Alalia

Alalia is a gross underdevelopment or complete absence of speech function, which is caused by organic damage to the areas of the cerebral cortex responsible for speech. This damage occurs in the prenatal period or in the first 3 years of a child’s life. With alalia, speech underdevelopment is systemic, i.e. the baby has a late appearance of speech reactions, a violation of sound pronunciation, syllabic structure, phonemic processes, poor vocabulary.

The content of the article:
Causes of alalia
Classification of alalia
Symptoms of motor alalia
Symptoms of sensory alalia
Examination of children with alalia
Correction of alalia
Prognosis and prevention of alalia
Alalia
Speech alalia is diagnosed in about 1% of preschoolers and 0.2-0.6% of school-age children, in boys its development is observed 2 times more often. A child with alalia needs psychological, medical and pedagogical influence, which must necessarily be of a complex nature, include drug therapy, as well as the development of mental functions, coherent speech, lexico-grammatical and phonetic-phonemic processes.

Causes of alalia
The reasons that lead to the occurrence of alalia are very diverse. In specific periods of early ontogenesis, they may be different. In the antenatal period, organic damage to the speech centers of the brain can be caused by fetal hypoxia, intrauterine infection, the threat of spontaneous termination of pregnancy, chronic somatic diseases of the pregnant woman.

The burdened course of pregnancy can lead to complications during childbirth and the occurrence of perinatal pathology. Alalia can be the result of premature, prolonged or transient childbirth, asphyxia of the newborn, the use of obstetric instruments.

Among the etiopathogenetic factors of alalia that affect the baby in the first years of life, there are meningitis, encephalitis, traumatic brain injuries, somatic diseases that lead to exhaustion of the central nervous system. Researchers also note a hereditary predisposition to alalia. Factors aggravating the effect of various causes of alalia are frequent illnesses of the child in the first years of life, operations performed under general anesthesia, unfavorable social conditions. Usually, in the anamnesis of young patients with alalia, the effect of a whole complex of factors is traced.

Organic brain damage leads to a slowdown in the maturation of nerve cells. The result is a decrease in the excitability of neurons, inertia of nervous processes and functional depletion of brain cells. With alalia, organic lesions of the cerebral cortex are weakly expressed, but multiple, therefore, the possibilities of independent speech development are very limited.

Classification of alalia
During the entire study of the problem, several classifications of alalia have been proposed, depending on its manifestation, mechanism, and severity of speech underdevelopment. Today, the classification of alalia according to V.A. Kovshikov is used in speech therapy. According to it , there are:

motor or expressive alalia;
sensory or impressive alalia;
mixed alalia (sensorimotor or motor-sensory, depending on the prevalence of speech development disorders).
The motor form of alalia occurs as a result of an early organic lesion of the cortical part of the speech motor analyzer. In this case, the child’s own speech does not develop, but the understanding of someone else’s speech is preserved. Depending on which area of the brain is damaged, there are 2 types of alalia — afferent motor and efferent motor. With afferent motor alalia, there is an organic lesion of the postcentral gyrus (lower parietal parts of the left hemisphere), which is accompanied by kinesthetic articulatory apraxia. With efferent motor alalia, damage to the premotor cortex (the posterior third of the inferior frontal gyrus, Broca’s center) occurs, accompanied by kinetic articulatory apraxia.

The sensory form of alalia occurs as a result of damage to the cortical part of the speech-hearing analyzer (the posterior third of the upper temporal gyrus, the Wernicke center). At the same time, the child’s higher cortical analysis is disrupted, as well as the synthesis of speech sounds. Despite the fact that his physical hearing is preserved, the child does not understand the speech of others.

Symptoms of motor alalia
Motor alalia symptoms can have different — both speech and non-speech-related (neurological, psychological).

Neurological symptoms in this form of alalia are primarily represented by motor disorders, poor coordination, poor development of finger motility. It is difficult for children with motor alalia to master even elementary self-service skills (lacing shoes, buttoning buttons) and performing small-motor operations (folding puzzles, mosaics).

