Alalia of speech in children. Forms and causes of speech alalia. Motor, sensory, sensorimotor

Causes and risk factors

Damage to the speech centers of the cerebral cortex, causing the development of alalia, occurs during pregnancy or at an early age, i.e. even before speech formation begins. Factors that significantly increase the risk of pathology include:

problems during pregnancy: hypoxia, toxicosis, infections (especially the TORCH complex), injuries, chronic diseases and bad habits in the mother;
birth injuries, asphyxia, pathological course of labor (protracted, fleeting);
premature birth;
severe illnesses in the first years of life: acute respiratory viral infections, pneumonia, conditions requiring the use of anesthesia;
traumatic brain injuries;
unfavorable social situation in the family.

Often, not one, but several pathological factors are involved in the formation of alalia, leading to the development of minimal brain dysfunction (MCD). This is a complex disorder manifested by mental retardation, including impaired speech functions.

Valery Anatolyevich Kovshikov

Valery Anatolyevich Kovshikov (1936–2000), candidate of pedagogical sciences, associate professor - this name is rightfully inscribed in large letters in the history of domestic speech therapy. Having graduated from the defectology faculty of Leningrad State Pedagogical Institute (now RGPU) named after. A.I. Herzen, V.A. Kovshikov worked for almost 40 years at the Department of Psychopathology and Speech Therapy (later - the Department of Speech Therapy) of this university.

Formation of associate professor V.A. Kovshikov was held under the guidance of leading experts in the field of correctional pedagogy - professors E.S. Ivanova, L.S. Volkova, R.I. Lala-eva, in collaboration with G.M. Sumchenko, G.A. Volkova, L.G. Paramonova and his other colleagues, who formed the scientific speech therapy school in the Northern capital of Russia. It is no coincidence that the leadership of the defectology faculty and department, and colleagues have invariably trusted V.A. for many years. Kovshikov editing collections of scientific papers on the problems of speech therapy and special pedagogy. Editing scientific publications and opposing dissertations performed by V.A. Kovshikov, have always been distinguished by their depth, integrativeness, conceptual approach, integrity and scientific foresight.

Range of scientific interests of V.A. Kovshikov in the field of theory and practice of speech therapy was quite broad and constantly deepened, especially in light of close creative cooperation with the Leningrad (St. Petersburg) Institute of Ear, Throat, Nose and Speech - one of the leading medical and defectological research centers in our country. Never breaking ties with practical (mass and special) educational institutions, Valery Anatolyevich carried out experimental research work at the base related to differential diagnostic, correctional and educational work with children of preschool and school age who have developmental problems. He paid a lot of attention to advisory and methodological work with teachers and parents of children suffering from speech, intellectual and behavioral developmental disorders.

Scientific and methodological heritage of V.A. Kovshikov compiles 70 scientific and scientific-methodological works, most of which are devoted to the problem of motor alalia. The versatility of the studied V.A. Kovshikov's theoretical and methodological issues on this problem reflect the depth of his scientific thought: mechanisms of expressive alalia, differential diagnosis of language and speech disorders, intellectual and linguistic insufficiency in the overall picture of speech dysontogenesis, individual characteristics of children with alalia, specifics of disorders of phonemic, syntactic systems of language, speech and non-speech activity - this and much more was the subject of his careful research.

V.A. Kovshikov conducted studies of normal and impaired speech and non-speech activity on the basis of linguistic, psycholinguistic and logopathopsychological methods, continuing and developing the traditions of the domestic psychological and speech therapy school (N.N. Traugott, V.K. Orfinskaya, A.A. Leontyev and etc.).

Corrective work with children suffering from alalia, V.A. Kovshikov recommended focusing on the formation of the linguistic mechanism of speech activity, using a concentric system of material distribution; Moreover, each concentration, in his opinion, should include gradually more complex material from all subsystems of the language (lexical, morphological, phonemic). V.A. Kovshikov, knowing well the domestic and foreign literature, rightly emphasized that much in the problem of alalia still remains insufficiently studied and debatable. Solving the problem of successful correction of alalia can only be successful if we use and deepen modern ideas about human speech activity.

V.A. Kovshikov also developed an original training course on the historiography of domestic speech therapy.

V.A. Kovshikov was, in the true sense of the word, a socially active person, took a direct part in cultural and educational events, devoted a lot of time to engaging students and research work, and was attentive and very interested in students’ mastery of professional skills. The scientist’s ideas were embodied and developed in theses and master’s theses of his students, many of whom became leading experts in the field of correctional pedagogy. All of them remember with gratitude and great warmth their teacher, his bright, interesting lectures, polemical scientific and methodological discussions, originality of judgments, persuasiveness and evidence of scientific argumentation, his sincere devotion to the “cause of speech therapy.”

