Alalia in children is a pathological absence or underdevelopment of speech, which is caused by organic lesions of the brain, in particular, cortical speech centers, which occurs, as a rule, in the prenatal period of development or in babies in the first years of life. At the same time, such children understand someone else's speech, but they cannot reproduce it on their own.
Description of pathology
Such a pathological condition is currently diagnosed in about one percent of preschool children, a little less often in schoolchildren. Motor alalia most often affects boys, in whom this disease is recorded twice as often as in the opposite sex.
Speech is one of the most important components of the neuropsychic development of children. Its formation occurs in the first years of life, subsequently it determines the quality of speech in other age periods. The act of speech is carried out through a certain system of organs,relating to the speech apparatus, which consists of peripheral and central sections. The central part of the speech apparatus is represented by the structures of the nervous system (subcortical nodes, pathways, cerebellum, nerves innervating vocal, respiratory, articulatory muscles, etc.).
The peripheral part of the speech apparatus consists of articulatory (lips, upper and lower jaws, tongue, soft and hard palate), vocal (larynx and vocal cords) and respiratory sections (thorax, trachea, bronchi and lungs). Violations in one of these structures can lead to the development of various types of speech disorders.
Causes of pathology
The main reasons for the formation of motor alalia in children include pathologies of the pathways that relate to Broca's center, as well as this area directly. Broca's center is a section of the cerebral cortex located in the posterior inferior part of the third frontal gyrus in the left hemisphere of the brain in right-handed people and provides motor organization of the speech process.
Motor alalia is a polyetiological pathological condition, that is, one that is caused by the undesirable influence of multiple factors. The main prerequisites that can cause organic lesions of the speech center in the cerebral cortex include:
- Various diseases of an infectious nature that develop during childbirth or in utero.
- Fetal hypoxia.
- Traumatization of the fetus (for example, when fallingwomen during pregnancy).
- Toxicosis.
- High risk of miscarriage.
- The presence of certain chronic pathologies in a woman during pregnancy (arterial hyper- or hypotension, pulmonary or heart failure, etc.).
In addition, prematurity, intracranial birth trauma, and neonatal asphyxia can lead to speech alalia in children. In children in the first years of life, the primary causes of this pathology include:
- Genetic predisposition.
- Encephalitis.
- Tranio-cerebral injuries.
- Some somatic diseases that can lead to exhaustion of the nervous system.
- Meningitis.
Risk factors for developing speech anomalies
Risk factors for motor alalia in children may be frequent diseases in young children. Such pathologies include endocrinological disorders, acute viral respiratory infections, pneumonia, lack of speech contacts, rickets, surgical interventions using general anesthesia, pedagogical neglect, as well as hospitalism (a complex of mental and somatic disorders that may be due to a long stay in hospital away from home and loved ones).
Alalia varieties
In medical practice, the following forms of this pathology are defined:
- Expressive (motor).
- Impressive (sensory alalia in children). This form is much less common than the motor form. With sensory alalia, the child does not understand the speech of other people enough, although he hears well. The reason for this is the defeat of the center of Wernicke. This center is located in the temporal region of the left hemisphere and plays the role of an auditory-speech analyzer. Since the perception and understanding of speech in a child with sensory alalia is impaired, speech formation is also impaired.
- Mixed (sensory-motor or motor-sensory, depending on whether the developmental disorder of which - impressive or expressive speech prevails).
Motor alalia, depending on the localization of the disturbed area, is divided into:
- afferent, which is characterized by damage to the lower parietal parts of the left hemisphere, which is accompanied by kinesthetic articulatory apraxia;
- efferent, in which predominantly premotor parts of the cerebral cortex are affected.
How does motor alalia manifest itself in a child?
Alalia symptoms
This disease is characterized by the presence of both speech and non-speech manifestations. The non-speech symptoms of this pathology, first of all, include such motor disorders as improper coordination of movements, underdevelopment of finger motor skills, and awkwardness. Motor alalia in these children may also be manifested by difficulties in forming self-service habits (for example, buttoning up buttons, lacing shoes, etc.), as well as in performing small precise movements of the fingers and hands (for example, folding puzzles, picking upconstructors, mosaics, etc.).
It is important to recognize the symptoms of alalia in children in a timely manner.
In addition, children with this pathology often have impaired memory (most often auditory-speech), attention, perception, volitional and emotional spheres of the personality. In patients with alalia, both hyperactive and overly passive behavior, fatigue and insufficient performance can be observed. In addition, in children with alalia, one can often notice violations of the facial muscles, aggression and increased irritability, poor adaptation in a team, difficulties in adapting to the conditions of the outside world.
Speech manifestations
Of the speech manifestations of motor alalia in a child, the following are noted:
- Wrong change of sounds in some words (literal paraphasia).
- Steady repetitions of the same word or phrase (perseveration).
- Loss of certain sounds from words (elision).
- Limited vocabulary (primarily verb forms and verbs).
- Replacing some complex words with similar ones in sound or meaning.
- Combining syllables from different words together.
- Loss of prepositions from sentences, as well as incorrect ordering of words in a phrase.
In the speech of such a patient, there is a predominance of nouns, usually in the nominative case. In addition, with this disease, there may be a partial or absolute refusal of speech (the so-called speech negativism). On the backgroundcharacteristic symptoms of alalia in children may be stuttering.