Giving a psychological description of children with motor alalia, it should be noted violations of attention, memory, perception. Such children may be hyperactive or, conversely, inhibited and sedentary. For kids with motor alalia, high fatigue, reduced performance, speech negativism are characteristic. Motor alalia in children leads to the fact that, due to speech insufficiency, the intellectual development of the child suffers a second time. However, as speech develops, it gradually returns to normal.

In motor alalia, there is a pronounced dissociation between impressive and expressive speech. The understanding of speech is preserved, but one’s own speech does not develop at all or develops with gross deviations. The stages of formation of speech skills (namely: humming, babbling, words, phrases, coherent speech) are delayed, and the speech reactions themselves are very simplified.

Despite the fact that a child with afferent motor alalia is theoretically capable of performing any articulatory movements, he has gross violations of sound reproduction. Often there are confusions and persistent replacements of articulatively disputed phonemes, which inevitably leads to the impossibility of reproducing the sound image of the word.

In the case of efferent motor alalia, the main speech defect is the inability to perform a series of consecutive articulatory movements, which is accompanied by a gross distortion of the syllabic structure of the word. Against the background of motor alalia, the lack of formation of a dynamic speech stereotype often leads to the appearance of stuttering.

The vocabulary of motor alalia is very far behind the age norm. The child learns all new words with difficulty, there are mainly everyday terms in his speech. An insignificant vocabulary leads to an inaccurate understanding of the meanings of words, inappropriate use of them in speech, replacement by sound and semantic similarity. A distinctive feature of motor alalia is the predominance of nouns in the nominative case in speech, a significant limitation of other parts of speech, difficulties with the formation and recognition of grammatical forms.

Coherent speech in motor alalia has a gross violation. It usually consists of short sentences. A child with speech alalia cannot consistently state events, separate the main from the secondary, convey the meaning of the event, determine the cause and effect, temporary connections.

With rough forms of motor alalia, speech does not develop at all, the child can only imitate sounds and pronounce individual babbling words, accompanying them with facial expressions and active gestures.

Symptoms of sensory alalia
The main defect in sensory alalia is a violation of the perception of reversed speech and understanding of its meaning. At the same time, sensory alalics fully retain their physical hearing. Often they suffer from hyperacusis — excessive sensitivity to sounds that are indifferent to others (rustling, creaking).

The child’s own speech activity with sensory alalia is increased. But speech at the same time is a set of meaningless sounds and fragments of words. Often, instead of answering a question, a child with sensory alalia repeats the question itself, i.e. someone else’s words. In this case, there is a so-called echolalia. In general, speech with sensory alalia is meaningless, it is incoherent and incomprehensible to others. There is a so-called logorrhea or “verbal salad”. In addition, in the speech of children with sensory alalia, there are syllable omissions (elision), obsessive repetitions of sounds and syllables (perseverations), combining parts of two words with each other (contamination), sound substitutions (paraphasias). At the same time, children with sensory alalia are very tolerant of their own speech, such a violation does not prevent them from communicating, because for this they use gestures and facial expressions.

In the case of a rough form of sensory alalia, the understanding of speech on the part of the child is completely absent, but in other cases it depends on the situation. But even if the meaning of the phrase is clear to the child, then it is worth changing the order of words in the sentence, the word form or the pace of speech, as understanding is lost. Often, in order to comprehend speech, a child with sensory alalia has to “read” from the lips of the speaker. There are children who understand only what they can say themselves, and in order to comprehend speech, they need to pronounce words. Under other circumstances, they have no understanding.

The lack of phonemic hearing leads to the fact that a child with sensory alalia does not distinguish words that have different meanings, but are similar in sound, and also cannot correlate the spoken or heard word with a particular phenomenon or object.

Gross distortion of speech development can also lead to secondary personality disorders, intellectual development delay. But categorical conclusions still should not be made. For mental lag in sensory alalia, it is easy to take a child’s misunderstanding of a speech task.

