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. Moreover, such children understand someone else’s speech, but cannot reproduce it on their own.
Pathology Description
A similar pathological condition is currently diagnosed in about one percent of preschool children, a little less often in schoolchildren. Motor alalia is most often affected by boys, in whom this disease is registered twice as often as in the opposite sex.
Speech is one of the most important components of the neuropsychic development of children. Its formation takes place in the first years of life, in the future it determines the quality of speech in other age periods. The act of speech is carried out through a specific system of organs related to the vocal apparatus, which consists of peripheral and central departments. The central section of the speech apparatus is represented by structures of the nervous system (subcortical nodes, pathways, cerebellum, nerves, innervating the vocal, respiratory, articulatory muscles, etc.).
The peripheral part of the vocal apparatus consists of articulatory (lips, upper and lower jaws, tongue, soft and hard palate), voice (larynx and vocal cords) and respiratory (chest, 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, which belong to the center of Broca, as well as this site directly. The center of Broca is a section of the cerebral cortex located in the posterior part of the third frontal gyrus in the left hemisphere of the brain in right-handers and providing motor organization of the speech process.
Motor alalia is a polyetiological pathological condition, i.e., one that is caused by the undesirable effect 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.
- Hypoxia of the fetus.
- Trauma to the fetus (for example, when a woman falls during pregnancy).
- Toxicosis.
- High risks of spontaneous termination of pregnancy.
- 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 injuries, and asphyxia of newborns can lead to the occurrence of speech alalia in children. In children in the first years of life, the primary causes of this pathology include:
- Genetic predisposition.
- Encephalitis.
- Traumatic brain injuries.
- Some diseases of a somatic nature that can lead to depletion of the nervous system.
- Meningitis
Risk Factors for Speech Anomalies
Risk factors for the occurrence of motor alalia in children can 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, and hospitalism (a complex of mental and somatic disorders that may be caused by a long stay in a hospital away from home and loved ones).
Varieties of Alalia
In medical practice, the following forms of this pathology are defined:
- Express (motor).
- Impressive (sensory alalia in children). This form is much less common than motor. With sensory alalia, the child does not understand enough other people's speech, 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 a hearing-analyzer. Since the perception and understanding of speech in a child with sensory alalia is impaired, the formation of speech is also impaired.
- Mixed (sensorimotor or motosensory, depending on whether a developmental disorder of any impressive or expressive speech prevails).
Motor alalia, depending on the location 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 premotor sections of the cerebral cortex are mainly affected.
How does motor alalia manifest itself in a child?
Symptoms of Alalia
This disease is characterized by the presence of both verbal and non-verbal manifestations. Non-verbal symptoms of this pathology, in the first place, include such motor disorders as improper coordination of movements, underdevelopment of finger motility, awkwardness. Motor alalia in such children can also manifest difficulties in the formation of self-care habits (for example, fastening buttons, lacing shoes, etc.), as well as in performing fine, precise movements with fingers and hands (for example, folding puzzles, assembling constructors, mosaics etc.).
Symptoms of alalia in children are important to recognize in a timely manner.
In addition, in children with this pathology, memory impairments (most often auditory-verbal), attention, perception, volitional and emotional spheres of the personality are not uncommon. In patients with alalia, both hyperactive and excessively passive behavior, fatigue and lack of performance can be observed. In addition, in children with alalia, it is often possible to notice impaired facial muscles, aggression and increased irritability, poor adaptation in the team, difficulties with adaptation to the conditions of the outside world.
Speech manifestations
Of the speech manifestations of motor alalia in a child, the following are noted:
- Erroneous change in sounds in some words (literal paraphase).
- Persistent repetitions of the same word or phrase (perseveration).
- The loss of certain sounds from words (elizia).
- Limited vocabulary (primarily verb forms and verbs).
- Replacing some complex words with similar ones in sound or meaning.
- Combining syllables from different words.
- Loss of prepositions from sentences, as well as incorrect construction of the order of words in a phrase.
