Symptoms of alalia in children aged 3-4 years

Alalia is a speech disorder that is not as well studied as, for example, dysarthria, and is included in the list of ICD-10 diseases. Experts cannot determine exactly the mechanisms of its occurrence and offer ways to effectively correct this defect. With alalia, all speech components are disrupted. Not only the child’s sound pronunciation is distorted, but also his grammatical structure and coherent speech. To overcome alalia, it is necessary to conduct comprehensive classes not only with a speech therapist, but also with a neurologist, defectologist, neuropsychologist, and psychologist.

Brief characteristics and classification

Alalia is a partial or complete absence of speech in children with intact hearing. The appearance of this defect is due to underdevelopment or damage to the speech areas of the brain. Alalia is considered one of the most difficult speech disorders, because without the help of a speech therapist, the child does not develop means of communication.

There are two types of alalia, differing in the mechanisms of formation:

• Motor alalia is when a child understands speech addressed to him, but cannot respond independently. Parents often say about such children that they understand everything, but cannot answer.
• Sensory - not only the mechanism of speech reproduction is impaired in the child, but also its perception. That is, he does not understand what others are saying. A characteristic feature of this form is echolalia - the child automatically repeats the words and phrases of those around him.

Parents should contact a specialist if their child:

• Does not answer when called and does not pay attention to the speech of others. But it reacts to non-speech and quiet sounds (creaking, rustling of paper).
• Does not listen to speech, as is typical for hearing-impaired children.
• Does not try to understand what is being said to him and does not use facial expressions or gestures to communicate.

To correct any form of alalia, you need to contact a specialist. This will allow the baby to form all the speech components and help him use them when communicating with others.

Varieties

Depending on the clinical picture of the pathology, developmental mechanisms and degree of speech impairment, alalia is classified into:

• Expressive (motor), expressed in violation of the pronunciation of phonemes. The baby understands the meaning of words and can show an object or action (using gestures). However, articulation is poorly developed.
• Impressive (sensory), when the child does not understand what other people say. He speaks clearly, but does not perceive being addressed to himself.
• Mixed (sensorimotor) - clinical manifestations combine the symptoms of the listed types.

1% of preschool children are diagnosed with sensorimotor alalia. In school-age children, the pathology occurs half as often.

With a mixed type of disorder, cells in the areas of the cerebral cortex responsible for speech formation are affected. Children have difficulty understanding adult speech and are slow to develop pronunciation skills. This form of the disease is called total because it often manifests itself against the background of mental retardation. It is difficult to treat sensorimotor disorder; the prognosis, even with comprehensive correctional work, is not always favorable.

Features of motor alalia

In this form, the pronunciation side of speech (expressive) is impaired due to organic damage to the speech areas of the cerebral cortex, namely Broca's area. Because of this, the process of forming statements is disrupted, while understanding speech remains intact. The causes of motor alalia are varied, almost all of them are due to severe pregnancy, intrauterine pathologies and diseases that affect the formation of brain structures, birth and postpartum injuries.

All these factors have an adverse effect on the nervous system, which causes disruption of the functioning of motor neurons.

The movement program is disrupted due to changes in the functioning of the speech center of the brain. But, in addition to the reasons listed, motor alalia (like sensory alalia) can be a symptom of more serious disorders:

• Developmental delay – the child develops more slowly mentally. He finds it difficult to complete simple tasks, it is difficult for him to make sentences, because this requires mental effort, and due to developmental delays, it is difficult for the baby to do this.
• Autism is one of the least studied and complex disorders. In this case, the baby simply has no need to interact with the outside world - he is comfortable in his own. Some children do not have speech until school age, others use speech only in everyday life.

With these variants, alalia is a sign of more complex disorders. Usually this defect is due to several reasons, so correctional work must be comprehensive.

Alalia correction

For alalia, patients are prescribed complex therapy, which includes psychological techniques, pedagogical correction, individual sessions with a speech therapist, and, if necessary, drug treatment.

Alalik children are sent to specialized kindergartens, correctional centers, hospitals, and sanatoriums.

