Characterized by frequent and repeated disturbances in speech sounds. The child's use of sounds below the level appropriate for his mental age - that is, the child's acquisition of speech sounds is either delayed or deviated, leading to disarticulation with difficulties in understanding his speech, omissions, substitutions, distortions of speech sounds, changes depending on their combination (then says correctly, then no). Most speech sounds are acquired by 6-7 years; by 11 years all sounds should be acquired.

In most cases, nonverbal intellectual level is within normal limits.

Etiology and pathogenesis

The cause of developmental articulation disorders is unknown. Presumably, the basis of speech impairment is a delay in the development or maturation of neuronal connections and neurological processes, and not organic dysfunction. The high percentage of children with this disorder who have multiple relatives with similar disorders suggests a genetic component. With this disorder, there is no subtle differentiation of motor kinesthetic postures of the tongue, palate, lips; brain basis - activity of the postcentral parts of the left hemisphere of the brain.

Prevalence

The incidence of articulation development disorders has been established in 10% of children under 8 years of age and in 5% of children over 8 years of age. This disorder occurs 2-3 times more often in boys than in girls.

Clinic

An essential feature is an articulation defect, with a persistent inability to apply speech sounds at expected developmental levels, including omissions, substitutions, and distortion of phonemes. This disorder cannot be caused by structural or neurological pathology and is accompanied by normal language development.

In more severe cases, the disorder is recognized at around 3 years of age. In milder cases clinical manifestations may not be recognized until age 6. The essential features of speech articulation disorder are an impairment in the child's acquisition of speech sounds, resulting in disarticulation with difficulty for others to understand his speech. Speech may be assessed as defective when compared with the speech of children of the same age and which cannot be explained by pathology of intelligence, hearing or the physiology of speech mechanisms. The pronunciation of speech sounds, which appear most late in ontogenesis, is often impaired, but the pronunciation of vowel sounds is never impaired. The most severe type of violation is omission of sounds. Substitutions and distortions are a less severe type of violation. Children with developmental articulation disorder may exhibit co-occurring social, emotional, and behavioral disorders. 1/3 of these children have mental disorder.



Differential diagnosis

Includes three stages:

1. Determining the severity of articulation disorder.

2. Exclusion of physical pathology that could cause pronunciation problems, dysarthria, hearing impairment or mental retardation.

3. Rule out developmental disorder expressive speech, pervasive developmental disorder.

For articulation disorders caused by structural or neurological pathology (dysarthria) characterized by low speech rate, uncoordinated motor behavior, disorders of autonomic functions, such as chewing and sucking. Pathology of the lips, tongue, palate, and muscle weakness are possible. The disorder affects all phonemes, including vowels.

Therapy

Speech therapy is most successful for most articulation errors.

Drug treatment is indicated in the presence of concomitant emotional and behavioral problems.

Expressive language disorder (F80.1).

Severe language impairment that cannot be explained by mental retardation, inadequate learning, and is not associated with a pervasive developmental disorder, hearing impairment, or neurological disorder. This is a specific developmental disorder in which the child's ability to use expressive spoken language is markedly below the level appropriate for his mental age. Speech understanding is within normal limits.

Etiology and pathogenesis

The cause of expressive language disorder is unknown. Minimal brain dysfunction or delayed formation of functional neuronal systems have been suggested as possible causes. A family history indicates that this disorder is genetically determined. The neuropsychological mechanism of the disorder may be associated with a kinetic component, with an interest in the process of the premotor parts of the brain or posterior frontal structures; with unformed nominative function of speech or unformed spatial representation of speech (temporo-parietal sections and the area of ​​the parieto-temporo-occipital chiasm) subject to normal left hemisphere localization of speech centers and dysfunction in the left hemisphere.



Prevalence

The incidence of expressive language disorders ranges from 3 to 10% in children school age. It is 2-3 times more common in boys than in girls. More common among children with a family history of articulation disorders or other developmental disorders.

Clinic

Severe forms of the disorder usually appear before age 3. Absence of individual word formations - to 2 and simple sentences and phrases by 3 years - a sign of delay. Later violations - limited vocabulary development, use of a small set of template words, difficulties in selecting synonyms, abbreviated pronunciation, immature sentence structure, syntactic errors, omission of verbal endings, prefixes, incorrect use of prepositions, pronouns, conjugations, inflections of verbs, nouns. Lack of fluency in presentation, lack of consistency in presentation and retelling. Understanding speech is not difficult. Characterized by adequate use of non-verbal cues, gestures, and the desire to communicate. Articulation is usually immature. There may be compensatory emotional reactions in relationships with peers, behavioral disorders, and inattention. Developmental coordination disorder and functional enuresis are often associated disorders.