V.A. Kovshikov, a talented teacher and scientist, made a significant contribution to the development of the theory and practice of speech therapy, to the system of training and advanced training of defectological personnel.

He passed away in the prime of his creative powers, without having time to defend his doctoral dissertation, without completing work with several of his students, without finishing another book. Students, colleagues and friends keep V.A. Blessed memory of Kovshikov.

Alalia is the absence or underdevelopment of speech due to organic damage to the speech areas of the cerebral cortex in the prenatal or early period of speech development.

The causes of alalia are varied. M.V. Bogdanov-Berezovsky, N.N. Traugott point to inflammatory or nutritional-trophic metabolic pathological processes occurring in the prenatal or early period of child development. E. Freshels, Yu. A. Florenskaya about children suffering from severe rickets or who have suffered severe diseases of the upper respiratory tract (whooping cough). N. I. Krasnogorsky speaks about severe cases associated with Z.R.R., associated with lack of nutrition and sleep in the first months of life.

With alalia, various degrees of severity are observed: from relatively mild forms, in which speech develops, although slowly and distorted, from about 3-4 years, to severe ones, when the child does not use speech even at 10-12 years. Later, with systematic and special help they master speech, but it is very defective and poor.

Alalia (according to M.E. Khvattsev) is the muteness of children who speak indistinctly, if they have insufficient intelligence, elementary hearing and articulatory apparatus for the development of speech. The child is silent or makes inarticulate sounds and sound combinations. Sometimes he pronounces words that are incomprehensible to others, echolalia is observed. The phonetics, vocabulary and syntax of an 8-10 year old alalia copy the speech of 2-3 year old children. Typical for the initial stage of alalia is silence and reluctance to speak. Such inhibition is caused by the poverty of the speech process, severe mental experiences of one’s inferiority.

There are two main forms of alalia: motor and sensory. The most common is mixed sensorimotor alalia. R.E. Levin identifies 3 forms of alalia (psychological classification):

-Children with insufficient acoustic perception - do not distinguish the sound stream, do not understand, do not speak (sensory defect)

-Children with insufficiency of acoustic perception – insufficient visual perception. There is no impairment of physiological vision, but subtle visual differentiations are not formed. Notes insufficiency of optical-spatial perceptions, they do not distinguish shape, size, color, because The cells of the cerebral cortex in the parietal-occipital regions are not developed.

-Children with insufficient mental activity. Children may be closer to normal in intelligence, but their mental activity is impaired (they cannot plan, switchability suffers, there are disturbances in all types of activities, children are passive, slow.)

R.E Levin does not distinguish motor alalia.

Other researchers (S.S. Lyapidevsky, N.N. Traugott) insist on motor alalia, noting that motor alalia is based on a violation of speech motor analyzers.

Brain damage is caused by brain damage, intrauterine ecephalitis, sometimes a complication after meningitis, unfavorable intrauterine developmental conditions, difficult childbirth, brain injuries, childhood diseases with complications on the brain. The earlier the disease occurs, the more extensive the speech impairment, because all further development of the brain proceeds abnormally (myelination of nerve fibers is delayed)

Sensory alalia.

If the child has normal hearing, he does not understand speech addressed to him, which means he does not speak. Cause: injuries and diseases of the brain (auditory-speech differentiations in the acoustic apparatus, in the temporal region did not develop subtly enough) Symptoms of sensory alalia: impaired phonemic hearing, poor attention and memory for oral speech (do not develop due to lack of understanding of verbal speech) B The result is vagueness and instability of phonemic patterns. Sensory alalitics have hearing impairment to one degree or another, which makes it difficult to perceive spoken speech. Sensory alaliks are easier than motor ones to imitate sounds and words and pronounce them more often. Sometimes speech arises spontaneously, although without awareness of its content.

Motor alalia.

This is a systemic underdevelopment of expressive speech of a central organic nature due to the underdevelopment, immaturity of linguistic concepts, the process of generating speech utterances with the relative preservation of semantic and sensorimotor operations. Motor alalik begins to understand other people's speech in a timely manner, but does not speak himself. There is often a misunderstanding of difficult words and phrases, complex sentences. The enrichment of expressive speech is limited, because they talk to him little, believing that speech is inaccessible to him. Motor speech imitation is especially severely impaired (they cannot repeat words that they have already learned to speak)

Symptoms of motor alalia:

Severe impairment of imitation of oral speech (lack of articulatory speech)

Repetition of the same sound, syllable is normal (a-a-a, bo-bo-bo), but the sound combinations are broken (instead of “au” he repeats “uu, ua”)

The more developed facial-gestural speech, the longer the indication of motor alalia, because verbal thinking is relatively intact.

