5. Speech disorders

If a child in two - two and a half years does not speak at all or speaks few words, this usually worries the parents and they see a doctor.

Well, what if a child talks a lot, but is it bad? It is not uncommon for a child of three or four years to speak so slurredly that only a mother can understand him. It happens that at this age children do not make some sounds, replace one sound with another, or their rhythm and pace of speech are disturbed - they say, choking, very quickly or, conversely, they pull words, etc. Such disturbances, as a rule, do not care much parents, and they tend to explain them that “small children are generally difficult to understand!”

Of course, in the early stages of speech development, the articulation of the sounds of all children is imperfect: they distort, skip or replace many sounds. However, this can be considered the “norm” for children no older than two and a half to three years. If articulation defects are noted in older children and hold on steadily, measures should be taken to eliminate them. When these defects and in young children are expressed very strongly, it is necessary to pay attention to them - if they are associated with some kind of disorder.

Currently, speech disorders are studied quite well, and many of them are successfully cured. For a wide range of parents, a detailed acquaintance with this area is hardly needed, but it will probably be helpful to have a general understanding of it. Parents, for example, should know what is a deviation from the correct development of speech, what is related to its disorders. This will help them to turn to a speech disorder specialist in time, and the defect can be corrected sooner. Remember: the more persistent a speech disorder has become, the harder it is to treat it.

There are four main groups of speech disorders:

1. Violations of sound pronunciation.

2. Disturbances of a rhythm and rate of speech.

3. Speech disorders associated with hearing impairment.

4. Underdevelopment of speech or loss of previously available speech.

Violations of sound pronunciation include spurious language (also called dyslalia) and dysarthria - inarticulate speech.

Tongue is expressed in the absence of some sounds (the child misses them in words), in the distortion of sounds (the child pronounces them incorrectly) and in replacing one sound with another.

Tongue is functional and mechanical. In functional tongue-tiedness, the hearing and the structure of the articulatory apparatus are normal, and the causes of speech disorders lie in the weakness of the nervous processes occurring in the brain. The mechanical form of tongue-tiedness is due to the congenital abnormalities in the structure of the oral and nasal cavities (lips, teeth, palate, nasal passages, etc.). With these lesions, not only the pronunciation of sounds suffers, but very often there are also disturbances in the tone of voice, speech rhythm, etc.

Functional impediment (skipping, distortion, replacement of sounds) in the second or third year of a child's life can be considered a natural phenomenon. There is even a term: "physiological dyslalia". If the defect of pronunciation persists at an older age, then you need to contact a speech therapist.

Most defects are observed in the pronunciation of sounds that have a difficult method of articulation. Moreover, the more difficult the articulation of sound, the greater the number of defects. More often than others there are defects in the pronunciation of sounds “p” and “l” (the so-called “pagan” sounds), somewhat less often - in the pronunciation of the sounds “c”, “c”, “c” (whistling), “w”, “f "," H "," u "(sizzling).

Violations of the pronunciation of the sound "p" are extremely diverse. This is the absence of "p": "Yuk" (hand,) "Koova" (cow), "Sha" (ball); burry "p", nasal "p": the sound "p" is replaced by the nasal "ng". Very often, the sound "p" is replaced by the sounds "l", "t", "d", "g", "d". For example, "onions" or "yyuka" (hand), "kolova" or "koyova" (cow), etc.

Another difficult sound is “l.” The drawbacks of its pronunciation are almost as numerous as the sound "p". There is also a lack of sound: “apa” (paw), “oshka” (spoon), “people” (people); there is a “two-lipped” or labial-dental “l”: instead of “l”, a sound is heard, the middle between “y” and “v” is “uam-pa” or “vamp” (lamp), “ear” or “louse” ( spoon); nasal "l" when the sound "l" is replaced by a nasal sound "ng". There are more rare violations, for example, the sound "l" is replaced by the sounds "p", "d", "n", "d", "c", etc.