In the speech of such a patient, a predominance of nouns is observed, as a rule, in the nominative case. In addition, with this disease, a partial or absolute rejection of speech (the so-called speech negativity) can be noted. Against the background of characteristic symptoms of alalia in children, stuttering may occur.
With the development of an 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 articulation movements, and this can be accompanied by a significant distortion of 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 can hardly learn new words, and their active vocabulary is more composed of phrases and words of everyday life.
Signs of alalia in children appear depending on age.
Insufficient vocabulary can lead to inadequate understanding of the meaning of a word, as well as inappropriate use of words. Children of 3 years with alalia are usually explained in simple and short sentences, which often leads to gross violations of speech formation.
Patients with this disease of children have significant difficulties in determining cause-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 can be accompanied by active facial expressions and gestures. Lag in mental development in children occurs due to severe speech impairment. With the formation of speech, such violations begin to gradually be compensated. All stages of the development of speech skills (babbling, humming, 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 affected by a number of factors, the most important of which are the degree of impairment in the child’s brain, overall development, the age when such a pathology was diagnosed, the regularity and quality of parents' activities with him.
In certain cases, after prolonged speech negativity, children begin to speak and quickly master speech skills, another group of patients has an early formation of speech, but in the subsequent it remains for a rather long period of time very scarce. In this case, other scenarios are possible.
Diagnosis of alalia in children
To diagnose this pathology, a full examination of the child is necessary for such specialists as a pediatric ENT specialist, neurologist, speech therapist, psychologist. When conducting a speech therapy examination of children, special attention should be paid to the collection of anamnesis, as well as to the features of the development of the child at an early age. To make an accurate diagnosis of motor alalia, one should also evaluate the child’s desire 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, and the presence of echolalia.
In addition, the level of passive and active vocabulary, the pronunciation quality of sounds, the syllabic structure of words, the grammatical characteristics of speech and phonemic perception are noted. To adequately assess 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 development 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, delayed speech development, oligophrenia is required.
Therapy of motor alalia
The treatment of this pathology is a whole complex of therapeutic measures. The formation of correct and full 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 medications and more diverse vitamin complexes. Physiotherapeutic techniques such as electropuncture, decimeter microwave therapy, magnetotherapy, acupuncture, electrophoresis, laser therapy, transcranial electrical stimulation, hydrotherapy are very effective in the treatment of motor alalia. In addition, the development of general and manual motor skills in a child, as well as thinking, memory, and attention, plays an important role in the treatment of alalia.
Logopedic 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, coherent speech is developed. Logo-rhythmic exercises and speech therapy massage also give a positive result.
With the development of motor alalia, it is recommended to begin to teach the child to read and write earlier, since reading and writing successfully help to develop oral speech and consolidate the learned material.
Treating alalia in children at home can be very effective.
Due to the plasticity of the children's brain and its quick adaptation skills, a complete cure for the disease is possible. Individual healthy brain cells take over the functions of inactive sites.
Each child with alalia undergoes therapy under the close supervision of a specialist. However, the home environment will not become an obstacle, because 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 deal with children's fingers, make them deft and skillful, then the baby’s speech will develop.
- Useful palm massage in a playful way.
- Finger games and gymnastics stimulate the development of fine motor skills. It can be simple exercises - for example, sorting cereals and legumes, folding mosaics and puzzles will help to activate the brain.
Today, there are a large number of video lessons on conducting classes with alalia, which can be used at home.
Possible consequences and complications
This disease in children can lead to serious violations of written language. In addition, children may develop stuttering, which manifests itself in the formation of oral speech skills.
Successful correction of such a pathology is most likely at the beginning of therapy in the early stages, from about 3-4 years old, as well as an integrated approach, which involves working with a child and drug treatment. With timely therapy, the prognosis of alalia in children is very favorable.
The importance of the degree of organic damage to the brain in a child. In case of 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 preventative measures are recommended:
- Timely register for pregnancy, undergo all examinations and follow the doctor’s prescription;
- minimize the risk of infection with infectious diseases and timely treat existing pathologies;
- avoid traumatic situations of excessive loads;
- eat balanced.
We examined the treatment of alalia in children.