Diagnostics

Indicators of expressive speech are significantly lower than indicators obtained from nonverbal intellectual abilities(non-verbal part of the Wechsler test).

The disorder significantly interferes with school success and Everyday life requiring verbal expression.

Not associated with pervasive developmental disorders, hearing impairment, or neurological disorder.

A specific developmental disorder in which a child's use of speech sounds is below the level appropriate for his mental age, but in which there is a normal level of language skills.

Diagnostic instructions:

The age at which a child acquires speech sounds and the order in which they develop are subject to considerable individual variation.

Normal development. At the age of 4 years, errors in the production of speech sounds are common, but the child can easily be understood strangers. Most speech sounds are acquired by the age of 6-7 years. Although difficulties may remain in certain sound combinations, they do not lead to communication problems. By the age of 11-12 years, almost all speech sounds should be acquired.

Pathological development. Occurs when a child's acquisition of speech sounds is delayed and/or deviated, resulting in: disarticulation with associated difficulty for others to understand his speech; omissions, distortions or substitutions of speech sounds; changes in the pronunciation of sounds depending on their combination (that is, in some words the child can pronounce phonemes correctly, but not in others).

A diagnosis can only be made when the severity of the articulation disorder is outside the range of normal variations appropriate to the child's mental age; nonverbal intellectual level within normal limits; expressive and receptive speech skills within normal limits; articulation pathology cannot be explained by a sensory, anatomical or neurotic abnormality; incorrect pronunciation is undoubtedly anomalous, based on the characteristics of speech use in the subcultural conditions in which the child finds himself.

Included:

Developmental physiological disorder;

Developmental articulation disorder;

Functional articulation disorder;

Babbling (children's form of speech);

Dyslalia (tongue-tied);

Phonological developmental disorder.

Excluded:

Aphasia NOS (R47.0);

Dysarthria (R47.1);

Apraxia (R48.2);

Articulation disorders combined with a developmental disorder of expressive speech (F80.1);

Articulation disorders combined with a disorder of receptive speech development (F80.2);

Cleft palate and other anatomical abnormalities of oral structures involved in speech functioning (Q35 - Q38);

Articulation disorder due to hearing loss (H90 - H91);

Articulation disorder due to mental retardation (F70 - F79).

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  • F81.9 Developmental disorder of learning skills, unspecified
  • F81.9 Developmental disorder of school skills, unspecified.
  • F82 Specific motor development disorder
  • A reciprocal pattern of interaction in which an event can simultaneously be a consequence of a previous event and the cause of a subsequent event.

    • Thanks to the ability to reproduce and understand speech, we can communicate normally with each other, exchange experiences and information, and build our lives. Therefore, any speech disorders negatively affect the quality of life. People who cannot fully express their thoughts have difficulty building a career or establishing personal life. Diagnosis and treatment of speech disorders is best done in childhood, without waiting for such pathologies to become advanced and move into adulthood. So, the topic of our conversation today on www..

    What is articulation?

    By the term articulation, speech therapists mean the work of the speech apparatus, which ensures the correct creation of sound. Articulation results in distinct sounds that can be heard by the human ear.

    Correct articulation ensures correct pronunciation of sounds. And an important role in this is played not by vocal connections, but by the organs of pronunciation - active or passive. The former include the tongue and lips, and the latter include the teeth, soft and hard palate, and gums.

    Causes of articulation disorders

    Speech articulation disorders in adults and children can be provoked by mechanical causes, which are represented by malocclusions, too short frenulum of the tongue and other pathological conditions. If the patient does not have any problems in the structure of the speech apparatus, doctors talk about a functional disorder - about incoordination of these organs.

    In children, articulation disorders are usually explained by genetic predisposition, perinatal pathologies and minimal organic lesions of the speech cortex. Also, such problems can be provoked by an unfavorable social environment, incorrect pronunciation of sounds among close relatives, and also bilingualism in the family. In some cases, articulation disorders appear due to physical weakness against the background of frequent infectious and chronic ailments, as well as underdevelopment of phonemic hearing.

    Among other things, speech therapists claim that children cannot pronounce all sounds correctly until the age of five. This is a physiological disorder of articulation, which is a variant of the norm.

    Correction of articulation disorders in children and adults

    Articulation disorders require timely treatment. It is best to diagnose and eliminate them while still in early childhood. If you do not cope with such problems, they will remain for life.

    In some cases, to successfully eliminate articulation disorders, you need to seek help from a dentist, for example, to correct a malocclusion or a short frenulum. The problem of a short frenulum can also be dealt with through a systematic series of exercises.

    If articulation disorders are caused by incoordination of the speech organs, then this problem can only be eliminated with the help of regular classes with a speech therapist or independent training.