Causes of motor alalia:

Congenital or acquired inferiority and abnormal development of speech motor systems due to damage by disease, physical trauma, intoxication or due to delayed development of differentiation in the motor centers of the speech motor zone of the cerebral cortex (Brocca's area).

Difficulties in independently pronouncing sounds are explained by the weakness of traces from the reproduction of sounds in the speech motor system of the brain or the weakness of the connections of this system with others (acoustic, optical).

Alalik's speech

Speech is simplified according to the type of speech of small children (mo-milk)

Repeats syllables, but cannot merge them into words. Often there are omissions and rearrangements.

A peculiar stuttering is noted as a stage of speech development: it occurs either simultaneously with the appearance of speech, or later when mastering a phrase. Sometimes the stuttering goes away, sometimes it remains.

There are frequent sharp violations of the melody of speech, tempo, rhythm, chanting with prolonged syllables or abrupt pronunciation of words in a sentence.

Phonemic and grammatical disorders, tongue-tiedness, nasality.

Loss of understanding is secondary in nature. This occurs as a result of: lack of habit of listening, rapid fatigue, and lack of habit of listening to complex speech.

The presence of a kind of expressive speech: alalik always says something, but does not know how to use the learned words in the right case, the word is reproduced based on the object, and not on memory.

Alalik's personality.

More often they are psychophysically inferior. Due to damage to the central nervous system, deprivation of the possibility of normal communication, difficulties in the speech act, negative personality traits develop: agitation, short temper, sudden mood swings, touchiness, tearfulness, stubbornness, inactivity in movements and thinking. Negativity is typical. Extraverbal disorders: disorders of attention, memory, thinking.

Formation of expressive speech of alalik .

The formation of speech is caused by a violation of the analytical-synthetic activity of the speech motor analyzer. These violations can be of a different nature:

Kinetic oral apraxia: difficulties in the formation and consolidation of articulatory structures, and subsequently in the motor differentiation of sounds.

Difficulty switching from one movement to another.

Difficulties in mastering the sequence of these movements to reproduce words / motor patterns /.

The development of the main leading component - the active vocabulary - is delayed. It turns out to be poor, insufficient, and distorted.

The phonetic side of speech also lingers.

The grammatical structure is formed distortedly.

Formation of impressive speech.

Impressive speech suffers secondarily and to a lesser extent in its development. Characteristic is a decrease in speech stimulus or speech negativism.

Diagnostic differences between alalia and similar conditions.

Difference between alalik and deaf-mute:

Presence of modulated screaming and babbling with intonations.

At the age of 1-3 months, reaction to sound.

Emerging kinesthetic (gestural) speech accompanied by screaming.

The expression of the eyes is lively, the face is expressive.

The difference between an alalik and a child with hearing loss:

Normal or slightly reduced hearing.

A ringing voice (muffled for those with hearing loss).

Complete absence of speech (in the case of the hard of hearing – babbling or distorted speech).

Alalik does not repeat words (a hard-of-hearing child repeats).

ALALIA

Alalia is a profound immaturity of speech function, caused by organic damage to the speech areas of the cerebral cortex. With alalia, speech underdevelopment is systemic in nature, that is, there is a violation of all its components - phonetic-phonemic and lexical-grammatical. Unlike aphasia, in which there is a loss of previously present speech, alalia is characterized by an initial absence or sharp limitation of expressive or impressive speech. Thus, alalia is spoken of if organic damage to the speech centers occurred in the prenatal, intranatal or early (up to 3 years) period of the child’s development.

Alalia is diagnosed in approximately 1% of preschool children and 0.6-0.2% of school-age children; Moreover, this speech disorder occurs 2 times more often in boys. Alalia is a clinical diagnosis, which in speech therapy corresponds to the speech conclusion ONR (general speech underdevelopment).

Causes of alalia

The factors leading to alalia are diverse and can act during different periods of early ontogenesis. Thus, in the antenatal period, organic damage to the speech centers of the cerebral cortex can be caused by fetal hypoxia, intrauterine infection (TORCH syndrome), the threat of spontaneous abortion, toxicosis, falls of a pregnant woman with injury to the fetus, chronic somatic diseases of the expectant mother (arterial hypotension or hypertension, heart or pulmonary failure).

