech development delays in children: causes, diagnosis and treatment // RMJ. 2016. No. 6. pp. 362–366. Speech development delays usually mean a lag in speech formation from age standards in children under the age of 3–4 years.
Meanwhile, this formulation implies a wide range of speech development disorders that have different causes. The period from the first year of life to 3–5 years is decisive for the formation of speech. At this time, the brain and its functions intensively develop. Any disturbances in speech development are a reason for immediate contact with specialists - a doctor (pediatrician, child neurologist, ENT doctor, child psychiatrist), speech therapist, psychologist. This is all the more important because it is in the first years of life that deviations in the development of brain functions, including speech, are best amenable to correction. Speech and its functions.
Speech is a special and most perfect form of communication, inherent only to humans.
In the process of verbal communication (communication), people exchange thoughts and interact with each other. Speech is an important means of communication between a child and the world around him. The communicative function of speech contributes to the development of communication skills with peers, develops the ability to play together, which is invaluable for the formation of adequate behavior, the emotional-volitional sphere and personality of the child. The cognitive function of speech is closely related to the communicative function. The regulatory function of speech is formed already in the early stages of child development. However, the adult’s word becomes a true regulator of the child’s activity and behavior only by the age of 4–5, when the child’s semantic side of speech is already significantly developed. The formation of the regulatory function of speech is closely related to the development of internal speech, purposeful behavior, and the ability for programmed intellectual activity. Speech development disorders affect the overall development of children’s personality, their intellectual growth and behavior, and make it difficult to learn and communicate with others [1, 2]. Forms of speech development disorders.
Specific language development disorders include those disorders in which normal language development is affected in the early stages.
According to the ICD-10 classification [3], these include disorders of the development of expressive language (F80.1) and receptive language (F80.2). In this case, disturbances appear without a previous period of normal speech development. Specific speech development disorders are the most widespread disorders of neuropsychic development; their frequency of occurrence in the child population is 5–10% [1, 4]. Alalia
(according to modern international classifications - “dysphasia” or “developmental dysphasia”) is a systemic underdevelopment of speech, it is based on an insufficient level of development of the speech centers of the cerebral cortex, which can be congenital or acquired in the early stages of ontogenesis, in the pre-speech period .
In this case, first of all, children’s ability to speak suffers; expressive speech is characterized by significant deviations, while speech understanding can vary, but, by definition, is much better developed [2]. The most common variants (expressive and mixed expressive-receptive disorders) are manifested by a significant delay in the development of expressive speech compared to the development of understanding. Due to difficulties in organizing speech movements and their coordination, independent speech does not develop for a long time or remains at the level of individual sounds and words. Speech is slow, poor, vocabulary is limited. There are many slips of the tongue (paraphasias), permutations, and perseverations in speech. Growing up, children understand these mistakes and try to correct them. In modern literature, both terms are used - “specific speech development disorders” and “developmental dysphasia” - and they refer to the same group of pediatric patients. But “developmental dysphasia” is considered a more accurate formulation of the diagnosis, since this term reflects both the neurological and evolutionary-age aspects of this disorder [2, 5]. Complete or partial loss of speech caused by local lesions of the speech areas of the cerebral cortex is called aphasia. Aphasia is the decay of already formed speech functions, so this diagnosis is made only after 3–4 years. With aphasia, there is a complete or partial loss of the ability to speak or understand someone else's speech. Dysarthria
is a violation of the sound pronunciation side of speech as a result of a violation of the innervation of the speech muscles.
Depending on the location of the lesion in the central nervous system (CNS), several variants of dysarthria are distinguished: pseudobulbar, bulbar, subcortical, cerebellar. Depending on the leading disorders underlying speech disorders in children, L.O. Badalyan [6] proposed the following clinical classification. I. Speech disorders associated with organic damage to the central nervous system. Depending on the level of damage, they are divided into the following forms: 1. Aphasia - the collapse of all components of speech as a result of damage to the cortical speech areas. 2. Alalia is a systemic underdevelopment of speech as a result of damage to the cortical speech zones in the pre-speech period. 3. Dysarthria - a violation of the sound pronunciation side of speech as a result of a violation of the innervation of the speech muscles. Depending on the location of the lesion, several variants of dysarthria are distinguished. II. Speech disorders associated with functional changes in the central nervous system (stuttering, mutism and surdomutism). III. Speech disorders associated with defects in the structure of the articulatory apparatus (mechanical dyslalia, rhinolalia). IV. Delayed speech development of various origins (due to prematurity, severe diseases of internal organs, pedagogical neglect, etc.). In the domestic psychological and pedagogical classification
[7], alalia (dysphasia), along with other clinical forms of speech retardation in children, is considered from the standpoint of general speech underdevelopment (GSD).
