Delayed speech development in children: causes, diagnosis and correction

Stages of child speech development

Trajectories of speech development are individual for each child, and therefore psychologists and other specialists in the field of early development do not establish clear standards for speech development in children. It is important to note that an indicator of speech development is not only the number of sounds and words that a child uses to communicate, but also his passive vocabulary, that is, those words that the child understands. Speech skills characteristic of the conditional norm in early and junior preschool age are presented in the table.

If there is a strong discrepancy between the child’s speech development level and age norms, it is advisable to seek advice from a specialist (neurologist, speech therapist, psychologist) in order to exclude a delay in psycho-speech development. Don't put it off until later.

Correction of speech pathologies

Speech is a unique form of communication that only humans use. For the child, it becomes a means of communication between him and the people around him, but only when the baby develops normally and is able to master the language. The formation of speech is one of the most important aspects of human development, but it is the highest mental function, which is directly dependent on the brain. It is important to promptly notice the slightest deviations in its development and quickly begin correcting speech disorders. As a higher mental function, speech consists of two interdependent components: auditory perception of sounds (this is provided by Wernicke's center, located in the auditory cortex of the temporal lobe) and sound reproduction - speech motor function (Broca's center, located in the lower parts of the frontal lobe, is responsible for it).

There can be many reasons for improper speech development, including:

pathologies, injuries, various infectious diseases suffered by the mother during pregnancy, intrauterine infections; prematurity; hypoxia and asphyxia during childbirth, birth injuries; diseases suffered by the child in the first years of life, especially those inflammatory processes and injuries that can lead to hearing impairment; genetic predisposition, if similar cases have already occurred in the family; defects of articulatory organs, both congenital and acquired; unfavorable situation in the family, when the child is abandoned and does not receive proper love and attention; pedagogical neglect, lack of emotional contact and verbal communication. Today, science offers two complementary classifications of speech disorders, which consider them from different aspects, helping to create a complete picture: clinical-pedagogical and psychological-pedagogical.

Clinical and pedagogical classification This classification, as the name suggests, is largely based on medicine and considers two large groups of speech disorders: one concerns oral, the other - written speech. The orientation is aimed at correcting the defect, therefore the classification uses an approach from the general to the specific.

Oral speech disorders This group, in turn, is further divided into two parts. The first is disorders of the phonation of utterances. It includes:

Dislalia

It is characterized by incorrect pronunciation of sounds with normal innervation of the speech apparatus and the presence of hearing. Two types of dyslalia are considered depending on the presence or absence of damage to the peripheral speech apparatus:

• Functional dyslalia - manifests itself in childhood, when the child learns to speak and masters the pronunciation system. They are caused by general physical weakness due to frequent illnesses during the formation of speech function, unfavorable upbringing conditions, insufficient development of phonemic hearing, and bilingualism in the family.
• Mechanical dyslalia - can occur at any age due to physical damage to the speech organs, structural features of the speech apparatus (defects in the structure of the jaws, dentition, defects in the frenulum of the tongue), abnormal structure of the lips, hard or soft palate, defects in the shape or size of the tongue.

Sometimes a combined form is observed, when functional and mechanical causes are combined. The following disturbances in the pronunciation of sounds in dyslalia occur:

• missing sound: yba instead of fish, astik instead of eraser;
• a distorted sound (the correct one is replaced by a non-existent one in our phonetic system): instead of the usual s, the child pronounces interdental, instead of r - grazing;
• replacing a difficult-to-articulate sound with an easier one: uuk instead of bow.

Dysphonia (aphonia)
Impaired or complete absence of phonation due to a defect in the vocal apparatus. Aphonia is characterized by the absence of phonation, dysphonia is characterized by disturbances in various parameters of the voice (pitch, timbre, etc.). They can appear at any stage of development, and the causes are functional or organic disorders of the voice-forming mechanism. The violation can be either separate or combined with other defects.

Bradylalia

The disorder manifests itself in a pathologically slow rate of speech, which occurs due to the slow implementation of the articulatory act. The defect is caused by functional or organic reasons, and speech sounds sluggish and monotonous.

Tahilalia

The opposite of bradyllalia, a centrally determined pathologically accelerated rate of speaking. It can also be organic or functional, occurring due to the accelerated implementation of the articulatory act. A person with tachylalia jabbers, his speech is stormy and hasty.

Changes in the tempo of speech lead to disturbances in its smoothness and expressiveness.
Stuttering
When stuttering, the tempo-rhythmic organization of speech is disrupted. This is a consequence of muscle spasms of the speech apparatus of various origins. The most common time of occurrence is the period of development of speech in the baby. Symptoms of stuttering appear on two sides - physiological and psychological.

• Physiological symptoms: convulsions of various shapes and localization, disturbances in motor skills (speech and general), melody and intonation of speech, unconscious movements of the face and body parts.
• Psychological symptoms: logophobia (when a child or adult is afraid to say specific sounds, words, or is afraid to speak in a certain situation - answering at the board, speaking in public, etc.), defensive speech and motor tricks, stylistic changes in speech, zero, moderate or a pronounced degree of fixation on the defect.

According to severity, the violation is classified into three degrees:

• mild - a person stutters only when nervous and excited, at a high rate of speech, when trying to tell something quickly;
• average - stuttering is not expressed or manifests itself very weakly in an idyllic, familiar environment, but when excited, in unusual circumstances, a person begins to stutter severely;
• severe – stuttering manifests itself regardless of the conditions and emotional state.

Rhinolalia
With rhinolalia, the timbre of the voice is disturbed and the pronunciation of the main number of sounds changes. Sometimes this occurs due to the physiological structure of the organs of the speech apparatus, and sometimes it can be a functional deviation. When speaking, the vocal-exhalatory stream comes out not only through the mouth, but also through the nose, where it creates a nasal resonance. Speech with this defect is unintelligible, nasalization or nasality is pronounced, and articulatory and acoustic disturbances occur. Congenital organic rhinolalia is caused by the following abnormalities: cleft palate, cleft lip, clefts of the hard palate, shortening of the soft palate, absence or bifurcation of a small uvula. Acquired causes include polyps, deviated nasal septum, adenoids, fibroids and tumors of the nasopharynx.

By design, rhinolalia is classified as follows:

• Closed - front or back; with it, only the timbre of the voice changes due to anatomical obstacles in the nasopharynx or nasal cavity.
• Open - the timbre changes, sounds are distorted due to the soft palate lagging behind the back wall of the pharynx when speaking.
• Mixed - combines both types.

