Alalia is a gross underdevelopment or complete absence of speech caused by organic lesions of the cortical speech centers of the brain that occurred in utero or in the first 3 years of a child’s life. With alalia, the late appearance of speech reactions, the poverty of vocabulary, agrammatisms, a violation of the syllable structure, sound pronunciation and phonemic processes are noted. A child with alalia needs a neurological and speech therapy examination. Psychological, medical and pedagogical influence with alalia includes drug therapy, the development of mental functions, lexical-grammatical and phonetic-phonemic processes, coherent speech.
Alalia is a deep lack of development of speech function, caused by organic damage to the speech areas of the cerebral cortex. With alalia, speech underdevelopment is of a systemic nature, that is, there is a violation of all its components – phonetic-phonemic and lexical-grammatical. Unlike aphasia , in which there is a loss of previously present speech, alalia is characterized by an initial absence or severe limitation of expressive or impressive speech. Thus, they speak of alalia if organic damage to the speech centers occurred in the intrauterine, intrapartum or early (up to 3 years) period of the child’s development.
Alalia is diagnosed in about 1% of preschoolers and 0.6-0.2% of school-age children; at the same time, this speech disorder occurs 2 times more often in boys. Alalia is a clinical diagnosis, which in speech therapy corresponds to the speech conclusion OHP ( general underdevelopment of speech ).
Alalia is based on organic damage to the speech centers of the cerebral cortex, which occurred in the prenatal period or after birth before the formation of coherent speech in the child. The factors leading to alalia are diverse and can affect at different periods of early ontogenesis:
- Antenatal period. Damage to the speech zones can be caused by fetal hypoxia , intrauterine infection (TORCH syndrome), the threat of spontaneous abortion , toxicosis , the fall of a pregnant woman with trauma to the fetus, chronic somatic diseases of the expectant mother ( arterial hypotension or hypertension , heart or pulmonary failure ).
- Intranatal period. Complications of childbirth and perinatal pathology are the natural result of the aggravated course of pregnancy. Alalia may result from asphyxiation of newborns , prematurity , intracranial birth trauma during premature, rapid or prolonged labor, the use of instrumental obstetric aids.
- Postnatal period. Some researchers point to a hereditary, family predisposition to alalia. Frequent and prolonged illnesses of children in the first years of life ( ARVI , pneumonia , endocrinopathy, rickets , etc.), operations under general anesthesia, unfavorable social conditions ( pedagogical neglect , lack of speech contacts, hospitalism syndrome ) aggravate the effect of the leading causes of alalia.
As a rule, in the anamnesis of children with alalia, the participation of not one, but a whole complex of factors leading to minimal cerebral dysfunction – MMD is traced.
Organic brain damage slows down the maturation of nerve cells, which remain at the stage of young immature neuroblasts. This is accompanied by a decrease in the excitability of neurons, inertness of the main nervous processes, and functional depletion of brain cells. Lesions of the cerebral cortex in alalia are mild, but multiple and bilateral, which limits the independent compensatory possibilities of speech development.
Over the years of studying the problem, many classifications of alalia have been proposed, depending on the mechanisms, manifestations and severity of speech underdevelopment. Currently, the classification of alalia according to V.A. Kovshikov, according to which they distinguish:
- Expressive (motor) alalia. At the heart of its emergence alalia is an early organic lesion of the cortical section of the motor speech analyzer. In this case, the child does not develop his own speech, however, the understanding of someone else’s speech remains intact. Depending on the damaged area, afferent motor and efferent motor alalia are distinguished. With afferent motor alalia, there is a lesion of the postcentral gyrus (lower parietal parts of the left hemisphere), which is accompanied by kinesthetic articulatory apraxia . Efferent motor alalia occurs when the premotor cortex (Broca‘s center, posterior third of the inferior frontal gyrus) is affected and is expressed in kinetic articulatory apraxia.
- Impressive (sensory) alalia. Sensory alalia occurs when the cortical part of the speech-auditory analyzer is damaged (Wernicke‘s center, the posterior third of the superior temporal gyrus). In this case, the higher cortical analysis and synthesis of speech sounds are disturbed and, despite the preserved physical hearing, the child does not understand the speech of others.
- Mixed alalia ( sensorimotor or motosensory alalia with a predominance of impaired development of impressive or expressive speech)
Symptoms of motor alalia
With motor alalia, there are characteristic non-speech (neurological, psychological) and speech manifestations. Neurological symptoms in motor alalia are represented, first of all, by movement disorders: awkwardness, insufficient coordination of movements, poor development of finger motor skills. Children have difficulties in mastering self-service skills (buttoning up buttons, lacing shoes, etc.), performing small-motor operations (folding mosaics, puzzles, etc.).
Considering the psychological characteristics of children with motor alalia, one cannot fail to note impairments of memory (especially hearing and speech), attention, perception, emotional-volitional sphere. According to the characteristics of behavior, children with motor alalia can be hyperactive , disinhibited or sedentary, inhibited. Most children with motor alalia have reduced performance, high fatigue, and speech negativism. Intellectual development in Alalik children suffers a second time, due to speech impairment. As speech develops, intellectual impairments are gradually compensated.
With motor alalia, there is a pronounced dissociation between the state of impressive and expressive speech, that is, the understanding of speech remains relatively intact, and the child’s own speech develops with gross deviations or does not develop at all. All stages of the formation of speech skills (humming, babbling, babbling monologue, words, phrases, contextual speech) occur with a delay, and the speech reactions themselves are significantly reduced.
