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

Article:

Dyslalia is one of the most common forms of speech dysfunction in children of all ages.
Accompanied by the inability to pronounce certain sounds. Separate combinations of these with a formally preserved ability to speak. The lexical structure does not suffer, like other formal components of correct speech. The key sign of the disorder is incorrect pronunciation of letters and reduction of sounds. According to statistics, the majority of cases occur in children aged 6 to 12 years; the disorder has no sexual preference. Despite this statistical calculation, the deviation begins much earlier. We are talking only about cases recorded in clinical practice. In fact, many parents do not turn to a speech therapist, believing that the pathology will disappear on its own as the child grows up, which turns out to be far from the truth. Without specific correction under the control of a speech therapist, the disorder progresses, leading to problems with reading and reproducing information received by ear.

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

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

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

Causes of dyslalia

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

Pathologies of the structure of the speech apparatus

Tongue frenulum and other tongue problems

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

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

Problems with the structure of the jaw and teeth

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

Less obvious reasons: high or low sky

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

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

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

Separately, they talk about problems with bite

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

Social reasons

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

Mental deficit

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

Restraint of a child’s speech development by the environment

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

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

Weak immunity, susceptibility to infectious diseases

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

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

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

Preschool children have insufficient mobility of the speech apparatus

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

Pedagogical neglect

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

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

Lesions of the hearing aid and central nervous system

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

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

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

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

Speech development disorders in children and their correction

Speech formation is one of the main characteristics of a child’s overall development. Normally developing children have good abilities to master their native language. Speech becomes an important means of communication between the child and the world around him, the most perfect form of communication inherent only to humans. But since speech is a special higher mental function provided by the brain, any deviations in its development should be noticed in time. For normal speech formation, it is necessary that the cerebral cortex reaches 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 main indicators of speech development from 1 year to 6 years are given in Table 1.

Speech is one of the complex higher mental functions and has two important components:

perception of speech sounds, for which Wernicke's center is responsible (located in the auditory cortex of the temporal lobe);
reproduction of sounds, words, phrases is a speech motor function, which is provided by Broca's center (located in the lower parts of the frontal lobe, in close proximity to the projection in the cortex of the muscles involved in speech).

Both speech centers in right-handers are located in the left hemisphere of the brain (Fig. 1), and in left-handers, on the contrary, in the right. In accordance with this, a distinction is made between impressive speech (the process of listening to speech, understanding the meaning and content of a speech utterance) and expressive speech (the process of speaking using language).

Figure 1. Speech centers of the brain

During speech development, children must master several subsystems of their native language. The first of these is phonetics, the system of speech sounds. Any language is based on a certain signal or phonemic feature, changing which changes the meaning of the word. This signal, semantically distinctive feature forms the basis of the sound units of language - phonemes (from the Greek phonema - “speech sound”). There are 42 phonemes in the Russian language, including 6 vowels and 36 consonants. The main semantic distinctive features include sonority and dullness (was-dust, house-volume, guest-bone), hardness and softness (dust-dust), stressed and unstressed (za'mok-zamo'k).

In addition, language is an ordered system in which all parts of speech are interconnected according to certain rules. The set of these rules makes up grammar, thanks to which words are formed into complete semantic units. Syntax sets the rules for combining words in a sentence, semantics explains the meaning of individual words and phrases, and pragmatics sets the social rules that dictate what, how, when, and to whom to speak. In the process of speech development, children master these laws of their native language (J. Butterworth, M. Harris, 2000).

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 a common cause of isolated speech delay. 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, a child with isolated speech delay should undergo 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.

Less commonly, a delay in speech development is associated with a child having autism or a general mental retardation. In such cases, an in-depth psychoneurological examination is indicated.

Classifications of speech development disorders in children

Diagnosis of speech development disorders requires the participation of not only doctors, but also speech therapists, psychologists, and special education specialists in helping the child. To date, no unified classification of speech disorders in children has been developed. Depending on the leading disorders underlying speech disorders in children, L. O. Badalyan (1986, 2000) proposed the classification below.

I. Speech disorders associated with organic damage to the central nervous system (CNS). Depending on the level of damage to the speech system, they are divided into the following forms.

Aphasia is the collapse of all components of speech as a result of damage to the cortical speech areas.
Alalia is a systemic underdevelopment of speech as a result of damage to the cortical speech zones in the pre-speech period.
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, several variants of dysarthria are distinguished: pseudobulbar, bulbar, subcortical, cerebellar.