In cases where the sound is absent or incorrectly articulated, specially selected exercises establish the correct way of articulatory organs for the pronunciation of this sound. If there is a persistent replacement of one sound by another, this indicates that the child has not only a lack of articulatory function, but also a poor distinction between speech sounds. In such cases, along with exercises for the correction of articulation, exercises for the recognition of sounds are also carried out - education of phonemic hearing.

We do not give here the exercises that are given to children to eliminate the defects in the pronunciation of various sounds, because in each case the speech therapist takes into account the degree of the violation, its features and gives instructions accordingly. In no case do not try to correct the shortcomings of the pronunciation of the child yourself - here you can not do without the help of a specialist.

Mechanical dyslaliae are a more severe disorder: after all, the correct structure of the jaws, teeth, tongue, nasopharynx is necessary not only for the correct formation of speech, but also for good nutrition, breathing, etc. If these functions are disturbed, the child often gets sick, his body weakens . With mechanical dislalia, not only articulation, but also the understanding of other people's speech often suffers, since these processes are closely interrelated.

With the wrong structure, the lips are not mobile enough, and, of course, the pronunciation of labial sounds will suffer first: "p", "b", "m" and labial-dental sounds "f" and "c". Poor lip mobility is reflected in the pronunciation of other sounds.

With irregularities in the structure of the teeth or their absence, the articulation of the sounds formed with the participation of the front teeth, - “s”, “s”, “c”, etc., suffers.

The most frequent deviation in the structure of the jaws is the wrong bite. Bite - the corresponding location of the teeth of the upper cavity in relation to the lower teeth. With the proper structure of the jaws, the upper incisors should slightly cover the lower, lateral molars while closing. If the occlusion is abnormal, the upper or lower jaw can protrude forward, there is a so-called cross bite, etc. The wrong bite interferes with chewing, breathing (the habit of breathing with the mouth develops). All these deviations in the structure of the jaws can lead to violations of the articulation, which we described when describing a functional dyslalia, in addition, additional sounds are often obtained: whispering, smacking, etc.

Defects in the structure of the jaws, nasopharynx affect the shape of the face, and children are painfully experiencing their physical disabilities.

Treatment should begin with an attempt to straighten an existing physical defect. To do this, as soon as possible contact a specialist in oral and maxillofacial surgery. At the same time, it is necessary to consult with a speech therapist regarding what exercises for setting sounds should be done to the child.

Among the abnormalities in the development of the facial skeleton is often found congenital nezalezheieie palate (complete - the entire length or incomplete). Currently, most professionals recognize in these cases the need for early surgical intervention. Lip surgery can be done in the first hours of a child's life. With a cleft palate make a prosthesis that will close the defect; the baby can then suck. In the future, such a prosthesis will help the correct development of the articulation of sounds. In the second year, it is already possible to do plastic surgery of the palate.

Parents should not hesitate to contact the surgeon, they should not postpone it until a later time, "when the baby grows up." Speech therapy classes are of great importance, since it is very important for such children to put on the correct breathing and sound of the voice, to train them to articulate sounds. In the crevices of the palate, speech therapy classes should begin before the operation and continue after it.

Quite often there is a violation of the pronunciation of the sounds "p", "sh", "g", "h", "u" when shortening the hyoid ligament ("bridle"). The question of whether to trim the frenulum is decided depending on how strongly the volume of movements of the tongue is reduced. Many experts strongly object to surgical treatment and recommend vibration massage and special gymnastics of the tongue.

This group of diseases includes dysarthria, or articulate speech disorder that occurs during brain injuries, inflammatory processes, or disorders of the cerebral circulation. All movements, including articulators, are very slow, awkward. Chewing and swallowing is difficult, and therefore salivation is often observed. The volume of movements of the tongue and lips is limited: the child cannot stretch his lips with a straw, bite his teeth, inflate his cheeks. The voice is quiet, deaf, sometimes disappears completely. Speech rate is slow, with uneven pauses.