As for the psychological characteristics of children with sensory alalia, they are characterized by increased distractibility, difficulties with attention retention, instability of memory and auditory perception. Such children may have chaotic behavior, impulsivity or, conversely, isolation and inertia. Sensory alalia in its pure form is quite rare. Most often there is a mixed sensorimotor form, which confirms the functional relationship of the speech-hearing and speech-motor analyzers.

Examination of children with alalia
In each case, alalia proceeds in its own way. But to determine if a child has serious problems with speech, you should know the norms of speech development. As a rule, at 2 months the baby has a characteristic gulling, and at 3-4 months — babbling. The child should pronounce the first words at 6-8 months, and build whole phrases by the year. If by the age of 2 the baby’s vocabulary is several words, speech is incomprehensible and incoherent, then it’s time to sound the alarm and go to the doctor: perhaps the child has speech alalia. Identifying it at an early stage will favorably affect the subsequent correction.

Children with alalia necessarily need the advice of specialists such as a pediatric neurologist, otolaryngologist, speech therapist, psychologist.

Neurological examination of a child with alalia is necessary in order to identify and assess the nature and extent of brain damage. In this case, the child may be recommended echoencephalography, EEG, MRI of the brain, X-ray of the skull. In order to exclude hearing loss with sensory alalia, it is necessary to conduct otoscopy, audiometry and other hearing studies.

Neuropsychological examination of a patient with alalia consists in the diagnosis of auditory-speech memory. Examination by a speech therapist with alalia begins with finding out the perinatal anamnesis, as well as the features of the early development of the child. At the same time, special attention should be paid to the timing of psychomotor and speech development. Diagnosis of a child’s oral speech with alalia (lexical and grammatical structure, impressive speech, phonetic and phonemic processes, articulatory motor skills) is carried out according to the examination scheme for general speech underdevelopment.

Differential diagnosis of alalia is carried out with dysarthria, hearing loss, oligophrenia, autism.

Correction of alalia
For children diagnosed with alalia, treatment consists in the competent and gradual correction of the child’s speech skills. They receive the necessary assistance in specialized preschool institutions, correctional centers, hospitals, sanatoriums.

Correction of alalia is carried out simultaneously with drug therapy, which is aimed at stimulating the maturation of brain structures, as well as physiotherapy (magnetotherapy, laser therapy, hydrotherapy, electrophoresis, electropuncture). With alalia, it is very important to work on the development of motor skills — manual and general, as well as mental functions (attention, memory, thinking).

Taking into account the fact that the violation is systemic in nature, alalia correction classes involve work on all sides of speech. In particular, with motor alalia in children, they stimulate speech activity, work on sound reproduction, dictionary formation, development of coherent speech, grammatical design of utterance. Speech therapy classes at alalia necessarily include speech therapy massage and logorhythmics.

With sensory alalia, first of all, the task is to learn to distinguish between non-verbal and speech sounds, differentiate words, correlate them with specific objects and actions, understand phrases and speech instructions, master the grammatical structure of speech. Then, with the accumulation of vocabulary, the formation of phonemic perception and subtle acoustic differentiations, you can proceed to the development of the baby’s own speech.

When correcting various forms of alalia, early literacy training of children is also recommended, because writing and reading help to better consolidate the acquired material and control oral speech.

Prognosis and prevention of alalia
The result of corrective work in alalia depends on many factors. In particular, the key to success is the early start of correction (from 3-4 years), complex nature, impact on all components of speech. An indispensable condition for the successful correction of alalia is that the formation of speech processes should be carried out in the unity of all mental functions. For a child with motor alalia, the prognosis is more favorable. With sensory and sensorimotor alalia, it is rather indefinite. The prognosis is also significantly influenced by the degree of organic brain damage. In the future, children with alalia may experience various violations of written speech during school education. It is important to remember that correctional work with alalia allows you to prevent the appearance of secondary intellectual disability.

As for the prevention of alalia, in order to prevent it, it is necessary to ensure a favorable course of pregnancy and childbirth, as well as early physical development of the child.

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