Specific speech articulation disorder. Specific speech articulation disorders In cases of severe articulatory disorders

Most speech sounds are acquired by 6-7 years; by 11 years all sounds should be acquired.

Includes three stages:

Dysarthria

Dysarthria is a disorder of the pronunciation organization of speech associated with damage to the central part of the speech motor analyzer and a violation of the innervation of the muscles of the articulatory apparatus. The structure of the defect in dysarthria includes violations of speech motor skills, sound pronunciation, speech breathing, voice and prosodic aspects of speech; with severe lesions, anarthria occurs. If dysarthria is suspected, neurological diagnostics (EEG, EMG, ENG, MRI of the brain, etc.) and speech therapy examination of oral and written speech are performed. Corrective work for dysarthria includes therapeutic interventions (medication courses, exercise therapy, massage, physical therapy), speech therapy classes, articulation gymnastics, speech therapy massage.

Dysarthria

Dysarthria is a severe speech disorder, accompanied by a disorder of articulation, phonation, speech breathing, tempo-rhythmic organization and intonation coloring of speech, as a result of which speech loses its articulation and intelligibility. Among children, the prevalence of dysarthria is 3-6%, but in recent years there has been a pronounced upward trend in this speech pathology. In speech therapy, dysarthria is one of the three most common forms of oral speech disorders, second only to dyslalia in frequency and ahead of alalia. Since the pathogenesis of dysarthria is based on organic lesions of the central and peripheral nervous system, this speech disorder is also studied by specialists in the field of neurology and psychiatry.

Causes of dysarthria

Most often (in 65-85% of cases) dysarthria accompanies cerebral palsy and has the same causes. In this case, organic damage to the central nervous system occurs in the prenatal, birth or early periods of child development (usually up to 2 years). The most common perinatal factors of dysarthria are toxicosis of pregnancy, fetal hypoxia, Rhesus conflict, chronic somatic diseases of the mother, pathological course of labor, birth injuries, birth asphyxia, kernicterus of newborns, prematurity, etc. The severity of dysarthria is closely related to the severity of motor disorders during Cerebral palsy: for example, with double hemiplegia, dysarthria or anarthria is detected in almost all children.

In early childhood, damage to the central nervous system and dysarthria in a child can develop after suffering neuroinfections (meningitis, encephalitis), purulent otitis media, hydrocephalus, traumatic brain injury, severe intoxication.

Classification of dysarthria

The neurological classification of dysarthria is based on the principle of localization and a syndromic approach. Taking into account the localization of damage to the speech-motor apparatus, the following are distinguished:

bulbar dysarthria associated with damage to the nuclei of the cranial nerves (glossopharyngeal, sublingual, vagus, sometimes facial, trigeminal) in the medulla oblongata
pseudobulbar dysarthria associated with damage to the corticonuclear pathways
extrapyramidal (subcortical) dysarthria associated with damage to the subcortical nuclei of the brain
cerebellar dysarthria associated with damage to the cerebellum and its pathways
cortical dysarthria associated with focal lesions of the cerebral cortex.

Depending on the leading clinical syndrome, cerebral palsy may include spastic-rigid, spastic-paretic, spastic-hyperkinetic, spastic-atactic, ataxic-hyperkinetic dysarthria.

Speech therapy classification is based on the principle of speech intelligibility for others and includes 4 degrees of severity of dysarthria:

1st degree (erased dysarthria) – defects in sound pronunciation can only be identified by a speech therapist during a special examination.

2nd degree - defects in sound pronunciation are noticeable to others, but overall speech remains understandable.

3rd degree - understanding of the speech of a patient with dysarthria is available only to those close to him and partially to strangers.

4th degree – speech is absent or incomprehensible even to the closest people (anarthria).

Symptoms of dysarthria

The speech of patients with dysarthria is slurred, unclear, and incomprehensible (“porridge in the mouth”), which is due to insufficient innervation of the muscles of the lips, tongue, soft palate, vocal folds, larynx, and respiratory muscles. Therefore, with dysarthria, a whole complex of speech and non-speech disorders develops, which constitute the essence of the defect.

Impaired articulatory motor skills in patients with dysarthria may manifest as spasticity, hypotonia, or dystonia of the articulatory muscles. Muscle spasticity is accompanied by constant increased tone and tension in the muscles of the lips, tongue, face, and neck; tightly closed lips, limiting articulatory movements. With muscle hypotonia, the tongue is flaccid and lies motionless on the floor of the mouth; the lips do not close, the mouth is half open, hypersalivation (salivation) is pronounced; Due to paresis of the soft palate, a nasal tone of voice appears (nasalization). In the case of dysarthria occurring with muscular dystonia, when attempting to speak, muscle tone changes from low to increased.

Sound pronunciation disturbances in dysarthria can be expressed to varying degrees, depending on the location and severity of damage to the nervous system. With erased dysarthria, individual phonetic defects (sound distortions) and “blurred” speech are observed.” With more pronounced degrees of dysarthria, there are distortions, omissions, and substitutions of sounds; speech becomes slow, inexpressive, slurred. General speech activity is noticeably reduced. In the most severe cases, with complete paralysis of the speech motor muscles, motor speech becomes impossible.

Specific features of impaired sound pronunciation in dysarthria are the persistence of defects and the difficulty of overcoming them, as well as the need for a longer period of automation of sounds. With dysarthria, the articulation of almost all speech sounds, including vowels, is impaired. Dysarthria is characterized by interdental and lateral pronunciation of hissing and whistling sounds; voicing defects, palatalization (softening) of hard consonants.

Due to insufficient innervation of the speech muscles during dysarthria, speech breathing is disrupted: exhalation is shortened, breathing at the time of speech becomes rapid and intermittent. Voice disturbances in dysarthria are characterized by insufficient strength (quiet, weak, fading voice), changes in timbre (deafness, nasalization), melodic-intonation disorders (monotony, absence or inexpressibility of voice modulations).

Due to slurred speech in children with dysarthria, auditory differentiation of sounds and phonemic analysis and synthesis suffer secondarily. The difficulty and insufficiency of verbal communication can lead to an undeveloped vocabulary and grammatical structure of speech. Therefore, children with dysarthria may experience phonetic-phonemic (FFN) or general speech underdevelopment (GSD) and associated corresponding types of dysgraphia.

Characteristics of clinical forms of dysarthria

Bulbar dysarthria is characterized by areflexia, amymia, disorder of sucking, swallowing solid and liquid food, chewing, hypersalivation caused by atony of the muscles of the oral cavity. The articulation of sounds is slurred and extremely simplified. All the variety of consonants is reduced into a single fricative sound; sounds are not differentiated from each other. Nasalization of voice timbre, dysphonia or aphonia is typical.

With pseudobulbar dysarthria, the nature of the disorder is determined by spastic paralysis and muscle hypertonicity. Pseudobulbar paralysis manifests itself most clearly in impaired tongue movements: great difficulty is caused by attempts to raise the tip of the tongue upward, move it to the sides, or hold it in a certain position. With pseudobulbar dysarthria, switching from one articulatory posture to another is difficult. Typically selective impairment of voluntary movements, synkinesis (conjugal movements); profuse salivation, increased pharyngeal reflex, choking, dysphagia. The speech of patients with pseudobulbar dysarthria is blurred, slurred, and has a nasal tint; the normative reproduction of sonors, whistling and hissing, is grossly violated.

Subcortical dysarthria is characterized by the presence of hyperkinesis - involuntary violent muscle movements, including facial and articulatory ones. Hyperkinesis can occur at rest, but usually intensifies when attempting to speak, causing articulatory spasm. There is a violation of the timbre and strength of the voice, the prosodic aspect of speech; Sometimes patients emit involuntary guttural screams.

With subcortical dysarthria, the tempo of speech may be disrupted, such as bradylalia, tachylalia, or speech dysrhythmia (organic stuttering). Subcortical dysarthria is often combined with pseudobulbar, bulbar and cerebellar forms.

A typical manifestation of cerebellar dysarthria is a violation of the coordination of the speech process, which results in tremor of the tongue, jerky, scanned speech, and occasional cries. Speech is slow and slurred; The pronunciation of front-lingual and labial sounds is most affected. With cerebellar dysarthria, ataxia is observed (unsteadiness of gait, imbalance, clumsiness of movements).

Cortical dysarthria in its speech manifestations resembles motor aphasia and is characterized by a violation of voluntary articulatory motor skills. There are no disorders of speech breathing, voice, or prosody in cortical dysarthria. Taking into account the localization of lesions, kinesthetic postcentral cortical dysarthria (afferent cortical dysarthria) and kinetic premotor cortical dysarthria (efferent cortical dysarthria) are distinguished. However, with cortical dysarthria there is only articulatory apraxia, while with motor aphasia not only the articulation of sounds suffers, but also reading, writing, understanding speech, and using language.

Diagnosis of dysarthria

The examination and subsequent management of patients with dysarthria is carried out by a neurologist (children's neurologist) and speech therapist. The extent of the neurological examination depends on the expected clinical diagnosis. The most important diagnostic value is given by electrophysiological studies (electroencephalography, electromyography, electroneurography), transcranial magnetic stimulation, MRI of the brain, etc.

Speech therapy examination for dysarthria includes assessment of speech and non-speech disorders. Assessment of non-speech symptoms involves studying the structure of the articulatory apparatus, the volume of articulatory movements, the state of facial and speech muscles, and the nature of breathing. The speech therapist pays special attention to the medical history speech development. As part of the diagnosis of oral speech in dysarthria, a study of the pronunciation aspect of speech (sound pronunciation, tempo, rhythm, prosody, speech intelligibility) is carried out; synchronicity of articulation, breathing and voice production; phonemic perception, level of development of the lexico-grammatical structure of speech. In the process of diagnosing written speech, tasks are given for copying text and writing from dictation, reading passages and comprehending what is read.

Based on the examination results, it is necessary to distinguish between dysarthria and motor alalia, motor aphasia, and dyslalia.

Correction of dysarthria

Speech therapy work to overcome dysarthria should be carried out systematically, against the background drug therapy and rehabilitation (segmental reflex and acupressure, acupressure, exercise therapy, therapeutic baths, physiotherapy, mechanotherapy, acupuncture, hirudotherapy), prescribed by a neurologist. A good background for correctional and pedagogical classes is achieved by using non-traditional forms of restorative treatment: dolphin therapy, touch therapy, isotherapy, sand therapy, etc.

In speech therapy classes for the correction of dysarthria, fine motor skills are developed ( finger gymnastics), motor skills of the speech apparatus (speech therapy massage, articulation gymnastics); physiological and speech breathing (breathing exercises), voice (orthophonic exercises); correction of impaired and consolidation of correct sound pronunciation; work on the expressiveness of speech and the development of verbal communication.

The order of production and automation of sounds is determined by the greatest availability of articulation patterns at the moment. Automation of sounds in dysarthria is sometimes carried out until complete purity of their isolated pronunciation is achieved, and the process itself requires more time and persistence than in dyslalia.

Forecast and prevention of dysarthria

Only early, systematic speech therapy work to correct dysarthria can give positive results. A major role in the success of correctional pedagogical intervention is played by the therapy of the underlying disease, the diligence of the dysarthric patient himself and his close circle.

Under these conditions, one can count on almost complete normalization of speech function in the case of erased dysarthria. Having mastered the skills of correct speech, such children can successfully study in secondary school, and the necessary speech therapy assistance is received in clinics or school speech centers.

In severe forms of dysarthria, only improvement in speech function is possible. Continuity is important for the socialization and education of children with dysarthria various types speech therapy institutions: kindergartens and schools for children with severe speech impairments, speech departments of psychoneurological hospitals; friendly work of a speech therapist, neurologist, psychoneurologist, massage therapist, and physical therapy specialist.

Medical and pedagogical work to prevent dysarthria in children with perinatal brain damage should begin from the first months of life. Prevention of dysarthria in early childhood and adulthood involves preventing neuroinfections, brain injuries, and toxic effects.

Articulation disorders in children and adults

- “brush your teeth” the baby smiles, opens his mouth, uses the tip of his tongue to brush the lower and upper teeth alternately;

- “knead the dough” the child smiles, then slaps his tongue between his teeth - “five-five-five”, then bites the tip of the tongue with his teeth;

- “cup” - the baby smiles, opens his mouth wide, sticks out his wide tongue and forms a “cup” out of it (raises the tip);

- “pipe” - the child should stretch his tense lips forward, while closing his teeth;

- “painter” - the child smiles, opens his mouth slightly and strokes (paints) the sky with the tip of his tongue;

- “mushrooms” - the baby needs to smile, then click his tongue (as if riding a horse) and stick his wide tongue to the palate;

- “kitty” - the baby smiles wider, opening his mouth. The tip of his tongue should rest against the lower teeth, and the tongue should be curved so that the tip rests against the lower teeth;

- “swing” - the child smiles, opens his mouth, the tip of his tongue goes behind the upper teeth, then behind the lower teeth.