The whole course of speech development in dysarthria is delayed, the babble period is often absent, by 2–3 years separate words appear, and the child begins to pronounce phrases (short, usually incorrectly constructed) only by 5–6 years. Later, the vocabulary increases, speech develops, but it remains illegible, blurred and monotonous. Some defectologists believe that children with dysarthria are mentally retarded. Most find that in these children there is only a delay in the development of intelligence associated with motor and speech disorders. With an improvement in their condition, these children can study well and exercise normal mental abilities.

Children with dysarthria need to be monitored by a neuropathologist (at least periodically). Since this disorder is always the result of a brain disease, it must be treated for a long time and patiently. The same lengthy and patient work should also be carried out to correct speech defects - of course, under the guidance of a speech therapist.

Disorders of rhythm and tempo of speech are of two types: non-convulsive and convulsive.

Often, children's speech becomes obscure, unintelligible due to the fact that its pace is disturbed: it either slows down very much or accelerates very much - these are violations of a non-convulsive nature.

Slow speech is based on the enhancement of the inhibitory process. Here there can be a stretched, slow pronunciation of sounds in a word, pauses between them - the child utters words almost syllableally (“vi ... for ... from ... ba ... and ... ku ..."); there may be a lengthening of the pauses between the words ("give ... me ... a hand ..."). The speech is monotonous, painful, causes tension and fatigue in the listeners, but the children themselves usually do not notice their defect.

The treatment consists in the use of tonics, therapeutic gymnastics and exercises in speech therapy rhythmics.

Acceleration of the rate of speech is associated with the predominance of the process of excitation in a child. The increase in the rate of speech is combined with the rapid pace of all motor responses. When these children are worried, it results in an even greater acceleration of speech, swallowing, rearrangement of syllables, etc.

... The treatment of such children is primarily in the need to reduce their general excitability (with the help of drugs, physiotherapy).

Imitation plays a large role in the development of speech rate disorders. Therefore, if someone in your family has a violation of rhythm and pace of speech (and usually it happens), then this person should also be treated, otherwise the child will have relapses all the time.

Stuttering is a disorder of rhythm and pace of speech with spasmodic spasm of speech muscles. It manifests itself in two forms - the so-called stuttering development and reactive stuttering.

Stuttering development is observed in early childhood, when the child still speaks ill, has many defects of articulation. If they talk to the baby at this time, teach him difficult words and phrases, then he can start stuttering. So, Yura P., at the age of two years and ten months, recited many poems, sang songs, was constantly involved by parents in conversation and made everyone laugh by using such “adult” words as “unthinkable”, “agreed”, etc. And then one day, telling his mother how he walked with his grandmother and ate ice cream, Yura suddenly stumbled on this word: “M-mo ... m-mo ..." and then he began to talk with a stutter.

Sometimes parents can not specify a certain point in the beginning of stuttering - it develops gradually.

The basis for the development of such a form of stuttering is the over-stimulation of the speech areas of the child’s brain. Therefore, the first measure should be the cessation of all conversations with the child. It is necessary to calm the baby, not allow him to talk, and limit the conversation with him.

Sometimes this “silence regime” straightens the situation for seven to ten days. Sometimes the disorder is quite persistent. As soon as the child has a stutter, you need to contact a speech therapist and strictly follow all his instructions.

Reactive stuttering (which develops as a reaction to some kind of strong effect) is most often the result of fright, mental trauma (severe family conflicts) or debilitating long-term illnesses.

Usually, all children ever experience fright, suffer more or less severe infections, witness conflicts in the family. However, stuttering occurs only in a relatively small part of the guys. That is why doctors believe that children who have a predisposition to this are starting to stutter are obviously children with some constitutional weakness of the nervous system. Indeed, stuttering children can usually see other signs of a neurotic state: poor appetite, restless sleep, night terrors, urinary incontinence, etc.