    Articulation exercises for children

    Children should do articulation exercises in front of a mirror. You can do this starting from the age of three.

    Exercises:

    - “window” - the child must open his mouth wide (heat), then close it (cold);
    - “brush your teeth” the baby smiles, opens his mouth, uses the tip of his tongue to brush the lower and upper teeth alternately;
    - “knead the dough” the child smiles, then slaps his tongue between his teeth - “five-five-five”, then bites the tip of the tongue with his teeth;
    - “cup” - the baby smiles, opens his mouth wide, sticks out his wide tongue and forms a “cup” out of it (raises the tip);
    - “pipe” - the child should stretch his tense lips forward, while closing his teeth;
    - “fence” - the baby needs to smile, then expose his closed teeth with tension;
    - “painter” - the child smiles, opens his mouth slightly and strokes (paints) the sky with the tip of his tongue;
    - “mushrooms” - the baby needs to smile, then click his tongue (as if riding a horse) and stick his wide tongue to the roof of his mouth;
    - “kitty” - the baby smiles wider, opening his mouth. The tip of his tongue should rest against the lower teeth, and the tongue should be curved so that the tip rests against the lower teeth;
    - “swing” - the child smiles, opens his mouth, the tip of his tongue goes behind the upper teeth, then behind the lower teeth.

    These are just a few articulation exercises that can be performed with your child at home.

    Exercises for adults

    Exercises:

    To develop the soft palate, yawn with your mouth closed;
    - “paint” with your tongue the upper arch inside the mouth - from the soft palate to the base of the upper teeth;
    - pronounce vowel sounds while yawning;
    - imitate gargling;
    - develop the lower jaw by moving it back and forth, as well as from side to side;
    - lower your jaws downwards with resistance;
    - develop your cheeks, alternately sucking or inflating them;
    - roll " balloon"from cheek to cheek;
    - pull both cheeks in so that a “fish mouth” is formed and move your lips;
    - snort like a horse;
    - chew your lips gently;
    - extend your tongue with a sharp tip more strongly, then place it relaxed on your lower lip.

    Speech articulation disorders in adults are just as correctable as in children. Namely, systematically performing articulation exercises will help get rid of articulation disorders at different ages.

    Articulation disorders may occur due to hypofunction (weakness, decreased range of motion, slowness of movement), hyperfunction (increased muscle tone) or impaired coordination of movements of anatomical elements that provide articulation. Articulation disorders can be generalized or more specific.
    - Generalized articulation disorders are articulation disorders that lead to distortion of the sound of all or most phonemes and are observed as with lesions of the central nervous system, and systemic diseases.
    - Specific articulation disorders are disorders that lead to distortion of the sound of individual groups of phonemes, and are associated with local structural pathological processes or damage to one or more nerves.
    - Articulation errors

    Error options that occur during articulation include omissions, distortions, phoneme substitutions, and additional phonemes.
    Articulation changes may be secondary to neurological disorders, but may also be secondary to structural damage to the articulatory apparatus.

    Common articulation errors in children are usually considered developmental disorders and are not classified as variants of dysarthria. True dysarthria can be observed in childhood (cerebral palsy, consequences of brain injury) and in adults due to impaired control of the muscles that support speech processes.

    Prosody disorders arise as a result of discoordination of the respiratory, vocal and articulatory components of speech and are manifested by changes in the rhythm and tempo of speech, stress and speech intonation.
    - Violations of the rhythm and tempo of speech production include acceleration or deceleration, inconsistency of articulation, the presence of temporary pauses, as well as various ratios of these violations.

    Violation of stress is observed in words, as well as phrases or sentences, which can lead to a change in the meaning of what is spoken.
    - Intonation errors can change the meaning of sentences (eg, You're going home. Are you going home?).
    - Prosody disorders are usually associated with ataxic dysarthria, hypokinetic dysarthria and right hemisphere aprosodic dysarthria. Persons with the latter type of disorder may also note difficulty understanding the prosodic characteristics of the speech of others.

    Examination of a patient with speech disorders

    History taking:
    1. The appearance of violations. When did the patient or family first notice changes in speech? Were there any age development any articulation problems?
    2. Rate of development. Did the speech changes appear suddenly or gradually? Did they reverse development, were they stable, or did they progress from the moment they appeared? Have there been fluctuations in the severity of impairments? Were there periods of normal speech along with periods of altered speech?

    3. The presence of associated neurological symptoms, especially those associated with damage to the upper or lower motor neurons, cranial or cervical nerves.
    4. Previous neurological diagnoses and previous treatments.
    5. Medicinal history and use of non-prescribed medications.