Drug therapy

The therapy method using drugs is aimed at stimulating the development of damaged brain structures. Patients are prescribed neurotropic drugs (Gammalon and others).

Medicines are prescribed on an individual basis, taking into account the physiological characteristics of the patient.

Classes with a speech therapist

Individual correctional lessons together with a speech therapist play the most important role in restoring proper speech development.

Correctional work is carried out in kindergartens, special centers or in the form of private lessons. In addition to classes with specialists who work on the development of speech skills, parents conduct correctional lessons at home with the child.

Corrective classes are aimed at:

• restoration of the baby’s speech development;

• formation of a stock of words in the lexicon;

• ability to speak clearly and articulately;

• mental development;

• elimination of “parasite words”;

• restoration of articulation;

• the ability to pronounce sounds correctly;

• the ability to correctly formulate one’s own statements;

• understanding the meaning of spoken phrases.

Physiotherapy

Along with prescribing medications, experts recommend that the child undergo certain physiotherapeutic courses. The following methods are effective for restoring speech development:

• water procedures (therapeutic baths, exercises in the pool, visiting a bathhouse, dousing with water);

• laser therapy;

• magnetic therapy;

• electrical stimulation;

• reflexology;

• electrophoresis.

Forms of motor alalia

There are two types of this defect:

• Kinesthetic. The lesion is located in the lower parts of the postcentral region of the cerebral cortex. This is a section of the afferent system responsible for organizing the program of movements of the articulatory apparatus. Damage to this area leads to difficulties in selecting the necessary movements. The child does not distinguish one movement from another; simple ones replace complex ones. This phenomenon is called oral apraxia.

In oral speech, the kinesthetic form of motor alalia manifests itself in the form of sound substitutions, although there may be distortions and confusions. With this option, the pronunciation of several groups of sounds is always impaired. As a result, there is underdevelopment of phonemic processes.

There may be disturbances in the tempo-rhythmic aspect of speech and distortion of the syllable structure. Due to difficulties in forming statements, alaliks have a reduced need for communication. Their intonation is intact, they can correctly reproduce the syllable structure of an adult, but they cannot do this on their own. With this option, they give GSD (general speech underdevelopment) of level 2 or 3.

• Kinetic. The localization of the lesion is the premotor area of ​​the cerebral cortex. This is a section of the efferent system, and if it is underdeveloped, the child has difficulties in forming a complex of movements, that is, articulatory patterns. With this variant of alalia, the functioning of the vocal and respiratory apparatus is disrupted. There may be difficulties in creating correct articulation and mastering the structure of words and other lexical units. In children with the kinetic form of alalia, distortions and a slow pace of speech dominate in oral speech.

The syllabic structure is disrupted and phonemic processes are underdeveloped. A child with such a defect has difficulties in realizing the communicative function of speech. In the kinetic form of alalia, neurological symptoms (motor and emotional-volitional spheres) are more pronounced than in the kinesthetic variant. In the kinetic version, the structure of the defect corresponds to ONR of level 1 or 2.

Having determined the structure of the defect, the specialist draws up a plan for corrective work. After all, each option has its own mechanism of impairment, which must be taken into account when selecting exercises to overcome the defect.

Correction of general speech underdevelopment

Children with ODD enter the correctional group of a preschool institution from the age of 5, where a speech therapist, together with teachers, works to overcome the disorder. The senior and preparatory groups work according to a special program T.B. Filicheva and G.V. Chirkina.

Don’t think that a correctional group is a death sentence. On the contrary, with this form of education, teachers have the opportunity to pay close attention to the problem of a child with ODD. And it will be easier for the child to cope with the violation, because the teachers of the correctional group have the appropriate education and work experience.

If a child has a level 1-2 OSD, then after kindergarten he enters a school for children with severe speech disorders. Children with level 3 ODD go to correctional classes in a public school; with OHP level 4 – study in regular classes.