The natural outcome of a complicated pregnancy is complications of childbirth and perinatal pathology. Alalia may be a consequence of asphyxia of newborns, prematurity, intracranial birth trauma during premature, rapid or prolonged labor, or the use of instrumental obstetric aids.

Among the etiopathogenetic factors of alalia that affect the first years of a child’s life, one should highlight encephalitis, meningitis, head injury, and somatic diseases leading to depletion of the central nervous system (hypotrophy). Some researchers point to a hereditary, family predisposition to alalia. Frequent and prolonged illnesses of children in the first years of life (ARI, pneumonia, endocrinopathies, rickets, etc.), operations under general anesthesia, unfavorable social conditions (pedagogical neglect, hospitalism syndrome, deficiency of speech contacts) aggravate the effect of the leading causes of alalia.

As a rule, the history of children with alalia reveals the participation of not one, but a whole complex of factors leading to minimal brain dysfunction - MMD.

Organic damage to the brain causes a slowdown in the maturation of nerve cells, which remain at the stage of young immature neuroblasts. This is accompanied by a decrease in the excitability of neurons, inertia of the main nervous processes, and functional exhaustion of brain cells. Damages to the cerebral cortex in alalia are mild, but multiple and bilateral, which limits the independent compensatory capabilities of speech development.

Alalia classification

Over many years of studying the problem, many classifications of alalia have been proposed depending on the mechanisms, manifestations and severity of speech underdevelopment. Currently, speech therapy uses the classification of alalia according to V.A. Kovshikov, according to which they distinguish:

expressive
(motor) alalia
impressive
(sensory) alalia
mixed
(sensorimotor or motosensory alalia with a predominance of impaired development of impressive or expressive speech)

The occurrence of the motor form of alalia is based on early organic damage to the cortical part of the speech motor analyzer. In this case, the child does not develop his own speech, but his understanding of someone else’s speech remains intact. Depending on the damaged area, afferent motor and efferent motor alalia are distinguished. With afferent motor alalia, damage to the postcentral gyrus (lower parietal parts of the left hemisphere) occurs, which is accompanied by kinesthetic articulatory apraxia. Efferent motor alalia occurs with damage to the premotor cortex (Broca's center, the posterior third of the inferior frontal gyrus) and is expressed in kinetic articulatory apraxia.

Sensory alalia occurs when the cortical part of the speech-hearing analyzer (Wernicke's center, the posterior third of the superior temporal gyrus) is damaged. In this case, the higher cortical analysis and synthesis of speech sounds is disrupted and, despite intact physical hearing, the child does not understand the speech of others.

Symptoms of motor alalia

With motor alalia, characteristic non-speech (neurological, psychological) and speech manifestations occur.

Neurological symptoms in motor alalia are represented primarily by movement disorders: awkwardness, lack of coordination of movements, poor development of motor skills of the fingers. Children have difficulty mastering self-care skills (buttoning buttons, tying shoes, etc.) and performing fine motor operations (folding mosaics, puzzles, etc.).

Considering the psychological characteristics of children with motor alalia, one cannot help but note impairments in memory (especially auditory-verbal), attention, perception, and emotional-volitional sphere. Based on their behavioral characteristics, children with motor alalia can be hyperactive, disinhibited, or sedentary and inhibited. Most children with motor alalia have reduced performance, high fatigue, and speech negativism. Intellectual development in alalik children suffers secondarily due to speech insufficiency. As speech develops, intellectual impairments are gradually compensated.

With motor alalia, there is a pronounced dissociation between the state of impressive and expressive speech, i.e., speech understanding remains relatively intact, but the child’s own speech develops with gross deviations or does not develop at all. All stages of the development of speech skills (humbling, babbling, babbling monologue, words, phrases, contextual speech) occur with a delay, and the speech reactions themselves are significantly reduced.

Despite the fact that a child with afferent motor alalia is potentially able to perform any articulatory movements (unlike dysarthria), sound pronunciation is grossly impaired. In this case, persistent substitutions and confusions of articulatory disputable phonemes arise, which leads to the impossibility of reproducing or repeating the sound image of a word.

With efferent motor alalia, the leading speech defect is the inability to perform a series of successive articulatory movements, which is accompanied by a gross distortion of the syllabic structure of the word. The lack of formation of a dynamic speech stereotype can lead to the appearance of stuttering against the background of motor alalia.

