General speech underdevelopment. Description, diagnosis, treatment.

General speech underdevelopment (GSD) is a disorder in which the sound and semantic components of speech are not formed with normal hearing and development.

OHP is a violation of the formation of all aspects of speech (sound, lexico-grammatical, semantic).

There are three levels of OHP.

The first level is the hardest. The child lacks common speech, the vocabulary is extremely limited, and the sound pronunciation and syllabic structure of words are impaired.

Second level - phrasal speech is grossly agrammatic, sound pronunciation of 10-15 sounds is defective, word formation skills are absent.

The third level is detailed phrasal speech with gaps in lexico-grammatical and phonetic-phonemic development, errors in the use of case constructions, word agreement, in the pronunciation of main groups of sounds, violation of the syllabic structure in difficult words.

OHP level 4 - the child’s speech is practically no different from peers, but disturbances are observed during pronunciation and construction of long phrases.

Causes of general speech underdevelopment (GSD) in children

As a rule, OHP occurs as a result of damage to the nervous system in a child during intrauterine development, immediate childbirth, or the first years of life (before speech skills begin to form). The most common causes of the disorder include:

• infections, toxicosis, bad habits, severe general illnesses of the mother during pregnancy;
• Rhesus conflict;
• fetal hypoxia;
• difficult birth accompanied by injury and/or asphyxia of the baby;
• traumatic brain injuries and neuroinfections in the first years of life;
• social factors: lack of attention from adults, unfavorable family environment, etc.

Nature of the defect

The causes of systemic underdevelopment of level 2 speech are divided into physiological and social. Social defects include both direct defects in upbringing - pedagogical neglect, lack of communication, and unfavorable developmental conditions: if the parents are deaf and mute or speak different languages ​​at home.

Physiological reasons are more common. These are pathologies of the structure of the oral cavity and neurological disorders associated with brain damage. Speech delays often result from:

• difficult pregnancy,
• difficult childbirth,
• infections,
• poisonings,
• traumatic brain injuries.

Often, children suffering from stage 2 ODD experience hyperkinesis (tics), impaired coordination of movements, and fine motor skills. Sometimes such patients find it difficult to concentrate on a task and get tired quickly. Insufficiency of auditory-verbal memory and verbal-logical thinking is often encountered. All these disorders not only accompany speech disorders, but also cause them to varying degrees. The NeuroSpectrum Center for Children's Speech Neurology and Rehabilitation provides a comprehensive approach to the correction of speech disorders and other deviations in child development.

Characteristics of OHP degrees

Depending on the degree of speech impairment in OHP, speech therapists distinguish 4 levels of speech development in a child, which largely determine the type of correction.

Level 1 of speech development (ONR first degree)

This degree of OHP in children is accompanied by a complete absence of speech, which inevitably affects the development of the baby. Characteristic signs of the disorder are:

• vocabulary consisting of the simplest words, their fragments or onomatopoeias;
• maximum reduction of complex words to 1-2 syllables or their absence in speech;
• active use of facial expressions and gestures to complement communication;
• lack of phrasal speech;
• relatively rich passive vocabulary (the child understands words addressed to him well).

Level 2 of speech development (ONR of the second degree)

A diagnosis of second-degree ODD in children means that the child can communicate, but with difficulty. Speech consists of a small number of commonly used words. Often, the child pronounces them incorrectly, but in the correct context. As a rule, the baby does not use adjectives and does not understand generalizations. During a conversation, short sentences are used without coordinating words. Articulation is significantly impaired.

Level 3 speech development (OHR third degree)

With this degree of OHP, the baby communicates actively and a lot, has a rich vocabulary and constructs phrases well, including complex sentences. As a rule, parents and close relatives understand him well, but for strangers a “translator” is required. The main problem is the pronunciation of sounds that are pronounced incorrectly, are replaced by simpler ones and often merge with each other.

Level 4 of speech development (ONR fourth degree)

With this degree of speech development disorder in children, manifestations of OHP are minimal and are characterized by:

• blurred sound pronunciation;
• periodically replacing sounds with similar ones;
• periodic errors in the use of certain words (usually adjectives);
• errors in the use of suffixes or cases, etc.

At the same time, the speech is more or less understandable, the vocabulary is rich. However, even this form of OHP can cause learning problems in preschool children, which, in turn, causes a decline in school performance.