Dysarthria
A type of speech pathology, expressed in difficulty in pronunciation and distortion of sounds due to insufficient innervation of the speech apparatus, when the central nervous system and peripheral nervous system are affected.

How severe the manifestations are depends on the severity and nature of the lesions. If in mild cases speech is simply slightly distorted due to individual incorrectly pronounced sounds, then in severe cases, with paralysis of the speech motor muscles, it becomes completely impossible (then they talk about anarthria). The localization of the lesion may also differ; depending on this, cortical, subcortical, cerebellar, bulbar and pseudobulbar forms are distinguished.

Dysarthria is classified according to severity:

• The first is that incorrect pronunciation of sounds is almost invisible; it can only be detected by a specialist during examination.
• The second is that although others notice the violations, they understand the speaker’s speech without any problems.
• Third, the expressiveness and pace of speech suffers; it contains distortions, omissions and substitutions of sounds. A person is fully understood only by those close to him, and by strangers only partially.
• The fourth is anarthria itself, in which speech is either absent altogether (severe), or is expressed by small sound-syllable activity and is practically incomprehensible even to relatives (moderate).

Another group of oral speech disorders is disturbances in the structural and semantic design of utterances, expressed by alalia and aphasia.
Alalia
With this disease, children with full hearing and intact intellect have no or underdeveloped speech. The reason lies in brain diseases and injuries that occurred before the child was 3 years old (during the so-called pre-speech period). Sometimes the areas of the cerebral hemispheres responsible for speech are damaged during childbirth. There are three types of alalia:

• Motor – develops due to dysfunction of the speech motor center (Broca’s center). With motor (or expressive) alalia, the child normally understands speech addressed to him, but his own phrasal speech is formed late (at 4 years and later), with incorrect construction of sentences from the point of view of grammar, and is characterized by a poor and slowly growing vocabulary. Often there is no babbling at the pre-speech stage. Sometimes it is accompanied by mental manifestations: difficulty concentrating, decreased performance, motor disinhibition, and impaired intellectual development.
• Sensory – develops due to dysfunction of the speech-hearing analyzer (Wernicke’s center). Hearing is preserved, but the child does not understand the speech of others well, does not distinguish sounds, and the phonetic aspect of speech is grossly impaired. This also results in a sharp limitation of his own speech; the child cannot concentrate for a long time and does not listen to what he is told. He distorts words, confuses similar sounds, and often does not respond when his name is called, although he reacts to surrounding noises. Auditory attention is scattered. Intellectually, underdevelopment is sometimes encountered, from minor delays to mental retardation.
• Sensorimotor is the most severe form, since the damage affects both Broca’s center and Wernicke’s center, that is, the ability to understand speech and speaking is simultaneously impaired while the intellect is initially preserved. Because of this, autism is often misdiagnosed. Correction of sensorimotor alalia takes longer and is more difficult: first of all, the child must be taught to understand addresses, and only then engage in speech reproduction.

Aphasia
A child’s complete or partial loss of speech function, which occurs after speech formation due to neuroinfections, injuries and brain tumors. There are only six forms of aphasia depending on the location of the damage:

• acoustic-gnostic;
• acoustic-mnestic;
• semantic;
• afferent motor;
• efferent motor;
• dynamic.

Written language disorders Two large groups of written language disorders involve difficulties in reading (dyslexia) and writing (dysgraphia).
Dyslexia

A selective specific disorder that prevents a child from fully mastering the ability to read. The child recognizes letters incorrectly, has difficulty adding them into syllables, and syllables, in turn, into words. Because of this, he cannot read the word correctly, does not understand or does not fully understand what he read. There are five types of dyslexia:

• Phonemic – occurs due to impaired formation of phonemic perception, analysis and synthesis. When reading, a child confuses phonetically similar sounds; it is difficult for him to remember the letters that represent similar sounds. Sometimes there is reading from letters, difficulties with merging them into syllables.
• Agrammatic - the grammatical structure of a word is disrupted during reading, parts of the word are confused: endings, prefixes, suffixes.
• Semantic - with this form, the child reads everything correctly from a technical point of view, but at the same time does not understand or misunderstands what he read. Manifests itself at the level of words, sentences, and text.
• Optical - expressed in a confusion of graphically similar letters during the reading process, sometimes mirror reading appears.
• Mnestic - the child perceives sounds and letters separately, it is difficult for him to understand how they relate and remember.

Dysgraphia
A selective specific disorder that prevents a child from fully mastering writing. He skips, replaces, mixes letters, distorts the composition of words, the structure of sentences. There are five forms of dysgraphia:

• Acoustic - is expressed in the replacement of letters in writing that indicate sounds similar in pronunciation (hissing-whistling, soft-hard, etc.) with correct pronunciation.
• Articulatory-acoustic - manifests itself when a child writes as he pronounces it, but pronounces it incorrectly, that is, substitutions and the absence of sounds in oral speech are transferred to writing.
• Associated with a violation of the analysis and synthesis of language - is expressed in the continuous writing of words that should be written separately (especially prepositions), and the separate writing of what should be written together (for example, a root and a prefix).
• Agrammatic - caused by the immaturity of the lexico-grammatical structure, which manifests itself in the form of agrammatisms when writing at various levels: from a word to a whole text.
• Optical - causes a number of writing disorders associated with incorrect writing of letters, their merging and replacement with graphic similarity. Mirror spelling often appears: words from left to right, mirror image.

Psychological and pedagogical classification This classification takes into account the functional aspects of speech, the relationship between the types of oral and written speech activity, and the structure of the speech system.
All violations are divided into two groups – violation of means of communication and violations in their use. Disruption of means of communication

In the first group there are:

General speech underdevelopment (GSD)

It includes complex disorders that lead to incorrect formation of its sound and semantic aspects, i.e. violations are observed both in phonetics and in vocabulary and grammar. We are talking about defects of various natures: aphasia and alalia, rhinolalia, dysarthria. All these pathologies have common features:

• speech appears with a considerable delay;
• there is a limited vocabulary;
• unclear pronunciation;
• sentences are not grammatically constructed correctly;
• The speech of a child with ODD is difficult to understand, especially by strangers.

