F80.1 Disorder of expressive speech. Speech Development Disorder

This disorder is a speech developmental disorder unrelated to or inadequate learning, nor is it associated with a general developmental disorder, neurological disorders, or auditory impairment. Expressive speech disorder is a specific developmental disorder in which a child uses colloquial expressive language significantly below the level that in given time corresponds to his mental age. At the same time, the understanding of the speech of others is at a normal level.

At school age, the frequency of these disorders ranges from three to ten percent. Moreover, boys suffer from expressive speech disorder three times more often than girls of the same age.

Expressive speech disorder is often found in those children among whose relatives there are patients suffering from articulation disorders, as well as other developmental disorders. If we talk about severe forms of the disease, then they usually manifest themselves before three years of age. If there are no separate word formations in simple sentences and phrases when the child is already three years old, then this is a sign of a delay. Later signs of a violation may manifest themselves in limited vocabulary development, when the child has difficulty selecting synonyms, using a set of template words, and pronouncing phrases in short.

Also, with an expressive speech disorder, prefixes, word endings are skipped, there are multiple syntactic errors, and so on. In the presence of this violation, there may be a complete lack of consistency in retelling and presentation, however, there are no difficulties with understanding speech. Also, this violation is characterized by adequate application non-verbal gestures, replicas, the child has a desire to communicate with others. In most cases the articulation is immature. Often there are emotional compensatory reactions when communicating with peers, inattention, behavioral disorders are allowed. If there is functional enuresis, or a disorder of coordination, then this is classified as a concomitant disorder.

Causes of Expressive Speech Disorder

Currently, experts do not name the exact causes of expressive speech disorder. As possible option untimely formation of neuronal functional systems can be accepted. If a family history is present, it may indicate a genetic origin this disorder. It is known that the neuropsychological mechanism of the disorder is related to the kinetic component if there is an interest in the work of the premotor brain regions, as well as the postfrontal structures. Often, expressive speech disorders are associated with the fact that the spatial representation of speech has not been formed - meaning the zone of the parietal temporo-occipital junction.

This is possible if there is a normal left hemispheric localization of the speech centers, or dysfunction directly in the left hemisphere. Another reason may be a delay in the development of neural connections with organic damage to the speech areas of the cortex. Basically, this applies to right-handers. In particular, there is a lot of data on the influence of genetic factors and an unfavorable social environment on the development of expressive speech. That is, when a child has constant and prolonged contact with people who are different low level speech development.

From the list of causes of expressive speech disorders, experts do not exclude such causes as hearing problems, various mental disorders, birth defects development speech apparatus, and other diseases. Also, it has been proven that correct pronunciation words are only capable of those people who have normal, without pathologies, hearing. Because of this, children's hearing needs to be checked regularly. If parents find that the baby has stopped babbling and is silent all the time, it is necessary to conduct an examination by contacting a pediatrician.

Treatment for Expressive Speech Disorder

In the treatment of this disorder, one should not count on instant results, since this is a rather lengthy process that requires patience, both for the doctor and the patient's parents, his close relatives. And first of all, preference is given to family therapy, speech therapy, which involves a significant number of various therapeutic measures, special classes. In particular, speech therapy includes such elements as mastering phonemes, the correct construction of phrases and sentences, increasing vocabulary. If there are signs of a concomitant or secondary disorder manifested in the behavioral sphere, in the emotional area, then the treatment involves the use of psychotherapeutic methods, and adequate medication is also prescribed.

Undoubtedly, such a violation significantly hinders the child's success in school, disrupts normal daily life, and the child cannot communicate if the use of verbal form is necessary. Therefore, treatment procedures must be started in a timely manner. When diagnosing an expressive speech disorder, the disease should be differentiated from such disorders as. In this case, there is an absolute violation of the intellect, both in the verbal and non-verbal spheres. Developmental disorders can be general, they are characterized by such signs as inadequate gestures and movements, lack of ability and desire to enter into social relations.