This classification is based on the principle “from particular to general”. OHP is heterogeneous in its developmental mechanisms and can be observed in various forms of oral speech disorders (alalia, dysarthria, etc.). Common signs include a late onset of speech development, a poor vocabulary, agrammatisms, pronunciation defects, and phoneme formation defects [7]. Underdevelopment can be expressed to varying degrees: from the absence of speech or its babbling state to extensive speech, but with elements of phonetic and lexico-grammatical underdevelopment. The three levels of OHP differ as follows: 1st – absence of common speech (“speechless children”), 2nd – the beginnings of common speech and 3rd – extensive speech with elements of underdevelopment in the entire speech system. The development of ideas about OSD is focused on creating correction methods for groups of children with similar manifestations of various forms of speech disorders. The concept of ONR reflects the close relationship of all components of speech during its abnormal development, but at the same time emphasizes the possibility of overcoming this lag and moving to qualitatively higher levels of speech development. However, the primary mechanisms of ANR cannot be elucidated without a neurological examination, one of the important tasks of which is to determine the location of the lesion in the nervous system, i.e., making a topical diagnosis. At the same time, diagnostics is aimed at identifying the main disrupted links in the development and implementation of speech processes, on the basis of which the form of speech disorders is determined. There is no doubt that when using the clinical classification of speech development disorders in children, a significant part of cases of OSD are associated with developmental dysphasia (alalia). For the normal development of speech
, it is necessary that the brain and especially the cortex of its cerebral hemispheres reach a certain maturity, the articulatory apparatus is formed, and hearing is preserved.
Another indispensable condition is a complete speech environment from the first days of a child’s life. The reasons for the delay in speech development
may be pathology during pregnancy and childbirth, dysfunction of the articulatory apparatus, damage to the organ of hearing, a general lag in the mental development of the child, the influence of heredity and unfavorable social factors (insufficient communication and education).
Difficulties in mastering speech are also typical for children with signs of retarded physical development, those who suffered serious illnesses at an early age, those who are weakened, or those who receive malnutrition. Hearing impairment
is the most common cause of isolated speech delay [8].
It is known that even moderately pronounced and gradually developing hearing loss can lead to delays in speech development. Signs of hearing loss in a baby include a lack of response to sound signals and an inability to imitate sounds, while in an older child there is excessive use of gestures and close observation of the movements of the lips of speaking people. However, the assessment of hearing based on the study of behavioral reactions is insufficient and is subjective. Therefore, if partial or complete hearing loss is suspected in a child with isolated speech delay, it is necessary to conduct an audiological examination. The method of recording auditory evoked potentials also provides reliable results. The sooner hearing defects are detected, the sooner it will be possible to begin appropriate corrective work with the baby or equip him with a hearing aid. The causes of delayed speech development in a child may be autism
or
general mental retardation
, which is characterized by uniform incomplete formation of all higher mental functions and intellectual abilities.
To clarify the diagnosis, an in-depth examination is carried out by a pediatric psychoneurologist [9]. On the other hand, it is necessary to distinguish between tempo delays in speech development
caused by a lack of stimulation of speech development under the influence of unfavorable social factors (insufficient communication and education).
A child’s speech is not an innate ability; it is formed under the influence of the speech of adults and largely depends on sufficient speech practice, a normal speech environment, and on upbringing and training, which begin from the first days of a child’s life. The social environment stimulates speech development and provides a speech pattern. It is known that in families with poor speech impulses, children begin to speak late and speak little. A delay in speech development may be accompanied by a general lack of development, while the natural intellectual and speech abilities of these children correspond to the norm. Neurobiological factors in the pathogenesis of speech development disorders.
Perinatal pathology of the central nervous system plays a significant role in the formation of speech disorders in children.
This is due to the fact that it is in the perinatal period that the most important events occur that have a direct and indirect impact on the processes of the structural and functional organization of the central nervous system. Taking this into account, it is advisable to identify risk groups for disorders of psycho-speech development already in the 1st year of life [10]. The high-risk group should include children who, in the first 3 months. life as a result of the examination, structural changes in the central nervous system were revealed, premature infants (especially with extremely low body weight), children with analyzer disorders (auditory and visual), insufficiency of cranial nerve functions (in particular V, VII, IX, X, XII), children with a delay in the reduction of unconditioned automatisms, long-lasting disorders of muscle tone [10]. In premature newborns, especially those with a short gestation period, an important period of development of the central nervous system (interneuronal organization and intensive myelination) occurs not in utero, but under difficult conditions of postnatal adaptation. The duration of this period can vary from 2–3 weeks. up to 2–3 months, and this period is often accompanied by the development of various infectious and somatic complications, which serves as an additional factor causing disturbances in psychomotor and speech development in immature and premature children. One of the main consequences of prematurity—hearing impairment—plays a negative role [10]. Studies have shown that approximately half of very premature children have delayed speech development, and at school age they have learning difficulties, problems with reading and writing, concentration and behavior control [11]. In recent years, the role of genetic factors in the formation of speech development disorders has also been confirmed [10]. Development of speech skills is normal.
For timely and accurate diagnosis of speech disorders in children, it is necessary to take into account the patterns of normal speech development. Children pronounce their first words by the end of the first year of life, but they begin to train their speech apparatus much earlier, from the first months of life, so the age of up to one year is a preparatory period in the development of speech. The sequence in the development of pre-speech reactions is shown in Table 1.