Three levels of development are identified depending on the severity of manifestations:

• The first level is absent speech (speechless children). Instead of phrases, onomatopoeia, babble, gestures and facial expressions are used for communication. The most common words are replaced with individual syllables (for example, “ma” instead of “mama”).
• The second level is where constant, albeit distorted, but relatively understandable words are added. Despite a small vocabulary, the child is able to construct simple sentences of 2-4 words. He often uses grammatical structures incorrectly, does not coordinate parts of speech, and misses words.
• The third level is the mildest violations. The child communicates in detailed sentences, although unhindered communication is difficult due to phonetic-phonemic underdevelopment and gaps in vocabulary and grammar.

Phonetic-phonemic underdevelopment (FFN)
Speech defects, which are a consequence of impaired perception and pronunciation, interfere with the correct formation of the pronunciation system. Here's how this condition manifests itself:

• Lack of differentiation of pairs or even groups of sounds when pronouncing. The child has difficulty distinguishing certain sounds and may replace several sounds with one, for example, “tyanki” instead of “sledge,” “tyasy” instead of “clock,” and “hoe” instead of “hat.” That is, the only soft “t'” is replaced by three sounds at once: s, ch and sh.
• Replacing sounds. In this case, the child follows the path of least resistance and replaces sounds that are difficult for him with those that are easier to articulate. For example, instead of “bump” he pronounces “syski” or “fyfki” (sh is replaced by s or f), and instead of “hand” he pronounces “luka” (p → l).
• Mixing sounds. When mixing, there is no stable use of sounds; in some situations (for example, in isolation) sounds are used correctly, and in others they are replaced with similar ones in articulation.

Disturbances in the use of means of communication
Basically, this part of the classification deals with stuttering, when, with correctly formed speech-motor organs, a person experiences difficulty communicating due to muscle spasms of the speech apparatus. This also includes combined defects, when general speech underdevelopment is added to stuttering.

To achieve the goals set for correction, speech disorders should be dealt with not only by specialists such as speech therapists and psychologists, but also by doctors - neurologists, psychiatrists, since such disorders do not act as isolated phenomena, but as a result of a malfunction in the body. The active participation of parents is equally important. In our Center for Neurology and Pediatrics, correctional work is structured in exactly this way - the joint efforts of specialists and relatives, especially timely ones, will help identify and correct speech disorders in a child.

How does speech development delay manifest itself?

Delayed speech development (DSD) is a pathology characterized by a violation of the timing of the appearance of speech, a reduced vocabulary, and defects in sound pronunciation and grammatical structure of speech. Symptoms of delayed speech or mental development of a child may include the following:

• Problems with chewing and swallowing food;
• Constantly open mouth, excessive salivation;
• Refusal to communicate;
• Lack of eye contact;
• Slurred speech, “porridge in the mouth”;
• Difficulties in understanding speech (does not respond to requests);
• Inappropriate behavior.

Experts distinguish three degrees of ZRR:

1. Mild degree of RRD – absence of pathologies of the nervous system. Violations of the emotional-volitional sphere are possible.
2. Moderate degree of mental retardation - a delay in speech development is combined with lesions of the nervous system. Such children may experience tremors, paralysis of the organs of articulation, tics, as well as various disturbances in the functioning of mental processes.
3. Severe degree of mental retardation is typical for children with lesions of the speech areas of the brain. In this case, there are serious difficulties in mastering speech in combination with disorders of memory, attention, thinking, and voluntary regulation (self-control).

Timely contact with specialists allows you to identify the cause of the child’s delayed speech development as early as possible and develop an individual plan for correctional and developmental classes.

Depending on the degree of mental retardation, an individual route of correctional work is determined. Children with severe speech development disorders require long-term support from various specialists.

Correction of general speech underdevelopment in preschool children

Lyubov Gorshkova

Correction of general speech underdevelopment in preschool children

General speech underdevelopment is a variety of complex speech disorders in which children have impaired formation of all components of the speech system related to its sound and semantic side, with normal hearing and intelligence.

General underdevelopment of speech can be observed in the most complex forms of childhood speech pathology: alalia, aphasia, as well as rhinolalia, dysarthria - in cases where insufficient vocabulary , grammatical structure and gaps in phonetic-phonemic development are simultaneously detected.

For the first time, a theoretical justification for general speech underdevelopment was formulated as a result of multidimensional studies of various forms of speech pathology in children of preschool and school age , conducted by R. E. Levina and a team of researchers at the Research Institute of Defectology (N. A. Nikashina, G. A. Kashe, L. F. Spirova, G.I. Zharenkova, etc.) in the 50-60s of the XX century.

T. B. Filicheva, G. V. Chirkina under general speech underdevelopment in children (with normal hearing and primarily intact intelligence)

understand a form of speech anomaly in which the formation of each of the components of the speech system is disrupted;
vocabulary, grammatical structure, sound pronunciation. In this case, there is a violation of both the semantic and pronunciation aspects of speech . The group with OHP includes children with various nosological forms of speech disorders (dysarthria, alalia, rhinolalia, aphasia)
in cases where there is a unity of pathological manifestations in the three indicated components.

Currently, in speech therapy there are two traditional classifications of speech : clinical-pedagogical and psychological-pedagogical. These classifications consider speech disorders in various aspects. But at the same time, the data of one and the other classification complement each other and serve common tasks: recruiting groups of children with speech pathology and implementing systemic, differentiated speech therapy, taking into account the symptoms and mechanisms of speech .

The clinical and pedagogical classification is not strictly correlated with clinical syndromes. She focuses on those disorders that should be the object of medical, psychological and speech therapy intervention.

In the process of making a speech therapy report, medical data and clinical characteristics are necessary, which make it possible to clarify a particular speech therapy diagnosis. Clinical characteristics are focused primarily on explaining the causes of speech disorders and treating the child, and not on a correction .

The clinical and pedagogical classification reveals the etiology, mechanisms, forms and types of speech disorders. This classification identifies the following forms of speech disorders: dyslalia, dysarthria or erased dysarthria, rhinolalia, voice disorders, motor, sensory alalia, childhood aphasia, adult aphasia, delayed speech development (ZRR, stuttering, tachylalia, stumbling (polturn)

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The psychological and pedagogical classification is focused on identifying, first of all, speech symptoms (symptological level)

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The symptomological level of analysis of speech disorders makes it possible to describe the external symptoms of language underdevelopment ( speech) , which serves as the basis for sending children to certain kindergarten groups or to a certain type of school.
The psychological and pedagogical classification was developed by R. E. Levina and employees of the speech therapy sector of the Institute of Defectology. This classification is based on linguistic and psychological criteria.The most significant among them is the identification of impaired components of speech systems (phonetic-phonemic aspect of speech , lexical-grammatical structure of speech ).