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. Delays in speech development of various origins (prematurity, severe diseases of internal organs, pedagogical neglect, etc.).

In domestic speech therapy, two classifications of speech disorders are used: clinical-pedagogical and psychological-pedagogical (L. S. Volkova, S. N. Shakhovskaya et al., 1999). These classifications, although they consider the same phenomena from different points of view, do not contradict, but complement one another and are focused on solving different problems of a single, but multifaceted process of correction of speech development disorders. It should be noted that both classifications relate to primary speech underdevelopment in children, i.e. to those cases when speech development disorders are observed with intact hearing and normal intelligence.

The clinical and pedagogical classification is based on the principle “from general to specific”, focused on detailing the types and forms of speech disorders, developing a differentiated approach to overcoming them (L. S. Volkova, S. N. Shakhovskaya et al., 1999). Disorders of the development of oral speech are divided into two types: phonation (external) design of the utterance, which are called disorders of the pronunciation side of speech, and structural-semantic (internal) design of the utterance.

Violations of phonation registration of utterances include:

Dysphonia (aphonia) is a disorder (or absence) of phonation due to pathological changes in the vocal apparatus; Dysphonia manifests itself in disturbances in the strength, pitch and timbre of the voice.
Bradylalia is a pathologically slow rate of speech, manifested in the slow implementation of the articulatory speech program.
Tahilalia is a pathologically accelerated rate of speech, manifested in the accelerated implementation of the articulatory speech program.
Stuttering is a violation of the tempo-rhythmic organization of speech, caused by the convulsive state of the muscles of the speech apparatus.
Dyslalia is a violation of sound pronunciation with normal hearing and intact innervation of the speech apparatus (synonyms: sound pronunciation defects, phonetic defects, phoneme pronunciation defects).

In the psycholinguistic aspect, pronunciation disorders can arise due to three main reasons: deficiencies in the operations of discrimination and recognition of phonemes (perception defects); unformed operations of selection and implementation of pronounced sounds; violation of the conditions for the realization of sounds in case of anatomical defects of the speech apparatus.

In most children, sound pronunciation reaches the language norm by 4–5 years. Most often, speech defects are caused by the fact that the child’s articulatory base has not been fully formed (the entire set of articulatory positions necessary to pronounce sounds has not been mastered) or the articulatory positions have not been formed correctly, as a result of which distorted sounds are produced.

Rhinolalia is a violation of voice timbre and sound pronunciation caused by anatomical and physiological defects of the speech apparatus. With rhinolalia, distorted pronunciation of all speech sounds is observed, and not individual ones, as with dyslalia.
Dysarthria is a violation of the sound pronunciation side of speech, caused by organic damage to the central nervous system and disorders of the innervation of the speech apparatus.

Violations of the structural-semantic (internal) design of a statement include two subtypes.

Alalia is the absence or underdevelopment of speech due to damage to the speech areas of the cerebral cortex in the prenatal or early (pre-speech) period of a child’s development (synonyms: dysphasia, early childhood aphasia, developmental dysphasia).
Aphasia is a complete or partial loss of speech caused by local lesions of the speech areas of the cerebral cortex (as a result of traumatic brain injury, cerebrovascular accidents, neuroinfections and other diseases accompanied by damage to the central nervous system).

The psychological and pedagogical classification (L. S. Volkova, S. N. Shakhovskaya et al., 1999) is built on the opposite principle - “from the particular to the general.” This approach is focused on speech therapy intervention as a pedagogical process, the development of speech therapy correction methods for working with a group of children (study group, class). For this purpose, the general manifestations of various forms of speech disorders are determined. In accordance with this classification, speech disorders are divided into two groups: impairment of means of communication and impairments in the use of means of communication. Communication disorders include phonetic-phonemic underdevelopment and general speech underdevelopment (GSD).

Phonetic-phonemic underdevelopment of speech is a violation of the processes of formation of the pronunciation system of the native language in children with various speech disorders due to defects in the perception and pronunciation of phonemes. The following main manifestations of this condition are identified (T. B. Filicheva et al., 1989).