OHP level 2: speech characteristics

Children begin to speak late - by the age of 3-4 years, or even later. Due to a limited vocabulary, they speak in short, simple sentences of a maximum of 4 words. Speech skills allow the baby to express his desire, identify household items and their actions.

In communication, he still uses non-verbal tools - facial expressions, gestures, amorphous words. Conjunctions, prepositions, cases - they throw it all out.

But children understand words addressed to them much better than in the first group of underdevelopment. Although they still don’t know the shapes, colors, names of body parts.

Phonemic hearing suffers: the baby cannot isolate an isolated sound, determine its position in a word, or select words with this sound. Confuses and speaks incorrectly almost all groups of sounds.

Outwardly, children with grade 2 ODD are clumsy, they have poor coordination of movements, underdeveloped fine motor skills, and often have neurological problems. They have worse memory and thought processes than their peers, they get tired quickly, get distracted, and cannot concentrate.

Diagnostics

Diagnosis of OHP requires an integrated approach.
A speech therapist directly assesses speech development, but before visiting this specialist it is necessary to undergo a medical examination with the participation of a neurologist, pediatrician and, in some cases, an otolaryngologist. During the consultation, the specialist gets to know the patient and conducts a speech therapy examination, which includes two stages. First, the speech therapist talks with the parents, clarifying the features of the baby’s development, the time of the appearance of humming, first words, etc. Contact is established with the little patient, and in the process of communication the work of the articulatory apparatus is assessed. The speech therapy examination itself includes an assessment of the formation and coherence of speech, active and passive vocabulary.

Correctional program for level 2 OPD

Children diagnosed with general speech underdevelopment type 2 at the age of 3–4 years are enrolled in a speech therapy group in a kindergarten. They will spend 3 years there—that’s exactly how long it will take to bring the students’ verbal skills closer to the age norm.

The correction program has several goals:

1. Enrich your vocabulary and activate it. For this purpose, the speech therapist offers lexical topics in classes (for example, “Seasons”, “Clothing”, “Dishes”, “Pets”, “Wild Animals”, “Birds”, “Professions”). For each topic, they offer a list of words that children should learn. Then they do exercises: name objects, their properties, describe pictures;
2. Develop vocabulary and grammar. Young students develop the skills of forming words, teach numbers, cases, and genders. In three years, they will learn to use ordinal numbers and words in three cases (genitive, instrumental and dative) without errors, answer the questions “how many?”, “whose?”, “where?” and where?";
3. Form coherent and phrasal speech. Pupils are taught to correctly construct simple sentences, and then short stories. They offer the following exercises: compose a story based on a picture, memorize a couplet or nursery rhyme, give a detailed answer to a question, and also formulate questions independently and conduct dialogues;
4. Improve sound pronunciation. First, the speech therapist develops articulation and then practices isolated sounds. Then they make up syllables, and then words.

Classes with students with general speech underdevelopment type 2 are conducted in groups in the form of a game.

Forecast TNR ONR level 2

If you start correction at the age of 3-4 years, then the prognosis is very good. Children who study in a speech therapy group gradually increase their vocabulary and become more active verbally. All this leads to a gradual improvement in their speech skills.

In general, by the first grade, most of them manage to overcome all difficulties, although they are still somewhat behind their peers without level 2 OHP. Therefore, it is necessary to continue classes with the school speech therapist.

Parents need to understand that there is still a risk. Such students have more difficulty with writing and reading skills, and therefore may have difficulties with learning. That is why it is necessary to continue studying until they fully meet the age norm of their daughter or son.

If you don’t take care of your child at all or don’t complete the correction to the bitter end, this can lead to serious complications: it will be difficult for the little person to establish contact with other people and make friends. It will be difficult for him to remember and concentrate on educational and other processes. It will be difficult to study in a regular school, so such students are enrolled in special schools.

Speech disorders also provoke mental retardation. Therefore, such a child will feel inferior and self-esteem will decrease. As a result, this will lead to behavioral disorders, isolation, aggression, and apathy.

Prevention of speech underdevelopment

Here are some recommendations for preventing pathology.

Firstly, regularly show your child to a pediatrician, regularly to a neurologist, and at 3 years old to a speech therapist. It’s better to “keep your finger on the pulse” than to miss the moment and waste time. Especially if your child has neurological problems, your pregnancy or childbirth was difficult, there was fetal hypoxia and other provoking factors.