It takes time to overcome general speech underdevelopment. Parents must understand that this is not a matter of one month and they need to make every effort: to develop the child’s speech, to encourage him to take a speech initiative. This, of course, is a lot of work with a speech therapist, psychologist, and also a neurologist.

Manifestations of motor alalia

The initial signs of alalia can be noticed in the first year of a child’s life. But parents don't attach any importance to this. These are later stages of humming and babbling; the child does not strive to communicate with his parents and does not react to their appearance. His cognitive activity is reduced. In case of such manifestations, it is worth seeking advice from a specialist who will accurately determine whether it is a violation or not and give recommendations on speech development.

Most often, parents begin to worry in the second year of a child’s life. During this period, the first words appear in the baby’s speech, which he puts into phrases, and a phonemic system characteristic of his native language begins to form. And if your baby has not spoken by the age of 1.5-2 years, speech therapy help is needed. The sooner you start treating your child, the more effective and favorable the prognosis for getting out of alalia will be. There is no need to listen to the popular opinion that it is normal when the first words appear by the age of three - it is wrong.

In the characteristics of children with motor alalia, they note that their pronunciation capabilities are well-developed, but they do not know how to use them. They cannot choose the appropriate sound to formulate the utterance. Therefore, in their speech there are substitutions of some phonemes for others, difficulties in voluntary repetition of sounds and words. At the same time, sometimes the baby can pronounce sounds correctly, only involuntarily.

Alaliks have a quiet and inexpressive voice, and their first words for a long time look like babble, often syllables are omitted. Phrasal speech is such because of the rhythmic pattern, and the syllabic structure of words is distorted, especially for long words. Children with this defect pronounce only the stressed syllable for a long time.

Children with motor alalia have a large number of words in their passive vocabulary, and they perfectly understand the speech of others. But in active speech they use them to a much lesser extent. A characteristic feature is that there are more nouns in the passive dictionary than verb vocabulary. The child replaces some words in speech with others that are included in the same thematic group (for example, instead of a table - a chair, etc.). Sometimes a baby can connect syllables from different words, so it can be difficult for others to understand what he is talking about.

There are violations of grammatical structure. In phrases and sentences, the baby incorrectly coordinates words and omits prepositions. To communicate with others, children with motor alalia use gestures and facial expressions.

Children also have non-speech signs of this disorder.

They are clumsy and have difficulty learning new motor skills, especially those related to finger motor skills. Disturbances in the functioning of the articulatory apparatus are especially noticeable: difficulties in moving the lips and tongue, which is one of the reasons for incorrect sound pronunciation.

Children with this disorder often have a reluctance to communicate with other people because they need to put in more effort to communicate than others. Some people understand that their speech is different from the speech of others, and are embarrassed by this feature. Alaliks develop attention, memory and thinking unevenly.

Some kids are characterized by lethargy and awkwardness, while another group is characterized by disinhibition and hyperactivity. They have difficulty adapting to new conditions and do not understand the rules of the game. Therefore, alaliks are closed and have difficulty making contact.

Some experts assign the disorder “motor alalia” to almost all non-speaking children. But parents must understand that they need not only a consultation with a speech therapist, but also with a neurologist in order to more accurately determine the specifics of the disorder.

What should parents be wary of?

Signs of OHP:

• Speech appears late (at 3-4 years, sometimes at 5 years);
• the baby speaks as if he has “porridge in his mouth”;
• makes many mistakes in speech: misses prepositions, finds it difficult to identify cause-and-effect relationships, rearranges syllables in words, cannot agree on parts of speech, etc.;
• It is difficult for a child to remember and retell the text;
• memory and attention suffer;
• the vocabulary is very limited, it is difficult for the child to express his thoughts;
• gross and fine motor skills are poorly developed.

In this case, parents should not listen to others who assure that the child will “soon speak,” but go for examination to a specialist.

There are 4 levels of speech development, taking into account the degree of OHP:

Level 1 – “speechless”.

The child’s vocabulary is very poor; the baby uses babbling words, impersonation, and gestures to communicate. In this case, the main task of the speech therapist is to develop the child’s understanding of the speech addressed to him and to achieve speech motivation from him.