- “paint” with your tongue the upper arch inside the mouth - from the soft palate to the base of the upper teeth;

Pronounce vowel sounds while yawning;

Imitate gargling;

Develop your lower jaw by moving it back and forth, as well as from side to side;

Lower your jaws downwards with resistance;

Develop your cheeks by alternately sucking or puffing them out;

Roll the “balloon” from cheek to cheek;

Pull in both cheeks to form a “fish mouth” and move your lips;

Snort like a horse;

Chew your lips gently;

Extend your tongue with its sharp tip further, then place it relaxed on your lower lip.

Specific speech articulation disorders (dyslalia) in children

The group of specific disorders of speech and language development (dyslalia) is represented by disorders in which the leading symptom is a violation of sound pronunciation with normal hearing and normal innervation of the speech apparatus.

The incidence of articulation disorders has been established in 10% of children under 8 years of age and in 5% of children over 8 years of age. It occurs 2-3 times more often in boys than in girls.

Functional dyslalia - defects in the reproduction of speech sounds in the absence of organic disorders1 in the structure of the articulatory apparatus.

Mechanical dyslalia is a violation of sound pronunciation caused by anatomical defects of the peripheral speech apparatus (bad bite, thick tongue, short frenulum, etc.).

Causes and pathogenesis of dyslalia

The cause of articulation disorders is not fully known. Presumably, the basis of the disorders is a delay in the maturation of neuronal connections, caused by organic damage to the speech zones of the cortex. There is evidence of a significant role of genetic factors. An unfavorable social environment and imitation of incorrect speech patterns have a certain significance.

Articulation disorders are expressed in a persistent inability to use speech sounds in accordance with the expected level of development, including incorrect production. omissions, replacements with incorrect ones or insertion of extra phonemes.

The basis of the articulation defect is the inability to voluntarily accept and maintain certain positions of the tongue, palate, lips necessary for pronouncing sounds. The intellectual and mental development of children corresponds to their age. You can observe concomitant disorders in the form of disturbances of attention, behavior and other phenomena.

Identification of anatomical defects that could cause a pronunciation disorder, which requires consultation with an orthodontist.

Differentiation from secondary disorders caused by deafness is based on data from an audiometric study and the presence of qualitative pathological signs of speech pathology.

Differentiation from articulation disorders caused by neurological pathology (dysarthria) is based on the following signs:

Dysarthria is characterized by low speech speed and the presence of disorders of chewing and sucking functions;
the disorder affects all phonemes, including vowels.

In doubtful cases, instrumental studies are performed to carry out differential diagnosis and establish the anatomical focus of the lesion: EEG, echoencephalography (EchoEG), MRI of the brain, CT of the brain.

It is no different from the prevention of other types of speech and language disorders.

Developmental articulation disorder

characterized by frequent and repeated disturbances of speech sounds, as a result of which speech becomes pathological. Language development is within normal limits. A number of terms are used to refer to these phenomena: infant speech, babbling, dyslalia, functional speech disorders, infantile perseveration, infantile articulation, delayed speech, lisp, inaccurate oral speech, lazy speech, specific speech development disorder, and slurred speech. In most mild cases, intelligence is not severely impaired and spontaneous recovery is possible. In severe cases, speech may be completely unintelligible, requiring long-term and intensive treatment.

Definition

An articulation disorder is defined as a significant impairment in the acquisition of normal articulation of speech sounds at an appropriate age. This condition cannot be caused by a pervasive developmental disorder, mental retardation, inner speech disorder, or neurological, intellectual, or hearing impairment. A disorder manifested by frequent incorrect pronunciation of sounds, replacement or omission of them creates the impression of “infant speech”.

The following are diagnostic criteria for developmental articulation disorder.

A. Significant impairment of the ability to correctly use speech sounds that should have already developed at the appropriate age. For example, a three-year-old child is unable to pronounce the sounds p, b and t, and a 6-year-old child is unable to pronounce the sounds p, sh, ch, f, ts.
B. Not associated with pervasive developmental disorder, mental retardation, hearing impairment, oral language disorder, or neurological disorder.

This disorder is not associated with any anatomical structure, auditory, physiological or neurological abnormalities. This disorder refers to a number of different articulation disorders, ranging from mild to severe forms. Speech may be completely understandable, partially understandable, or incomprehensible. Sometimes the pronunciation of only one speech sound or phoneme (the smallest volume of sound) is affected, or many speech sounds are affected.

Epidemiology

The incidence of developmental articulation disorders has been established in approximately 10% of children under 8 years of age and approximately 5% of children over 8 years of age. This disorder is 2-3 times more common in boys than in girls.

Etiology

The cause of developmental articulation disorders is unknown. It is generally believed that simple developmental delay or delay in the maturation of neurological processes, rather than organic dysfunction, underlies speech impairment.

A disproportionately high rate of articulation disorders is found among children from large families and low socioeconomic classes, which may indicate one of the possible reasons- incorrect speech at home, and reinforcement of the deficiency on the part of these families.

Constitutional factors are more than factors environment influence whether a child will or will not suffer from an articulation disorder. The high percentage of children with this disorder who have multiple relatives with similar disorders may indicate a genetic component. Poor motor coordination, poor lateralization, and right- or left-handedness have been shown to be unrelated to developmental articulation disorder.

Clinical features

In severe cases, the disorder is first recognized around 3 years of age. In less severe cases, the disorder may not be obvious until age 6. Significant features of developmental articulation disorder include articulation that is judged to be defective when compared with the speech of children of the same age and which cannot be explained by pathology of intelligence, hearing, or the physiology of speech mechanisms. In very mild cases, there may be a violation of the articulation of only one phoneme. Usually single phonemes are disrupted, those that are mastered at an older age, in the process of normal language acquisition.

The speech sounds that are most often mispronounced are the latest in the sequence of mastered sounds (r, sh, ts, zh, z, h). But in more severe cases or in young children, there may be a violation of the pronunciation of sounds such as l, b, m, t, d, n, x. The pronunciation of one or more speech sounds may be impaired, but the pronunciation of vowels is never impaired.

A child with developmental articulation disorder cannot pronounce certain phonemes correctly and may distort, substitute, or even omit phonemes that he or she cannot pronounce correctly. When skipping, the phonemes are completely absent—for example, “goy” instead of “blue.” During substitution, difficult phonemes are replaced with incorrect ones - for example, “kvolik” instead of “rabbit”. When distorted, approximately correct phonemes are selected, but their pronunciation is incorrect. Occasionally something is added to the phonemes, usually vowels.

Gaps are most often found in the speech of young children and appear at the end of words or consonant clusters. Distortions, which are found mainly in older children, are expressed in sounds that are not part of the speech dialect. Distortions may be the last type of articulation disorder remaining in the speech of children whose articulation disorders have almost disappeared. The most common type of distortion is "lateral slip", in which the child produces sounds with a stream of air passing through the tongue, which produces a whistling effect, and also "lisp", in which the sound is formed when the tongue is very close to the roof of the mouth, which produces a hissing effect. Effect. These disturbances are often intermittent and random. A phoneme may be pronounced correctly in one situation, but incorrectly in another. Articulation disorders are especially common at the end of words, in long syntactic complexes and sentences, and during rapid speech. Omissions, distortions and substitutions also appear in normal children learning to speak; while normal children quickly correct their pronunciation, children with articulation disorder do not. Even as the child grows and develops, when the pronunciation of phonemes improves and becomes correct, this sometimes applies only to newly learned words, while previously learned incorrectly words may still be pronounced incorrectly.

By the third grade, children sometimes overcome articulation disorder. However, after the fourth grade, if the deficiency has not previously been overcome, spontaneous recovery from it is unlikely, therefore it is especially important to correct the disorder before complications develop.

In most mild cases, recovery from articulation disorders is spontaneous, and is often facilitated by the child's admission to kindergarten or school. These children are fully advised to have sessions with a speech therapist aimed at developing speech sounds if they do not have spontaneous improvement by the age of six. For children with significant pronunciation disorders, with incomprehensible speech, and especially for those of them who are very worried about their defect, it is necessary to ensure an early start of classes.

Other specific developmental disorders commonly occur, including developmental expressive language disorder, developmental receptive language disorder, reading disorder, and developmental coordination disorder. There may also be functional enuresis.

Delays in language development and achievement of developmental milestones, such as saying the first word and first sentence, are also observed in some children with developmental articulation disorder, but most children begin to speak at normal ages.

Children with developmental articulation disorders may exhibit a variety of co-occurring social, emotional, and behavioral disorders. Approximately one third of these children have a mental disorder, such as hyperreactivity with attention disorder, separation anxiety disorder, avoidance disorder, adjustment disorder, and depression. Those children who have a severe articulation disorder, or those whose disorder is chronic, without remission or repeated, constitute a risk group for the development of mental illness.

Differential diagnosis

The differential diagnosis of developmental articulation disorder involves three stages: first, it is necessary to determine that the articulation disorder is severe enough to be considered pathological and excludes normal pronunciation disorders in young children; secondly, it should be noted that there is no physical pathology that could cause a pronunciation disorder and exclude dysarthria, hearing impairment or mental retardation; thirdly, it is necessary to establish that expressive language is expressed within normal limits and exclude developmental language disorder and pervasive developmental disorders. Approximately, we can be guided by the fact that a 3-year-old child normally correctly pronounces m.n, b, p, v, f, g, x, t, k, d;, and a normal 5-year-old child pronounces all sounds correctly.

To exclude physical factors that could cause some types of articulation disorders, it is necessary to carry out neurological, structural and audiometric examination methods.

Children with dysarthria, whose articulation disorder is caused by structural or neurological pathology, differ from children with developmental articulation disorder in that dysarthria is extremely difficult to correct, and sometimes not at all. Mindless chatter, slow and uncoordinated motor behavior, difficulty chewing and swallowing, and restricted and slow tongue protrusion and retraction are signs of dysarthria. Slow speech rate is another sign of dysarthria.

Forecast

Recovery is often spontaneous, especially in children whose articulation disorder involves only a few phonemes. Spontaneous recovery rarely occurs after the age of 8 years.

Treatment

Speech therapy treatment is considered successful for most articulation errors. Corrective classes are indicated when the child’s articulation is such that his speech is incomprehensible, when the child suffering from articulation disorders is over 6 years old, when speech difficulties clearly cause complications in dealing with peers, difficulties in learning and negatively affect the formation of one’s own image, when the disorders the articulations are so heavy that many consonants are mispronounced, and when errors involve omissions and phoneme substitutions rather than distortions.

Bibliography

Kaplan G.I., Sadok B.J. Clinical psychiatry, T. 2, – M., Medicine, 2002

Multiaxial classification of mental disorders in childhood and adolescence. Classification of mental and behavioral disorders in children and adolescents in accordance with ICD-10, - M., Smysl, Academy, 2008

What is Specific Speech Articulation Disorder -

In most cases, nonverbal intellectual level is within normal limits.

The incidence of articulation development disorders has been established in 10% of children under 8 years of age and in 5% of children over 8 years of age. This disorder occurs 2-3 times more often in boys than in girls.

What provokes / Causes of Specific Speech Articulation Disorder:

The cause of developmental articulation disorders is unknown. Presumably, the basis of speech impairment is a delay in the development or maturation of neuronal connections and neurological processes, and not organic dysfunction. The high percentage of children with this disorder who have multiple relatives with similar disorders suggests a genetic component. With this disorder, there is no subtle differentiation of motor kinesthetic postures of the tongue, palate, lips; brain basis - activity of the postcentral parts of the left hemisphere of the brain.

Symptoms of Specific Speech Articulation Disorder:

An essential feature is an articulation defect, with a persistent inability to apply speech sounds at expected developmental levels, including omissions, substitutions, and distortion of phonemes. This disorder cannot be caused by structural or neurological pathology and is accompanied by normal language development.

In more severe cases, the disorder is recognized at around 3 years of age. In milder cases, clinical manifestations may not be recognized for up to 6 years. The essential features of speech articulation disorder are an impairment in the child's acquisition of speech sounds, resulting in disarticulation with difficulty for others to understand his speech. Speech may be assessed as defective when compared with the speech of children of the same age and which cannot be explained by pathology of intelligence, hearing or the physiology of speech mechanisms. The pronunciation of speech sounds, which appear most late in ontogenesis, is often impaired, but the pronunciation of vowel sounds is never impaired. The most severe type of violation is omission of sounds. Substitutions and distortions are a less severe type of violation. Children with developmental articulation disorder may exhibit co-occurring social, emotional, and behavioral disorders. 1/3 of these children have a mental disorder.