Specialists who treat stuttering, such as S. S. Lyapidevsky, believe that the development of stuttering always has a weakened cortex at the base: against this background, strong negative effects cause a breakdown of nervous activity — the development of neurosis, one of whose manifestations will be stuttering.

In the treatment of stuttering, along with speech therapy, medical assistance is also needed. A stuttering child must be under the supervision of a neurologist. Experience shows that the most successful treatment is stuttering in the hospital.

We have already said that we will not concern here either the treatment methods or the nature of the exercises that are used in the treatment of certain speech disorders, so that the parents do not try to start treating the child without the advice of a speech therapist and doctor. But we can talk about the prevention of the development of stuttering in children - this is exactly what the family and children's institution should take care of.

The children calm, balanced stuttering is extremely rare; This means that special attention should be paid to the so-called nervous children - this is what threatens the development of speech neuroses and, first of all, stuttering.

For such children it is especially important to establish a firm regimen, to ensure that they have enough sleep, do not overwork. It is necessary to create for them a calm atmosphere in the family, in kindergarten or school: children are equally hard to feel both the rough treatment of them, and quarrels, conflicts between loved ones.

Relatively small children should also be careful in speech loads: if the child is agitated, weeping, sleeping uneasily, etc., one should not read him too much, tell him, should not rush to teach him difficult words, difficult phrases, especially he also has a "physiological impediment". Against the background of unworked articulation, the abundance of difficult new words will easily lead to a “breakdown” of nervous activity.

From our point of view, the prevention of stuttering in nervous children is an extremely important task. If parents are forced to comply with all these conditions, when the trouble happened - the child began to stutter, then, to be sure, it is easier to take the necessary measures in advance and try to save the baby from developing his speech neurosis.

It must be borne in mind that stuttering often resumes after treatment. The reasons for the recurrence of stuttering are the same as the reasons that originally caused it: conflicts in the family and school, overwork, weakening infections. Consequently, recurrences of stuttering can be warned if the people around them try to create a calm atmosphere for the child.

Hearing impairment and related speech disorders.

So far we have talked about such violations of speech function, in which the hearing of the child does not suffer. Meanwhile, even a slight impairment of hearing results in delayed speech development. If during this period there is a significant loss of hearing, the child’s speech will not develop at all.

When they want to find out if a small child hears, they first check how he reacts to sounds of medium volume and loud: conversation, shouting, ringing. If the baby does not turn on these sounds, then with a high degree of probability we can say that he is deaf. Однако если вы хлопнули дверью или похлопали в ладоши и ребенок дал реакцию — это вовсе не доказательство наличия у него слуха, т. к. это будет реакция на вибрацию воздуха, а не на звук.

Для более старших ребятишек — около пяти месяцев и более — хорошей пробой является такая: ребенку дают две одинаковые звучащие игрушки — две дудки, дне резиновые птички, две шарманки и т. д. Одна из них исправна и звучит, другая — испорчена. Если ребенок слышит, он всегда выбирает звучащую игрушку, глухой же ребенок играет обеими игрушками или обе оставляет без внимания.

При малейшем подозрении на нарушение слуха у ребенка нужно обратиться к врачу. У детей примерно с 5 лет имеется возможность очень точного определения того, в каких пределах потерян слух, с помощью специального прибора — аудиометра. Аудиометр позволяет выяснить, какие звуковые колебания и при какой силе ребенок воспринимает. (Частоту колебаний звука в секунду определяют в особых единицах — герцах, а силу его — в децибелах).

При обследовании слуха с помощью аудиометра вычерчивают кривую: по горизонтали откладываются те звуковые частоты, в пределах которых больной слышит, а по вертикали — силу звуков, при которой они воспринимаются. Потеря слуха характеризуется обоими этими показателями.

Обычно люди говорят с громкостью (т. е. силой звуков) в 20–40 децибелов (дб), а частота звуковых колебаний находится в пределах от 250 до 2000 герц (гц) — это называют «зоной речевых частот».