Level 2 – the child uses simple phrases of 2-3 words

, while gross errors in speech are observed, vocabulary lags behind the age norm. The baby cannot combine objects according to a common characteristic (spoon, fork, plate - dishes; apple, pear, plum - fruits). The pronunciation of many sounds is impaired, speech is unintelligible.

Level 3 – an expanded phrase appears.

Despite the fact that at this level the child’s speech becomes more lively, he still uses simple sentences. Sound pronunciation is impaired. The vocabulary is increasing, but the baby still finds it difficult to understand common phrases and complex turns of phrase. He uses prepositions incorrectly, may omit them, and there are errors in coordinating parts of speech (“I saw a dog and went home” instead of “I saw a dog and went to home”).

Level 4 – in general, the child’s grammatical structure is approaching the norm

, but it is difficult for him to pronounce words with complex syllabic composition (“blalazhan” instead of “eggplant”), he makes mistakes when inflecting words (“five chickens” instead of “five chickens”). During a retelling, it is difficult for a child to follow the plot line, and when memorizing poems, he often confuses the words. Residual gaps in speech development are noticeable.

Principles of organizing speech therapy work to overcome alalia

Regardless of the form of this speech disorder, correctional work will be based on general principles for overcoming the defect:

• The principle of the necessary formation of speech components in accordance with structural and functional requirements (with the exception of sensory alalia).
• The principle of the simultaneous development of speech and non-speech processes - during the lesson, not only speech is corrected, but also the motor sphere and higher mental functions.
• The principle of an active approach in the formation of speech skills - all instructions are accompanied by actions and visual material.
• The principle of relying on physiological norms for the development of children's speech.
• The principle of development of the semantic side, that is, it is necessary to explain the meaning of actions.
• The principle of overcoming a child’s reduced need for communication.
• The principle of step-by-step correctional work.
• The principle of relying on intact speech functions.
• The principle of relying on the senses is compensation for underdevelopment of speech function at the expense of other analyzers.
• The principle of taking into account the child’s capabilities, that is, an adult must make adequate demands.
• The principle of relying on the leading type of speech: the specialist forms in the child an understanding that speech is the main tool for interacting with the outside world.
• The principle of clarity and commentary on activities - it is necessary to use pictures, toys, and didactic games; the adult must voice his actions.

For correctional work to be effective, a specialist must build classes based on these principles. It is necessary to correct not only speech processes, but also other areas so that the child’s development is harmonious. Any underdevelopment of a function or slow operation of any process can lead to an imbalance in speech development. All these principles allow us to take into account the specifics of working with this defect.

Stages of speech therapy assistance

Regardless of the form of alalia and the structure of the defect, speech therapy work to overcome this disorder consists of four stages:

1. Preparatory. At this stage, the speech therapist forms the prerequisites for speech activity. The specialist creates situations that encourage the child to communicate. It also forms his understanding of the importance of speech in a person’s life. At the preparatory stage, work is carried out to develop the tempo-rhythmic aspect of speech and higher mental functions.
2. At the second stage, initial speech skills are formed. They work to expand and clarify the vocabulary, teach the child to relate a word to an object. The speech therapist teaches the child to recognize words by their sound design and corrects sound pronunciation. In addition, they give exercises to generalize and classify objects.
3. The goal of the third stage is the formation of a statement as the main speech unit. The speech therapist focuses on correcting grammatical structure and teaching the child how to structure a statement.
4. At the fourth stage, the concept of the communicative and cognitive functions of speech is formed. The speech therapist gives more tasks for the formation of coherent speech - this is its planning, developing self-control skills. The specialist teaches alalik to choose speech means to form a statement.

The speech therapist selects exercises for each stage in accordance with the form of alalia. Taking into account the peculiarities of the structure of the defect, the specialist will be able to organize the work in such a way that it is possible to achieve high results and maximally correct deficiencies in speech development.