Diagnosis of Specific Speech Articulation Disorder:

Includes three stages:

1. Determining the severity of articulation disorder.
2. Exclusion of physical pathology that could cause pronunciation problems, dysarthria, hearing impairment or mental retardation.
3. Exclusion of developmental disorder of expressive speech, general developmental disorder.

Articulation disorders caused by structural or neurological pathology (dysarthria) are characterized by low speech speed, uncoordinated motor behavior, and disorders of autonomic functions, such as chewing and sucking. Pathology of the lips, tongue, palate, and muscle weakness are possible. The disorder affects all phonemes, including vowels.

Treatment for Specific Speech Articulation Disorder:

Speech therapy is most successful for most articulation errors.

Drug treatment indicated in the presence of concomitant problems of an emotional and behavioral nature.

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Specific speech articulation disorder

What is Specific Speech Articulation Disorder?

Characterized by frequent and repeated disturbances in speech sounds. The child's use of sounds below the level appropriate for his mental age - that is, the child's acquisition of speech sounds is either delayed or deviated, leading to disarticulation with difficulties in understanding his speech, omissions, substitutions, distortions of speech sounds, changes depending on their combination (then says correctly, then no). Most speech sounds are acquired by 6-7 years; by 11 years all sounds should be acquired.

In most cases, nonverbal intellectual level is within normal limits.

What causes Specific Speech Articulation Disorder:

Symptoms of Specific Speech Articulation Disorder:

Diagnosis of Specific Speech Articulation Disorder:

Includes three stages:

1. Determining the severity of articulation disorder.

Treatment for Specific Speech Articulation Disorder:

Speech therapy is most successful for most articulation errors.

Drug treatment is indicated in the presence of concomitant emotional and behavioral problems.

F80.0. Specific speech articulation disorder

A specific developmental disorder in which a child's use of speech sounds is below the level appropriate for his mental age, but in which there is a normal level of language skills. A diagnosis can only be made when the severity of the articulation disorder is outside the range of normal variations appropriate to the child's mental age; nonverbal intellectual level within normal limits; expressive and receptive speech skills within normal limits; articulation pathology cannot be explained by a sensory, anatomical or neurotic abnormality; incorrect pronunciation is undoubtedly anomalous, based on the characteristics of speech use in the subcultural conditions in which the child finds himself.

Developmental physiological disorder;

Developmental articulation disorder;

Functional articulation disorder;

Babbling (children's form of speech);

Phonological developmental disorder.

F80.1. Expressive language disorder

A specific developmental disorder in which a child's ability to use expressive spoken language is markedly below the level appropriate for his mental age, although speech comprehension is within normal limits. There may or may not be articulation disorders.

Often, a lack of spoken language is accompanied by a delay or disturbance in verbal and audio pronunciation. The diagnosis should be made only when the severity of the delay in expressive language development exceeds the normal range for the child's mental age; Receptive language skills are within normal limits for the child's mental age (although they may often be slightly below average). Impaired spoken language becomes evident from infancy without any long, distinct phase of normal speech use. However, it is not uncommon to encounter the initially apparently normal use of several individual words, accompanied by speech regression or lack of progress. Often similar expressive speech disorders are observed in adults; they are always accompanied by a mental disorder and are organically caused.

Delayed speech development according to the type of general speech underdevelopment (GSD) of levels I-III;

Developmental dysphasia of expressive type;

Developmental aphasia of expressive type.

F80.2. Receptive language disorder

A specific developmental disorder in which the child's understanding of speech is below the level appropriate for his mental age. In all cases, expansive speech is also noticeably impaired and a defect in verbal-sound pronunciation is not uncommon.

A diagnosis can only be made when the severity of the delay in receptive language development is beyond normal variations for the child's mental age and when criteria for pervasive developmental disorder are not met. In almost all cases, the development of expressive speech is also seriously delayed, and violations of verbal-sound pronunciation are common. Of all the variants of specific speech development disorders, this variant has the highest level of concomitant socio-emotional-behavioral disorders. These disorders do not have any specific manifestations, but hyperactivity and inattention, social inattention

ability and isolation from peers, anxiety, sensitivity or excessive shyness are common. Children with more severe forms of receptive language impairment may experience quite significant delays in social development; imitative speech is possible with a lack of understanding of its meaning and a limitation of interests may appear. Similar speech disorders of the receptive (sensory) type are observed in adults, which are always accompanied by a mental disorder and are organically caused.

The structure of speech disorders is indicated by the second code R47.0.

Developmental receptive dysphasia;

Developmental receptive aphasia;

speech articulation disorder

Universal Russian-English dictionary. Akademik.ru. 2011.

See what “speech articulation disorder” is in other dictionaries:

F80.1 Expressive language disorder - A specific developmental disorder in which the child's ability to use expressive spoken language is markedly below the level appropriate for his mental age, although speech comprehension is within normal limits. In this case, there may be or... ... Classification of mental disorders ICD-10. Clinical descriptions and diagnostic guidelines. Research diagnostic criteria

Speech or language developmental disorder - Disorders characterized primarily by severe impairments in speech development or language acquisition (syntax or semantics) that cannot be explained by a general delay in intellectual development. Most often there is a delay in development... ... Great Psychological Encyclopedia

Speech violations - various. deviations from the norm in the process of formation of speech function, or the collapse of already established speech. R.n. arise under the influence of various organic and/or functional causes. character, having an innate or acquired nature and associated with... Psychology of communication. encyclopedic Dictionary

F80.0 Specific speech articulation disorder - A specific developmental disorder in which the child's use of speech sounds is below the level appropriate for his mental age, but in which there is a normal level of speech skills. Diagnostic guidelines: Age of acquisition... ... Classification of mental disorders ICD-10. Clinical descriptions and diagnostic guidelines. Research diagnostic criteria

Aphasia in children (speech development disorders) is a disorder in the formation of speech mechanisms in children, caused by a delay or damage to the development of speech function. It is assumed that the mentioned disorders are caused by delayed biological maturation of the brain in the prenatal period of life,... ... Encyclopedic Dictionary of Psychology and Pedagogy

Speech disorder is a general name for various speech disorders. It is not yet clear which speech disorders should be designated by this term. Some authors distinguish between functional (psychogenic) speech disorders, for example, stuttering, and... ... Encyclopedic Dictionary of Psychology and Pedagogy

“F80” Specific developmental disorders of speech and language - These are disorders in which normal speech development is disrupted in the early stages. The conditions cannot be explained by neurological or speech pathology, sensory damage, mental retardation or environmental factors. Child... ...Classification of mental disorders ICD-10. Clinical descriptions and diagnostic guidelines. Research diagnostic criteria

F80.0 Specific speech articulation disorder. - Note. This disorder is also called specific phonological speech disorder. A. Articulatory (phonological) skills, as measured by standardized tests, are below 2 standard deviations for the child's age. B.... ... Classification of mental disorders ICD-10. Clinical descriptions and diagnostic guidelines. Research diagnostic criteria

List of ICD-9 codes - This article should be Wikified. Please format it according to the article formatting rules. Transition table: from ICD 9 (chapter V, Mental disorders) to ICD 10 (section V, Mental disorders) (adapted Russian version) ... ... Wikipedia

Dyslalia is an articulation disorder in which the patient uses vocabulary correctly, but pronounces some sounds incorrectly (tongue-tied). Dyslalia is a characteristic symptom of a speech defect acquired by children who have suffered since childhood... ... Medical terms

dysarthria is a disorder of articulation with unclear pronunciation (especially consonants), slowness and intermittency of speech.

Included:

Developmental physiological disorder;

Developmental articulation disorder;

Functional articulation disorder;

Babbling (children's form of speech);

Dyslalia (tongue-tied);

Phonological developmental disorder.

F80.1. Expressive language disorder

Included:

Motor alalia;

Delayed speech development according to the type of general speech underdevelopment (GSD) of levels I-III;

Developmental dysphasia of expressive type;

Developmental aphasia of expressive type.

F80.2. Receptive language disorder

The structure of speech disorders is indicated by the second code R47.0.

Included:

Developmental receptive dysphasia;

Developmental receptive aphasia;

Lack of perception of words;

Verbal deafness;

Sensory agnosia;

Sensory alalia;

Congenital auditory immunity;

Wernicke's developmental aphasia.

Disorders included in section F80-F89 must have the following characteristics:

onset of the disorder in infancy or childhood;
the presence of damage or delay in the development of functions closely related to the biological maturation of the central nervous system;
constant course, without remissions or relapses, characteristic of many mental disorders.
Etiology

Disorders of psychological development are characterized by a hereditary burden of similar or related disorders. The role of genetic factors in the etiology of most disorders is important. Hereditary factors are polygenic. Environmental influence is not of primary importance, but in most cases it has a significant impact on the development of impaired functions.

The modern point of view on etiology is multifactorial. The most significant interacting groups of factors are: heredity, temperament, minimal brain dysfunction, somatic pathology, especially with brain damage, socio-economic and cultural factors.

F80 Specific speech development disorders

Etiology and pathogenesis

The cause of specific language development disorders is unknown. Normal speech development is disrupted in the early stages of ontogenesis. The condition cannot be explained by neurological or speech pathology, sensory damage, mental retardation or environmental factors.

Late acquisition of spoken language (in comparison with age norms).

Delayed speech development is often accompanied by difficulties in reading and writing, disturbances in interpersonal relationships, and emotional and behavioral disorders. There is no clear difference from normal variants; clinical judgment is important based on basic neuropsychological criteria and age norms, taking into account the severity of the course and associated problems.

Differential diagnosis

Conducted with mental retardation - with this diagnosis, speech delay is in accordance with the general level of cognitive functioning and is part of the general mental retardation or general

developmental delays. Developmental language disorders should be distinguished from disorders secondary to deafness or certain other specific neurological disorders. Severe deafness in early childhood always leads to a delay and distortion of speech development, but speech disorders in this case are a consequence of hearing damage.

The most preferable combination of speech therapy, psychotherapy and symptomatic drug treatment is the same as for all forms of mental retardation. Typically, a “family approach” to treatment is used (that is, addressing the child's problems by working with the family). In the treatment of speech disorders, methods of intensive neurophysiological rehabilitation by V. I. Kozyavkin, acupuncture, laser therapy and multimodal stimulation of the reflexogenic zones and speech zones of the cerebral cortex are used.

In the drug treatment of speech disorders, nootropics (piracetam, pantogam, aminalon, encephabol, oxybral) are preferred. Cerebrolysin is effective for disorders of motor, speech and cognitive functions, especially in cases of neuron death. An amino acid drug, cogitum, stimulates cerebral and neurosensory processes to a greater extent. It is also advisable to use vasoactive agents (Cavinton, cinnarizine, theonicol, nicotinic acid) or phezam (containing piracetam and cinnarizine). Recognan (citicoline, nicholine) is used to treat cortical dysfunctions, including memory and speech disorders. In spastic forms of disorders, the prescription of drugs that reduce muscle tone (mydocalm, myelostan, sirdalud) and magnesium drugs is justified.

F80.0 Specific speech articulation disorder

Characterized by frequent and repeated disturbances in speech sounds. The child's use of sounds is below the level appropriate for his mental age, that is, the child's acquisition of speech sounds is either delayed or deviated, leading to disarticulation with difficulties in understanding his speech, omissions, substitutions, distortions of speech sounds, changes depending on their combination (then says right, then no). (Most speech sounds are acquired by age 6-7; by age 11, all sounds should be acquired.)

A number of terms are used to refer to these phenomena: infant speech, babbling, dyslalia, functional speech disorders, infantile articulation, imprecise oral speech, lazy speech, developmental articulation disorder, lisp.

In most cases, nonverbal intellectual level is within normal limits.

Etiology and pathogenesis

The cause of developmental articulation disorders is unknown. Presumably, the basis of speech impairment is a delay in the development or maturation of neuronal connections and neurological processes, and not organic dysfunction. The high percentage of children with this disorder who have multiple relatives with similar disorders suggests a genetic component. (With this disorder, there is no subtle differentiation of motor kinesthetic postures of the tongue, palate, lips - the brain basis for the activity of the postcentral parts of the left hemisphere of the brain).

Prevalence

An essential feature is an articulation defect with a persistent inability to apply speech sounds at expected developmental levels, including omissions, substitutions, and distortion of phonemes. This disorder cannot be caused by structural or neurological pathology and is accompanied by normal language development.

In more severe cases, the disorder is recognized at around 3 years of age. In milder cases, clinical manifestations may not be recognized for up to 6 years. The essential features of speech articulation disorder are impairments in the child's acquisition of speech sounds, leading to disarticulation with difficulty in others understanding his speech. Speech may be assessed as defective when compared with the speech of children of the same age, and which cannot be explained by pathology of intelligence, hearing or the physiology of speech mechanisms. The pronunciation of speech sounds, which appear most late in ontogenesis, is often impaired, but the pronunciation of vowel sounds is never impaired. The most severe type of violation is omission of sounds. Substitutions and distortions are a less severe type of violation. Children with developmental articulation disorder may exhibit co-occurring social, emotional, and behavioral disorders. 1/3 of these children have a mental disorder.