So, in the first year of life, the child’s speech apparatus is preparing to pronounce sounds. Humming, “flute”, babbling, modulated babbling are a kind of game for the baby and give the child pleasure; for many minutes he can repeat the same sound, training in a similar way in the articulation of speech sounds. At the same time, the active formation of speech understanding occurs. An important indicator of speech development up to one and a half to two years is not so much the pronunciation itself, but the understanding of addressed speech (receptive speech). The child must listen carefully and with interest to adults, understand speech addressed to him well, recognize the names of many objects and pictures, and follow simple everyday requests and instructions. In the second year of life, words and sound combinations already become a means of verbal communication, that is, expressive speech is formed. The main indicators of normal speech development from 1 year to 4 years: • The appearance of clear, meaningful speech (words) – 9–18 months. • At first (up to one and a half years), the child mainly learns to understand speech, and from 1.5–2 years he quickly develops active speech and his vocabulary grows. The number of words that the baby understands (passive vocabulary) is still greater than the number of words that he can pronounce (active vocabulary). • The appearance of phrases of 2 words – 1.5–2 years, of 3 words – 2–2.5 years, of 4 or more words – 3–4 years. • Volume of active vocabulary: – by 1.5 years, children pronounce 5–20 words, – by 2 years – up to 150–300 words, – by 3 years – up to 800–1000 words, – by 4 years – up to 2000 words Early signs of trouble in speech formation.