Prognosis and prevention

The prognosis for sensory alalia depends on the timeliness of starting therapy. With a mild degree of impairment, active participation of parents in correction, and regular classes with a speech therapist, the result will be good. Speech disorders are eliminated and complications are prevented. The child acquires communication skills, communicates freely with peers, and can master the school curriculum.

With late treatment and lack of proper attitude on the part of parents, lack of regularity of classes, recovery is in question, unfortunately.

Prevention of sensory alalia

Prevention of speech disorders, as well as other health problems, begins at the stage of pregnancy planning. A woman needs to undergo diagnostics to identify health problems. Then correct the detected violations. Only after this can you plan to conceive.

During pregnancy, it is important to follow the doctor’s recommendations: undergo examinations and tests on time. If necessary, take medications and vitamins. Lifestyle and nutrition play an important role - a pregnant woman and her unborn baby need food rich in vitamins and microelements, adequate sleep and rest, and fresh air for proper development. Stress, intoxication, bad habits, and work in hazardous working conditions should be excluded.

It is necessary to prevent damage to the central nervous system during childbirth, in the early postnatal period and the first year of life.

Parents need to be especially careful if there is a person in the family with speech impairments. Children, especially small ones, repeat with adults: in this way he can copy an adult who speaks poorly or does not speak at all.

We also want to draw parents’ attention to the fact that sensory alalia does not go away on its own in children. This is a serious speech therapy, psychological, and sometimes psychiatric pathology with many causes, which can only be overcome with the joint efforts of doctors, parents and the child himself. Therefore, we recommend that you contact a specialist as soon as possible if signs of sensory alalia are detected and begin treatment.

Features of speech therapy assistance for motor alalia

Correction of motor alalia, in addition to the basic principles and stages of work, has special directions:

• normalization of motor functions - all tasks must be commented on;
• development of the emotional-volitional sphere - work is also carried out in the context of speech, thereby performing a regulatory function;
• development of the psychological basis of speech - correction of higher mental functions;
• development of verbal-logical thinking and speech regulation;
• correction of sound pronunciation and overcoming oral apraxia;
• in the development of phonemic processes, the main emphasis is on speech perception;
• development of the expressive side of speech.

You need to start working from the moment the baby starts having difficulties. Therefore, for diagnosis, it is important that parents can tell the speech therapist about when the stages of humming, babbling and the first words occurred. Then the speech therapist will be able to organize the work as efficiently as possible.

Recommendations for conducting classes

In addition to the speech therapist, a defectologist should also work with alalik. Because, in addition to difficulties with speech, he also has disturbances in the emotional-volitional sphere. A defectologist pays more attention to the correction of higher mental functions and personality characteristics.

It is also necessary to be observed by a neurologist, because the cause of the defect is organic damage to certain areas of the cerebral cortex. He will prescribe appropriate medication to help your child perform better.

During the first lessons it is very important to establish contact. The adult’s task is to arouse the child’s desire to communicate. The classes should have a calm, relaxing atmosphere. Praise your child for any achievements, create a situation of success, then he will remain interested in activities.

Causes of alalia

Pathology can be acquired as well as congenital. The root cause of the development of a speech defect is organic damage to the central nervous system. Provoking factors of intrauterine organic disorder are:

• fetal asphyxia;

• severe toxicosis in the expectant mother;

• fetal infection;

• risk of miscarriage;

• chronic somatic pathologies in a pregnant woman - hypertension, hypotension, heart disease, pulmonary failure, etc.

Often the reasons for the development of alalia are not one, but several provoking factors. Pathology in a baby can develop against the background of a difficult birth with simultaneous fetal hypoxia or during the process of delivery, when the newborn suffers intracranial injury as a result of improper use of obstetric instruments.

Scientific research has shown that alalia can be hereditary. In addition, complex or severe pathologies can lead to the development of speech defects, for example, a prolonged course of ARVI. The defect can also be caused by weakening of the body after surgery using general anesthesia.

The root causes of acquired alalia may be:

• meningococcal infection;

• development of encephalitis;

• brain injury;

• complications after acute respiratory viral infections, acute respiratory infections, influenza, pneumonia, and other diseases;

• rickets.