Vocabulary in motor alalia significantly lags behind the age norm. New words are difficult to learn; the active vocabulary contains mainly everyday terms. A small vocabulary causes an inaccurate understanding of the meanings of words, their inappropriate use in speech, and substitutions based on semantic and sound similarity. A characteristic feature of motor alalia is the absolute predominance of nouns in the nominative case in the vocabulary, a sharp limitation of other parts of speech, difficulties in the formation and differentiation of grammatical forms.

Phrasal speech with motor alalia is represented by simple short sentences (one- or two-part). As a consequence, with alalia there is a gross violation of the formation of coherent speech. Children cannot consistently present events, highlight the main and secondary, determine temporary connections, cause and effect, or convey the meaning of phenomena and events.

In severe forms of motor alalia, the child has only onomatopoeia and individual babbling words, which are accompanied by active facial expressions and gestures.

Symptoms of sensory alalia

With sensory alalia, the leading defect is a violation of the perception and understanding of the meaning of spoken speech. At the same time, the physical hearing of sensory alaliks is preserved, and they often suffer from hyperacusis - increased susceptibility to various sounds.

Against the background of auditory agnosia, own speech activity in children with sensory alalia is increased. However, their speech is a set of meaningless sound combinations and fragments of words, echolalia (unconscious repetition of other people's words). In general, with sensory alalia, speech is incoherent, meaningless and incomprehensible to others (logorrhea - “word salad”). In the speech of children with sensory alalia there are numerous perseverations (obsessive repetitions of sounds, syllables), syllable elision (omissions), paraphasia (sound substitutions), contamination (combining parts of different words with each other). Children with sensory alalia are not critical of their own speech; Facial expressions and gestures are widely used for communication.

In severe forms of sensory alalia, there is no understanding of speech at all; in other cases it is situational in nature. However, even if the child has access to the meaning of a phrase in a certain context, when the word form, word order in a sentence, or rate of speech change, understanding is lost. Often, children with sensory alalia are helped to understand speech by “reading the lips” of the speaker.

Insufficiency of phonemic hearing in sensory alalia leads to inability to distinguish paronymous words; unformed correlation of the audible and spoken word with a particular object or phenomenon.

Gross distortion of speech development with sensory alalia leads to secondary disorders of personality, behavior, and delayed intellectual development. The psychological characteristics of children with sensory alalia are characterized by difficulty turning on and maintaining attention, increased distractibility and exhaustion, instability of auditory perception and memory. Children with sensory alalia may experience impulsiveness, chaotic behavior or, on the contrary, inertia and isolation.

In its pure form, sensory alalia is rarely observed; Mixed sensorimotor alalia is usually found, which indicates the functional continuity of the speech-auditory and speech-motor analyzers.

Examination of children with alalia

Children with alalia need consultation with a pediatric neurologist, pediatric otolaryngologist, speech therapist, and child psychologist.

Neurological examination of children with alalia is necessary to identify and assess the nature and extent of brain damage. For this purpose, the child may be recommended EEG, echoencephalography, skull radiography, and MRI of the brain. To exclude hearing loss with sensory alalia, it is necessary to conduct otoscopy, audiometry and other studies of auditory function.

A neuropsychological examination of a child with alalia includes diagnostics of auditory-verbal memory. Speech therapy examination for alalia begins with clarifying the perinatal history and characteristics of the early development of the child. Particular attention is paid to the timing of psychomotor and speech development. Diagnostics of oral speech (impressive speech, lexico-grammatical structure, phonetic-phonemic processes, articulatory motor skills, etc.) is carried out according to the examination scheme for OHP.

Differential diagnosis of alalia is carried out with mental retardation, dysarthria, hearing loss, autism, mental retardation.

Alalia correction

The method of corrective action for any form of alalia should be of a comprehensive psychological, medical and pedagogical nature. Children with alalia receive the necessary help in specialized preschool educational institutions, hospitals, correctional centers, and sanatoriums.

Work on speech is carried out against the background of drug therapy aimed at stimulating the maturation of brain structures; physiotherapy (laser therapy, magnetic therapy, electrophoresis, DMV, hydrotherapy, IRT, electropuncture; transcranial electrical stimulation, etc.). With alalia, it is important to work on the development of general and manual motor skills, mental functions (memory, attention, ideas, thinking).

Given the systemic nature of the disorder, speech therapy classes to correct alalia involve working on all aspects of speech. With motor alalia, the child’s speech activity is stimulated; work is underway on the formation of active and passive vocabulary, phrasal speech, and grammatical formatting of statements; development of coherent speech and sound pronunciation. Logorhythmics and speech therapy massage are included in the outline of speech therapy classes.