In accordance with the specified criteria, this classification distinguishes two groups of speech disorders:

Group 1 - violation of means of communication .

Group 2 - disorders in the use of means of verbal communication (stuttering)

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The first group of speech disorders, according to R. E. Levina, includes phonetic-phonemic underdevelopment and general speech underdevelopment (GSD)

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Phonetic-phonemic underdevelopment is a violation of the formation of the pronunciation system of the language due to insufficient phonemic perception and articulation of speech .

General underdevelopment of speech is characterized by a violation of the formation of all components of the speech system in their unity (sound aspect of speech , phonemic processes, vocabulary, grammatical structure of speech ) in children with normal hearing and relatively intact intelligence.

General underdevelopment of speech can be observed in various forms of speech pathology (according to clinical and pedagogical classification)

: motor, sensory alalia, childhood aphasia, dysarthria, including erased dysarthria.

In the etiology of general underdevelopment of speech, various factors of both a biological and social nature are identified. Biological factors include: infections or intoxication of the mother during pregnancy, incompatibility of the mother and fetus according to the Rh factor or group affiliation, pathology of the natal period, postnatal diseases of the central nervous systems and brain injury in the first years of a child’s life, etc.

At the same time, general underdevelopment of speech may be due to unfavorable conditions of upbringing and training, and may be associated with mental deprivation during sensitive periods of speech . In many cases, general underdevelopment of speech is a consequence of the complex influence of various factors, for example, hereditary predisposition, organic failure of the central nervous system (sometimes easily expressed, unfavorable social environment.

The most complex and persistent option is general speech underdevelopment , caused by early organic brain damage.

E. M. Mastyukova attaches particular importance in the etiology of ONR to perinatal encephalopathy, which can be hypoxic (due to intrauterine hypoxia and asphyxia during childbirth, traumatic (due to mechanical birth trauma, bilirubin (due to incompatibility of the blood of the mother and fetus according to the Rh factor or group affiliation) .

Typical for the entire OHP group is: late appearance of speech , a sharply limited vocabulary, pronounced agrammatism, defects in pronunciation and phoneme formation, characteristic violations of the syllabic structure of words. Speech underdevelopment in preschool children can be expressed to varying degrees: from the complete absence of speech means of communication to extensive speech with elements of lexico-grammatical and phonetic disorders.

Clinical types of general speech underdevelopment are varied . In the classification of E. M. Mastyukova, three groups of children with OHP .

Group I is an uncomplicated variant of OHP, characterized by the presence of only signs of general speech underdevelopment . In children with this variant of OHP, local lesions of the central nervous system are not detected. In the anamnesis of these children, there is most often no indication of a pathological course of pregnancy and childbirth, only sometimes mild toxicosis of the second half of pregnancy or prolonged asphyxia is observed. In the postnatal period, these children may experience somatic weakness, frequent infectious and colds. From a psychological point of view, these children show general emotional and volitional immaturity and lack of formation of regulation of voluntary activity.

In children of the first group, there is a lack of fine differentiated movements of the fingers and difficulties in the dynamic organization of movements.

In the second group of children, a complicated variant of OCD of central organic origin is detected. In children of this group, OHP is characterized by more complex symptoms and pathogenesis. Impaired speech development is combined with neurological and psychopathological symptoms. Severe neurological symptoms in these children indicate not only the immaturity of the central nervous system, but also gross damage to certain brain structures.

In this group, according to E. M. Mastyukova, the most common syndromes are:

1. Hypertension-hydrocephalic syndrome, which is characterized by increased intracranial pressure, an increase in head size, and expansion of the venous network in the temple area. Children syndrome experience rapid exhaustion, increased excitability, disinhibition, irritability, frequent headaches, and dizziness.

2. Cerebrasthenic syndrome is characterized by increased neuropsychic exhaustion, emotional instability, impaired attention and memory. Cerebrasthenic syndrome in some cases manifests itself against the background of emotional and motor anxiety, in others it is accompanied by lethargy, lethargy, and passivity.

3. Movement disorder syndromes manifest themselves in changes in muscle tone, in impaired coordination of movements, in the immaturity of general , fine manual, and articulatory motor skills, which in turn manifests itself in the form of tremor, synkinesis, violent movements, mild paresis, spasticity, characterizing erased dysarthria .

In general, children the second group are characterized by insufficiency of gnosis , praxis, and gnosispraxis.

The immaturity of the emotional-volitional sphere is manifested in these children in emotional lability, in the superficiality of emotions, in the insufficiency of volitional processes .

Children with group III OHP have alalia (mainly motor alalia)

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Currently, the etiology of alalia is correlated with damage to the speech zones of both the left and right hemispheres. Children with motor alalia have complex dysontogenetic disorders; encephalographic studies show that children with motor alalia have not only local lesions of the cerebral cortex, but also lesions of the subcortical structures of the brain .

Despite the variability in the clinical characteristics of children with OSD , what they have in common is systemic speech underdevelopment . of speech is especially complex and persistent .

Speech underdevelopment in children can be expressed to varying degrees: from complete absence of speech to minor developmental deviations. Taking into account the degree of unformed speech of R. E. Levina identified three levels of her underdevelopment .

Thus, general speech underdevelopment is one of the complex speech disorders, characterized by pathology of all speech .

Causes and diagnosis of speech delay

If you suspect that your baby has a delay in speech development, you should definitely seek specialized help. The following specialists will help you most accurately determine the causes of RRD:

• Pediatrician (assessment of the child’s overall development);
• Neurologist (study of the state of the brain, gross and fine motor skills);
• Otolaryngologist (hearing test);
• Psychologist (assessment of the level of mental development);
• Speech therapist (examination of articulation organs, diagnostics of the level of speech understanding, study of vocabulary, sound pronunciation, grammatical structure of speech, phrasal speech).
• In some cases, additional examination by a defectologist, audiologist, orthodontist, or psychiatrist may be required.

The reasons for delayed speech development may be the following:

1. Biological causes: birth injuries, prematurity, minimal brain dysfunction, inflammatory diseases (encephalitis, meningitis), increased intracranial pressure, hearing diseases, heredity.
2. Psychological reasons: lack of communication, overprotection, poor environment, and so on.