Children who do not try to speak at 2–2.5 years should be a cause for concern. However, parents may notice certain prerequisites for problems in speech development earlier. In the first year of life, one should be alarmed by the absence or weak expression at appropriate times of humming, babbling, first words, reaction to adult speech and interest in it; at one year - the child does not understand frequently used words and does not imitate speech sounds, does not respond to speech addressed to him, and resorts only to crying to attract attention to himself; in the second year - lack of interest in speech activity, replenishment of passive and active vocabulary, the appearance of phrases, inability to understand the simplest questions and show an image in a picture. At 3–4 years of life, signs of dysfunctional speech formation should cause high concern in comparison with the normal characteristics of its development, which are given in Table 2. Lack of assistance at an early age for children with speech underdevelopment leads to a number of consequences: communication disorders and conditioned They include difficulties in adapting to a group of children and in contacts with other people, immaturity in the emotional sphere and behavior, and insufficient cognitive activity. This is confirmed by the data of our study to assess the indicators of age-related development of children with dysphasia [12]. We examined 120 patients aged from 3 to 4.5 years (89 boys and 31 girls) with developmental dysphasia - a disorder of expressive speech development (F80.1 according to ICD-10 [3]) and a picture of level 1-2 OHP according to psychological and pedagogical classification [7]. Children whose speech development delay was caused by hearing loss, mental retardation, autism, severe somatic pathology, malnutrition, as well as the influence of unfavorable social factors (insufficient communication and education) were excluded from the study group. We studied indicators of age-related development using the Developmental Profile 3 (DP-3) methodology [13] in five areas: motor skills, adaptive behavior, social-emotional sphere, cognitive sphere, speech and communication abilities. A structured interview form was used, conducted by a specialist with parents. Based on the data obtained, it was determined what age the child’s development corresponds to in each of the areas and at what age interval he lags behind the normal indicators for his calendar age. When studying the anamnesis, many parents indicated that already at an early age they paid attention to the absence or limitation of babbling in children. Parents noted silence and emphasized that the child understood everything, but did not want to speak. Instead of speech, facial expressions and gestures developed, which children used selectively in emotionally charged situations. The first words and phrases appeared late. Parents noted that, apart from speech delays, in general the children were developing normally. The children had a poor active vocabulary and used babbling words, onomatopoeia, and sound complexes. There were many reservations in the speech, which the children paid attention to and tried to correct what was said incorrectly. At the time of the examination, the volume of the active vocabulary (stock of spoken words) in children with level 1 SLD did not exceed 15–20 words, and with level 2 SLD – 20–50 words. Table 3 presents the results of the examination, showing at what age interval there was a lag from normal indicators in three groups of children with developmental dysphasia, divided by age: (1) from 3 years 0 months. up to 3 years 5 months; (2) from 3 years 6 months. up to 3 years 11 months; (3) from 4 years 0 months. up to 4 years 5 months