Undifferentiated pronunciation of pairs or groups of sounds. In these cases, the same sound can serve as a substitute for two or even three other sounds for the child. For example, the soft sound t' is pronounced instead of the sounds s', ch, sh: “tyumka” (bag), “tyaska” (cup), “hoe” (hat).
Replacing some sounds with others. Sounds that are difficult to pronounce are replaced by easier ones, which are characteristic of the early period of speech development. For example, the sound l is used instead of the sound r , the sound f - instead of w . In some children, a whole group of whistling and hissing sounds can be replaced by the sounds t and d : “tobacco” (dog).
Mixing sounds. This phenomenon is characterized by the unstable use of a number of sounds in different words. A child can use sounds correctly in some words, but in others, replace them with similar ones in articulation or acoustic characteristics. So, a child, able to pronounce the sounds r , l or s in isolation, in speech utterances says, for example: “The carpenter is planing a board” instead of “The carpenter is planing a board.”

Such violations indicate underdevelopment of phonemic hearing (the ability to distinguish phonemes), which is confirmed during the examination. Underdevelopment of phonemic hearing prevents the full implementation of sound analysis of words. That is why, by school age, this group of children has insufficient prerequisites for learning to write and read.

OSD includes various complex speech disorders, in which the formation of all components of the speech system related to the sound and semantic side suffers. By OHP we understand the impaired formation of all components of the speech system in their unity (sound structure, phonemic processes, vocabulary, grammatical structure, semantic aspects of speech) in children with normal hearing and initially preserved intelligence.

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. 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. Depending on the degree of impairment in the formation of means of communication, ONR is divided into three levels. According to R. E. Levina (1968), these levels of speech underdevelopment are designated as:

lack of common speech (so-called “speechless children”);
the beginnings of common speech;
developed speech with elements of underdevelopment in the entire speech system.

Thus, the development of ideas about OSD in children is focused on the development of correction methods for groups of children with similar manifestations of various forms of speech disorders. It is necessary to take into account that ONR can be observed with various lesions of the central nervous system and deviations in the structure and functions of the articulatory apparatus (R. E. Levina, 1968; L. S. Volkova, S. N. Shakhovskaya et al., 1999), i.e. e. for various clinical forms of oral 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 proportion of cases of OHP turn out to be associated with alalia. At the same time, damage to various zones of the cerebral cortex in the pre-speech period entails a certain originality in the formation of alalia symptoms.

Alalia is one of the most severe speech development disorders. Alalia is a systemic underdevelopment of speech of central origin. The insufficient level of development of the speech centers of the cerebral cortex, which underlies alalia, can be congenital or acquired in the early stages of ontogenesis, in the pre-speech period. The cause of alalia may be early organic damage to the central nervous system due to the pathology of pregnancy and childbirth. In recent years, special attention of researchers has been drawn to the role of hereditary factors in the formation of both speech abilities and various speech development disorders, including alalia.

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 given only to children over 3–4 years old. With aphasia, there is a complete or partial loss of the ability to understand spoken speech or speak, that is, to use words and phrases to express one’s thoughts. Aphasia is caused by damage to the speech centers in the cortex of the dominant hemisphere (for right-handers - left, for left-handers - right) in the absence of disturbances in the articulatory apparatus and hearing.

In cases of lesions of the speech centers in children under the age of 3–4 years, speech usually develops, but with a pronounced lag. Domestic experts refer to this condition as alalia. The international term “dysphasia” or “developmental dysphasia” is more accurate. Similar to aphasia in adults, motor and sensory alalia (dysphasia) are distinguished.

Motor alalia (dysphasia) is a systemic underdevelopment of expressive speech of central origin. The child has disturbances in articulatory praxis and the organization of speech movements, therefore speech development is delayed. There is a search for articulation, an inability to perform certain articulatory movements and their sequences. The child cannot find the correct sequence of sounds in a word, words in a phrase, and cannot switch from one word to another. This leads to an abundance of errors, permutations, and perseverations in speech (multiple repetition of the same syllable or word). As a result, in a child with motor alalia, with good hearing and sufficient understanding of speech, in the absence of paresis of the articulatory muscles, independent speech does not develop for a long time, or it remains at the level of individual sounds and words.

Already at an early age, attention is drawn to the absence or limitation of babbling. Parents note silence, emphasize that the child understands everything, but does not want to speak. Instead of speech, facial expressions and gestures develop, which children use selectively in emotionally charged situations.

The first words and phrases appear late. Parents note that, in addition to speech delays, in general, children develop normally. As their vocabulary increases, the difficulties children have in mastering word structure become more noticeable. Speech is slow. There are many slips of speech in the speech stream, which children pay attention to and try to correct what was said incorrectly - especially as they develop. Examples of word distortions: button - “kubyka”, “puzyka”, “puzuvisa”, “kubiska”; February - “Fral”, “Viral”, “Faral”.