    Objective examination:

    1. There are three stages of objective examination.
    Stage 1. Study of samples of spontaneous speech and speech in the process of special testing.
    Stage 2. Interpretation of speech samples with assessment of the state of each element of the speech system, determination of norm and pathology, as well as the nature of existing deviations. It is recommended to examine the oral cavity, oro- and nasopharynx, and chest mobility.
    Stage 3. Determining the nature of the identified disorders, correlating them with known patterns and clinical variants of dysarthria.

    2. Study of individual elements of the speech system.
    - Breathing. Assess the degree of fatigue by counting to 20 during one exhalation. Voice pitch, volume of speech, length of phrases, and clarity or explosiveness of speech should be assessed by listening carefully.
    - Phonation. The patient should pronounce the long vowel sound “a” as clearly and as long as possible. Other phonemes (such as "and") require more tension vocal cords, while the researcher must evaluate their sound quality, duration, pitch, sound stability and volume. To assess the true effectiveness of the vocal cords, it is necessary to compare the retention time of the phonemes “s” and “z”. With normal functioning of the vocal cords, it is possible to maintain the sound of these two consonants for the same amount of time. If the sound of the “z” is noticeably shorter, there is a true reduction in the effective functioning of the vocal cords. Ask the patient to cough briefly to clarify abnormalities. If there are deviations, consultation with an otorhinolaryngologist or laryngoscopic examination is recommended.
    - Resonance is assessed by the patient's pronunciation of different types of phonemes. The condition of the soft palate is studied when pronouncing the sound “a”, which the patient must hold out for as long as possible, and the degree of fatigue must be noted. Another technique is to pronounce a long “and”, while the researcher closes and opens the nasal passages. At normal resonance, the sound should remain virtually unchanged.

    A specific developmental disorder in which a child's use of speech sounds is below the level appropriate for his mental age, but in which there is a normal level of language skills. A diagnosis can only be made when the severity of the articulation disorder is outside the range of normal variations appropriate to the child's mental age; nonverbal intellectual level within normal limits; expressive and receptive speech skills within normal limits; articulation pathology cannot be explained by a sensory, anatomical or neurotic abnormality; incorrect pronunciation is undoubtedly anomalous, based on the characteristics of speech use in the subcultural conditions in which the child finds himself.

    Included:

    Developmental physiological disorder;

    Developmental articulation disorder;

    Functional articulation disorder;

    Babbling (children's form of speech);

    Dyslalia (tongue-tied);

    Phonological developmental disorder.

    F80.1. Expressive language disorder

    A specific developmental disorder in which a child's ability to use expressive spoken language is markedly below the level appropriate for his mental age, although speech comprehension is within normal limits. There may or may not be articulation disorders.

    Often, a lack of spoken language is accompanied by a delay or disturbance in verbal and audio pronunciation. The diagnosis should be made only when the severity of the delay in expressive language development exceeds the normal range for the child's mental age; Receptive language skills are within normal limits for the child's mental age (although they may often be slightly below average). Impaired spoken language becomes evident from infancy without any long, distinct phase of normal speech use. However, it is not uncommon to encounter the initially apparently normal use of several individual words, accompanied by speech regression or lack of progress. Often similar expressive speech disorders are observed in adults; they are always accompanied by a mental disorder and are organically caused.

    Included:

    Motor alalia;

    Delays speech development by type of general speech underdevelopment (GSD) levels I-III;

    Developmental dysphasia of expressive type;

    Developmental aphasia of expressive type.

    F80.2. Receptive language disorder

    A specific developmental disorder in which the child's understanding of speech is below the level appropriate for his mental age. In all cases, expansive speech is also noticeably impaired and a defect in verbal-sound pronunciation is not uncommon.

    A diagnosis can only be made when the severity of the delay in receptive language development is beyond normal variations for the child's mental age and when criteria for pervasive developmental disorder are not met. In almost all cases, the development of expressive speech is also seriously delayed, and violations of verbal-sound pronunciation are common. Of all the variants of specific speech development disorders, this variant has the highest level of concomitant socio-emotional-behavioral disorders. These disorders do not have any specific manifestations, but hyperactivity and inattention, social inattention

    ability and isolation from peers, anxiety, sensitivity or excessive shyness are common. Children with more severe forms of receptive language impairment may experience quite pronounced delays in social development; Imitative speech is possible with a lack of understanding of its meaning and a limitation of interests may appear. Similar speech disorders of the receptive (sensory) type are observed in adults, which are always accompanied by a mental disorder and are organically caused.

    The structure of speech disorders is indicated by the second code R47.0.

    Included:

    Developmental receptive dysphasia;

    Developmental receptive aphasia;

    Lack of perception of words;

    Verbal deafness;

    Sensory agnosia;

    Sensory alalia;

    Congenital auditory immunity;

    Wernicke's developmental aphasia.