With sensory alalia, the tasks are to master the distinction between non-speech and speech sounds, the differentiation of words, their correlation with specific objects and actions, the understanding of phrases and speech instructions, and the grammatical structure of speech. As the vocabulary accumulates, subtle acoustic differentiations and phonemic perception are formed, the development of the child’s own speech becomes possible.

Classification: forms of alalia in children

The development of alalia in a child can be caused by damage to various parts of the cerebral cortex. Depending on the location of the pathological focus, the symptoms of the disease may vary, which allows us to distinguish three main forms:

motor (expressive): the area responsible for speech production suffers; at the same time, the child understands the words addressed to him, can follow commands, but is not able to pronounce articulate sounds; within this form, afferent and efferent varieties of alalia are also distinguished; in the first case, the child cannot control the functioning of the speech apparatus and pronounces sounds incorrectly; in the second, there is difficulty in switching articulatory acts, i.e. It is difficult for the child to follow the sequence of speech movements.
sensory (impressive): occurs when the auditory-speech analyzer is damaged, i.e. the child cannot understand speech addressed to him, and, accordingly, cannot speak;
mixed: signs of both forms are observed; Depending on the predominance of certain symptoms, sensorimotor and motosensory varieties of alalia in children are distinguished.

Expressive alalia

Expressive alalia is a language disorder that is characterized by a violation of the assimilation in the ontogenesis of expressive speech of the inventory of linguistic units and the rules of their functioning, which in the process of speech generation is manifested in the impossibility or in the disorder of the production of grammatical, lexical and phonemic operations with complete or relative preservation of semantic and motor ( articulatory) operations.
Expressive alalia is caused by organic lesions of the brain in the prenatal, natal or early postnatal periods. There is an opinion that most children with alalia have (or had in the early stages of their development) mild but multiple damage in both hemispheres of the brain.

The mechanism of alalia is still poorly understood. Representatives of different directions in the study of alalia agree that the disorder of the language mechanism is based on organic failure of the brain. At the same time, some researchers associate the disorder in the functioning of the language mechanism with pathology of motor skills, others with pathology of certain aspects of mental activity, and still others with selective failure in mastering language as a unique sign system. The last point of view is the most well-reasoned.

Alalia by a violation of all subsystems of the language: syntactic, morphological, lexical and phonemic. Typical manifestations of alalia are agrammatism, word search disorders, difficulties in “selecting” phonemes and establishing their order, and violations of the syllabic structure of words. Many children with alalia have a variety of non-linguistic disorders - neurological and psychopathological. The degree of language disorder in different children can be different and manifest itself within the boundaries from a complete (or almost complete) absence of expressive speech to minor deviations in the functioning of language subsystems: first (most severe), second (moderate) and third (mild) degrees of system impairment language (or, in the terminology of other authors, the first, second and third “levels of development (underdevelopment) of speech”).

During its development, alalia undergoes a number of quantitative and qualitative changes. Having mastered relatively simple units of language and the rules of their functioning, children for a long time experience difficulties in mastering more complex units and rules. Having mastered oral speech to a certain extent, they cannot fully master written speech for a long time.

The necessary criteria for determining expressive alalia are: 1) delay in the rate of normal language acquisition; 2) pathological development of language; 3) the presence at certain stages of ontogenesis, to varying degrees of severity, of violations of all subsystems of language; 4) preservation of hearing; 5) satisfactory understanding of spoken language accessible to a certain age.

It should be noted that expressive alalia can manifest itself in children with severe neurological and psychopathological disorders (for example, in children with cerebral palsy, in oligophrenic children, etc.). These variants of alalia are specific, have not yet been well studied and are difficult to diagnose. A very large number of different terms are used to refer to alalia, which reflects different ideas about it and insufficient knowledge of its etiology, mechanism and dynamics. The most common terms are “alalia idiopathic” (congenital), “hearing muteness”, “aphasia” (“dysphasia”), “developmental aphasia” (“ontogenetic aphasia”), “speech development delay” and “constitutional delay”, “general underdevelopment speech", "impaired language acquisition", "language inability". Examples of rarely used and uninformative terms: “muteness”, “congenital alogy”, “non-speaking children”, “children with severe (profound) speech impairments”. These terms carry an uncertain meaning and many fundamentally different forms of speech disorders can be subsumed under them.