Differential diagnosis

Includes three stages:

Identification of the severity of articulation disorder.
Exclusion of physical pathology that could cause pronunciation problems, dysarthria, hearing impairment, or mental retardation.
Exclusion of developmental expressive language disorder, general developmental disorder.
Articulation disorders caused by structural or neurological pathology (dysarthria) are characterized by low speech speed, uncoordinated motor behavior, and disorders of autonomic functions, such as chewing and sucking. Pathology of the lips, tongue, palate, and muscle weakness are possible. The disorder affects all phonemes, including vowels.

Speech therapy is most successful for most articulation errors.

Drug treatment is indicated in the presence of concomitant emotional and behavioral problems.

F80.1 Expressive language disorder

Severe language impairment that cannot be explained by mental retardation, inadequate learning, and is not associated with a pervasive developmental disorder, hearing impairment, or neurological disorder. This is a specific developmental disorder in which the child's ability to use expressive spoken language is markedly below the level appropriate for his mental age. Speech understanding is within normal limits.

Etiology and pathogenesis

The cause of expressive language disorder is unknown. Minimal brain dysfunction or delayed formation of functional neuronal systems have been suggested as possible causes. A family history indicates that this disorder is genetically determined. The neuropsychological mechanism of the disorder may be associated with a kinetic component when the premotor parts of the brain or posterior frontal structures are interested in the process; with unformed nominative function of speech or unformed spatial representation of speech (temporo-parietal sections and the area of the parieto-temporo-occipital chiasm) subject to normal left hemisphere localization of speech centers and dysfunction in the left hemisphere.

Prevalence

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

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

Diagnostics

Indicators of expressive speech are significantly lower than indicators obtained for nonverbal intellectual abilities (nonverbal part of the Wechsler test).

The disorder significantly interferes with success in school and everyday life that requires verbal expression.

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

Differential diagnosis

It should be carried out by mental retardation, which is characterized by a complete impairment of intelligence in the verbal and non-verbal sphere; with pervasive developmental disorders characterized by a lack of internal language for symbolic or imaginary play, inadequate use of gestures, and an inability to maintain warm social relationships.

Acquired aphasia or dysphasia is characterized by normal speech development before injury or other neurological disorders.

Speech and family therapy are preferred. Speech therapy includes phoneme mastery, vocabulary, construction of proposals. If there are signs of a secondary or concomitant behavioral or emotional disorder, medication and psychotherapy are indicated.

F80.2 Receptive language disorder

A specific developmental disorder in which the child's understanding of speech is below the level corresponding to his mental development. Often there is a defect in phonetic-phonemic analysis and verbal-sound pronunciation. The terms used to refer to this disorder are: aphasia or developmental dysphasia, receptive type (sensory aphasia), word deafness, congenital auditory retardation, developmental Wernicke's sensory aphasia.

Etiology and pathogenesis

The cause of this disorder is unknown. There are theories of minimal organic brain damage, delayed neuronal development, and genetic predisposition, but none of the theories has received final confirmation. Possible neuropsychological mechanisms are disturbances in the sound discrimination zone: the posterior parts of the left temporal region, or disturbances in the differentiation of non-verbal components of speech due to dysfunction of the right hemisphere of the brain. (Most children with receptive language disorder respond better to environmental sounds than to speech sounds.)

Prevalence

The incidence of the disorder varies from 3 to 10% in school-age children. It occurs 2-3 times more often in boys than in girls.

The disorder is usually discovered around the age of 4 years. Early signs are inability to respond to familiar names (in the absence of nonverbal cues) with early age, inability to identify multiple objects by 18 months, inability to follow simple instructions by age 2 years. Late impairments - inability to understand grammatical structures - negatives, comparisons, questions; misunderstanding of paralinguistic components of speech - tone of voice, gestures, etc. The perception of prosodic characteristics of speech is impaired. The difference between such children is in normal imitative speech - “sweet speech with an abundance of literal paraphasia” - they hear something, but reflect it in words that sound similar. However, what is typical is the normal use of gestures, normal role-playing games and attitude towards parents. Compensatory emotional reactions, hyperactivity, inattention, social inability, anxiety, sensitivity and shyness, isolation from peers are common. Enuresis and developmental coordination disorder are less common.

Differential diagnosis

In expressive language developmental disorder, understanding (decoding) of speech stimuli remains intact. If articulation is impaired, other speech abilities are preserved. Hearing impairment, mental retardation, acquired aphasia and pervasive developmental disorders should be excluded.

Approaches to the management of children with this pathology are different. There is a point of view about the need to isolate such children with subsequent training in speech skills in the absence of outside stimuli. Psychotherapy is often recommended to manage associated emotional and behavioral problems. Family therapy is used to find the right forms of relationship with the child.

F80.3 Acquired aphasia with epilepsy (Landau-Kleffner syndrome)

Represents a regression of speech skills after a period of normal speech development. Main features: sensorimotor aphasia, epileptic EEG changes in the form of multifocal spikes and spike-wave complexes (the temporal regions of the brain are involved, often bilaterally) and epileptic seizures.

Etiology and pathogenesis

In most cases unknown. Presumably the presence of an encephalitic process. 12% of children with Landau-Kleffner syndrome have a family history of epilepsy. Instrumental research methods (pneumoencephalography, CT, arteriography) do not reveal morphological abnormalities. Brain biopsy and serological studies provide ambiguous results and do not confirm the presence of a specific encephalopathy.

Onset is typical between 3 and 7 years of age, but can occur earlier or later. At the onset of the disease, there is a relatively slowly progressive impairment of speech understanding. From a neuropsychological point of view, auditory verbal agnosia develops. In the future, expressive speech disorders are added to the impairment of speech understanding. Spontaneous speech disappears within a few weeks or months. Often there is a complete loss of speech. The operational side of thinking remains intact. In 50% of children with Landau-Kleffner syndrome, behavioral disorders are detected, primarily hyperdynamic syndrome. Clinically, epileptic seizures appear only in 70% of cases. In 1/3 of cases, a single attack or status epilepticus is observed at the onset of the disease. After reaching the age of 10, attacks are observed in only 20% of patients, and after 15 years they stop. The EEG records multiple bilateral high-amplitude spikes and spike-wave complexes, most pronounced in the temporal regions. With age, epileptic manifestations in the EEG become less noticeable and by the age of 15-16 years disappear in all patients. In adolescence, there is a slight improvement in speech. However, with sensorimotor aphasia, speech is not completely restored. The prognosis for speech restoration depends on the age of manifestation and the time of initiation of antiepileptic therapy and rehabilitation speech therapy sessions.

Most children with this disorder often come to the attention of clinicians not even because of seizures, and especially not for speech disorders, but because of behavioral disorders - “disinhibition”, hyperkinesis. Neurophysiologists indicate that EEG is the only pathognomonic criterion for identifying the syndrome at those stages when proper treatment can still save speech, although the prognosis is unfavorable.

A beneficial effect is expected from taking corticosteroids early in the disease. Throughout the disease, it is recommended to take anticonvulsants. The first choice drugs are carbamazepines (Finlepsin), the second choice is Lamictal (lamotrigine). Speech therapy and family therapy are recommended throughout the illness.

F81 Specific developmental disorders of school skills

These disorders arise from disturbances in the processing of cognitive information, which largely results from biological dysfunction. It is characteristic that normal acquisition of skills is disrupted from the early stages of development. They are not the result of adverse learning conditions and are not associated with brain injury or illness. It is necessary to evaluate not the level of learning, but school achievements, taking into account the dynamics of development, since the severity and lag in reading by 1 year at seven years has a completely different meaning than by 1 year at 14 years.

The type of manifestations of disorders usually changes with age: speech delay in preschool years disappears in spoken language, but is replaced by a specific reading delay, which in turn decreases in adolescence; in adolescence, spelling/writing disorders occur. That is, the condition is equal in all respects, but the dynamics of growing up are taken into account. School skills are not just a function of biological maturation: they must be taught and learned. Specific school skills disorders cover groups of disorders that manifest specific and significant deficits in learning school skills in a given age group-grade, population, school, etc.

These disorders are not a direct consequence of other conditions - mental retardation, gross neurological defects, emotional or gnostic disorders. Often combined with hyperactivity disorder and attention deficit disorder, specific motor function disorders. This does not mean at all that these are children with delayed skills and will “catch up with their peers over time”; such violations are observed in adolescence and during further education. They are associated with the appearance of secondary disorders in the form of lack of interest in learning, a poor educational program, and emotional disorders.

Diagnostics

Diagnostic requirements:

There must be the most clinically significant degree of impairment in any skill:

the presence of delays or deviations in speech development in the preschool period;
associated problems - inattention or hyperactivity, emotional disturbances or behavioral disturbances;
the presence of qualitative violations is a clear difference from the norm;
inadequate response to therapy (lack of effect when increasing help at home and/or at school).
The disorder is more strictly specific and does not depend on mental retardation or general decline intellectual level. Diagnosis of disorders is carried out on the basis of psychological and pedagogical testing. The impairment must be present from the first years of education and not acquired during education. Impairments must not be due to untreated or uncorrected visual or auditory disorders.

Specific developmental disorders of school skills include:

specific reading disorder - “dyslexia”;
specific impairment of writing skills - “dysgraphia”;
a specific disorder of arithmetic skills - “dyscalculia”;
mixed disorder of school skills - "learning difficulties".
F81.0 Specific reading disorder

A developmental disorder of reading ability involving delays and impairments in reading ability that cannot be explained by mental retardation or inadequate learning and that is not the result of a visual, hearing, or neurological disorder. Defined by various terms: alexia, dyslexia, reading retardation, developmental word blindness, specific reading delays, backward reading, developmental dyslexia, spelling disorder combined with reading disorder.

Etiology and pathogenesis

The disorder is genetically determined, since it is significantly more common in members of individual families than in the population as a whole. In general, there is a high likelihood of minimal neurological disorders and disturbances in brain maturation processes. As a result of the reverse nature of cerebral asymmetry, there may be a movement of language lateralization to the cerebral hemisphere, which is less differentiated in relation to the performance of language function, which affects the development of reading ability. Specific reading impairments in children are usually preceded by developmental language disorders or difficulties in processing auditory information. Complications during pregnancy, antenatal and perinatal complications, including prematurity and low birth weight, are typical for children with reading disorders. Secondary reading disorders can occur in children with postnatal organic lesions in the left hemisphere and in children with disorders in the corpus callosum, which block the transmission of visual information from the unaffected right hemisphere to the “speech” left hemisphere.

Prevalence

This disorder affects 4 to 8% of school-age children. It is 2-4 times more common in babies than in girls.

Reading impairment is usually recognized at the age of 7-8 years. The development of reading skills is a complex, intermodal operation involving cognitive and perceptual processes and requiring intact and balanced function of the entire central nervous system.

Diagnostic criteria: reading productivity is significantly below the level expected in accordance with the child’s age, lack of pronounced success in correctional work.

When learning the alphabet: difficulties in retelling the alphabet, categorizing sounds (with normal hearing acuity). Later - errors in oral reading: omissions, replacements, distortions or additions of words or parts of words; slow pace of reading, prolonged hesitation or loss of place, attempts to start reading again, inaccuracy of what was read, rearrangement of words and sentences or letters in words. Violations of specific functions of verbal memory - during direct reproduction. Inability to remember facts from what has been read, or to draw conclusions or conclusions from the essence of what has been read. At a later age, spelling difficulties are noted with the presence of a large number of phonetic errors.

Associated secondary emotional and/or behavioral disorders are characteristic.

Differential diagnosis

Reading impairments may be primarily caused by a generalized intellectual disorder, mental retardation, which can be tested using standardized intelligence tests. It is possible to differentiate the lack of normal reading skills from a reading disorder by conducting a standardized study of children of a given school in age groups.

Reading impairment may be a comorbid syndrome of other emotional and behavioral disorders associated with attention deficit hyperactivity disorder, conduct disorders, and depression. Psychoeducational tests can help in differential diagnosis. The set of tests includes standardized tests for spelling, writing essays and taking dictation, copying text, and assessing the adequacy of using a pencil. Projective tests are also informative (“House - tree - person”, “My family”) followed by a story based on the drawings; completing unfinished sentences.

The preferred method of treatment is corrective educational therapy. Emotional reactions are more important than specific teaching methods. Neuropsychological correction with an integrative approach to mastering phonetic combinations and the spatial structure of words is effective. Associated emotional and behavioral disorders should be treated with appropriate medications and psychotherapeutic methods. Family counseling therapy has a good effect.