Despite the fact that a child with afferent motor alalia is potentially available to perform any articulatory movements (as opposed to dysarthria ), sound pronunciation is grossly impaired. In this case, persistent substitutions and mixing of articulatory disputable phonemes arise, which leads to the impossibility of reproducing or repeating the sound image of a word.
With efferent motor alalia, the leading speech defect is the impossibility of performing a series of consecutive articulatory movements, which is accompanied by a gross distortion of the syllable structure of the word. The lack of formation of a dynamic speech stereotype can lead to the appearance of stuttering against the background of motor alalia.
Vocabulary in motor alalia lags far behind the age norm. New words are learned with difficulty, in the active dictionary there are mainly everyday terms. A small lexical stock leads to an inaccurate understanding of the meanings of words, their inappropriate use in speech, substitutions for semantic and sound similarity. A characteristic feature of motor alalia is the absolute predominance of nouns in the nominative case in the dictionary, a sharp restriction of other parts of speech, difficulties in the formation and differentiation of grammatical forms.
Phrasal speech with motor alalia is represented by simple short sentences (one- or two-part). As a result, with alalia there is a gross violation of the formation of coherent speech. Children cannot consistently present events, highlight the main and the secondary, determine temporary connections, cause and effect, convey the meaning of phenomena and events.
With coarse forms of motor alalia, the child has only onomatopoeia and individual babbling words, which are accompanied by active facial expressions and gestures.
Sensory Alalia Symptoms
In sensory alalia, the leading defect is impaired perception and understanding of the meaning of addressed speech. At the same time, sensory alaliks retain their physical hearing, and they often suffer from hyperacusis – increased susceptibility to various sounds.
Against the background of auditory agnosia , children with sensory alalia increase their own speech activity. However, their speech is a set of meaningless sound combinations and scraps of words, echolalia (unconscious repetition of someone else’s words). In general, with sensory alalia, speech is incoherent, meaningless and incomprehensible to others ( logoreya – “verbal salad”). In the speech of children with sensory alalia, there are numerous perseverations (obsessive repetitions of sounds, syllables), elision of syllables (omissions), paraphasias (sound substitutions), contamination (combining parts of different words with each other). Children with sensory alalia are not critical of their own speech; facial expressions and gestures are widely used for communication.
In gross forms of sensory alalia, understanding of speech is completely absent; in other cases it is situational. However, even if the child understands the meaning of the phrase in a certain context, when the word form, the order of words in the sentence, the rate of speech are changed, understanding is lost. Often in the understanding of speech, children with sensory alalia are helped by “reading from the lips” of the speaker.
Insufficiency of phonemic hearing with sensory alalia leads to nondiscrimination of paronyms; the lack of formation of the correlation of the audible and spoken word with this or that object or phenomenon.
A gross distortion of the development of speech with sensory alalia leads to secondary disorders of personality, behavior, and a delay in intellectual development. The psychological characteristics of children with sensory alalia are characterized by difficulty in turning on and retaining attention, increased distraction and exhaustion, instability of auditory perception and memory. Children with sensory alalia may show impulsivity, chaotic behavior, or, on the contrary, inertia, isolation.
In its pure form, sensory alalia is rarely observed; mixed sensorimotor alalia is usually found, which indicates the functional continuity of the speech-auditory and speech-motor analyzers.
Children with alalia need advice from a pediatric neurologist , pediatric otolaryngologist, speech therapist , and child psychologist.
- Neurological examination . It is necessary to identify and assess the nature and extent of brain damage. For this purpose, the child can be recommended EEG , echoencephalography , skull X-ray , MRI of the brain . To exclude hearing loss in sensory alalia, it is necessary to conduct otoscopy , audiometry, and other studies of auditory function . Neuropsychological examination includes diagnostics of auditory-speech memory.
- Speech therapy examination . It begins with clarifying the perinatal history and characteristics of the early development of the child. Particular attention is paid to the timing of psychomotor and speech development. Diagnostics of oral speech (impressive speech, lexico-grammatical structure, phonetic-phonemic processes, articulatory motor skills, etc.) is carried out according to the examination scheme for OHP.
Differential diagnosis of alalia is carried out with ZRR , dysarthria, hearing loss, autism , oligophrenia .
The method of corrective action in any form of alalia should be of a complex psychological, medical and pedagogical nature. Children with alalia receive the necessary assistance in specialized preschool educational institutions, hospitals, correctional centers, sanatoriums. Alalia symptoms classification reasons
Work on the speech is carried out against the background of drug therapy aimed at stimulating the maturation of brain structures; physiotherapy ( laser therapy , magnetotherapy, electrophoresis , UHF, hydrotherapy , IRT , electropuncture; transcranial electrostimulation , etc.). With alalia, it is important to work on the development of general and manual motor skills, mental functions (memory, attention, ideas, thinking).
Correction of motor alalia
Given the systemic nature of the disorder, speech therapy classes to correct alalia involve working on all aspects of speech. With motor alalia, the child is working on:
- stimulation of speech activity;
- the formation of an active and passive vocabulary,
- phrasal speech,
- the grammatical design of the statement;
- the development of coherent speech,
- sound pronunciation.
Logorhythmics and speech therapy massage are included in the canvas of speech therapy classes .
Correction of sensory alalia
With sensory alalia, tasks are set to master:
- distinguishing between non-speech and speech sounds,
- differentiation of words, correlating them with specific objects and actions,
- understanding of phrases and speech instructions,
- grammatical structure of speech.
With the accumulation of the vocabulary, the formation of subtle acoustic differentiations and phonemic perception, the development of the child’s own speech becomes possible. With various forms of alalia, relatively early teaching of children to read and write is recommended, since writing and reading allows you to better consolidate the material learned, as well as control oral speech.