Vocabulary is formed slowly, distorted, and incorrect use of words is common. Substitutions of words based on external signs of an object or action are typical: washes-washes, ax-hammer, cup-glass, etc. Children do not know how to use synonyms, antonyms, and generalizing words. The stock of adjectives and adverbs is narrow and monotonous.

The vocabulary is poor, limited to everyday topics. The child cannot explain the meaning of words and does not know how to use word formation. In their statements, children find it difficult to coordinate words, use gender and numerical endings, and do not use prepositions and conjunctions. Their phrases consist of unchangeable words (“Book, Tanya!” and a gesture of request), which makes them understandable only in a certain situation. The number and order of words in the sentences are disturbed; the child responds with one or two words (mainly nominative sentences-nouns in the correct or distorted case version) in combination with a gesture. In case of alalia, the lack of formation of the sentence structure is a consequence of the immaturity of internal speech operations - choosing a word and constructing a plan of utterance.

There is a systematic underdevelopment of all aspects and functions of speech. There are difficulties in constructing phrases, mastering grammatical structure, insufficient development of imitative activity (including imitative speech) and all forms of voluntary speech. Children are not able to gradually transfer familiar words from a passive to an active vocabulary.

With little speech activity, the child’s general cognitive activity suffers. Speech during alalia is not a full-fledged means of communication, organization of behavior and individual development. Intellectual deficiency and a limited supply of knowledge, observed in many children with alalia at different age periods, are therefore secondary in nature.

In some cases, children with alalia develop pathological personality traits and neurotic character traits. As a reaction to speech impairment, they experience isolation, negativism, self-doubt, tension, increased irritability, touchiness, and a tendency to cry. Some children use speech only in emotionally charged situations. The fear of making a mistake and causing ridicule from others leads to the fact that they try to get around speech difficulties, refuse verbal communication, and are more willing to use gestures. Speech disability “excludes” the child from the children’s group and, with age, increasingly traumatizes his psyche.

Sensory alalia (dysphasia) is a systemic underdevelopment of impressive speech of central origin, caused primarily by disturbances in the auditory-speech analyzer. This leads to disorders in the analysis and synthesis of speech signals, as a result of which a connection is not formed between the sound image of a word and the object or action it denotes. The child hears but does not understand the spoken speech.

Sensory alalia is considered a less studied condition than motor alalia. Apparently, this is due to the fact that in its pure form it is much less common; its timely recognition and differential diagnosis can be quite difficult. In particular, it is always necessary to differentiate sensory alalia from hearing loss, which can interfere with normal speech development, as well as autism.

The degree of underdevelopment of the speech-hearing analyzer can be different.

In more severe cases, the child does not understand the speech of others at all, treats it as noise devoid of meaning, does not even react to his own name, and does not distinguish between the sounds of speech and noises of a non-speech nature. He is indifferent to any speech and non-speech stimuli. In other cases, he understands individual words, but loses them against the background of a detailed statement (as happens, for example, in healthy people with insufficient knowledge of a foreign language). When addressing him, the child does not catch all the words and their shades, which results in an incorrect reaction. Phonemic perception develops slowly and remains unformed for a long time. For children with sensory alalia, the situation plays a big role. Often they understand the content of statements only in a certain context and find it difficult to perceive the meaning when changing the forms and order of words, or using grammatical structures.

Often children do not perceive changes in a particular task by ear, and do not distinguish what was said in error from the correct option. Sometimes they ask to repeat the speech addressed to them and understand only what is spoken several times. Some children only understand what they can say themselves. Such pronunciation helps to improve understanding.

Children often look at the speaker's face. In this case, speech understanding improves due to the reinforcement of the auditory impression from the visual analyzer - “reading from the face” occurs. Sometimes a child understands only a certain person - a mother, a teacher - and does not understand when someone else says the same thing.

Children with sensory alalia can spontaneously repeat individual syllables, sound combinations, words and short phrases they hear, although this repetition is unstable. Imitation of speech sounds with sensory alalia is not constant and largely depends on the situation. Children are not able to form connections between an object and its name; they do not form a correspondence between the words they hear and the words they pronounce. The child's understanding of the meanings of the words he pronounces is unstable. His active vocabulary exceeds his passive one.

When pronouncing words, the child is not confident in the correctness of his own speech and looks for adequate speech movements, for example: elephant - “sleep”, “vylon”, “sylon”, “salon”. Errors in speech are qualitatively different than with motor alalia. On the one hand, diffuse undifferentiated perception of sounds leads to their incorrect pronunciation, and on the other hand, errors lead to numerous searches for the necessary kinesthesia.

