Alaliya – the rough underdevelopment or total absence of the speech caused by the organic defeats of the cortical speech centers of a brain which happened vnutriutrobno or in the first 3 years of life of the child. At an alaliya late emergence of speech reactions, poverty of a lexicon, agrammatisms, violation of syllabic structure, a sound pronunciation and phonemic processes is noted. The child with an alaliya needs neurologic and logopedic inspection. - medico-pedagogical influence at an alaliya includes medicamentous therapy, development of mental functions, lexical and grammatical and fonetiko-phonemic processes, the coherent speech.
Alaliya – the deep not formation of speech function caused by organic damage of speech zones of a cerebral cortex. At an alaliya the underdevelopment of the speech has system character, i.e. violation of all its components – fonetiko-phonemic and lexical and grammatical takes place. Unlike aphasia at which loss of earlier being present speech takes place the alaliya is characterized by initial lack or sharp restriction of the expressional or impressivny speech. Thus, speak about an alaliya in case organic damage of the speech centers happened in pre-natal, intranatalny or early (up to 3 years) the period of development of the child.
Alaliya is diagnosed approximately for 1% of preschool children and 0,6-0,2% of children of school age; at the same time twice this violation of the speech meets at boys more often. Alaliya is the clinical diagnosis to which in logopedics there corresponds the speech conclusion GUS (general underdevelopment of the speech).
The factors leading to an alaliya are diverse and can influence during various periods of early ontogenesis. So, the fruit hypoxia, pre-natal infection (TORCH syndrome), threat of spontaneous termination of pregnancy, toxicoses, falling of the pregnant woman with a fruit travmatization, chronic somatic diseases of future mother (arterial hypotonia or hypertensia, seryodechny or pulmonary insufficiency) can bring in the antenatalny period to organic defeat of the speech centers of a cerebral cortex.
As natural result of the burdened course of pregnancy serve complications of childbirth and perinatal pathology. Alaliya can be a consequence of asphyxia of newborns, prematurity, an intra cranial patrimonial trauma at premature, transient or long birth, application of tool obstetric grants.
Among the etiopatogenetichesky factors of an alaliya influencing in the first years of life of the child it is necessary to allocate the encephalitis, meningitis, ChMT, somatic diseases leading to exhaustion of TsNS (hypotrophy). Some researchers point to hereditary, family predisposition to an alaliya. Frequent and long diseases of children in the first years of life (a SARS, pneumonia, endokrinopatiya, rickets and so forth), operations under the general anesthesia, adverse social conditions (pedagogical neglect, a gospitalizm syndrome, deficiency of speech contacts) aggravate action of the leading reasons of an alaliya.
As a rule, in the anamnesis of children with an alaliya participation not of one, but the whole complex of the factors leading to the minimum brain dysfunction – MMD is traced.
Organic injuries of a brain cause delay of maturing of nervous cages which remain at a stage of young unripe neyroblast. It is followed by decrease in excitability of neurons, inertness of the main nervous processes, a functional exhaustion of cells of a brain. Damages of a cerebral cortex at an alaliya carry unsharply expressed, but multiple and bilateral character that limits independent compensatory opportunities of speech development.
Classification of an alaliya
For many years studying of a problem the set of classifications of an alaliya depending on mechanisms, manifestations and degree of expressiveness of an underdevelopment of the speech was offered. Now in logopedics classification of an alaliya by V. A. Kovshikov according to which allocate uses:
- expressional (motor) alaliya
- impressivny (touch) alaliya
- mixed (a sensomotorny or motor-touch alaliya with prevalence of violation of development of the impressivny or expressional speech)
Early organic defeat of cortical department of the rechedvigatelny analyzer is the cornerstone of emergence of a motor form of an alaliya. In this case at the child own speech does not develop, however the understanding the stranger of the speech remains safe. Depending on the damaged zone distinguish an afferent motor and efferent motor alaliya. At an afferent motor alaliya defeat of the post-central crinkle (the lower parietal departments of the left hemisphere) takes place that is followed by kinestetichesky artikulyatorny apraxia. The efferent motor alaliya arises at defeat of premotorny bark (Brock's center, a back third of the lower frontal crinkle) and is expressed in kinetic artikulyatorny apraxia.
