speech and language developmental disorders
Introduction
Introduction to speech and language development disorders Speech and language developmental disorders refer to disorders of language acquisition in the early stages of development, manifested as delays and abnormalities in pronunciation, language comprehension, or development of verbal expression, which affect learning, professional, and social functions. These conditions are not due to abnormalities in the nervous or speech mechanisms, sensory defects, mental retardation or environmental factors. Language development disorder refers to obstacles in the understanding, expression and communication process caused by various reasons, including expression language disorder, sensory language disorder and acquired aphasia with epilepsy. Language development disorder refers to developmental and rhythmic rhythm disorders in verbal speech, including specific speech dysarthria and speech fluency disorder (stuttering). basic knowledge Sickness ratio: 0.1% Susceptible people: children Mode of infection: non-infectious Complications: autism, child autism
Cause
Causes of speech and language development disorders
The etiology of mixed speech disorder is mainly neurobiological factors, generally caused by genetic or cortical damage. About 2/3 patients can detect positive signs of nervous system, EEG can often find non-specific abnormalities, more common in the left hemisphere, CT There may also be non-specific abnormal findings, and there are many reasons for verbal fluency disorder (stuttering), but no theory can be explained alone as a cause.
Basic factors (10%):
Genetic, neurological, psychosocial and psychological factors may interfere with the clear pronunciation of children.
Environmental factors (30%):
It is associated with the onset of stuttering and the development of stuttering symptoms. For example, long-term living with stuttering parents, stuttering is easy to persist.
Contributing factors (10%):
When and where and under what circumstances are stuttering, these conditions are the triggering factors.
Sound pipeline factor (10%):
The sound pipeline has failed and interferes with the way the speech is spoken.
Other factors (10%):
Emotional stress, excitement or imitating the stutterer's speech.
Prevention
Speech and language development disorder prevention
Language is the medium for children to learn and understand the surrounding things. Whether the language ability is normal or not will often affect the overall development of children. In recent years, the public has been paying more and more attention to children's language problems, but parents often fail to clearly distinguish whether young children have language barriers or understanding. .
In general, if a child does not say a single word at the age of two or fails to speak a simple sentence at the age of three, it may indicate that they have a language barrier. Parents should promptly report to the family doctor, maternal and child health if in doubt. Inquiries from schools or kindergartens attended by children or children can greatly reduce the chances of delaying the diagnosis.
Mastering children's understanding and expression includes whether they are born and born in full term, whether they have congenital diseases and their medical history and family history, and their past language performance. Standard language assessment includes language understanding and expression, and the results will be Compared with the language ability of children of the same age, if necessary, the speech therapist will observe the communication mode, pronunciation performance, social and play ability of the child and the family to further understand their communication skills, and the language therapy is integrated into children of daily life. The key period for developing language is 0 to 5 years old. If a child is diagnosed with a language problem, he or she should be treated at this critical time. The sooner the child gets the appropriate language treatment, the more help they have in future language development, the speech therapy The teacher will set a child-friendly treatment goal based on the child's language problem and its severity, age, current ability and parental expectations.
The treatment program is mainly practiced through the game and the child. The speech therapist will also teach the parents how to promote the motivation of the child to learn the language and increase the chance of practicing in the daily life. After the parents learn, they can follow the homework provided by the speech therapist. Practice and child review, language therapy is the main method to deal with speech and language development disorders, parent involvement and cooperation is very important.
1. Improve the possible unfavorable factors in the fostering environment. For example, try to use only one language in the family. The main supporters should use the language as loudly, simply, clearly and repeatedly.
2. Develop an individualized training program based on accurate assessment of speech, language development, and intelligent development. For children with specific speech dysphonic disorders, first determine the training objectives, and generally select the earliest sounds of normal children in their false voices ( The easiest sound is the target sound, and the phoneme is learned by means of perception, contrast, imitation, maximum approach, practice, etc., and then the appropriate syllable, word, sentence level learning, for susceptibility or according to the language development level of the child Children with expressive language disorder develop a training plan based on the principle of closest to the level of development, and use the principle of behavioral shaping as a training method. Pay special attention to one-on-one intensive training and daily life scenarios. Under the combination of learning, children's items of interest and toys are matched with words. First, create various scenarios to encourage children to communicate with any gestures or voices, and then gradually correct their bad communication methods.
3. Strive for family support and cooperation, and actively carry out training within the family. Parents and primary caregivers play a vital role in children's language development and language therapy.
4. At the same time, attention should be paid to hyperactivity, attention to defects, anxiety and other concomitant problems.
Complication
Speech and language developmental disorders Complications autism children autism
Autism, autism, and mental illness can cause single or multiple defects in physical activity, feeling, intelligence, language, mood, and behavior of a child, so that learning and social difficulties are often encountered.
Symptom
Symptoms of speech and language development disorders Common symptoms Brain development disorders Stuttering dysphonic dysarthria Hearing impairment Hearing tremors Fear Anxiety convulsions
Speech and language developmental disorders refer to disorders of normal language acquisition in the early stages of development, manifested as delays and abnormalities in pronunciation, language comprehension or development of verbal expression, which affect learning, professional and social functions. Abnormalities in neurological or speech mechanisms, sensory defects, mental retardation or environmental factors. This developmental disorder occurs in early childhood development and cannot be directly attributed to abnormalities in neurological or speech mechanisms, sensory defects, mental retardation, and extensive development. Obstacles or environmental factors, children can communicate or understand well in some very familiar situations, but in any case, the language ability is impaired.