Sometimes there is an incoherent reproduction of all the words known to the child - a kind of logorrhea; perseverations are noted with repetitions of a heard or spoken word or phrase (echolalia), while the words are not comprehended and not remembered.

The words contain numerous errors in stress, sound substitutions, and distortions, and with each new repetition the nature of the distortions and substitutions usually changes. The child learns new words and phrases slowly. The child's statements are imprecise and may be difficult to understand. He is not critical of his own speech. Distortions in expressive speech are caused by the inferiority of perception of one’s own speech and the speech of others.

Due to the instability of understanding the meanings of words, children, having received verbal instructions, act uncertainly, seek help, have limited opportunities for organizing role-playing games, and cannot listen for a long time when they are read or told.

In less severe forms of sensory alalia, when children have formed their own speech, they speak easily, without tension, do not think about the choice of words, the accuracy of the statement, the construction of the phrase, and do not notice the mistakes made. Children do not control their own speech; they use words and phrases that are not related to the situation and are devoid of meaning. Speech is fragmentary. Because the child's statements are inaccurate in content and erroneous in form, it is often difficult for others to understand what he is talking about. In spoken words there are many sound substitutions, omissions, perseverations, connections of parts of words with each other (contamination). In general, the speech of a child with sensory alalia can be characterized as increased speech activity against the background of impaired understanding of the speech of others and insufficient control over one’s own speech.

Sensory alalia in its pure form is relatively rare; much more often sensory deficiency accompanies motor alalia. In these cases we speak of motor alalia with a sensory component or sensorimotor alalia. The existence of mixed forms of alalia indicates the functional continuity of the speech-motor and speech-auditory analyzers. A thorough examination of a child with alalia makes it possible to clarify the nature of the disorders, establish the leading inferiority in the structure of speech disorders and determine the optimal approaches to their correction.

Treatment of speech development disorders in children

In order for assistance to a child with a delay in speech development to be effective, an integrated approach and coordinated work of different specialists (doctors, speech therapists, psychologists, teachers), as well as the active participation of parents, are necessary. It is important that these joint efforts are aimed at early detection and timely correction of speech disorders in children. The main areas of correctional work for speech development disorders in children are: speech therapy work, psychological and pedagogical correctional measures, psychotherapeutic assistance to the child and his family, as well as drug treatment.

Since alalia represents the most 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 and psychological-pedagogical correctional measures should be carried out over a long period of time and systematically. In the process of speech development in children with alalia, certain positive dynamics can be traced; they consistently move from one level of speech development to another, higher one. They acquire new speech skills and abilities, but often remain children with underdeveloped speech. During schooling, children experience difficulties in mastering written language skills. Therefore, along with speech therapy and psychological and pedagogical correction, children with alalia are recommended to be prescribed repeated courses of therapy with nootropic drugs.

Nootropics are a group of drugs that differ in their composition and mechanisms of action, but have a number of common properties: they have a positive effect on the higher integrative functions of the brain, improve memory, facilitate learning processes, stimulate intellectual activity, increase the brain’s resistance to damaging factors, improve cortical-subcortical connections.

Figure 2. Changes in the vocabulary of children with motor alalia in the control and main (encephabol treatment) groups over 2 months

Treatment of alalia is a long process, during which there is a need for repeated therapeutic courses with nootropic drugs, for example, encephabol (Fig. 2) or others (Table 2). The repeated prescription of nootropics is also due to the fact that in addition to speech disorders, many children with alalia have to overcome concomitant cognitive, motor and behavioral disorders. It is advisable to prescribe nootropic drugs in the form of monotherapy, while paying attention to the individual selection of optimal dosages and duration of treatment. In the first days of use, a gradual increase in dose is recommended. The duration of treatment courses ranges from 1 to 3 months. Most nootropic drugs are prescribed in the first half of the day.

Side effects during treatment with nootropic drugs in children are rare, they are unstable and insignificantly expressed. They often occur due to insufficiently strict parental control and inaccurate adherence to the medication regimen (taking into account a gradual increase in dose) and administration in the morning and afternoon. Possible side effects of drug therapy with nootropic drugs include: increased emotional lability, irritability, difficulty falling asleep and restless sleep. If such complaints appear, clarifications should be made to the drug prescription regimen and the dose should be slightly reduced.

In conclusion, we should once again emphasize the need for early detection, timely and comprehensive diagnosis and correction of speech development disorders in children, combining the efforts of doctors, speech therapists, teachers and psychologists.