The touch alaliya arises at defeat of cortical department of the recheslukhovy analyzer (Vernike's center, a back third of the top temporal crinkle). At the same time the highest cortical analysis and synthesis of sounds of the speech and, despite safe physical hearing is violated, the child does not understand the speech of people around.
Symptoms of a motor alaliya
At a motor alaliya take place characteristic nonverbal (neurologic, psychological) and speech manifestations. The neurologic symptomatology at a motor alaliya is presented, first of all, by motive frustration: awkwardness, insufficient co-ordination of movements, poor development of motility of fingers of hands. Children have difficulties with mastering skills of self-service (fastening of buttons, a footwear zashnurovyvaniye, etc.), performance of melkomotorny operations (folding of a mosaic, puzzles and so forth).
Considering the psychological characteristic of children with a motor alaliya, it should be noted violations of memory (especially slukhorechevy), attention, perception, the emotional and strong-willed sphere. On features of behavior children with a motor alaliya can be hyperactive, stirred up or inactive, slowed down. Most of children with a motor alaliya have the reduced working capacity, high fatigue, speech negativism. Intellectual development at children-alalikov suffers again, owing to speech insufficiency. In process of development of the speech intellectual violations are gradually compensated.
At a motor alaliya the expressed dissociation between a condition of the impressivny and expressional speech is noted, i.e. the understanding of the speech remains rather safe, and own speech at the child develops with rough deviations or does not develop absolutely. All stages of formation of speech skills (festivities, babble, a lepetny monologue, words, phrases, the contextual speech) happen to delay, and speech reactions are considerably reduced.
In spite of the fact that performance of any artikulyatorny movements is potentially available to the child with an afferent motor alaliya (unlike a dizartriya), the sound pronunciation is roughly broken. At the same time there are permanent replacements and mixtures artikulyatsionno of disputable phonemes that results in impossibility of reproduction or repetition of a sound image of the word.
At an efferent motor alaliya the leading speech defect is the impossibility of performance of a series of consecutive articulation movements that is followed by rough distortion of syllabic structure of the word. Not formation of a dynamic speech stereotype can lead to emergence of stutter against the background of a motor alaliya.
The lexicon at a motor alaliya considerably lags behind age norm. New words are acquired hardly, in the active dictionary there are, mainly, everyday terms. The small lexical stock causes inexact understanding of word meanings, their inappropriate use in speeches, replacements on semantic and sound similarity. Characteristic feature of a motor alaliya is absolute prevalence in the dictionary of nouns in the Nominative case, sharp restriction of other parts of speech, difficulties in education and differentiation of grammatical forms.
The phrase speech at a motor alaliya is submitted by simple short sentences (one - or two-member). As a result, at an alaliya there is a gross violation of formation of the coherent speech. Children cannot consistently state an event, allocate main and minor, define temporary communications, cause and effect, to convey meaning of the phenomena and events.
At gross forms of a motor alaliya the child has only onomatopoeias and separate lepetny words which are followed by an active mimicry and gesticulation.
Symptoms of a touch alaliya
At a touch alaliya the leading defect is violation of perception and understanding of sense of the turned speech. At the same time physical hearing at touch alalik is kept, and they quite often suffer from a giperakuziya – the raised susceptibility to various sounds.
Against the background of acoustical agnosia own speech activity at children with a touch alaliya is increased. However their speech represents a set of senseless sound combinations and scraps of words, ekholaliya (unconscious repetition of someone else's words). In general at a touch alaliya the speech is incoherent, deprived of sense and is unclear for people around ( – "verbal salad"). At the speech of children with a touch alaliya there are numerous perseveration (persuasive repetitions of sounds, syllables), elisions of syllables (admissions), paraphasias (sound replacements), contaminations (association of parts of different words with each other). To own speech children with a touch alaliya are not critical; for communication widely use a mimicry and gestures.