Глухота не означает, что ухо не улавливает никаких звуков: какие-то остатки слуха всегда есть. Но беда в том, что они могут быть восприняты лишь при очень большой силе звука — в 80—100 дб (нужно сказать, что 80 дб — это крик, а 100 дб — фортиссимо большого оркестра!).

В зависимости от того, каковы остатки слуха у ребенка, и ведется с ним дальнейшая работа.

Очень большое значение имеет возраст, когда ребенок потерял слух. Чем раньше это случилось, тем тяжелее это сказывается на речи. Дети, родившиеся глухими и потерявшие слух на втором-третьем году жизни, будут немыми, они не могут овладеть речью без специального обучения. Но речевой аппарат этих детей обычно в порядке, у них нет поражения речевых отделов мозга, поэтому при правильных занятиях умственное развитие этих детей будет нормальным, а позднее у них ставится и звуковая речь.

Дети, потерявшие слух в пять-шесть лет, теряют речь лишь в редких случаях, а оглохшие в семь — одиннадцать лет сохраняют речь полностью.

Затруднения в овладении речью возникают уже при снижении слуха на 15–20 дб — такие случаи называют не глухотой, а тугоухостью. Эти дети тоже требуют специального лечения и обучения.

Тугоухость и даже глухота совсем не свидетельствуют о том, что ребенок обречен на задержку умственного развития. Можно привести большое количество примеров, когда несмотря на тяжелую тугоухость, приближающуюся к глухоте, дети могли обучаться в массовой школе. Но это те случаи, когда родители рано обращались к логопеду и упорно занимались с ребятами. Родители получают очень подробную инструкцию и обучают ребенка (обучаясь вместе с ним) зрительному восприятию речи («чтению» мимики говорящего человека) и восприятию тактильно-вибрационной чувствительности (произнесение гласных и звонких согласных сопровождается вибрацией гортани, которую можно ощутить рукой). Это требует много времени и усилий со стороны семьи, но обеспечивает правильное развитие ребенка. Примерно та же работа проводится и с глухими детьми, но их обучение, как правило, осуществляется в специальных школах.

Главное, что хотелось бы здесь подчеркнуть: при своевременном обращении к логопеду и систематических занятиях тугоухий или глухой ребенок вырастет полноценным человеком, поэтому родители не должны падать духом. Надо настроить себя и ребенка на спокойную длительную работу, которая, как правило, завершается успехом.

Недоразвитие речи и утрата имевшейся речи.

Недоразвитие речевой деятельности (алалия) является или следствием того, что созревание нервных клеток речевой области левого полушария в силу каких-то причин запаздывает, или результатом раннего поражения этих клеток при инфекциях, интоксикациях, родовых травмах или травмах вскоре после рождения. Утрата речи (афазия) происходит при очаговых поражениях речевых областей коры мозга у детей или взрослых людей, речь которых уже была сформирована.

Алалии разделяют на моторную, когда страдает речь самого ребенка, и сенсорную, когда нарушается понимание речи других людей. Обычно на практике у ребенка выделяется лишь преобладание моторных или сенсорных нарушений. Моторная и сенсорная алалия в чистом виде почти не встречаются.

У детей, страдающих алалией, речь развивается поздно, запас слов пополняется медленно, и используются в речи они неправильно. Ребенок часто ищет нужную последовательность звуков в слове, но не может ее найти; это приводит к многократным повторениям, перестановке слогов, искажению слов. «Мунека… магака… магага», — мучительно подбирает звукосочетания пятилетний Гриша, пытаясь сказать слово «бумага».

Дети-алалики не изменяют слова по числам, падежам, в их речи отсутствуют связки и т. д., поэтому в семь-восемь лет ребенок говорит как двух-трехлетний: «Катя гуляет садик», «книга бах стол пол».