Literature

Badalyan L. O. Neuropathology. M.: Academy, 2000. 382 p.
Butterworth J., Harris M. Principles of developmental psychology: trans. from English M.: Cogito-Center, 2000. 350 p.
Volkova L. S., Shakhovskaya S. N. Speech therapy. 3rd ed. M.: Vlados, 1999. 678 p.
Levina R. E. Fundamentals of the theory and practice of speech therapy. M.: Education, 1968. 367 p.
Filicheva T. B., Cheveleva N. A., Chirkina G. V. Fundamentals of speech therapy. M.: Education, 1989. 221 p.

N. N. Zavadenko, Doctor of Medical Sciences, Professor of Russian State Medical University, Moscow

Differences between dyslalia and other similar disorders

Dyslalia must be distinguished from dysarthria and aphasia.

Dysarthria

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

Aphasia

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

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

Forms of dyslalia, classification of pathological changes

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

Based on the scale of speech dysfunction:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Causes

The cause of the development of mechanical dyslalia is organic defects in the anatomical structure of the peripheral articulatory apparatus, which includes: jaws, teeth, lips and tongue.

Among the anomalies of the articulation apparatus leading to dyslalia, the most common are:

short frenulum of the tongue or upper lip;
macroglossia - massive, tongue;
microglossia - narrow, small tongue;
thick, inactive lips;
malocclusion: deep, cross, open;
anomalies of the dentition: diastemas, sparsely located or small;
high narrow or low flat upper palate.

Anatomical defects that cause mechanical dyslalia can be congenital or occur as a result of diseases and injuries of the dental system.

With functional dyslalia, the structure of the articulatory apparatus is not changed, i.e., there is no organic basis for the violation of sound pronunciation.

In this case, the causes of dyslalia are social or biological factors:

pedagogical neglect;
"lisping" of adults when talking to children;
tongue-tied, hasty speech of others;
bilingualism in the environment;
minimal brain dysfunction;
general physical weakness.

Symptoms and clinical picture depending on the type of disorder

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

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

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

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

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

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

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

Diagnosis of dyslalia

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

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

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

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

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

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

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

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

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

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

Diagnostics

A speech therapist examines the structure and mobility of the organs of the articulatory apparatus through visual inspection and using special test exercises.

In the process of a speech therapy examination, the nature of the disorder is revealed, namely the absence, replacement, mixing and distortion of sounds in various positions - in isolation, in open, closed or consonant syllables, words at the beginning, middle or end, as well as phrases and texts.

Then the state of phonemic hearing is checked - the ability to auditory differentiate all correlating phonemes.

For mechanical dyslalia, a speech therapist can refer the patient for consultation to an orthodontist or dental surgeon, and for functional dyslalia, to a neurologist.

If hearing loss is suspected, a consultation with an otolaryngologist and a study of the function of the auditory analyzer is carried out.

Treatment of dyslalia

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

How many stages of correction work are there for dyslalia?

There are three in total:

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

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

Preparation

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

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

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

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

Skill building

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

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

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

Formation of communication skills

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

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

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

Symptoms

Four types of sound pronunciation defects in dyslalia: omissions, substitutions, confusion and distortion of sounds.

By skipping a sound we mean its complete loss in one position or another: at the beginning, in the middle or at the end of a word.

Sound replacement is a persistent replacement of one sound with another, also present in the phonetic system of the native language. Sound substitutions are caused by the failure to distinguish phonemes based on subtle articulatory or acoustic features. With dyslalia, sounds can be replaced that differ in place of articulation or method of formation, on the basis of sonority-voicelessness or hardness-softness.

They talk about mixing sounds if two correctly pronounced sounds are constantly confused in the speech stream, that is, their use is either appropriate or inappropriate.

Distortion of sounds is an irregular pronunciation, the use in speech of sounds that are absent in the phonetic system of the Russian language. For example, velar or uvular pronunciation [r], interdental or lateral pronunciation [s] and others. Distortion of sounds is usually found in mechanical dyslalia.

With functional dyslalia, as a rule, the pronunciation of one or more sounds is impaired; in the case of mechanical dyslalia - a group of sounds similar in articulation. Thus, an open anterior bite will contribute to the interdental reproduction of the sounds of anterior lingual articulation [z], [s], [ts], [h], [zh], [sh], [sch], [d], [t], [l ], [n], because the tip of the tongue cannot be held behind the front teeth.

Prevention

It is enough to follow simple recommendations:

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

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