For the development of expressive speech, plot pictures are used (a set of plot pictures is available in the application). The sequence of work with the plot picture is as follows: (1) The child is presented with a card, which he is asked to carefully consider. At the first stages, the time is not fixed, later it is limited first to 10, and then to 5 minutes, as speech skills are formed. After the time has elapsed (or when ready), the picture is removed. The psychologist (teacher) working with the child must prepare questions for the picture in advance (for example, when working with the picture “Shepherdess”: Who is shown in the picture? What is the girl wearing? Why is she holding a staff? Why does the lamb have a bell around its neck? How old is the girl years? What does the girl have on her head?, etc.); (2) The child should be asked to tell what he understood from the picture; as a rule, at the first stages of work, the child gives short, stating answers: “I saw a girl”, “A girl with a lamb”. The child should be asked to describe what he saw in detail, using pre-prepared questions. In many cases, with a violation of expressive speech, it is not possible to immediately get accurate answers. In this case, you can invite the child to look at the picture again. If, even when directly viewing the picture, the child finds it difficult to describe, he should be asked to redraw the picture into an album. Pictures presented as stimuli are not colored. When redrawing, they should be colored in, which will allow the child to perceive the details in a differentiated way, and the psychologist (teacher) to assess the degree of detailing by the child of the elements of the stimulus drawing. Do not ask your child to color the stimulus card as this will make it unsuitable for further work! Challenge your child to redraw and then color the drawing. Observing the tactics of redrawing the picture, one can assess the nature of the child's work with visual images and draw diagnostic conclusions; (3) When the child has redrawn and colored the picture (redrawing stimulates the development of motor skills), you should ask him a number of additional clarifying questions using his drawing (What color is the girl's apron? How is she dressed? What color is the dress, cap, shoes? What is she wearing girl? What is the girl holding? Why does she need a staff? etc.). The more questions are asked, the better the next stage of work will be prepared: the formation of the plot integrity of the drawing; (4) Show the story card to the child again. Ask him to tell what he sees in the picture. Evaluate the coherence and consistency of the presentation. Compare the sequence of elements of a descriptive story with the tactics of redrawing a picture. Note similarities and discrepancies in sequence for subsequent diagnostic findings; (5) Prepare questions to help the child develop the story into a story that has a plot. Explain to the child that he has seen picture books more than once. The artist depicted in the pictures only a part of what is written in the book. Ask him to make short story in which the picture would play the role of an illustration. If the child finds it difficult to come up with a plot, tell him the topics for the story, watch how the child uses the details of the drawing in developing the plot (for example: “The lamb is missing” - the girl lost her little lamb - she went to look for him - “Probably he got lost in the forest!” - “We need to take a staff to scare away the wolf!” - the bell rang - the lamb was found - two significant details of the drawing are used in the plot) and follow the dynamics during the classes. By the dynamics, you can judge the success of your work and plan the next corrective stages, in particular, the level of complexity of the exercises.

At the first stages of work, one picture can be worked out within two to three hours. For kids younger age and with organic pathology of the central nervous system, it is necessary to take breaks during work. Please note that the break is organically woven into the work, ask the child to take a pose, like the hero of the picture (and if there are several heroes, let him try to be a little each of them), watch what actions the child can use in the context of the work (for example: dialogical speech for characters during the game, motor skills). In the future, in the course of work, it takes less and less time to work out the picture. Ideally, after looking at the picture for 3-5 minutes, having studied its details, the child should learn to store the fixed image in memory and work with it, creating a story of 20-30 sentences within 5-7 minutes, including 3 -5 essential details of the incentive card.

In the course of working with plot pictures, it is necessary to assess in time the stage when it is necessary to proceed to the formation of skills dialogical speech. Please note that with a real interlocutor, dialogic speech can be carried out spontaneously, without visible violations. Only when great experience working with children or good knowledge of the individual characteristics of speech this child violations can be quickly identified and dialogue skills assessed. The dialogue of the same child looks completely different if he has to work with abstract interlocutors or stimulus picture material. The work on the formation of dialogic speech skills takes place in several stages. (1) First, there is an oral dialogue with the child. It can be devoted to any topic, it is better if it is a discussion of a book, film, picture. Then the psychologist has an additional opportunity to assess the structure of speech and the logic of constructing a phrase, the appropriateness of using words in the context of speech, the child's thinking, including specific thinking disorders (see below). (2) At the next stage, it is reasonable to use the given topic of dialogue with a real interlocutor. The topic must be chosen randomly. For the development of dialogic speech and monologue (see below), it is convenient to use several games that allow you to fill in breaks in work, being both a rest and a working component. They can be successfully included in work with a group of children.

Game 1. "Exam". The topics of dialogues (monologues) are written on small pieces of paper, which are placed in a hat (pouch). The player (or players) must remove the topic (examination ticket) from the hat and immediately enter into a dialogue (pronounce a monologue) with the player indicated by the host or with the host himself. The host (examiner) has the right to help a little, but his main task is to assess speech skills. If there are many players, then they can rate each other. The final mark (in the group game) is the average (according to experience, all players leave the exam with fours and fives). The game has an option that adds fun and randomness, when the task has to be completed not by the one who took it out of the hat, but by another player (next, for example, clockwise by the number of points that fell on dice). The game is easy to simplify or complicate, focusing on the level of the players.