At gross forms of a touch alaliya the understanding of the speech is absent absolutely; in other cases has situational character. However, even if the sense of the phrase in a certain context is available to the child, at change of a word form, words order in the sentence, tempo of speech the understanding is lost. Often with judgment of the speech children with a touch alaliya are helped by "reading from lips" speaking.
Insufficiency of phonemic hearing at a touch alaliya leads to not distinction of words paronyms; not formation of correlation of the heard and pronounced word with this or that subject or the phenomenon.
Rough distortion of development of the speech at a touch alaliya leads to secondary violations of the personality, behavior, a delay of intellectual development. Psychological features of children with a touch alaliya are characterized by the difficulty of inclusion and deduction of attention increased by an otvlekayemost and an exhaustion, instability of acoustical perception and memory. At children with a touch alaliya impulsiveness, a randomness of behavior or, on the contrary, inertness, isolation can be noted.
Purely touch alaliya is observed infrequently; usually the mixed sensomotorny alaliya meets that indicates functional continuity of recheslukhovy and rechedvigatelny analyzers.
Inspection of children with an alaliya
Children with an alaliya need consultation of the children's neurologist, children's otolaryngologist, logopedist, children's psychologist. Neurologic inspection of children with an alaliya is necessary for identification and assessment of character and a damage rate of a brain. For this purpose EEG, an ekhoentsefalografiya, a X-ray analysis of a skull, brain MRT can be recommended to the child. The relative deafness exception at a touch alaliya requires carrying out an otoskopiya, audiometriya, etc. researches of acoustical function.
Neuropsychological inspection of the child with an alaliya includes diagnostics of slukhorechevy memory. Logopedic inspection at an alaliya begins with clarification of the perinatal anamnesis and features of early development of the child. Special attention is paid for terms of psychomotor and speech development. Diagnostics of oral speech (the impressivny speech, a lexical and grammatical system, fonetiko-phonemic processes, articulation motility etc.) is carried out according to the scheme of inspection at ONR.
Correction of an alaliya
The technique of correctional influence at any forms of an alaliya has to carry complex - medico-pedagogical character. Children with an alaliya receive the necessary help in specialized preschool educational institutions, hospitals, the correctional centers, sanatoria.
Work on the speech is conducted against the background of the medicamentous therapy directed to stimulation of maturing of brain structures; physical therapy (laser therapy, magnetotherapy, electrophoresis, DMV, balneotherapy, IRT, elektropunktura; transkranialny electrostimulation, etc.). At an alaliya it is important to work on development of the general and manual motility, mental functions (memory, attention, representations, thinking).
Considering the system nature of violation, logopedic classes in correction of an alaliya assume work on all parties of the speech. At a motor alaliya at the child speech activity is stimulated; work on formation of the active and passive dictionary, the phrase speech, grammatical execution of the statement is conducted; development of the coherent speech, sound pronunciation. The outline of logopedic occupations joins a logoritmika and logopedic massage.
At a touch alaliya tasks to seize distinction of nonverbal and speech sounds, differentiation of words, their correlation with concrete subjects and actions, understanding of phrases and speech instructions, a grammatical system of the speech are set. In process of accumulation of the dictionary, formation of thin acoustic differentiations and phonemic perception there is possible a development of own speech of the child.
At various forms of an alaliya rather early training of children in the diploma as the letter and reading allows to fix better the acquired material is recommended, and also to control oral speech.
Forecast and prevention of an alaliya
As the key to success of correctional work at an alaliya serves its early (from 3-4 years) the beginning, complex character, system impact on all components of the speech, formation of speech processes in unity with development of mental functions. At a motor alaliya the speech forecast more favorable; at a touch and sensomotrny alaliya – uncertain. Substantially the forecast is influenced by extent of organic damage of a brain. In the course of school training children with an alaliya can have violations of a written language (a dysgraphia and a dyslexia).
The prevention of an alaliya at children includes providing conditions for favorable course of pregnancy and childbirth, early physical development of the child. Correctional work on overcoming an alaliya allows to prevent emergence of secondary intellectual insufficiency.