F81.1 Specific spelling disorder

Diagnostically, a specific writing disorder - “dysgraphia” - is more significant. In this disorder, the ability to spell words and/or write words correctly is impaired. When writing, there are no phonetic errors; the alternation of letters, the writing of prefixes, suffixes, endings, etc. are mostly impaired. Reading skills and reading comprehension should be within normal limits, difficulties in spelling/writing should not be caused by inadequate training or defects in visual, auditory, neurological functions.

Etiology and pathogenesis

According to one hypothesis, developmental writing disorder is the result of the combined influence of one or more of the following disorders: developmental expressive language disorder, developmental receptive language disorder, developmental reading disorder. This theory allows that the central areas that process cognitive information may have neurological or functional defects, that is, the premotor and post-central parts of the brain (kinetic component) are more affected. However, it should be noted that these are largely functional disorders. There may be a hereditary predisposition to this disorder.

Prevalence

There are no exact figures regarding the frequency of violations. No gender differences were found. The disorder is believed to be familial in nature.

Violations are detected to a greater extent in the lower grades of school. Difficulties manifest themselves in spelling and expressing thoughts in age-appropriate grammatical forms. Oral and written speech contains a large number of grammatical errors, is poorly organized in meaning, but is relatively phonetically intact. Reading skills (both accuracy and comprehension of what is read) are within the age range. Writing difficulties should not be due to inadequate learning or visual, auditory or neurological deficits. Associated features include refusal and reluctance to go to school, complete written assignments, and poor performance in other areas. Most children show frustration and anger towards their inability and failure at school. As a consequence of alienation and despair, chronic depression and violent conduct disorder may develop.

Differential diagnosis

Diagnosis is based on poor performance in written composition. When writing ability is below intellectual ability. The presence of a pervasive developmental disorder or mental retardation excludes this diagnosis.

The most best treatment today - remedial training. Concomitant psychotherapy is effective. Drug treatment is aimed at relieving associated emotional and behavioral problems.

F81.2 Specific numeracy disorder

In the past, this disorder was known as acalculia, dyscalculia, or arithmetic disorder. Includes only a specific numeracy disorder that cannot be explained general underdevelopment or inadequate training. The deficit concerns basic computational skills - addition, subtraction, multiplication, division. Reading skills within normal limits.

Etiology and pathogenesis

The modern point of view is that the disorder is polyetiological. The maturity of brain structures, cognitive, emotional, and socioeconomic factors play an important role in the development of the disorder and its severity. It is likely that difficulties with counting are determined by genetic factors. It is typical for intact auditory-perceptive and verbal skills to have disturbances in optical-spatial activity (probably due to impaired functioning of the parieto-occipital-temporal chiasm zones of the speech-dominant hemisphere). Failure to maintain the counting program or loss of elements is characteristic of dysfunction of the anterior parts of the left hemisphere.

Prevalence

The incidence of numeracy disorders is unknown, but is less common than reading disorders. No gender differences were found.

The ability to master simple arithmetic operations, counting, addition, subtraction below the expected norms with intact intelligence.

difficulty in consciously mastering counting;
difficulty in mastering cardinal and ordinary systems;
difficulty performing arithmetic operations;
difficulty in combining objects into groups.
There are difficulties in understanding verbal and visual symbols and remembering the sequence of arithmetic operations. Characterized by poor spatial organization of calculations, failure to master the ordinal arrangement of numbers, and a pathological inability to learn, for example, the multiplication table with intact auditory and verbal abilities. Some children with numeracy disorders have difficulties learning to read and write due to problems with the encoding and decoding processes.

Diagnostics

Careful examination of school performance can identify the disorder in early childhood. The final diagnosis is made on the basis of testing in the presence of indicators well below the expected level and with adequate intellectual development for a given age.

General personality disorder or mental retardation must be excluded. Examination of other children in the same class helps in making a diagnosis. In case of numeracy disorder, behavioral disorders and attention deficit hyperactivity disorder may occur; these should be excluded as a primary disease.

Currently, remedial training is most effective. The subtype of the disorder, the severity of the impairment present, and the specific training program must be taken into account. Correction of concomitant coordination and sensorimotor disorders increases the effectiveness of remedial training. Drug treatment is symptomatic.

F82 Specific motor development disorder

An essential feature of the disorder is a serious impairment of motor coordination, which cannot be explained by general intellectual retardation or any congenital or acquired neurological disorder, developmental dysplasia. The diagnosis is made if the disorder significantly affects learning or daily life. There is characteristic motor clumsiness with some degree of impairment in visuospatial cognitive tasks.

Etiology and pathogenesis

Possible etiological factors are divided into two groups: developmental and organic factors. The developmental hypothesis suggests that the cause of this disorder is immaturity or delay in the development of perceptual-motor skills. According to this theory, a favorable prognosis for this disorder is possible, since the maturation of brain structures interested in the pathological process occurs.

According to the organic theory, minimal cerebral insults or dysfunctions create a predisposition to the development of motor dysfunction. These disorders are a consequence of prenatal and perinatal complications: toxicosis of pregnancy in the mother, fetal hypoxia, low birth weight; intrauterine events that may cause brain injury or physical injury to the fetus or newborn. Infantile clumsiness syndrome is sometimes diagnosed as a minimal brain dysfunction, but this term is currently not recommended because it has many different and sometimes conflicting meanings.

Prevalence

The incidence of this disorder in children aged 5 to 11 years is 6%. The ratio of incidence between boys and girls is unknown, but as with most developmental disorders, boys are more affected than girls. Data on a larger percentage of cases among relatives are not available.

In infancy and early childhood, the disorder manifests itself as a delay in achieving normal developmental milestones (eg, turning, crawling, sitting, standing, walking, etc.). Coordination difficulties are not caused by visual or hearing defects or neurological disorders. At the age of 2-4 years, awkwardness manifests itself in all areas of activity that require motor coordination. Such children are clumsy in their movements, slowly learn to run, jump, climb up and down steps, do not hold objects in their hands, and drop them easily. Their gait is unsteady and they often stumble and hit obstacles. There may be difficulties in tying shoelaces, catching a ball, unfastening and fastening buttons. The degree of impairment varies from disorders of “fine motor skills” (poor handwriting) to gross motor incoordination. Erased speech disorders may be observed, which are more concomitant in nature (usually including fine articulation).

Poor drawing skills are typical, children poorly perform tasks with composite pictures, construction sets, construction models, do not understand board games, or recognize cards - these are children with typical subcortical dysfunction, immaturity of the right hemisphere of the brain and/or disturbances in the formation of interhemispheric relationships.

During the examination, immaturity of the development of the nervous system, the presence of total synkinesis and mirror movements, and signs of poor fine motor coordination are revealed. Tendon reflexes are either increased or decreased on both sides. There are no neurological disorders, manifestations of cerebral palsy, or muscular dystrophy.

At older ages, there are often secondary disorders (poor school performance, disturbances in the sphere of emotions and behavior, a tendency to low self-esteem, isolation). In general, motor clumsiness persists throughout adolescence and throughout adult life.

Diagnostics

The diagnosis is made if the following criteria are met:

The success of motor coordinated actions is significantly lower than the expected level corresponding to chronological age and intellectual abilities.
A movement disorder has a significant impact on success in learning and in everyday life.
The disorder is not associated with a physical illness (cerebral palsy, hemiplegia, muscular dystrophy, etc.).
Differential diagnosis

Mental retardation is characterized by a general decrease in the level of performance of all types of activities, both in the verbal and non-verbal spheres. It is necessary to exclude general developmental disorders, especially those combined with those in the motor sphere.

Neurological and neuromuscular diseases (cerebral palsy, muscular dystrophy, hemiplegia) are accompanied by the presence of neurological signs.

Includes a combination of medicinal, neurophysiological, neuropsychological methods for correcting motor dysfunction and modified methods of perceptual motor learning and physical education. Most preschool-aged children benefit from the Montessori method, which promotes motor skill development. Secondary behavioral or emotional problems and concomitant speech disorders require adequate medication and psychotherapeutic treatment. Family counseling therapy is recommended to reduce anxiety and guilt in parents.

F83 Mixed specific developmental disorders

This is an underdeveloped group of disorders in which there is a mixture of specific disorders of language development, school skills and/or motor functioning, but there is no significant predominance of any one of them. The diagnosis is made when there is significant overlap of specific disorders in the presence of dysfunctions that meet the criteria of two or more headings F80., F81., F82.

F84 General developmental disorders

Includes a group of disorders characterized by qualitative abnormalities in social communication and a limited, stereotypical, repetitive set of interests and activities. In most cases, development is impaired from infancy, always in the first 5 years.

In some cases, the disorders are combined and are presumably caused by congenital rubella, tuberous sclerosis, cerebral lipidosis, and X chromosome fragility. Any of the accompanying conditions are coded separately. If mental retardation is present, it is mandatory to code it as well (F70-F79), but it is not a mandatory sign of general developmental disorders.

F84.0 Childhood autism

Childhood autism itself includes autistic disorder, infantile autism, infantile psychosis, and Canper's syndrome.

The first descriptions of this disorder were made by Henry Maudsley (1867). In 1943, Leo Kanner, in his work “Autistic Disorders of Affective Communication,” gave a clear description of this syndrome, calling it “infantile autism.”

Etiology and pathogenesis

The causes of childhood autism are not fully known.

There are a number of clinically and experimentally confirmed hypotheses about the etiopathogenesis of the disorder:

weakness of instincts and affective sphere;
information blockade associated with perception disorders;
disruption of the processing of auditory impressions, leading to blockade of contacts;
disruption of the activating influence of the reticular formation of the brain stem;
dysfunction of the frontal-limbic complex, leading to a disorder of motivation and behavior planning;
distortion of serotonin metabolism and the functioning of serotonergic systems of the brain;
disruption of the paired functioning of the cerebral hemispheres.
Along with this, there are psychological and psychoanalytic causes of the disorder. Genetic factors play a significant role, since the disease is more common in families with autism than in the general population. Autism is to some extent associated with an organic brain disorder (often a history of complications during fetal development and childbirth), correlation with epilepsy in 2% of cases (according to some data, in the general pediatric population of epilepsy in 3.5%) . Some patients have diffuse neurological abnormalities - “soft signs”. There are no specific EEG abnormalities, but various EEG pathologies were found in 83% of autistic children.

Prevalence

The prevalence of childhood autism is 4-5 cases per 10,000 children. First-born boys predominate (3-5 times more often than girls). But in girls, autism is more severe, and, as a rule, these families have already encountered cases of cognitive impairment.

In his original description, Kanner identified the main features that are still used today.

The onset of the disorder is before the age of 2.5-3 years, sometimes after a period of normal development in early childhood. Usually these are beautiful children with a thoughtful, sleepy, detached face, as if drawn with a pencil - “the face of a prince.”
Autistic loneliness is the inability to establish warm emotional relationships with people. Such children do not respond with a smile to the caresses and expressions of love of their parents. They do not like to be held or hugged. They react to parents no more than to other people. They behave the same way with people and inanimate objects. Anxiety is practically not detected when separated from loved ones and in unfamiliar surroundings. Lack of eye contact is typical.
Speech disorder. Speech often develops with a delay or does not occur at all. Sometimes it develops normally until the age of 2, and then partially disappears. Autistic children make little use of the categories of “meaning” in memory and thinking. Some children make noise (clicks, sounds, wheezing, nonsense syllables) in a stereotypical manner without the desire to communicate. Speech is usually constructed in the form of immediate or delayed echolalia or in the form of stereotypical phrases out of context, with incorrect use of pronouns. Even by the age of 5-6 years, most children refer to themselves in the second or third person, or by name, without using “I”.
"Obsessive desire for monotony." Stereotypical and ritualistic behavior, insistence on keeping everything unchanged and resistance to change. They prefer to eat the same food, wear the same clothes, and play repetitive games. The activities and play of autistic children are characterized by rigidity, repetition and monotony.
Bizarre behavior and mannerisms are also common (for example, the child constantly spins or sways, fiddling with his fingers or clapping his hands).
Deviations in the game. Games are often stereotypical, dysfunctional and non-social. Atypical manipulation of toys predominates, imagination and symbolic features are absent. A predilection for playing with unstructured material - sand, water - has been noted.
Atypical sensory reactions. Autistic children respond to sensory stimuli either extremely strongly or too weakly (to sounds, pain). They selectively ignore speech addressed to them, showing interest in non-speech, often mechanical sounds. The pain threshold is often lowered, or an atypical reaction to pain is noted.
Other symptoms may also occur in childhood autism. Sudden outbursts of anger or irritation or fear without any obvious cause. Sometimes these children are either hyperactive or confused. Self-harm behavior such as head banging, biting, scratching, hair pulling. Sometimes there are sleep disturbances, enuresis, encopresis, and eating problems. In 25% of cases, seizures may occur during prepubertal or puberty.