Дети с алалией обычно плохо учатся. Им трудно дается последовательность произнесения звуков, поэтому они плохо читают, а плохая техника чтения мешает пониманию читаемого.

У детей-алаликов наблюдается плохое развитие моторики — они малоподвижны, неловки, медлительны. Многие из них с большим трудом могут научиться одеваться, причесываться и т. д. Тонкие движения пальцев рук неразвиты, некоординированны.

Поскольку имеется недоразвитие речевых областей мозга, в работе с детьми-алаликами нужно использовать другие области мозга, более полноценные — слуховые, зрительные или осязательные и в занятиях опираться главным образом на них. Обычно у этих детишек имеются более или менее выраженные невротические наслоения. Это тоже требует лечения. Нужно обратить внимание на развитие общей моторики; логопеды здесь отмечают особенно благотворное влияние занятий по ритмике. С нашей точки зрения, очень большое влияние должна также оказать тренировка тонких движений пальцев рук — вы помните о тесной связи функций пальцев рук и речи?

В более легких случаях алалии родители с помощью логопеда сами могут справиться с расстройством речи ребенка. В более тяжелых случаях нужно помещать ребенка в специальные лечебные учреждения. За три-четыре месяца лечения и обучения ребенка в стационаре у детей пяти-шести лет с отсутствием многих звуков, с отдельными лепетными словами появляется речь фразами (конечно, простыми, типа «дети идут в школу», «Валя, на книгу»), словарь увеличивается на несколько десятков слов, ребята заучивают стихотворения.

При афазии, как и при алалии, нарушения обычно носят смешанный характер, однако, как правило, преобладает потеря способности понимать чужую речь или способности артикулировать слова.

Here is an example. У мальчика 13 лет, ученика 6-го класса, стала расти опухоль в левой височной области; он начал забывать названия предметов и имена людей, затем перестал понимать даже простые фразы. Наряду с таким грубым нарушением понимания речи, мальчик легко подражал слышимым словам и даже мог механически читать, совершенно не понимая того, что читает. Это — случай с преимущественным нарушением понимания.

Другой пример: девочка тоже 13 лет, у которой развилась опухоль в височной и нижнетеменной областях. У нее трудности в понимании речи окружающих были значительно меньше, но собственная ее речь пострадала очень сильно. Например, она говорила: «Девочка рас… рас… ращ… ращ… азывает волосы».

Оба эти случая окончились благополучно, и после операций дети поправились.

Афазия, даже очень тяжелая, проходит у детей быстро, если устранена основная причина расстройства речи — удалена опухоль мозга, рассосалось кровоизлияние после травмы и т. д.

Восстановление речи у детей происходит не только быстрее, но и полнее, чем у взрослых людей. Однако нельзя полагаться только на высокие восстановительные возможности детского мозга. Нужно лечить ребенка, и нужно с ним заниматься. В остром периоде лучше лечить в стационаре, когда же состояние улучшится, можно лечить детей амбулаторно, одновременно проводя с ними логопедические занятия.

В заключение этого раздела хочется подвести небольшой итог.

Психическое здоровье ребенка, в том числе и правильное развитие у него речи, во многом зависит от внимания и заботы семьи. Логопеды утверждают, что 80 % случаев заикания — невротического происхождения. А разве режим, спокойная обстановка, общее укрепление нервной системы ребенка не в наших руках?! Подумайте, какой огромный процент речевых неврозов можно предупредить, если взрослые достаточно почувствуют свою ответственность за это!

Еще один вопрос. Когда мы говорили о лечении разных форм речевых расстройств, то все время подчеркивали необходимость длительной и систематической работы с ребенком. Это — основное условие, которое поможет вам справиться с бедой, если она случилась.

Dyslalia, dysarthria, disturbances in the tempo and rhythm of speech, alalia, aphasia - you can cope with all these disorders completely or achieve a significant improvement in the state of speech, but you must help your child persistently, with love and faith in success!