Secondly, protect your child from injury and illness, especially in the first year of life. If your daughter or son hit his head hard during a fall, for example, it is better to show him to a neurologist and do an ultrasound as indicated.

Thirdly, work with your child and develop him. Talk, show, explain, read books and fairy tales, learn rhymes, develop fine motor skills, play - all this is necessary to master speech.

Correction of OHP in children

The choice of method for correcting general speech underdevelopment in children depends on what it presents. The child works individually with a speech therapist or attends specialized kindergarten groups. Classes are aimed at:

• improving speech understanding;
• replenishment of active and passive vocabulary;
• activation of speech at the first level of speech development;
• conversation coherence training;
• improved articulation;
• strengthening memory and attention;
• honing fine motor skills, which affects the quality of speech, etc.

If necessary, classes are supplemented with medications aimed at improving the functioning of the central nervous system.

Diagnosis of OHP group 2

Diagnosis is approached in a comprehensive manner. It is attended by a pediatrician and specialized specialists - an otolaryngologist, a psychiatrist, a neurologist, and a speech therapist.

The pediatrician’s task is to collect anamnesis, assess the patient’s general health, and give referrals to other doctors.

The task of the otolaryngologist is to assess hearing acuity, identify or exclude deafness and other hearing disorders.

The psychiatrist’s task is to assess the patient’s mental health and rule out mental disorders and diseases that are accompanied by speech disorders. These include, for example, autism, mental retardation.

The neurologist’s task is to assess the baby’s neurological status, since most often speech development disorders are associated precisely with damage to the central nervous system and speech centers of the brain. Therefore, the neurologist refers the patient to hardware diagnostics and only after that makes a diagnosis.

The task of a speech pathologist-defectologist is to determine the form and level of speech underdevelopment and draw up a correction program.

If necessary, drug therapy, massage, physiotherapy and speech therapy massage are included. The role of parents is also important - they should also work with their child at home.

In some cases (for example, with rhinolalia), consultation with a maxillofacial surgeon is necessary. Surgery may be required to correct the defect that prevents the baby from speaking.

Diagnosis by a speech therapist

A speech pathologist examines the medical history obtained as a result of examinations by other specialists. Asks parents to provide information about the course of pregnancy and childbirth, the baby’s speech activity, when he began to coo, said the first word - these data are very important for identifying the causes of underdevelopment.

The speech therapist evaluates the baby’s motor skills, especially fine motor skills, since there is a connection between motor and speech development.

Next, he evaluates the little patient’s oral speech - each of its components. This is necessary to determine speech underdevelopment and the degree of understanding of the baby’s native language. He evaluates this according to 4 criteria:

1. Connectivity. The speech therapist evaluates how coherently and competently the child speaks, the order of words in sentences, the consistency and logic of presentation. With general underdevelopment of second-level speech, children cannot consistently express their thoughts or tell something. To assess this characteristic of speech, the speech therapist gives the baby a picture that he must describe, or an audio recording that he must retell. Or simply asks questions that the baby must answer;
2. Lexico-grammatical processes. It is assessed how much the child understands the plural and singular numbers, cases, synonyms, antonyms, agreements, as well as generalizing categories, shapes, colors, properties. Children with general underdevelopment of speech at the second level have difficulty selecting the right words, use one word to denote several words that are close in meaning, and generally construct phrases with gross errors;
3. Syllable structure. Children with speech development group 2 simplify complex words, reduce them to 1 - 2 syllables, and also change syllables in places and skip them;
4. Sound pronunciation. In case of II degree OHP, it suffers. Kids can pronounce up to 20 sounds incorrectly - this is almost all groups. They cannot conduct a sound analysis due to phonemic hearing impairments.

Based on the data obtained, the specialist determines the form of speech pathology, the degree of its severity and draws up an individual correction program.

Prevention

Diagnosing a child with ODD does not mean that this disorder cannot be eliminated. Timely and correct correction, compliance with all recommendations of speech therapists and doctors often provides a good result, in which the baby’s speech becomes coherent and understandable until it fully complies with the age norm. Associated violations in this case are also corrected.

Prevention of OHP in children is, first of all, following all doctor’s recommendations during pregnancy, childbirth and the first years of the baby’s life, reducing the risk of injury and regular developmental activities, talking with the child, reading books. It is also important to promptly consult a specialist at the first signs of speech impairment.