Kanner initially believed that the mental abilities of children with autism were normal. However, about 40% of children with autism have a score of 10 below 55 (severe mental retardation); 30% - from 50 to 70 (mild retardation) and about 30% have scores above 70. Some children show abilities in a particular area of activity - “fragments of functions”, despite a decrease in other intellectual functions.

Diagnostics

Criteria:

inability to establish meaningful relationships with people from the beginning of life;
extreme isolation from the outside world, ignoring environmental stimuli until they become painful;
insufficient communicative use of speech;
lack or insufficient eye contact;
fear of changes in the environment (“identity phenomenon” according to Kanner);
immediate and delayed echolalia (“gramophone parrot speech” according to Kanner);
delayed development of the “I”;
stereotypical games with non-play objects;
clinical manifestation of symptoms no later than 2-3 years.
When using these criteria it is important:
a) do not expand the content;
b) build diagnostics at the syndromic level, and not on the basis of formal recording of the presence of certain symptoms;
c) take into account the presence or absence of procedural dynamics of the identified symptoms;
d) take into account that the inability to establish contact with other people creates conditions for social deprivation, leading to symptoms of secondary developmental delays and compensatory formations.

The dynamics of core disorders in childhood autism have a number of patterns. Unlike schizophrenia, they are characterized by low procedural progression and tend to varying degrees of positive dynamics. However, a diagnosis of childhood autism persists at any age. In younger patients (up to 5 years), the prognosis depends on the severity of autistic manifestations themselves, the presence or absence of organic lesions, the rate of development of intelligence and speech, and the time of treatment. 10-20% may experience improvement at 4-6 years of age; 10-20% of patients may be at home; 60% show only slight improvement.

Differential diagnosis

Incomplete syndromes are more common. They must be distinguished from childhood psychoses and Asperger's autistic psychopathy. Childhood schizophrenia rarely occurs before the age of 7 years. It is accompanied by hallucinations or delusions, seizures are extremely rare, and mental retardation is not typical.

Hearing disorders should be excluded. (Autistic children rarely babble, while deaf children babble relatively normally until age 1). The audiogram and evoked potentials indicate significant hearing loss in deaf children.

Language development disorder differs from autism in that the child responds appropriately to people and is capable of nonverbal communication.

Mental retardation must be differentiated from childhood autism, since about 40-70% of autistic children suffer from moderate or severe mental retardation. Main distinguishing features:

1) mentally retarded children usually relate to adults and other children in accordance with their age;
2) they use speech, which they speak to one degree or another, to communicate with others;
3) they have a relatively flat delay profile, without “splinters” of enhanced functions;
4) in a child with childhood autism, speech is more affected than other abilities.

Disintegrative (regressive) psychosis (lipoidosis, leukodystrophy or Heller's disease) usually appears between the ages of 3 and 5 years. The disease begins after a period of normal development and progresses over several months with the development of intellectual impairments, all areas of behavior, with stereotypies and mannerisms. The prognosis is unfavorable.

Includes three areas:

Treatment of behavioral disorders.
Medical-psychological-pedagogical correction.
Family therapy.
There is a need for diversity, versatility and complexity of treatment and rehabilitation measures with the unity of biological and psychological methods. Medical, pedagogical and psychological assistance is most productive at the main stages of personality formation (up to 5-7 years).

Drug treatment. The pathogenetic effect of medications is maximum before the age of 7-8 years, after which the medications have a symptomatic effect.

Currently, amitriptyline is most recommended as the main psychotropic drug for preschool children (15-50 mg/day) in long courses of 4-5 months. Some researchers assign the role of an etiopathogenic agent to vitamin B6 (in doses of up to 50 mg/day). Atypical antipsychotics are applicable: risperidone (Rispolept) in doses of 0.5-2 mg/day. within 1-2 years. When taken, behavioral disorders are reduced, hyperactivity, stereotypies, fussiness and withdrawal are reduced, and learning is accelerated.

Fenfluramium, a drug with antiserotonergic properties, affects behavior disorders and autism.

Tranquilizers have no effect on pathogenetic links. They affect neurotic symptoms. Benzodiazepines are more appropriate.

Traditional antipsychotics have an ambiguous effect on the clinical picture. Drugs without a pronounced sedative effect are preferred (haloperidol 0.5-1 mg/day; triftazine 1-3 mg/day); sometimes small doses of neuleptil are effective. In general, antipsychotics do not provide significant and lasting improvement. Replacement therapy (nootropil, piracetam, aminalon, pantogam, baclofen, phenibut, etc.) is used in extensive repeated courses for a number of years.

The prospects for drug therapy depend on the timing of initiation, regularity of use, individual validity and inclusion in the overall system of treatment and rehabilitation work.

A huge role is given to psychotherapeutic work with the child and parents. Most autistic children are unable to study in a regular school and require special education. It is generally accepted that it is better for an autistic child to live at home and attend a special day school.

F84.1 Atypical autism

A pervasive developmental disorder that differs from childhood autism by age of onset or one of the diagnostic criteria:

This or that sign of abnormal and/or impaired development first appears only after the age of 3 years;
There are no sufficiently distinct disturbances in one of the psychopathological areas necessary for a diagnosis of autism (impaired social interaction, communication; stereotypical, repetitive behavior).
Atypical autism is most common in children with profound mental retardation, low functioning, and in individuals with severe specific receptive language disorder.

F84.2 Rett syndrome

Rett syndrome is a progressive degenerative disease of the central nervous system, presumably of genetic origin, occurs predominantly in girls, named after the Austrian scientist A. Rett, who first described it in 1966. The author reported on 31 girls with regression of mental development, autistic behavior, loss of purposeful movements and the appearance of special stereotypical motor acts, “squeezing hands.”

Etiology and pathogenesis

The hereditary nature of the disease was confirmed. The pathogenesis of the disease remains controversial. The genetic nature is associated with the fragile X chromosome and the presence of mutations in genes that regulate the replication process. A selective deficiency of a number of proteins regulating the growth of dendrites, a low number of glutamine receptors in the basal ganglia, dopaminergic receptors in the caudate nucleus, and impaired cholinergic function were revealed. The “interrupted development” hypothesis, which is based on a deficiency of neurotrophic factors, was put forward by D. Armstrong. Damage to the lower motor neurons, basal ganglia, and involvement of the spinal cord, brainstem, and hypothalamus is suspected.

Analysis of morphological changes in Rett syndrome indicates a slowdown in brain development after birth and a stop in its growth by 4 years of age. A slowdown in the growth of the body and individual organs (heart, liver, kidneys, spleen) was revealed.

Prevalence

Its frequency is relatively high - 1: 10,000 girls. More than 20 thousand cases of the disease have been described in the world; most are sporadic, less than 1% are familial. A study of twins showed concordance for Rett syndrome in monozygotic pairs and discordance in dizygotic pairs. The geographic distribution of Rett syndrome is uneven. There has been a cluster of patients in certain small rural areas - "Rettaareals", which may be associated with existing population isolates. This concentration of the disease is observed in Norway, Italy, Albania and Hungary.

In the ante- and perinatal periods, in the first half of life, development is assessed as normal. However, in many cases, congenital hypotonia and a slight delay in the development of basic motor skills are observed. Onset of the disease from 4 months. up to 2.5 years, but most often it manifests itself at the age of 6 months. up to 1.5 years. Describing the psychopathological process in Rett syndrome, some authors talk about “dementia,” others talk about the unevenness of mental disorders.

During the course of the disease there are 4 stages:

Stage I (child's age 0-12 months): weakness of muscle tone, slower growth in the length of the hands, feet, and head circumference.
Stage II (age 12-24 months): ataxia of the trunk and gait, waving and jerking movements of the arms, unusual fiddling of the fingers.
Stage III: loss of previously acquired skills, ability to play, communications (including visual).
Stage I: breakdown of speech, appearance of echolalia (including retarded ones), incorrect use of pronouns.

The first stage is stagnation. Includes slowed psychomotor development of the child, slowed head growth, loss of interest in games, diffuse muscle hypotonia. The second stage - regression of neuropsychic development is accompanied by attacks of anxiety, “inconsolable screaming,” and sleep disturbances. Within a few weeks, the child loses previously acquired skills and stops speaking, which is often mistakenly interpreted as autism. Stereotyped movements appear - “washing hands”, squeezing them, pulling them off; sucking and biting hands, tapping them on the chest and face; ataxia and apraxia. Balance when walking is impaired and the ability to walk is lost. More than half of children experience abnormal breathing in the form of apnea for up to 1-2 minutes, alternating with periods of hyperventilation. Respiratory disturbances are observed during wakefulness and are absent during sleep. 50-80% of girls with Rett syndrome experience epileptic seizures of various types, which are difficult to treat with anticonvulsants. Most often these are generalized tonic-clonic seizures, complex and simple partial seizures, and drop attacks.

After the regression phase, the third pseudostationary stage begins, covering a long period of preschool and early school age. The children's condition is relatively stable. Profound mental retardation, convulsive seizures, extrapyramidal disorders such as muscular dystonia, ataxia, and hyperkinesis come to the fore. There are no attacks of anxiety.

At the end of the first decade of life, the fourth stage begins - the progression of motor disorders. Patients become immobilized, spasticity, muscle atrophy, secondary deformations - scoliosis increase, and vasomotor disorders appear, mainly in the lower extremities. Characterized by growth retardation without delayed puberty. There is a tendency to develop cachexia. Convulsive attacks are rare. In patients with Rett syndrome, against the background of a total collapse of all spheres of activity, emotional communication and attachments corresponding to the level of their mental development are preserved for the longest time.

Diagnostics

Diagnostic criteria for Rett syndrome according to E. Trevathan

Required.

1) normal pre- and perinatal periods;
2) normal psychomotor development during the first 6-18 months of life;
3) normal head circumference at birth;
4) slowing of head growth in the period from 5 months to 4 years;
5) loss of acquired hand movements between the ages of 6 and 30 months, associated in time with impaired communication;
6) deep damage to expressive and impressive speech, severe delay in psychomotor development;
7) stereotypical hand movements, reminiscent of squeezing, pulling hands, clapping, “washing hands,” rubbing them, appearing after the loss of purposeful movements;
8) the appearance of gait disorders (apraxia and ataxia) at the age of 1-4 years.

Additional:

1) respiratory disorders (periodic apnea during wakefulness, interspersed with hyperventilation, aerophagia);
2) convulsive seizures;
3) spasticity, often combined with dystonia and muscle atrophy;
4) scoliosis;
5) growth retardation;
6) hypotrophic small feet;
7) EEG abnormalities (slow background rhythm and periodic slowing of the rhythm to 3-5 Hz, centrotemporal spikes are described as in fragile X chromosome and rolandic epilepsy).

Exclusive:

1) intrauterine growth retardation;
2) retinopathy or optic disc atrophy;
3) microcephaly at birth;
4) perinatally acquired brain damage;
5) presence of metabolic or progressive neurological disease;
6) severe neurological disorders as a result of head injury and infections.

The diagnosis, even if all the mandatory criteria are present, is considered preliminary until 2-5 years of age.

Differential diagnosis

Differential diagnosis of Rett syndrome and early childhood autism. (International Conference on Rett Syndrome, 1988.) Sign of Rett Syndrome RDA.

Autistic traits at 6-18 months of age. None. Often appear.

Stereotypes. Rhythmic movements of both hands along the midline of the body. More complex and not in the middle line.

Stereotypical manipulations with objects. None. Typical.

Trunk motor skills and gait. Progressive ataxia and apraxia. Manneriness, sometimes gracefulness of posture and gait.

Convulsive seizures. Significantly higher frequency and polymorphism. Significantly lower frequency and polymorphism

Breathing disorders, bruxism, slow growth of the head and limbs. Typical. None.

Mostly symptomatic. The drug of choice is bromocriptin. In the presence of convulsive attacks, anticonvulsants are recommended. Family therapy is appropriate. A broad educational approach is required to help develop adaptive skills.

F84.3 Other disintegrative disorder of childhood

(Geller syndrome, symbiotic psychosis, childhood dementia, Heller-Zappert disease)

Rapidly progressive dementia in young children (after a period of normal development) with a distinct loss over several months of previously acquired skills, with the appearance of abnormalities in social, communicative or behavioral functioning.

Etiology and pathogenesis

The causes of the disorder are not clear. The prevailing idea is that the disease has an organic nature.

After a period of normal development up to 2-3 years for 6-12 months. total dementia is formed. There is often a prodromal period of an unclear illness: the child becomes willful, irritable, anxious and hyperactive. Speech becomes impoverished and then disintegrates. Previously acquired behavioral, gaming and social skills are lost. Loss of control over bowel and bladder function. Interest in the environment is lost, stereotypical motor actions are characteristic. The deterioration is followed by a plateau for several months, and then slight improvement may occur. The disorder is often comorbid with a progressive neurological condition, which is usually coded separately.