Game 2. "Target". The game is convenient for a group and for two participants. A target is hung on the wall - a sheet of paper, a ring where you need to hit, like a basketball basket, in a word - any goal. Those who play one ball for all (preferably light, because you may have to play in the room). The starting line is marked, away from the target, it was very difficult to hit. Players take turns trying to hit the target. The host has the right to offer them help: the one who successfully completes the task can come closer to the target by 1, 2 or 3 steps (depending on the difficulty of the task). Examples of tasks: how many letters are in a word, come up with a synonym, come up with an antonym, say a variant of a greeting that has not yet been named by anyone. You can answer only while the ball is flying, i.e. there is no time to think. The game is scored. It is very difficult for younger children and children with severe developmental disorders and organic pathology of the central nervous system.

Game 3. "Ladder". The players have to climb the stairs, where each step is a task. Of course, there are insidious steps that "break" under the players, forcing them to slide down, there are also steps that promise good luck - they throw the player up. The tasks in the game should be easy, but numerous - the main task is to stimulate the participants to expressive emotional speech, to teach them to verbally formulate their feelings that arise in the event of a sudden failure (a step broke under the player) or equally sudden luck.

(3) Having worked out the dialogue with real interlocutors, they move on to dialogues between abstract interlocutors. For work, you can use one or two plot pictures. If one picture is used, then the topic of the dialogue is partly predetermined by the plot (for example, the dialogue of a girl and a lamb in the picture "Shepherdess"), if two, then a sudden and unique (due to different plot twists depending on the relative position of the pictures) storyline arises , which determines the course of the dialogue of heroes independent of each other. The second task is more difficult. Dialogues between abstract interlocutors presented in plot pictures are only successful for children who have already learned how to work with plot pictures (see above). Having worked through each picture to the level of a story, which includes several essential details, the child will be able to operate with elements connecting the characters, forming not so much a formal description of the stimulus picture as creating an individual image of the event depicted in the picture, and correlating two events with each other.

The tasks of the psychologist at this stage of work include assessing the success of the child's actions, stimulating his work with leading questions, helping to build connecting links, which requires a certain skill, and what should be learned. Do not forget that in the process of correction, diagnostic work continues, which is especially important if the work is carried out in a group (see below).

Chronological series of plot pictures can also be used to compose a story and dialogues. Stimulus material should be presented in the form of several cards, which the child should place in the correct order. For example, the chronological series "Man" contains 4 pictures - a baby, a teenager, an adult, an old man. Having worked through each picture separately, using them in dialogues (for example, the dialogues of a teenager (he has a ball) with an old man about broken window or the benefits of physical education), the child must form visual and verbal images of essential details that characterize a person’s age, which helps him in chronological evaluation of events in a series of pictures.

Download pictures to work with your child! You will need Corel Draw 9.0 or higher.

Psychiatrist, psychotherapist Perezhogin Lev Olegovich, Ph.D.
mobile phone. 773-9306

Severe language impairment that cannot be explained by mental retardation, inadequate learning, and that is not associated with a general developmental disorder, hearing impairment, or neurological disorder. This is a specific developmental disorder in which the child's ability to use expressive colloquial speech markedly below the level corresponding to his mental age. Understanding speech within the normal range.

Prevalence

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

What causes Expressive Speech Disorder:

The cause of the developmental disorder of expressive language is unknown. Minimal brain dysfunction or delay in the formation of functional neuronal systems has been put forward as possible causes. The presence of a family history indicates the genetic determinism of this disorder. 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 postfrontal structures; with the immaturity of the nominative function of speech or the immaturity of the spatial representation of speech (temporo-parietal regions and the area of ​​the parietal-temporal-occipital chiasm) under the condition of normal left-hemispheric localization of speech centers and impaired functioning in the left hemisphere.

Symptoms of Expressive Speech Disorder:

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

Diagnosis of Expressive Speech Disorder:

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

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

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

Differential Diagnosis

Should be carried out with mental retardation, for which is characterized by a complete violation of intelligence in the verbal and non-verbal sphere; With common developmental disorders which are characterized by a lack of internal language of symbolic or imaginary play, inadequate use of gestures, and an inability to maintain cordial social relationships.