The Republican Scientific and Practical Center for Mental Health is developing new technologies for the treatment of speech disorders in children, including those with autism. Experience has been accumulated in the use of transcranial magnetic stimulation (TMS), micropolarization, and bioacoustic correction in the treatment of mental disorders.

Together with a German company, a scientific project is being carried out on the combined use of TMS and transcutaneous electrical neurostimulation (TENS) in children from 3 to 16 years old with specific speech development disorders and in patients with speech disorders due to autism. The study was approved by the ethics committee of the Republican Scientific and Practical Center for Mental Health.

Causes and characteristics of speech disorders

The procedure for transmitting impulses to the central nervous system

Normal speech development has wide age limits for the development of speech as a higher mental function. However, the absence of single words or words-related speech formations by two years, or simple expressions or two-word phrases by three years, should be regarded as a significant sign of delay. The number of children with speech disorders is growing, according to a number of studies - 25% among children of primary school age.

The formation of speech in girls and boys differs not only in the timing of the appearance of various speech elements, but also in their quality. For example, it is believed that girls are more inclined to construct words that are not in common use. While boys strive for greater accuracy through semantic differentiation, etc.

Speech development disorders are at the intersection of many specialties. Speech is a key factor for the development of a child’s thinking and intelligence in general, therefore, disruption of its formation inevitably entails communication problems, behavioral disorders, and school failure. Speech development delays are observed in a wide range of diseases.

Thus, their cause may be chronic otitis media and other conditions leading to hearing impairment, abnormalities in the development of the articulatory apparatus, cerebral palsy, etc. In addition, speech disorders occur in children with autism. In some cases, at the initial stage it is impossible to establish the etiology of the disorder, therefore, dynamic observation is necessary for accurate diagnosis and assessment of prognosis. Speech development is often influenced by hereditary predisposition, immune and neurochemical disorders, or environmental factors.

In a number of disorders, normal speech development occurs up to a certain age, and then the process stops or even regresses (such conditions are defined not as a delay in speech development, but as a developmental deviation). For comparison: in autism, speech development, as a rule, is altered even at the pre-speech stage (an animation complex is not formed, the humming is poor, low-emotional, “bird-like” language, at the same time the child pronounces whole phrases, but does not use them for communication).

Diagnosis of speech development disorders requires the participation of not only doctors, but also speech therapists, psychologists, specialists in correctional pedagogy, together with the child’s parents.

The basis of many speech development disorders is an impaired balance of inhibition and excitation processes in the brain, which is determined by various neurophysiological mechanisms: the work of synapses, the level of activity of the glutamatergic (excitation) and GABAergic (inhibition) systems, interhemispheric and intracortical interactions, deficiency or excess of certain micro- and macroelements, vitamins, etc. Therefore, restoration of the imbalance of these processes is the basis of the applied hardware treatment methods.

Treatment methods for speech disorders

Currently, there are no medications that could lead a child with a speech development disorder to a full recovery or to an undoubted improvement in the condition, so much attention is paid to speech therapy and psychotherapeutic correction, as well as hardware neurostimulation methods.

Neurostimulation technologies, which include TMS, transcranial electrical stimulation, micropolarization, TENS, are alternative methods of modulating the brain in neurological and mental disorders. Their advantage compared to pharmacotherapy is the absence of toxic effects on the body. In this case, the clinical effect is achieved through the impact of small currents on the excitable structures of the nervous system, which allows you to directly modulate their work and control the processes of neuroplasticity.

The most effective hardware method for treating brain diseases is considered to be TMS, in which a high-intensity alternating magnetic field is focused on certain cortical areas, generating small currents in the axons, which is transmitted both to the cortical neurons adjacent to the site of stimulation, and to the deep parts of the brain and other cortical areas. zones functionally associated with the stimulation zone. This makes it possible to non-invasively influence entire neural networks.

Using certain TMS protocols (high- and low-frequency), it is possible to cause activation of both excitation and inhibition in the central nervous system. In autism, processes of excessive excitation of cortical neurons predominate, caused by hyperactivity of glutamatergic structures, multiple formation of an excessive number of neural connections, which interferes with the learning and normal development of the child, the formation of stable forms of behavior and speech skills. The impact of low-frequency TMS on prefrontal structures can reduce hyperactivity and stabilize the processes of neuroplasticity.

The Republican Scientific and Practical Center for Mental Health has accumulated experience in the use of TMS in the treatment of mental and behavioral disorders, as well as in the introduction of scientifically based techniques into medical practice. Thus, in 2019, the Ministry of Health approved the instructions for use “Method of treatment of general developmental disorders, specific disorders of speech and language development with transcranial magnetic stimulation,” which describes in detail the algorithm for using TMS for these disorders.

Selecting a transcranial magnetic stimulation protocol

Combined TMS and TENS procedure

In young children, the right hemisphere of the brain is ontogenetically more developed, primarily responsible for concrete imaginative thinking. Speech centers are located in the left hemisphere. The impact of low-frequency TMS on the dorsolateral prefrontal cortex (DPFC) of the subdominant hemisphere causes long-term inhibition in its neurons and reduces its antagonistic inhibitory effect on homologous zones of the left hemisphere. This promotes the activation of functional centers in the left hemisphere, which are primarily responsible for logical-abstract analytical thinking.

The high-frequency TMS protocol (10 Hz or more) on the projection of the right DPPC, although (as is believed in a number of studies) to be more effective, is undesirable for use in children.

Firstly , in children the threshold of the evoked motor response (the minimum intensity of the pulsed magnetic field supplied by the device to generate an action potential of 50 μV in certain muscles of the hand) is quite high - 70-100% of the device’s power, therefore it is difficult to tolerate when applying a therapeutic series of high-frequency pulses .

Secondly, in early childhood, especially in autism, slow-wave activity is recorded according to the electroencephalogram, so there is a risk of provoking a generalized seizure when performing high-frequency TMS.

After low-frequency TMS of the right DLPK (for 20 minutes), low-frequency TMS is applied to the homologue of the projection of the speech center in the right hemisphere to activate a similar center in the dominant hemisphere. One TMS procedure lasts 20–30 minutes. The course of treatment includes 15–20 procedures performed daily or every other day with a break on weekends.