It seems logical that the most significant lag was in the formation of speech and communication abilities, but at the same time the degree of this lag increased - from 17.3 ± 0.4 months. in the 1st group to 21.2±0.8 in the 2nd and 27.3±0.5 months. in the 3rd group. Along with the increase in the severity of differences from healthy peers in speech development, the lag in all other areas not only persisted, but also increased with each six-month age period. This indicates, on the one hand, the significant influence of speech on other areas of the child’s development, and on the other, the close relationship and inextricability of various aspects of individual development. The main directions of complex therapy

for developmental dysphasia in children are: speech therapy work, psychological and pedagogical correctional measures, psychotherapeutic assistance to the child and his family, drug treatment.
Since developmental dysphasia is a complex medical, psychological and pedagogical problem, the complexity of the impact and continuity of work with children by specialists of various profiles are of particular importance when organizing assistance to such children. Speech therapy assistance is based on the ontogenetic principle, taking into account the patterns and sequence of speech formation in children. In addition, it is individual, differentiated, depending on a number of factors: the leading mechanisms and symptoms of speech disorders, the structure of the speech defect, the age and individual characteristics of the child. Speech therapy and psychological-pedagogical correctional activities are a purposeful, complexly organized process that is carried out over a long period of time and systematically. Under these conditions, correctional work gives most children with developmental dysphasia the means sufficient for verbal communication. The most complete correction of speech development disorders is facilitated by the timely use of nootropic drugs. Their prescription is justified based on the main effects of this group of drugs: nootropic, stimulating, neurotrophic, neurometabolic, neuroprotective. One of these drugs is acetylaminosuccinic acid (Cogitum). Cogitum is an adaptogenic and general tonic that normalizes nervous regulation processes and has immunostimulating activity. Cogitum contains acetylaminosuccinic acid (in the form of dipotassium salt of acetylaminosuccinate) - a synthetic analogue of aspartic acid - a non-essential amino acid found mainly in the tissues of the central nervous system. For pediatricians and pediatric neurologists, such properties of aspartic acid are important, such as participation in DNA and RNA synthesis, influence on increasing physical activity and endurance, normalization of the balance between the processes of excitation and inhibition in the central nervous system, immunomodulatory effect (acceleration of antibody formation processes) [14]. Aspartic acid is involved in a number of metabolic processes, in particular, it regulates carbohydrate metabolism by stimulating the transformation of carbohydrates into glucose and the subsequent creation of glycogen reserves; Along with glycine and glutamic acid, aspartic acid serves as a neurotransmitter in the central nervous system, stabilizes nervous regulation processes and has psychostimulating activity [14]. In neuropediatric practice, the drug has been used for many years for indications such as delayed psychomotor and speech development, consequences of perinatal lesions of the central nervous system, neuroinfections and traumatic brain injuries, cerebrasthenic and astheno-neurotic syndromes. Release form. Oral solution in ampoules of 10 ml. 1 ml of the drug contains 25 mg of acetyl-aminosuccinic (aspartic) acid, and 1 ampoule (10 ml) – 250 mg. The composition of the drug includes: fructose (levulose) - 1.0 g, methyl parahydroxybenzoate (methyl-n-hydroxybenzoate) - 0.015 g, aromatics (banana flavor) - 0.007 g, distilled water - up to 10 ml per 1 ampoule. The drug does not contain crystalline sugar or its synthetic substitutes, therefore it is not contraindicated in diabetes mellitus. Dosage regimens. The drug is given orally undiluted or with a small amount of liquid. For children aged 7–10 years, it is recommended to take 1 ampoule (250 mg) orally in the morning, for children over 10 years old – 1–2 ampoules (250–500 mg) in the morning. For patients from 1 to 7 years of age, the dose is determined by the doctor individually [14]. In our experience, it is preferable for children under 7 years of age to take 5 ml (1/2 ampoule) 1 or 2 times a day. The duration of treatment is usually 2–4 weeks. For a single dose, the drug is prescribed in the morning, for a double dose, the second dose is prescribed no later than 16–17 hours. Before prescribing Cogitum, it is necessary to obtain written informed consent from parents/legal representatives for treating a child with acetylaminosuccinic acid, indicating that they are familiar with the indications, contraindications and side effects and do not object to prescribing the drug to a child. Side effects.
Although hypersensitivity reactions (allergic reactions) to individual components of the drug are possible, they are rare. There are no reports of drug overdoses in the literature. If necessary, children with delays in speech development may be prescribed repeated courses of treatment with nootropic drugs. An open controlled study confirmed clinical effectiveness for developmental dysphasia in children aged 3 years to 4 years 11 months. two-month therapeutic courses of hopantenic acid, pyritinol and a drug containing a complex of peptides obtained from the pig brain [15]. To objectively assess the effectiveness of the therapy, parents are recommended to monitor the growth of vocabulary, improvement in the pronunciation of sounds and words, and the emergence of new phrases in the child’s speech. It is advisable to record the results of these observations in the form of special diary entries, which will be discussed with specialists during repeat visits to them. Constant contact with specialists (doctor and speech therapist), conducting consultations over time is an important condition for the success of the treatment.

What types of expressive speech disorders occur?

Among expressive speech disorders, the most common is dysarthria - the inability to use the speech organs (tongue paralysis). Its frequent manifestations are chanted speech. Manifestations of aphasia, a disorder of speech function that has already formed, are also not uncommon. Its peculiarity is the preservation of the articulatory apparatus and full hearing, but the ability to actively use speech is lost.

There are three possible forms of expressive language disorder (motor aphasia):

• Afferent. It is observed if the postcentral parts of the dominant cerebral hemisphere become damaged. They provide the kinesthetic basis necessary for full movements of the articulation apparatus. Therefore, it becomes impossible to voice some sounds. Such a person cannot pronounce letters that are similar in their method of formation: for example, sibilant or prelingual. The consequence is a violation of all types of oral speech: automated, spontaneous, repeated, naming. In addition, there are difficulties with reading and writing.
• Efferent. Occurs when the lower parts of the premotor area are damaged. It is also called Broca's area. With this disorder, the articulation of specific sounds does not suffer (as with afferent aphasia). For such people, switching between different speech units (sounds and words) causes difficulty. While clearly pronouncing individual speech sounds, a person cannot pronounce a series of sounds or a phrase. Instead of productive speech, perseveration or (in some cases) speech embolus is observed.