Of the existing terms that best meet the requirements for a term as an element of the language of science, and which to a greater extent reflect the specifics of the designated object, are, from our point of view, the terms “alalia” and “developmental aphasia” (otherwise “ontogenetic aphasia"). Of the two terms used to designate the form of alalia, in which auditory perception and speech understanding are preserved, but expression and speaking are impaired, namely, from the terms “motor” and “expressive,” the latter seems more successful, since it captures the typical for This form of pathology of speech activity is a disorder of linguistic (speech) expression and at the same time the rigid attachment of this disorder to its mechanism, about which very little is still known, is removed.

Due to the fact that different authors put different content into the concept of expressive alalia and sometimes define the boundaries of alalia very broadly (i.e., they consider various variants of language development disorders to be alalia), there is currently no convincing statistical data on its distribution. However, the available data are scarce and contradictory.

If you still try to summarize them and find the average indicators, then with certain reservations we can assume that alalia is observed in 0.1% of the population. Moreover, this figure varies depending on age. Thus, among preschool children, those suffering from alalia account for approximately 1.0%. Among children of primary school age - 0.6%, middle and older - 0.2%. In relation to all forms of pathology of speech activity in all age groups, alalia is 0.5%, in children - approximately 4.0%. Alalia is more common in males; The ratio of the incidence of alalia between the sexes is 2:1. According to clinical observations, compared to impressive (sensory) alalia, expressive alalia is much more common (there are no exact statistics).

Symptoms of motor alalia in children

Signs of motor alalia in children are divided into neurological, psychological and speech therapy. Neurologists, first of all, note a violation of coordination of movements and fine motor skills. The child often falls and has great difficulty performing small tasks, such as fastening buttons or putting together a jigsaw puzzle.

Psychological symptoms include characteristic behavioral patterns. The baby alternates between periods of excessive activity and severe lethargy; performance and perseverance suffer significantly. There is a decrease in memory, especially for sounds, as well as lack of attentiveness.

Speech skills in the motor form of alalia are formed much later than in other children. The child has difficulty pronouncing sounds and often distorts words: omits or adds syllables, swaps them or even replaces them with ones that sound similar.

The vocabulary is significantly impoverished, since the baby does not always understand the meaning of a particular word and often uses unfamiliar concepts inappropriately. Sentences usually consist of 1-3 syllables, do not have verbs, adjectives or adverbs, and nouns are often used in the nominative case. Strong difficulties arise when trying to retell a text or talk about an event.

In severe form, speech as such is absent, replaced by babbling and onomatopoeia, which are complemented by gestures and facial expressions.

Alalia

Neurological status

With motor alalia, characteristic non-speech (neurological, psychological) and speech manifestations occur. Neurological symptoms in motor alalia are represented primarily by movement disorders: awkwardness, lack of coordination of movements, poor development of motor skills of the fingers. Children have difficulty mastering self-care skills (buttoning buttons, tying shoes, etc.) and performing fine motor operations (folding mosaics, puzzles, etc.).

Psychological status

Speech status

In severe forms of motor alalia, the child has only onomatopoeia and individual babbling words, which are accompanied by active facial expressions and gestures.

Symptoms of sensory alalia

Sensory alalia in children is associated with a violation of the analysis of heard speech in the central nervous system, which determines its symptoms.
The child constantly “talks” a lot and actively gestures. His speech is a set of syllables, sounds and even individual words that are pronounced unconsciously. Experts call this symptom “logorrhea.” The second important symptom indicating sensory alalia is lack of speech understanding. In relatively mild cases, the child perceives individual words or phrases. In this case, it is enough to change the wording of the sentence so that the sentence becomes meaningless for the baby. In severe cases, even minimal understanding is absent.

The psychological development of the child suffers significantly. Experts note a pronounced delay in intellectual development, secondary personality and behavior disorders. The child is often impulsive, hyperactive, or, conversely, withdrawn.

It is important to understand that in most cases, children have symptoms of both sensory and motor alalia; this allows doctors to diagnose such a child with a sensorimotor or motor-sensory form of the disease.

In modern speech therapy, Alalia is divided into 2 main forms - Expressive (motor) Alalia and Impressive (sensory) Alalia. There is also a combination of them - sensorimotor alalia. All this is a classification of alalia.

Expressive (motor) alalia is a systemic underdevelopment of expressive speech of a central organic nature, caused by the immaturity of linguistic operations in the process of generating a speech utterance with the relative preservation of semantic and sensorimotor operations.

Impressive (sensory) alalia is a speech disorder of central origin, manifested in the child’s inability to understand spoken speech due to insufficient functioning of the speech-hearing analyzer.