Transcutaneous electrical neurostimulation technique

An alternative method for activating cortical structures is to stimulate the peripheral nerves of the extremities using TENS. Cutaneous electrodes are attached to the projection of the median or ulnar nerves of the dominant arm and deliver a low-intensity alternating electrical current, which can spread both to the periphery from the site of action and centripetally to the neurons of the brain.

The method has been known since 1965, but was used mainly for the treatment of pain syndromes. In the last decade, functional TENS has been actively used in the recovery of patients after traumatic brain injuries and strokes with aphasia and paresis of the limbs. The projection of the hand and muscles involved in the act of speech, as well as the motor center of speech (Broca's center) are both structurally and functionally connected. Therefore, activation of the motor and sensory centers of the hand during TENS promotes speech development by analogy with activities for the development of fine motor skills (finger games, drawing, etc.). In addition, electrical stimulation of peripheral nerves activates neuroplasticity processes in the brain.

The use of cortical magnetic field stimulation and electrical stimulation of peripheral nerves makes it possible to have a multimodal, multi-level effect on the processes of neuroplasticity and brain development in children. The combined use of TMS and TENS has not only a synergistic, but also a potentiating effect on the functional state of the brain.

The study evaluates the dynamics of clinical symptoms, the degree of restoration of impaired speech function (initially and after the course of treatment): subjective manifestations (assessment by the patient and the child’s parent) and objective assessment by the researcher according to the treatment protocol.

Contraindications for inclusion in the study are intracranial ferromagnetic and cochlear implants, focal changes in the brain (neoplasms, inflammatory diseases of the central nervous system in the acute period, large cerebral aneurysms or suspicion of them), acute and chronic diseases in the stage of decompensation.

Clinical case of combined TMS and TENS use

The parents of a five-year-old girl, who was diagnosed with childhood autism at the age of 3, contacted the Republican Scientific and Practical Center for Mental Health. During the conversation, it turned out that the absence of speech had been observed since the age of two. During the initial examination, the psychologist noted hysterical behavior. The child reacts to the mother’s requests with excitement and aggression. The girl rubs her face and hands, sways, does not respond to her name, does not answer questions. Speech is spontaneous. Pronounces individual sounds, syllables, rarely words that do not correspond to the situation, does not look into the eyes of the interlocutor and others - he looks away, does not fix it on the object. There is no pointing gesture. Self-service skills are not fully developed. Play activities are not age appropriate. The girl cannot cope with folding pyramids or simple puzzles, and does not participate in role-playing games.

Results of the EEG study: pronounced diffuse disturbances of cortical rhythms were revealed with a predominance of irregular slow activity in the theta and delta ranges of medium amplitude without zonal differences, against the background of which low-amplitude beta activity was recorded. Alpha rhythm index - 13%.

A course of combined low-frequency TMS was prescribed to the projection of the right DLPK (10 minutes), then to the projection of the inferior frontal gyrus of the right hemisphere of the brain (10 minutes) and TENS of the peripheral nerves of the right hand (10 minutes). The course of treatment is 16 daily procedures (except weekends).

After completing the course of TMS and TENS, the patient noted an improvement in communication: the understanding of spoken speech increased, words appeared (for example, greetings and farewells at the end of the treatment session), and voice modulation began. Attention and perseverance have increased significantly. After the 8th TMS and TENS procedure, the patient became interested in toys and independently put together a multi-component puzzle. The background of the mood leveled out: the girl began to fulfill requests more calmly. The patient mastered and began to independently use a mobile phone to watch animated films. An improvement in visual-spatial orientation was revealed.

After the course of treatment, the EEG became more organized; slow-wave activity was not recorded.

Classes with a psychologist, speech therapist, and a second course of hardware treatment after 3 months are recommended.

Summary

As a rule, combined TMS and TENS are well tolerated by children and do not require special preparation. During the session, the child sits in a chair, with the parent sitting opposite (to reduce the patient’s anxiety and play games). There may be slight twitching of facial muscles during magnetic stimulation and arm muscles under the influence of electrical impulses from the TENS device, which does not require special treatment. You can work with your child during the procedure. At the end of the session, the child can attend a speech therapist or educational classes, and even with greater effectiveness in implementing educational programs, since stimulation technologies improve attention. In some cases, daytime rest or sleep is recommended to relieve emotional arousal after visiting the first stimulation procedures and normalizing biorhythms.

Behavioral and speech changes may be noted by the 4th–7th procedure, however, it has been proven that only with a course of TMS and TENS a lasting clinical effect occurs. Repeated courses of hardware treatment should be performed after 3–6 months.

The Republican Scientific and Practical Center for Mental Health is ready to accept patients from all over the country aged 3–12 years for treatment using combined TMS and TENS. Contacts for communication with the authors of the project are in the editorial office of "".

Correction of mental retardation in children

Methods for correcting and treating speech delay depend on the cause of the disorder and are established by specialists after diagnostic examinations. In some cases, doctors prescribe medication and massages. We will tell you in general terms about how to help your child learn to speak at home. These classes will be a good addition to working with specialists.

• Verbal communication with loved ones. Communication leads to development. Playing together with adults, emotional intimacy is something without which the harmonious development of the baby is impossible. Try to ask your child questions more often, encourage dialogue and joint exploration of the world.
• Exploring the world around us. It is necessary to support the child’s cognitive interest in every possible way, develop observation, thinking and imagination. To help your child develop a holistic picture of the world, walk with your child more often, talk and ask questions, read books, play, and conduct experiments.
• Development of auditory perception. Auditory perception makes it possible to understand speech, recognize various sounds of nature, household noises and hear music. An example of an exercise from this category is the game “Whose Sound?” An adult hides behind a screen and uses objects to make various sounds: rustling a bag, tearing paper, knocking with spoons, ringing a bell, pouring water, and so on. The baby must guess which object each sound corresponds to.

Regularity and consistency are important in speech development. When working with your baby at home, start by practicing simple skills and only when they are accessible to the baby, then move on to more complex exercises.