It is worth mentioning separately such a feature of efferent aphasia as the telegraphic style of speech. Its manifestations are the exclusion of verbs from the dictionary and the predominance of nouns. Involuntary, automated speech and singing may be preserved. The functions of reading, writing and naming verbs are impaired.

• Dynamic. It is observed when the prefrontal regions, the areas in front of Broca's area, are affected. The main manifestation of such a disorder is a disorder affecting active voluntary productive speech. However, reproductive speech (repeated, automated) is preserved. For such a person, expressing thoughts and asking questions is difficult, but articulating sounds, repeating individual words and sentences, and answering questions correctly are not difficult.

A distinctive feature of all types of motor aphasia is the person’s understanding of the speech addressed to him, the completion of all tasks, but the impossibility of repetition or independent expression. Speech with obvious defects is also common.

Agraphia as a separate manifestation of expressive language disorder

Agraphia is the loss of the ability to write correctly, which is accompanied by preservation of motor function of the hands. It occurs as a consequence of damage to the secondary associative fields of the cortex of the left hemisphere of the brain.

This disorder becomes concomitant with oral speech disorders and is extremely rarely observed as a separate disease. Agraphia is a sign of a certain type of aphasia. As an example, we can cite the connection between damage to the premotor area and a disorder of the unified kinetic structure of writing.

In the case of minor damage, a person suffering from agraphia may correctly write specific letters, but may misspell syllables and words. It is likely that there are inert stereotypes and a violation of the sound-letter analysis of the composition of words. Therefore, such people find it difficult to reproduce the required order of letters in words. They may repeat individual actions several times that disrupt the overall writing process.

Alternative interpretation of the term

The term “expressive speech” refers not only to the types of speech and the features of its formation from the point of view of neurolinguistics. It is the definition of the category of styles in the Russian language.

Expressive styles of speech exist in parallel with functional ones. The latter include bookish and conversational. Written forms of speech are journalistic style, official business and scientific. They belong to book functional styles. Conversational is represented by the oral form of speech.

Means of expressive speech increase its expressiveness and are designed to enhance the impact on the listener or reader.

The word “expression” itself means “expressiveness”. The elements of such vocabulary are words designed to increase the degree of expressiveness of oral or written speech. Often, several expressive synonyms can be selected for one neutral word. They may vary depending on the degree of emotional stress. There are also often cases when for one neutral word there is a whole set of synonyms that have exactly the opposite connotation.

The expressive coloring of speech can have a rich range of different stylistic shades. Dictionaries include special symbols and notes to identify such synonyms:

• solemn, high;
• rhetorical;
• poetic;
• humorous;
• ironic;
• familiar;
• disapproving;
• dismissive;
• contemptuous;
• derogatory;
• sulgaric;
• abusive.

The use of expressively colored words must be appropriate and competent. Otherwise, the meaning of the statement may be distorted or take on a comical sound.

Expressive speech styles

Representatives of modern science of language classify the following styles as:

1. Solemn.
2. Familiar.
3. Official.
4. Jocular.
5. Intimately affectionate.
6. Mocking.

The contrast to all these styles is neutral, which is completely devoid of any expression.

Emotionally expressive speech actively uses three types of evaluative vocabulary as an effective means of helping to achieve the desired expressive coloring:

1. The use of words that have a clear evaluative meaning. This should include words that characterize someone. Also in this category are words that evaluate facts, phenomena, signs and actions.
2. Words with significant meaning. Their main meaning is often neutral, however, when used in a metaphorical sense, they acquire a rather bright emotional connotation.
3. Suffixes, the use of which with neutral words allows you to convey a variety of shades of emotions and feelings.

In addition, the generally accepted meaning of words and the associations attached to them have a direct impact on their emotional and expressive coloring.