With the development of the afferent form, the patient can perform a variety of articulatory movements, however, there is a significant violation of sound pronunciation. In cases of efferent alalia, the main speech defect is the inability to perform sequential articulatory movements, and this may be accompanied by a significant distortion in the structure of words and syllables. The vocabulary of such a child is much poorer than that provided for his age norm. Children with this pathology have difficulty learning new words, and their active vocabulary mostly consists of phrases and everyday words.
Signs of alalia in children appear depending on age.
Lack of vocabulary can lead to inadequate understanding of the meaning of a word, as well as inappropriate use of words. Children aged 3 years with alalia tend to express themselves in simple and short sentences, which often leads to gross violations of speech formation.
Children with this disease have significant difficulties in determining cause-and-effect relationships, secondary and main, temporary relationships, describing the meaning of events, correct and gradual presentation of the essence. In certain cases, with motor alalia in children, only babbling words and onomatopoeia are observed, the use of which may be accompanied by active facial expressions and gestures. Mental retardation in children occurs due tosevere speech impairment. During the formation of speech, such violations begin to be gradually compensated. All stages of the development of speech skills (babbling, cooing, words, phrases, and subsequently contextual speech) in a child with alalia are somewhat late.
The formation of speech skills in patients with this pathology is also influenced by a number of factors, the most important of which are the degree of impairment in the child's brain, general development, the age when such a pathology was diagnosed, the regularity and quality of parenting sessions with him.
In certain cases, after prolonged speech negativism, children begin to speak and quickly master speech skills, in another group of patients, early speech formation is observed, but subsequently it remains very poor for quite a long period of time. In this case, other scenarios are also possible.
Diagnosis of alalia in children
To diagnose this pathology, a full examination of the child by such specialists as a pediatric otorhinolaryngologist, neurologist, speech therapist, and psychologist is necessary. When carrying out a speech therapy examination of children, special attention should be paid to the collection of anamnesis, as well as the developmental features of the child at an early age. To make an accurate diagnosis of motor alalia, one should also assess the desire of the child to speak, determine the presence of difficulties in repeating what he heard, evaluate auditory perception, use of gestures and facial expressions, understanding and perception of speech, the presence of echolalia.
In addition, the level of passive and active vocabulary, the quality of pronunciation of sounds, the syllable structure of words, the grammatical characteristics of speech and phonemic perception are noted. For an adequate assessment of the severity of organic brain damage, the following instrumental research methods may be required:
- electroencephalography;
- magnetic resonance imaging of the brain;
- echoencephalography;
- X-ray examination of the skull.
As methods of differential diagnosis in cases of sensory alalia and hearing loss, audiometry, otoscopy and some other methods of studying auditory functions are used.
In addition, differential diagnosis with autism, dysarthria, speech delay, mental retardation is required.
Motor Alalia Therapy
Treatment of this pathology is a whole complex of therapeutic measures. The formation of correct and complete speech skills is carried out against the background of drug therapy, and the main goal here is to stimulate the maturation of brain structures. Patients are prescribed nootropic medicines and a variety of vitamin complexes. Very effective in the treatment of motor alalia are such physiotherapeutic techniques as electropuncture, decimeter wave therapy, magnetotherapy, acupuncture, electrophoresis, laser therapy, transcranial electrical stimulation, hydrotherapy. In addition, an important role in the treatment of alalia is played by the development of general and manual motor skills inchild, as well as thinking, memory, attention.
Speech therapy correction of alalia in children includes work with all aspects of speech and provides not only classes with a speech therapist, but also specially selected regular exercises at home. Thus, a passive and active vocabulary is formed, active work is underway on the development of phrasal speech, grammar, sound pronunciation, and coherent speech develops. Positive results are also given by logarithmic exercises and speech therapy massage.
With the development of motor alalia, it is recommended to start teaching the child to read and write earlier, since reading and writing successfully help develop oral speech and consolidate the learned material.
Treating alalia in children at home can be very effective.
Due to the plasticity of the child's brain and its rapid adaptation skills, a complete cure for the disease is possible. Separate he althy brain cells take over the functions of non-working areas.
Each child with alalia undergoes therapy under the close supervision of a specialist. However, the home environment will not become an obstacle, because the parents themselves can provide all possible assistance in treating the baby.
- The development of fine motor skills is associated with speech activity. If you regularly engage with children's fingers, make them dexterous and skillful, then the baby's speech will develop.
- Massage of the palms in a playful way is useful.
- Finger games and gymnastics will stimulate the development of fine motor skills. These can be simple activities - for example, sorting cerealsand legumes, folding mosaics and puzzles will help activate the brain.
Today, there are a large number of video tutorials on conducting classes for alalia that can be used at home.
Possible consequences and complications
This disease in children can lead to serious violations of written speech. In addition, children may develop stuttering, which manifests itself in the development of oral speech skills.
Successful correction of such a pathology is most likely when therapy is started in the early stages, from about 3-4 years old, as well as an integrated approach that involves working with the child and drug treatment. With timely therapy, the prognosis of alalia in children is very favorable.
The degree of organic brain damage in a child is important. With minor injuries, the pathology in most cases can be completely cured.
Prevention
For preventive purposes, all conditions should be provided for the correct course of pregnancy, as well as the subsequent development of the child. A number of preventive measures are recommended:
- register for pregnancy on time, undergo all examinations and follow doctor's orders;
- to minimize the risk of contracting infectious diseases and to treat existing pathologies in a timely manner;
- avoid traumatic situations of excessive loads;
- eat a balanced diet.
We reviewed the treatment of alalia in children.