• Breathing exercises. The formation of speech breathing is the most important stage in the development of coherent and correct speech in a preschooler. The most effective way to develop it in preschool children is breathing exercises, which contribute to the formation of a smooth and sufficiently long exhalation and practice of pronouncing sounds and syllables. You can read more about breathing exercises in one of our previous articles.
• Articulation gymnastics. Speech or articulation gymnastics promotes the development of speech organs. Your baby will definitely enjoy these fun exercises and will help him learn to pronounce sounds correctly.
• Finger games are a unique way to develop a baby. They are a kind of massage and gymnastics for the fingers and toes. The movements are usually accompanied by short, funny poems, and children repeat them with pleasure. For kids, finger games are an independent activity, and for older preschoolers they can become a warm-up between exercises.
• Development of fine motor skills: playing with water and bulk materials, modeling, appliqué, drawing, lacing and much more. Choose games that your child likes, because pleasure from the process also plays an important role in the development of the baby.

Modern approaches to the development and correction of speech of preschool children

Klavdia Trizno

Modern approaches to the development and correction of speech of preschool children

Formation of correct speech in children is one of the main tasks of modern preschool education . Currently, serious changes are taking place in the organization of speech correction work in kindergartens. However, the number of preschoolers with speech disorders, unfortunately, is not decreasing. I can note this fact as a teacher who has been working in a speech therapy group for many years. Today, figurative speech, rich in synonyms, additions and descriptions, in preschool is a rare phenomenon. The reasons for this phenomenon are varied and numerous. Therefore, the task of timely formation of children’s speech , prevention and correction of various speech disorders is still urgent.

In order to achieve sustainable results in the prevention and overcoming of speech , it is important to understand that overcoming speech disorders in preschoolers is a task not only for the speech therapist teacher, but for all interested adults. A decisive role is played by high-quality interaction and cooperation between educators, specialists and parents. It is an integrated approach to the correction of speech disorders , as well as a combination of the best traditional methods with modern approaches and forms of work, that allows us to achieve the best results and creates the necessary starting conditions for the child to move to the next stage of education and successfully master the primary school program.

interaction in the development and correction of a child’s speech as a system that solves three blocks of problems:

Block I - creation of a unified correctional and educational space ;

Block II - organization of a correctional and developmental educational environment;

Block III - correction of speech underdevelopment through a multidimensional impact on speech and extra-speech processes, stimulating the cognitive activity of children.

The goal of teachers’ work on the development and correction of speech of preschool children is the development of the child’s initial communicative competence. According to the federal state educational standard for preschool education , “speech development includes mastery of speech as a means of communication and culture; enrichment of the active vocabulary; development of coherent , grammatically correct dialogue and monologue speech ; development of speech creativity ; development of sound and intonation culture of speech , phonemic hearing; acquaintance with book culture, children's literature, listening comprehension of texts of various genres of children's literature; formation of sound analytical-synthetic activity as a prerequisite for learning to read and write.”

To achieve these targets, educational work is planned and carried out in four main areas (direct educational activities, educational activities in special situations, creating conditions for independent activities of children and interaction with parents and social partners).

1. As in any kindergarten, work begins with planning. In August, educators and specialists jointly develop work programs. Individual educational routes are developed for children with disabilities and they are accompanied throughout the year by specialists from the psychological, medical and pedagogical council of the preschool educational institution, and dynamic monitoring is carried out. development of children is assessed . This is a very important area of ​​work at the present stage, requiring rethinking and bringing it into line with modern requirements . Our kindergarten is participating in experimental work in this area with the Novosibirsk Pedagogical College No. 1 named after. A. S. Makarenko, and our group is a pilot group.

2. In direct educational activities we actively use information and communication technologies. It's no secret that for today's preschoolers , born in the digital age, this is simply necessary. The inclusion of ICT in the educational process arouses interest, increases the involvement and activity of children and allows them to successfully solve many correctional problems . We use specialized technologies in our work (for example, the speech therapy correction program “Games for Tigers”

etc., as well as independently developed media presentations and
developmental tasks using an interactive whiteboard. A positive emotional background, which is also important for high-quality correctional work , is helped to create “Speech therapy chants”
by G. S. Ovchinnikova and
“Speech therapy songs”
by E. Zheleznova.

3. Recently, quest technologies or educational quests have become widespread and very popular. We are happy to join this movement and conduct speech therapy quests both in the group and in the fresh air. This is truly a very interesting and effective form of work that arouses great interest and activity among children, thanks to the combination of an extraordinary organization of educational activities and an exciting plot. We also use gaming innovative lapbook technology and are currently planning work on creating a large speech therapy lapbook as the final product of the year’s work.

4. To ensure the child’s initiative and implement such a principle of the Federal State Educational Standard for Education as individualization of the educational process, we actively use project activities. This form also allows us to solve another important task of correctional work , namely, the inclusion of parents in the educational process. Several projects were successfully implemented this academic year: the environmental project “Feed the birds in winter”

, a children's thematic project
"Healthy lifestyle and professions"
as part of the festival-competition
"Nutrition and Health"
. The children went on numerous excursions: to the fire department,
"Children's Auto City"
, educational
, to their parents' work. Work on the project requires involvement in communication with adults and peers and high speech activity. The product of the project was children's mini-presentations and author's little books "My Future Profession"
. Our project was among the winners of the regional competition, and now we, together with parents, are preparing a creative presentation for the city stage.

Another project - “Writers of Novosibirsk for Children”

.
Its implementation allows us to solve the very important task of introducing children to fiction. We all know that fiction serves as an effective means of mental, moral and aesthetic education and has a huge impact on the development and enrichment of a child’s speech . Various genres of literary and folklore works allow you to work on all aspects of speech (phonetic, lexical, grammatical)
.
But today, most parents not only do not see the importance of reading in teaching and raising children, but they themselves do not read or read little. This is what the survey of parents and the survey of children in the group, which was conducted in September 2015, showed. Very few parents and children could name writers from their native land. “Writers of Novosibirsk for Children”
project is to create conditions for
the development of children’s speech by introducing children and parents to reading fiction;
acquaintance with the works of writers of Siberia and Novosibirsk. In the process of implementing the project, children and parents became acquainted with the works of Taisya Pyankova, Yuri Magalif, Vladimir Shamov, Nelly Zakusina, and Elizabeth Stewart. A literary salon took place with the participation of Novosibirsk poetess Elena Nikolaevna Zinovatnaya. Children were able not only to listen and recite poems, but also to communicate with the author, ask questions that interested them, and receive autographed books. Thematic exhibitions were arranged in the book corner, and a variety of productive and creative children's activities were organized. The most interesting form of cooperation with parents was parent readings, when in the afternoon fathers and mothers read works of art for children. 5. A very effective form for introducing children to the world of fiction and for the development of speech in general is our network interaction with the N. Ostrovsky Library, which is carried out on the basis of an agreement and a joint plan for educational work. We offer excursions monthly. In cold weather or ice, when we cannot take the children out, library specialists come to our kindergarten. “There’s a Library Next Door” were organized for children in a fun and accessible way for children.