All 3 forms of alalia are corrected (often to the speech norm). Recently, the humanities (studies of humans) sciences - neurophysiology, neurochemistry, neuropsychology, psycholinguistics - have received rapid development. It is the psycholinguistic approach, on the basis of which correctional techniques are created, that allows solving the problems of alalia.

Differences between sensory and motor alalia. Alalia forms.

Many parents ask speech therapists the question: “Which alalia is worse - sensory or motor?” Without treatment, the prognosis for the development of a child’s personality with SA is worse than with MA. In correctional work, the differences are as follows: with Sensory alalia, the first stages of speech therapy work on the transition from OHP 1 to OHP 2 take 2-3 times longer. But at the same time, in children with Motor alalia, subsequent correctional work takes 2-3 times longer. Read more about the differences between motor and sensory alalia

Sensorimotor alalia.

SMA is the most severe form of alalia, in which both aspects of oral speech are impaired: understanding and speaking, all the symptoms of both sensory and motor alalia are present. It is children with SMA who are most often confused with autism. Treatment of sensorimotor alalia should begin with the sensory component, because ontogenetically the child initially develops an understanding of human speech, only after which “reproduction” becomes possible. Then, having already developed an understanding (it takes me up to six months of work), I begin parallel work with the sensory and motor components. The duration of correction of SMA consists of the duration of treatment of sensory and motor alalia and takes 2 times longer.

According to my observations during speech therapy sessions:

· in non-speaking children 2-2.5 years old with sensory alalia, there are no motor (expressive) disorders (of the two dozen children with AS I studied with, there were no symptoms of motor alalia). Therefore, if a child at this age is diagnosed with SMA, in the process of correctional work the diagnosis can be refined to simple sensory alalia.

· Non-speaking children 5-6 years old were all diagnosed with Sensorimotor alalia, i.e. There were manifestations of both alalia. I have never encountered pure sensory alalia at this age. Of course, 3 dozen sensorimotor alalikov of this age is not enough compared to research at universities to claim that there is no primary SMA.

· While working on the correction of alalia in children from 2.5 to 5 years old, I noticed that the later they started, the more motor problems are identified, and the longer the speech therapy work takes. Based on the results of observations, it can be assumed that many children with SMA have a disorder of expressive (motor) speech secondary, i.e. an early start of speech therapy work will shorten its duration for this reason as well.

Possible complications and consequences

If parents do not take a child with alalia to a specialist or do not follow his recommendations, the condition progresses. If we are talking about the motor form of the disease, the baby may encounter problems such as:

speech negativism (reluctance to speak);
stuttering;
dysgraphia and dyslexia (reading and writing disorders).

Any form of speech impairment without correction causes delayed intellectual development, significant difficulties in learning and socialization of the child.

Diagnostics

Any form of speech impairment, regardless of the severity and severity of the symptoms, requires a comprehensive examination with the participation of a neurologist, psychologist, speech therapist, otolaryngologist and other specialists. A neurological examination is aimed at searching for a pathological focus in the cerebral cortex, as well as excluding other causes of speech impairment. The study usually includes:

electroencephalography (EEG);
Ultrasound of the brain (echoencephalography);
MRI of the brain;
X-ray of the sella turcica.

The ENT examines the hearing organ: otoscopy, audiometry and other tests aimed at identifying hearing loss, and also evaluates the condition of the oral cavity and larynx. It is mandatory to evaluate auditory-verbal memory, diagnose the structure of speech, etc. During consultations, it is necessary to tell doctors in detail about the progress of pregnancy and childbirth, injuries and illnesses suffered, as well as all the features of the physical and mental development of the baby.

Treatment of alalia in children

Treatment methods for sensory, motor and mixed forms of alalia in children depend on the severity of symptoms, the severity of the disease, and the presence or absence of signs of other disorders. Depending on the specific situation, doctors may prescribe drug therapy and physical therapy to stimulate adequate brain function.

In parallel, constant work is carried out with a psychologist and speech therapist, with regular attendance at classes and consolidation of the results at home. The training is aimed at developing fine motor skills, improving the pronunciation of specific sounds and individual words.

If necessary, the chosen treatment regimen is adjusted and supplemented with massage, physical therapy, and psychotherapy.

Prognosis and prevention

The prognosis depends on the severity of the disease, as well as the time of initiation of correction.
If you contact a specialist in a timely manner and regularly and carefully follow all recommendations, the likelihood of successful correction increases. The motor form of alalia is easier to eliminate, but with the sensory and sensorimotor forms the prognosis is not always favorable. Prevention of alalia means following all doctor’s recommendations during pregnancy, regular activities with your baby, and minimizing the risk of injuries and diseases.