The prognosis of the disease is unfavorable. Most patients remain with severe mental retardation.

Differential diagnosis

The disorder resembles adult-onset dementia but differs in 3 respects:

1) there is no evidence of recognized organic disease or damage;
2) loss of acquired skills may be accompanied by some degree of recovery and restoration of function;
3) communication disorders are of a nature similar to autism, and not to intellectual decline.

Differential diagnosis is carried out with autism, early childhood schizophrenia. Geller syndrome is characterized by general mental devastation.

Mostly symptomatic. Includes three areas: treatment of behavioral disorders and neurological disorders; activities of social and educational services; family assistance and family therapy.

There is no evidence of the effectiveness of any form of drug therapy, except for short-term treatment of behavioral disorders. (There are reports that the disorder is caused by a "filterable virus" and the clinical specificity is related to age characteristics defeats.)

F84.5 Asperger's syndrome

(autistic psychopathy, childhood schizoid disorder)

This rare condition was first described by Asperger (1944).

Characterized by disturbances in social behavior (as in autism) in combination with stereotypical, repetitive actions. Against the background of normal cognitive development and speech.

Etiology and pathogenesis

The causes of autistic psychopathy are unknown. Some cases probably represent a milder version of childhood autism, but most of the time it is a distinct disorder. Symptoms usually persist into adulthood. Most people suffering from this disease are able to work, but they do not develop relationships with other people, and rarely do any of them get married.

Prevalence

The condition is more common in boys (8:1 ratio).

Until the age of 3, there is a period of normal development. Then disturbances appear in relationships with adults and peers. Speech becomes monotonous. The child begins to remain distant, isolated, and devotes a lot of time to a narrow, stereotypical circle of interests. Behavior is determined by impulsiveness, contrasting affects, desires, and ideas. Some children display the ability to develop an unusual, non-standard understanding of themselves and those around them. Logical thinking is well developed, but knowledge is extremely uneven. Active and passive attention is unstable. Unlike other cases of childhood autism, there is no significant delay in speech and cognitive development. In appearance The detached “beautiful” expression on the face attracts attention, the facial expressions are frozen, the gaze is turned into emptiness, the fixation on the faces is fleeting. Sometimes the gaze is directed “inward”. Motor skills are angular, movements are irregular, stereotypical. The communicative functions of speech are weakened, it is unique in melody, rhythm and tempo, the voice is either quiet or harsh. Characterized by attachment to home, not to family.

Differential diagnosis

Unlike childhood autism, the diagnosis of Asperger's syndrome is based on the presence of communication and social interaction disorders; limited, stereotypical behavior, interests and activities and the absence of general speech and cognitive delays.

Management of patients suffering from Asperger's syndrome includes psychological and pedagogical measures, behavioral and family psychotherapy. Drug treatment is auxiliary.

Undeveloped mouth muscles or weak facial muscle tone are among the causes of speech development deviations.

Based on the position of N.A. Bernstein about the level organization of voluntary movements and actions, a number of researchers and specialists in this field (in particular E. V. Sheremeteva) suggested that articulation, as the highest symbolic level of voluntary movement, can be formed while all underlying levels of voluntary movement are preserved. The peripheral part of articulation is built above the objective level of oral movements that fulfill life-sustaining nutritional needs: sucking, biting, chewing, swallowing. Therefore, they considered it possible to evaluate the potential possibility of articulation by observing the objective level of movements of the articulators - lips, tongue, lower jaw - in the process of eating and the state of facial expressions in free activity.

Having analyzed the results of the study by E.V. Sheremeteva, in the oral articulation base, precursors of speech underdevelopment (indicators of deviations from the normal course of speech development) at an early age were identified:

refusal of solid food: the child prefers homogeneous, well-chopped masses. Often, so that children do not go hungry, their parents bring yoghurts, curds, etc. to kindergarten. This eating behavior can have different causes: late introduction of solid foods; parents spent a long time (up to a year or even two) grinding the child’s food until smooth; maintaining the sucking reflex (breastfeeding) up to two, two and a half years; disruption of the innervation of the mandibular muscles;

difficulties in the process of chewing and, as a result, spitting, which is associated with a violation of the innervation of the corresponding muscle groups. With this reduction in physical activity, the muscles that lift and hold the lower jaw and the lingual muscles weaken;

general amicability in the process of eating: the child sits for a very long time over the plate or with a piece in his hand, then slowly brings the spoon to his mouth or takes a bite, begins to chew lazily (lack of pleasure “written” on the face from the eating process);

Liquid food or liquid is often spilled due to insufficient formation of the lip grip: the child does not sufficiently grasp the edge of a spoon or cup with his lower lip (liquid spills) or grabs pieces of food from the spoon directly with his teeth. They say about such people: “He doesn’t eat carefully.” In reality, the innervation of the labial muscles is impaired and, as a result, their strength, dexterity and coordination.

an increase in the threshold of receptive sensitivity of the skin of the circumlabial space, which also indicates a violation of the innervation of the corresponding muscle groups: the child drinks kefir or jelly, the remains of which, due to insufficient automation of object movement, remain around the lips. He does not try in any way to reduce irritation from residual liquid. They say about such children: “Very untidy.”

If the perceptive sensitivity of the periolabial space is preserved, and the innervation of the lingual muscles is impaired, then under similar conditions the following is observed:

absence of circular licking movements of the tongue when a thick drink or liquid porridge gets on the lips or perioral space: the child in such cases wipes the upper lip with improvised means;

pulling the back of the tongue up with the tip of the tongue not expressed under similar conditions;

reducing irritation of the skin surface of the lips using the lower lip or other means;

raising the tip of the tongue to the level of the corner of the lips when trying to lick the upper lip.

In general, there is limited mobility of the lower jaw in the masticatory muscles; slight or quite pronounced displacement of the lower jaw to the side at rest, during chewing and during articulation; with pathology of the tone of the masticatory muscles, there is a decrease in the intensity and volume of chewing movements, discoordination of movements of the lower jaw during articulation; disruption of the process of biting off a piece (which can also be complicated by anomalies of the dental system); synkinesis is detected in the motility of the lower jaw during movements of the tongue (especially when raising the tongue to the upper lip or when pulling it towards the chin).

E.G. Chigintseva also notes the peculiarities in the lingual muscles: pathological conditions of muscle tone are observed, which in some cases are accompanied by structural features of the tongue (with spasticity, the tongue is often massive, drawn in a lump deep into the oral cavity or elongated as a “sting”; this can be combined with shortening of the frenulum represented by in the form of a dense cord; with hypotonia, the tongue is in most cases thin, flaccid, spread out at the bottom of the oral cavity, which can be complicated by shortening of the sublingual fold, which appears thin and translucent); There are violations of the position of the tongue (at rest and during movement) in the form of deviation to the side, protruding the tongue from the mouth, inserting the tongue between the teeth; a slight or fairly pronounced limitation in the mobility of the lingual muscles is detected; hyperkinesis, tremor, fibrillary twitching of the tongue; increase or decrease in the pharyngeal reflex. In the muscles of the soft palate, sagging of the velum palatine is noted (with hypotension); deviation of the uvulus (uvula of the soft palate) from the midline. In the vegetative nervous system Mostly mosaic disorders are observed in the form of easily occurring facial spasms (redness or pallor), cyanotic tongue, hypersalivation (intense salivation, which can be constant or intensify under certain conditions).

Factors influencing the development of speech function G.V. Chirkina also includes later lesions of the central nervous system of traumatic or infectious origin, intoxication, severe somatic infections complicated by traumatic situations (separation from the mother, pain shock), even if they were temporary and not permanent).

In a child with rhinolalia, even with a unilateral, complete or partial cleft, inhalation is carried out more actively through the cleft, i.e. through the mouth, not through the nose. A congenital cleft contributes to a “vicious adaptation,” namely, an incorrect position of the tongue, its root, and only the tip of the tongue remains free, which is pulled back middle part oral cavity (the root of the tongue is raised excessively upward, covering the cleft, and at the same time the pharyngeal space). The tip of the tongue is located on the bottom of the mouth in the middle part, approximately at the level of the fifth tooth of the lower row.

Food entering the nose through a cleft also appears to cause excessive development of the root of the tongue, which closes the cleft. So, in a child with a congenital cleft, the most important, most vital functions stabilize the position of the excessively elevated tongue root. As a result, the air stream, when leaving the subglottic space, is directed almost perpendicular to the palate. This makes it difficult to exhale through the mouth during speech and creates a nasal tone in the voice. In addition, the constant position of the raised tongue root inhibits the movements of the entire tongue. As a result, the implementation of the necessary movements of the tongue for the articulation of speech sounds in rhinolalic patients fails; in addition, a weak exhalatory stream, not entering the front part of the oral cavity, does not stimulate the formation of various articulatory closures in the upper part of the speech apparatus. Both of these conditions lead to severe pronunciation problems. To improve the pronunciation of a particular sound, rhinolalics direct all the tension to the articulatory apparatus, thereby increasing the tension of the tongue and labial muscles, involving the muscles of the wings of the nose, and sometimes all the facial muscles.

In the process of speech dysontogenesis, adapted (compensatory) changes in the structure of the organs of articulation are formed:

· high elevation of the root of the tongue and its shift to the posterior zone of the oral cavity; relaxed, inactive tip of the tongue;

· insufficient participation of the lips when pronouncing labialized vowels, labiolabial and labiodental consonants;

· excessive tension of facial muscles;

· the occurrence of additional articulation (laryngealization) due to the participation of the walls of the pharynx.

L.P. Borsch notes that a short frenulum is a developmental defect, expressed by the formation of a fold of the mucous membrane, fixing the tongue sharply anteriorly, sometimes almost to the teeth. It is often detected in parents or close relatives of children, which can be considered a family trait; Anomalies and bite are similar. When studying medical records of the development of children with pathology of the frenulum of the tongue, the author found that in 94.7% there was a syndrome of motor disorders; 52.7% - dysplasia hip joints; in 69.4% - delayed psychomotor development; in 38.4% - injury to the cervical spine; 8.8% - children's cerebral paralysis.

Newborns with a short frenulum of the tongue may experience restlessness when feeding. It is explained by difficulties in sucking and swallowing. Babies do not suck the norm. Such children's sleep is superficial, intermittent, restless, and they cry a lot.

If the correction is not carried out on time, then this is aggravated with age by the fact that speech is formed with deviations; the child is not understood by his peers; Adults, trying to pronounce sounds correctly, evoke negative emotions in response. He withdraws into himself, prefers to talk less, play alone, and an “inferiority complex” begins to form. This often contributes to the development of bad habits. They are characterized by a decrease in the emotional-volitional sphere and mood lability. Such children are unbalanced, hyperexcitable, and have difficulty calming down. They are very touchy, whiny, and sometimes aggressive. These children have difficulty making contact and refuse to perform certain tongue movements during receptions.

By the beginning of school, speech remains unclear, and the pronunciation of several groups of sounds is impaired. Speech is inexpressive, voice intonation is poor. This makes such children more vulnerable and withdrawn, although their intellectual abilities are quite developed. For the most part, such children are self-critical.

The identified features of the oral motor basis of articulation made it possible to assume that in the absence of timely correctional assistance, at best, disturbances in sound pronunciation and general blurriness in the flow of speech will occur.

Early diagnosis is carried out based on the assessment of non-speech disorders, which include the following:

violation of the tone of articulatory muscles (face, lips, tongue) such as spasticity (increased muscle tone), hypotension (decreased tone) or dystonia (changing nature of muscle tone);

limitation of the mobility of articulatory muscles (from the almost complete impossibility of performing articulatory movements to minor restrictions on their volume and amplitude);

disturbance of the act of eating: disturbance of the act of sucking (weakness, lethargy, inactivity, irregular sucking movements; leakage of milk from the nose), swallowing (choking, choking), chewing (absence or difficulty chewing solid food), biting off a piece and drinking from a cup;

hypersalivation (increased salivation): increased salivation is associated with limited movements of the tongue muscles, impaired voluntary swallowing, paresis of the labial muscles; it is often aggravated due to the weakness of kinesthetic sensations in the articulatory apparatus (the child does not feel the flow of saliva); hypersalivation may be constant or worsen under certain conditions;

oral synkinesis (the child opens his mouth wide during passive and active hand movements and even when trying to perform them);

breathing disorders: infantile breathing patterns (predominance of abdominal breathing after 6 months), rapid, shallow breathing; discoordination of inhalation and exhalation (shallow inhalation, shortened weak exhalation); stridor.

During the development of speech, systemically controlled auditory-motor formations are formed, which are real, material signs of language. For their actualization, the existence of an articulatory base and the ability to form syllables are necessary. Articulatory base - the ability to bring the organs of articulation into positions necessary for the formation, formation of sounds that are normative for a given language.