,
“Tumbling, running, skipping”
,
“My native district of Dzerzhinsky”
,
“The winter forest is full of fairy tales and miracles”
,
“Safety rules”
,
“Mom is a dear word”
,
“The good world of Korney Chukovsky”
, etc. We also successfully cooperate with schools.
For example, in addition to excursions to schools, for several years we have been collaborating with the literary and theater club “Fairy Tales”
of school No. 57. This year, students in grades 3 and 4 prepared and conducted for us the program “Fairy Tale Carousel for Our Little Friends.”
It was especially pleasant to see among the young actors already grown-up graduates of our kindergarten! We enjoyed watching the mini-plays “The Monkey’s House” (based on the fairy tale by Boris Zakhoder)
and “The Invisible Guest”
(Romanian fairy tale)
. This is important for motivating our children because they see that what they participate in in kindergarten will be useful to them in school.

6. We not only watch the theater, but also, of course, participate in theatrical activities. “Tales of Childhood” has been operating in our kindergarten for 6 years now.

The creative group of the studio consists of teachers from our institution: senior teacher, educators, music director.
6 performances were staged, they were awarded diplomas of laureates of the international festival of children's and youth theatrical creativity “Times are the connecting thread”
.
The performances “The Princess and the Pea”
and
“The Little Flower of Seven Flowers”
​​were shown on the small stage of the
Globus
.
This year our children took part in the play “The Wizard of the Emerald City”
. A total of 52 children took part in it. It is difficult to overestimate the importance of theatrical activities. During the production of the play, we see a huge increase in motivation and noticeable progress in the children’s conscious attitude towards working on their own speech.

subject-spatial environment plays a huge role in successfully overcoming speech disorders For correctional and developmental work, not only a separate speech therapy room is used, but also a speech center in the group, which is a specially equipped space for individual games or games in small subgroups, as well as for joint activities of an adult and a child. When designing the speech center, we took into account the principles reflected in the Federal State Educational Standard for Education, and also provided a variety of materials; compliance with the age and individual characteristics of children, the structure of speech disorders; design aesthetics. The speech center is located next to the library and theater center. The leading toy, the “mistress”
of the correctional center, is the multifunctional toy Kvakusha, made by the mother of our pupil. The basis of the speech center includes gaming and didactic material in the following sections: sound pronunciation, development of fine motor skills, phonemic hearing and consolidation of acquired skills in teaching literacy, vocabulary, grammatical structure of speech and development of coherent speech , enrichment of vocabulary, formation of higher mental processes. Children have access not only to purchased educational games and equipment , but also to manuals made by parents and teachers. The most interesting of them were presented at the exhibition of pedagogical ideas “Mosaic of Childhood”
, as part of the scientific and practical conference of
preschool education workers in the Novosibirsk region in September 2021.
8. The group has been operating a mini-museum “Russian Izba”

, which is used both for independent activities of children and for the implementation of the author’s technology
“Introducing
preschool children to the origins of their native culture .
Patriotic, spiritual and moral education of children is a popular, relevant direction in preschool pedagogy . I think this is very important and correct. It is difficult to overestimate the importance of our cultural heritage for the development of a child , including the formation of beautiful, correct speech . Throughout the year, together with parents, we hold various ritual and folklore holidays: “Cabbage Gatherings”
,
Carols”
,
“Heroic Fun”
,
“Svetlaya
Easter" and others.
Our children participated in the concert program of the folklore ensemble “Rozhdestvo” under the direction of O. Gurina “Come, guests, to us!”
at the Novosibirsk State Philharmonic.
The guys performed the dance “Timonya”
.

9. I would like to say a few words about one more effective direction in correcting children’s speech - motor activity. The influence of motor activity on the functional state of the brain, and in particular, on the development of the sensory and motor aspects of speech , has been proven in experimental studies conducted under the leadership of M. M. Koltsova preschool children with complex types of speech disorders have psychomotor deficiencies development , coordination is often impaired. “Sudarushka” helps us solve this problem.

.
In the process of choreographic activity, arbitrariness of movements and switchability from one movement to another
develops The sequence of movements, their accuracy, proportionality and smoothness are formed. Our children not only dance wonderfully at the holidays, but also successfully participate in various competitions. 10. Participation in competitions of various types has a positive impact on children’s motivation, contributes to the formation of their social competence, and is a significant factor for parents. This year our children successfully participated in All-Russian, regional, and city competitions.

11. And the last thing I want to say is the importance of parents’ direct participation in the process of development and correction of children’s speech . This is often not easy. But our kindergarten and group have accumulated sufficient experience in constructive cooperation with the parents of pupils. And being a city innovation platform in this area, we use many modern , interesting forms of cooperation. We have already talked about some. We would like to add that, based on our experience, the following forms of interaction are effective: questionnaires and surveys with the obligatory presentation of results at parent meetings and subsequent joint planning and holding of events of various types (themed leisure and entertainment , family competitions, exhibitions, etc., holding discussions, clubs on interests, evenings of questions and answers with the involvement of specialists, as well as the presentation of positive parental experience, holding Understudy Day and Days of meetings with interesting people, organizing platforms for interactive communication with a pedagogical focus (we have a closed VKontakte group: we practice posting recommendations, links to interesting webinars, video materials, literary texts and works, recommendations from a speech therapist for home exercises to consolidate sounds, etc.) The main thing is that the information is regularly updated.

This approach allows us to successfully solve the assigned tasks, obtain the expected results in our work and positive dynamics in the speech development of children .

conclusions

Speech development is a complex process, and it occurs differently for each child. If the baby is healthy, speech development occurs naturally when you communicate with him and talk about the world around him. Your child watches you and tries to copy your speech, so it is important to monitor the correctness of your own speech. It is necessary to create a favorable environment for the child in which he can fulfill the needs characteristic of his age. You can offer your child games to develop fine motor skills, as well as introduce them to articulation and finger gymnastics. If you feel that your baby is experiencing difficulties and the development of his speech is far behind the conventional boundaries of the norm, you must definitely consult with specialists to rule out health problems and delayed speech development.