If you have any doubts about your baby's speech, do not worry ahead of time. Doctors and speech therapists at the SM-Doctor clinic will conduct the necessary tests and diagnostics, and, if necessary, draw up a program of corrective measures.

Let's learn to speak like big people!

The key to effective correction is a correct diagnosis. Doctors and speech therapists must make sure that the child has a general underdevelopment of speech of the second level, or find other, at first glance, similar conditions. For example, hearing loss, mental retardation, autism. It is also important to determine the specific speech pathology - alalia, aphasia, dysarthria or other conditions. This knowledge will help determine the methods and forms of correctional work.

During the examination, the speech therapist will ask the parents about how the baby was developing and will pay attention to his general skills. Then the child is tested: they are given a short text to listen to and asked to retell it, or asked to compose a story using pictures. This helps to evaluate:

1. understanding the text or meaning of pictures;
2. the ability to present information logically and consistently;
3. the ability to correctly construct a sentence;
4. lexicon;
5. knowledge of colors, geometric shapes, body parts;
6. pronunciation of sounds.

The speech therapist will ask the child leading and additional questions. Our Center’s specialists first establish contact with the baby and only then begin tests. Like the speech therapy classes that will follow the test, all tasks are presented in a playful form and will definitely interest the child.

During the classes, the child will expand his vocabulary, learn to construct sentences, use prepositions, pronouns and adjectives. The child will learn to construct and answer questions correctly, and then compose stories independently. When correcting speech underdevelopment of the second level, work is also being done on sound pronunciation. Sometimes this takes a lot of time, because with such a diagnosis the child can pronounce 15–20 sounds incorrectly, and they need to be put in a certain sequence.

After speech impairments are corrected, the child needs the supervision of a speech therapist for several years: if he has difficulties with reading and writing, a specialist will be able to help in time. Timely correction of speech therapy problems will help maintain interest in studying and avoid unnecessary problems in relationships with classmates.

Correction of severe speech disorders

Correction of TNR is always lengthy and often requires the participation of a team of specialists. Since many diagnoses are associated with organic lesions, medical support (psychiatrist, neurologist, therapist, pediatrician) is necessary. In addition, regular classes with specialists with pedagogical and psychological education are necessary. To remove psychological blocks, a child psychologist is needed. The speech therapist deals directly with the correction of pronunciation, the defectologist helps in the development of thinking and memory.

The forecast for improvement depends on the consistency and regularity of classes. When a child misses several lessons in a row, the accumulated skills are lost, and specialists have to start all over again.

The difficulty of rehabilitation also lies in the fact that an individual work program is drawn up for each child, including all his characteristics. This includes:

• speech therapy exercises to correct the underlying disorder;
• speech therapy massage and articulation gymnastics;
• development of higher mental activity and motor skills;
• improvement of psycho-emotional state and social adaptation.

The optimal age to start classes is 3 years. It is during this period that it is possible to level out the delay in speech development and avoid making one of the diagnoses of the psychoneurological field.

Not every violation can be corrected; it all depends on the situation and the severity of the violation. Cases with organic lesions of the cortex and innervation apparatus require longer and more serious correction. And logoneurosis caused by psychotrauma initially has a more favorable prognosis.

The role of parents is also important, as they need to be actively involved in all stages of the child’s development. It is important to ensure strict adherence to the daily routine and maintenance of a calm atmosphere in the family, since the emotional-volitional sphere of the child is not sufficiently developed.

Ember Center specialists provide assistance to children with severe speech impairments at any stage. During the consultation, defectologists and psychologists give recommendations regarding changing the model of interaction with the child, which helps improve mutual understanding and make it easier to complete homework. For example, we use additional visual materials (cards, toys) to improve the perception of verbal information.

Severe speech disorders require daily attention to detail, constant remedial training and close cooperation of all specialists and parents.

For successful correction of TNR, it is important that parent-child relationships are harmonious. If parents experience a feeling of guilt and increased anxiety, this can lead to overprotection of the child and inhibit the correction of his condition. In this case, it is recommended to work through emotions and fears with a family psychologist.

Our center has all the conditions for successful correction of severe speech disorders.

Author of the article: speech therapist O.I. Fedotova

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).

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.

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

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3. Volkova L. S., Shakhovskaya S. N. Speech therapy. 3rd ed. M.: Vlados, 1999. 678 p.
4. Levina R. E. Fundamentals of the theory and practice of speech therapy. M.: Education, 1968. 367 p.
5. 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