At acquired aphasia or dysphasia characterized by normal speech development before trauma or other neurological disorders.

Treatment for Expressive Speech Disorder:

Speech and family therapy is preferred. Speech therapy includes mastery of phonemes, vocabulary, sentence construction. If there are signs of a secondary or concomitant disorder in the field of behavior or emotions, drug treatment and psychotherapy are indicated.

State characteristic

This group of speech disorders is represented by disorders characterized by systemic underdevelopment of expressive speech with relative preservation of sensory perception. With this pathology, underdevelopment of speech is due to an organic lesion of the speech areas of the brain. The clinical picture of a speech defect is due to the impaired formation of the phonemic and grammatical aspects of speech.

Phonemic disorders are manifested in defects in sound pronunciation of varying degrees of severity. Lexical disorders characterized by poor vocabulary, a low level of verbal generalization, and difficulties in the formation of a speech utterance. Grammatical violations exist in the form of agrammatisms (errors in the use of verbal endings, violations of word formation, etc.), difficulties in the use of prepositions, verbs, conjunctions.

In terms of severity, such speech disorders can be different: from mild forms to severe ones, in which anarthria practically occurs.

In children with this type of speech pathology, violations of higher mental functions (memory, thinking, attention) are most often observed, there is a general motor awkwardness, discoordination of movements, motor slowness or hyperactivity. Often suffers fine motor skills fingers. Underdevelopment of speech inhibits development cognitive activity child, which manifests itself in a delay mental development generally.

This group includes, following the logopedic classification:

1. Delays (impairments) of speech development, manifested in general underdevelopment of speech (OHP) I - Level III.

2. Motor alalia.

3. Motor aphasia.

Criteria for differential diagnosis between OHP and alalia is the severity of the speech defect.

The lesion in the brain in this case is localized mainly in the post-central and premotor zones of the left hemisphere dominant in speech (in right-handers).

Alalia is a systemic underdevelopment of speech, in which all components of speech are impaired. The child is practically silent, while specific disorders of speech understanding and intellect are not detected.

General underdevelopment speech level I corresponds to clinical picture alalia. For OHP level III - speech disorders are represented by violations in sound pronunciation, minor agrammatisms, poverty of vocabulary. Emotional-volitional immaturity takes place in the mental appearance of these children. Often OHP manifests itself in school and is expressed in the difficulties of learning to read and write. Level II OHP is characterized by more severe violations, consisting in pronounced violations of sound pronunciation, gross violations of the grammatical and lexical aspects of speech. Speech disorders are combined here with neurological and psychopathological symptoms and syndromes. Often there is a hypertensive-hydrocephalic syndrome, syndromes of movement disorders. In mental processes, there is a decrease in cognitive activity, attention, memory, praxis, gnosis. Children in this group experience learning difficulties.

Children with OHP level I (alalia) have the most persistent specific speech disorders. Children of this group are characterized by extremely low speech activity, as a result of which their speech is often represented by separate words. There are violations of attention, memory, thinking, disorders of the emotional-volitional sphere, often behavior. There are changes in the EEG examination.

Conditions of treatment

Comprehensive medical and pedagogical treatment is carried out in outpatient settings and children's specialized institutions.

List of required examinations

Additional diagnostic studies:

Audiogram

Specialist consultations (mandatory):

Speech therapist;

Psychiatrist;

Psychologist;

Neurologist;

Psychotherapist.

Additional expert advice:

Neuropsychologist;

Geneticist;

Principles of therapy

1. Courses speech therapy classes. The form of classes is individual and group or a combination of 2 forms.

OHP level I (alalia) 45 - 90 lessons;

OHP level II - 45 - 90 lessons;

OHP level III - 45 - 90 lessons.

Thus, children with alalia receive from 135 to 270 lessons. According to indications, the course can be extended.

2. Logorhythmics 20 - 45 lessons per course.

3. Classes with a psychologist 20 - 45 per course.

4. Medical treatment- prescribed by a psychiatrist.

Medication is prescribed by a psychiatrist.

Nootropic drugs;

sedatives;

Antipsychotics;

antidepressants;

Vitamins.

5. Psychotherapeutic impact:

Family psychotherapy (3 - 5 sessions or more according to indications);

Game psychotherapy.

Additional therapeutic measures:

Physiotherapy;

Right choice profile of the educational institution.

Duration of treatment

The duration of corrective measures is from 1 to 3 or more years.

Expected results of treatment

The maximum possible restoration of speech function (sound pronunciation, vocabulary, grammar) and compensation for mental disorders.