In the process of mastering pronunciation skills under the control of one’s hearing and kinesthetic sensations, one gradually finds and retains in memory those articulatory patterns that provide the necessary acoustic effect that corresponds to the norm. If necessary, these articulatory positions are reproduced and reinforced. When finding the correct patterns, the child must learn to distinguish articulatory patterns that are similar in the pronunciation of sounds, and develop a set of speech movements necessary for the formation of sounds.

E.F. Arkhipova, characterizing children with erased dysarthria, reveals the following pathological features in the articulatory apparatus. It is indicated that the muscles of the organs of articulation are paretic, which manifests itself in the following: the face is hypomimetic, the facial muscles are flaccid upon palpation; Many children do not maintain the closed mouth pose, because... the lower jaw is not fixed in an elevated state due to laxity of the masticatory muscles; lips are flaccid, their corners are drooping; During speech, the lips remain flaccid and the necessary labialization of sounds is not produced, which worsens the prosodic aspect of speech. The tongue with paretic symptoms is thin, located at the bottom of the mouth, flaccid, the tip of the tongue is inactive. With functional loads (articulation exercises), muscle weakness increases.

L.V. Lopatina notes spasticity of the muscles of the organs of articulation, manifested in the following: the face is amicable, the facial muscles are hard and tense on palpation. The lips of such a child are constantly in a half-smile: the upper lip is pressed against the gums. During speech, the lips do not take part in the articulation of sounds. Many children who have similar symptoms do not know how to perform the “tube” articulation exercise, i.e. pull the lips forward, etc. With a spastic symptom, the tongue is often changed in shape: thick, without a pronounced tip, inactive

L.V. Lopatina points to hyperkinesis with erased dysarthria, which manifests itself in the form of trembling, tremor of the tongue and vocal cords. Tremor of the tongue appears during functional tests and loads. For example, when asked to support a wide tongue on the lower lip with a count of 5-10, the tongue cannot maintain a state of rest, tremors and slight cyanosis appear (i.e., blue discoloration of the tip of the tongue), and in some cases the tongue is extremely restless (waves roll through the tongue in longitudinal or transverse direction). In this case, the child cannot keep his tongue out of the mouth. Hyperkinesis of the tongue is often combined with increased muscle tone of the articulatory apparatus. When examining the motor function of the articulatory apparatus in children with erased dysarthria, the ability to perform all articulation tests is noted, i.e. Children, according to instructions, perform all articulatory movements - for example, puff out their cheeks, click their tongue, smile, stretch out their lips, etc. When analyzing the quality of performing these movements, one can note: blurriness, unclear articulation, weakness of muscle tension, arrhythmia, decreased range of movements, short duration of holding a certain pose, decreased range of movements, rapid muscle fatigue, etc. Thus, under functional loads, the quality of articulatory movements sharply falls. During speech, this leads to distortion of sounds, their mixing and deterioration in the overall prosodic aspect of speech.

E.F. Arkhipova, L.V. Lopatin identifies the following articulation disorders, which manifest themselves:

in difficulties switching from one articulation to another;

in a decrease and deterioration in the quality of articulatory movement;

in reducing the time of fixation of the articulatory form;

in reducing the number of correctly performed movements.

Research by L.V. Lopatina et al. identified disturbances in the innervation of facial muscles in children: the presence of smoothness of the nasolabial folds, asymmetry of the lips, difficulties in raising the eyebrows, and closing the eyes. Along with the characteristic symptoms for children with erased dysarthria are: difficulties switching from one movement to another, reduced range of movements of the lips and tongue; Lip movements are not performed in full, they are approximate, and there are difficulties in stretching the lips. When performing exercises for the tongue, selective weakness of some muscles of the tongue, imprecision of movements, difficulties in spreading the tongue, lifting and holding the tongue at the top, tremor of the tip of the tongue are noted; In some children, the pace of movements slows down when performing a task repeatedly.

Many children experience: rapid fatigue, increased salivation, and the presence of hyperkinesis of the facial and lingual muscles. In some cases, a deviation of the tongue (deviation) is detected.

Features of facial muscles and articulatory motor skills in children with dysarthria indicate neurological microsymptoms and are associated with paresis of the hypoglossal and facial nerves. These disorders are most often not detected primarily by a neurologist and can only be identified during a thorough speech therapy examination and dynamic observation during correctional speech therapy work. A more in-depth neurological examination reveals a mosaic of symptoms of the facial, glossopharyngeal and hypoglossal nerves, which determines the features and variety of phonetic disorders in children. Thus, in cases of predominant damage to the facial and hypoglossal nerves, disorders of the articulation of sounds are observed, caused by inadequate activity of the labial muscles and muscles of the tongue. Thus, the nature of speech disorders depends on the state of the neuromuscular apparatus of the organs of articulation.

In order for a person’s speech to be articulate and understandable, the movements of the speech organs must be natural, accurate and automated. In other words a necessary condition The implementation of the phonetic design of speech is a well-developed motor skill of the articulatory apparatus.

When pronouncing various sounds, the speech organs occupy a strictly defined position. But since in speech sounds are not pronounced in isolation, but together, smoothly following one another, the organs of the articulatory apparatus quickly move from one position to another. Clear pronunciation of sounds, words, phrases is possible only if there is sufficient mobility of the organs of the speech apparatus, their ability to quickly rearrange and work clearly, strictly coordinated, and differentiated. Which implies accuracy, smoothness, ease of movement of the articulatory apparatus, pace and stability of movement.

Thus, disturbances in the motor capabilities of the articulatory apparatus are one of the causes of deviations in the speech development of young children. Analysis of studies on the state of articulation in young children with speech development disorders allowed us to highlight the following features:

· there is insufficient mobility of the muscles of the tongue, lips, lower jaw;

· peculiarities of articulation are manifested in difficulties in switching from one articulatory pose to another, in difficulties in maintaining an articulatory pose;

· It is possible to study the state of articulation of young children by observing the child’s eating behavior.

Conclusions on Chapter I

The development of articulation is an important component of normal speech development. Articulation is the work of the speech organs (articulatory apparatus) when pronouncing syllables, words, phrases; This is the coordination of the action of the speech organs when pronouncing speech sounds, which is carried out by the speech zones of the cortex and subcortical formations of the brain. When pronouncing a certain sound, auditory and kinesthetic or speech motor control is realized.

In order for speech to be articulate and understandable, the movements of the speech organs must be natural, accurate and automated. In other words, a necessary condition for the implementation of phonetic speech is well-developed motor skills of the articulatory apparatus. The articulatory apparatus is an anatomical and physiological system of organs, including the larynx, vocal folds, tongue, soft and hard palate, teeth of the upper and lower jaws, lips, nasopharynx and resonator cavities involved in the generation of speech and voice sounds. Any disturbances in the structure of the articulatory apparatus, whether congenital or early acquired (before the age of 7 years), invariably entail difficulties in the formation and development of speech.

All movements of the articulation organs are determined by the work of the motor analyzer. Its function is the perception, analysis and synthesis of stimuli coming to the cortex from the movement of the speech organs. In the speech motor zone, a complex and subtle differentiation of speech movements and the organization of their sequence occur.

In ontogenesis, the process of development of articulation is formed sequentially: screaming, humming, early babbling; late syllabic babble; first words, phrases; further subtle differentiation of articulatory structures.

Eating behavior is one of the indicators of articulation development. If a child prefers soft food to hard food, and the organs of articulation are not mobile enough during meals, then this indicates insufficient development of the muscles of the mouth and lips.

Deviations of speech development at an early age are underdevelopment of the cognitive and linguistic components of speech development, caused by a violation of psychophysiological prerequisites and/or a discrepancy between microsocial conditions and the child’s capabilities. It manifests itself in the difficulties of forming the initial children's vocabulary and phrasal speech. It can be an independent speech pathology or part of the structure of any form of deviant development.

Studying the state of articulation in young children with speech development disorders is possible by organizing observation of the child’s eating behavior.

It is recommended to carefully collect complaints and medical history, taking into account a survey of parents. .

A comment. The inspection is divided into several stages. These include clarifying complaints, clarifying the history of the present disease, and the characteristics of the patient’s life.

2.2 Physical examination.

Consultation with a neurologist is recommended.
Level of strength of recommendation A, level of certainty of evidence I.
A speech therapy examination of the child is recommended.
Level of strength of recommendation A, level of certainty of evidence I.
A comment. A speech therapy examination must be comprehensive, holistic and dynamic, and also have its own specific content aimed at analyzing speech disorders. The complexity, integrity and dynamism of the examination are ensured by the fact that all aspects of speech and all its components are examined, moreover, against the background of the entire personality of the subject, taking into account the data of his development - both general and speech - starting from an early age.
It is recommended to evaluate indicators of speech development: speech activity, sound pronunciation, understanding of addressed speech, active vocabulary, phrase development, lexico-grammatical structure of speech. Speech activity means the desire to use speech for communication, activity in the use of language.
Level of strength of recommendation A, level of certainty of evidence I.
A comment. The level of sound pronunciation, its compliance or the degree of inconsistency with the child’s age is assessed. To assess the understanding of addressed speech, the child is asked, using only speech instructions, to show objects in a picture, perform certain actions, gradually complicating the tasks. If you have an understanding of speech at the everyday level, you should identify an understanding of the meaning of prepositions, differences in tense, number, and case.
The volume of the active vocabulary is assessed by the number of nouns, verbs, and adjectives used in speech. The wider the active vocabulary, the more signs A child can name one object, more accurately define an action, and convey shades of meaning.
The assessment of the lexical and grammatical structure of speech is carried out on the basis of the child’s correct use of gender, number, case, prepositions, verb tenses, and word formation skills in speech. During a psychological examination, indicators such as the child’s communications, emotional background, mental development (mainly non-verbal intelligence) are first assessed.
A pathopsychological (experimental psychological) study is recommended.

A comment. A pathopsychological study includes a conversation with the patient, an experiment, observation of the patient’s behavior during the study, collection and analysis of anamnesis, comparison of experimental data with the life history of the subject. Under experiments in modern psychology refers to the use of any diagnostic procedure to model an integral system of cognitive processes, motives and personality characteristics.
It is recommended to consult a psychiatrist (if indicated).
Strength of recommendation level C, level of certainty of evidence III.
It is recommended to consult an audiologist (if indicated).
Strength of recommendation level B, level of certainty of evidence II.
A comment. In case of speech disorders, a comprehensive examination is necessary, including a consultation with an audiologist who evaluates hearing and identifies its problems; if necessary, audiography can be performed.

2.3 Instrumental diagnostics.

An EEG is recommended.
Strength of recommendation level B, level of certainty of evidence II.
A comment. Electroencephalography is used for all neurological, mental and speech disorders.
An MRI of the brain is recommended.
Strength of recommendation level B, level of certainty of evidence II.
A comment. Using MRI, three-dimensional images of the head, skull, brain, and spine can be obtained. Magnetic resonance imaging, performed in vascular mode, allows you to obtain images of the vessels supplying blood to the brain. MRI can detect changes in the brain associated with its physiological activity. Thus, with the help of MRI, the position of the patient’s motor, visual or speech centers of the brain, their relationship to the pathological focus - tumor, hematoma (so-called functional MRI) can be determined.

2.4 Differential diagnosis.

Mental retardation.
Children with SDD perform unsatisfactorily on nonverbal tests and tasks, they have insufficiently expressed cognitive interest and desire to communicate, and are not active in using gestures or maintaining games.
Autism.
In autism, the need for communication and the ability to socially interact are impaired, and they can also cause impaired speech development. Speech is not used for communicative purposes or is not used enough. Uneven and asynchronous rates of speech development are noted. Phrasal speech can be formed with a delay, often without a preceding babbling period. Characteristic features include echolalia, cliched phrases, the use of verbs in an indefinite form or in the imperative mood, a long absence of the pronoun “I” in speech, there is no expression or gestures in speech, there is an inability to dialogue, children do not ask questions. The pronunciation of sounds, the melody of speech, the rhythm, and tempo are impaired.

Dysarthria

Dysarthria

Causes of dysarthria

Classification of dysarthria

Symptoms of dysarthria

Characteristics of clinical forms of dysarthria

Diagnosis of dysarthria

Correction of dysarthria

Forecast and prevention of dysarthria

Articulation disorders in children and adults

Specific speech articulation disorders (dyslalia) in children

Developmental articulation disorder

Definition

Epidemiology

Etiology

Clinical features

Differential diagnosis

Forecast

Treatment

Bibliography

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Specific speech articulation disorder

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F80.0. Specific speech articulation disorder

F80.1. Expressive language disorder

F80.2. Receptive language disorder

speech articulation disorder

See what “speech articulation disorder” is in other dictionaries:

F80.1. Expressive language disorder

F80.2. Receptive language disorder

2.2 Physical examination.

2.3 Instrumental diagnostics.

2.4 Differential diagnosis.

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