Language barrier
(1) expressive language disorder: it is a specific language development disorder. The expressive oral application ability of children is significantly lower than that of their mental age, but the speech comprehension is within the normal range, and the incidence rate is about the age of school-age children. 3% to 10%, boys are 2 to 3 times more likely than girls, and have a family history of developmental unclear or other developmental disorders. The incidence is high, and the disease may be related to brain damage, brain problems or genetic factors. However, the evidence has not been sufficient so far, and the clinical manifestations are as follows:
Words are not spoken when you are 12 years old, and you don't speak 2 words or phrases when you are 3 years old.
After the age of 23, the vocabulary expansion is limited, repeated, too many common words are used too much, it is difficult to choose appropriate words and words to replace, the speech is too short, the sentence structure is naive, the syntax is wrong, misuse or no preposition, pronoun , verbs and nouns, sentences are not smooth.
3 Spoken language defects are often accompanied by delayed or abnormal word formation.
4 Expression language developmental retardation is beyond the normal range of children's mental age, while the sensory speech skills are still within the normal range. Non-verbal expressions (such as expressions, gestures) and internal speech are relatively complete, and social ability when not speaking Also relatively lossless.
5 children often accompanied by emotional disorders, behavioral disorders, hyperactivity, inattention, and poor relationship with peers, especially in school age.
6 A small number of children with mild deafness, but the severity is not enough to cause speech delay.
7 There may be a family history of expressive language disorders.
(2) Receptive language disorder: It is a specific language development disorder. Children's understanding of speech is lower than that of their mental age. Almost all children's language expression is significantly impaired, and voice abnormalities are also common. The incidence of school-age children is about 3% to 10%, boys are 2 to 3 times more than girls, the cause of the disease is unknown, early thought to be related to sensory dysfunction, brain damage and genetic factors, but there is no clear theory or evidence Support, there are also studies that may occur on the basis of impairment of hearing discrimination, most children respond better to the voice in the environment than the voice of the conversation, the clinical manifestations are as follows:
When you are 11 years old, you don't respond to familiar names. You can't recognize several common items when you are one and a half years old, or you can't follow simple daily instructions when you are 2 years old.
2 language understanding barriers, after 2 years of age still can not understand the grammatical structure, do not understand the meaning of other people's intonation and gestures, the severity of which exceeds the normal variation range of children of the same age, accompanied by abnormal language expression and pronunciation.
3 Most children have partial hearing loss in real voice, lacking the ability to distinguish sound orientation and source, but the degree of deafness is not enough to cause the current level of language damage.
4 Such children are often accompanied by social-emotion-behavioral disorders, with hyperactivity, inattention, poor socialization, anxiety, sensitivity or excessive shyness.
5 social development is delayed, and interest is obviously limited.
6 The prognosis is worse than the expressive language disorder, and the severely ill patients with hearing impairment and sensory comprehensive analysis have poor prognosis.
(3) Acquired aphasia associated with epilepsy (Landau-Kleffner syndrome): mainly expressed as comprehensible aphasia, which means that the child develops normal language function before the disease, and loses the sensitivity and expressive language function after the disease. Syndrome, also known as "acquired aphasia with epilepsy," occurs two years before and after speech loss, with paroxysmal EEG abnormalities or seizures involving one or both temporal lobe, rather than Language intelligence and hearing are normal, the cause of this disease is unknown, but the clinical features suggest that it may be caused by encephalitis, which is characterized by:
1 typical cases start from 3 to 7 years old, but can also start earlier or later.
More than 2 sudden onset, normal speech function development before the disease, the emergence and rapid progress of aphasia symptoms, language skills are lost in a few days or weeks, usually no more than 6 months.
3 convulsions and language loss vary greatly in the order of occurrence, and the interval between the two can be several months to two years.
4 The most characteristic is that the sensory language is seriously impaired, and hearing difficulties are often the first symptom.
5 Some children become silent, some can only make incomprehensible sounds, and some show that the lighter speech is not fluent and unclear and accompanied by dysphonia.
6 Behavior and emotional disturbances are common in the months after the language begins to lose, but this situation tends to improve when the child can re-use a communication method.
7 The cause of this disease is unknown. It may be an encephalitis, mainly symptomatic treatment. About 2/3 of the children have residual linguistic defects, and about 1/3 fully recover.
2. Speech disorder
(1) Specific speech dysarthria: It is a specific speech development disorder. Children's ability to use language is lower than their mental age, but speech skills are normal. Specific speech dysarthria accounts for children with speech disorders. A large proportion, but the cause is still unknown.
There are obvious individual differences in the age at which speech is obtained and the order in which different speeches are obtained. Normally developing children often have incorrect pronunciation at the age of 4, and can learn most speech at the age of 6, although there may be difficulty in pronunciation of some complex sounds. It should not hinder communication. When you are 11 to 12 years old, you should be able to master almost all pronunciation.
Children with delayed learning and deviation often experience the following symptoms.
1 The pronunciation is wrong when speaking, making it difficult for people to understand. "Speech is like a foreigner."
2 The voice is omitted, distorted or replaced, giving the impression that the speech is too fast and too urgent.
3 The same phonetic pronunciation is inconsistent, that is, it is pronounced correctly in some words and not elsewhere.
(2) Speech fluency disorder (stuttering): It is a speech disorder characterized by abnormal rhythm of speech. There are two common stutterings, namely, sputum stuttering and tonic stuttering. The former is the sputum of the vocal organ muscles, and there are many repetitions. The syllable of the first word, the latter is the rigidity of the vocal organ muscles, difficult to emit or pause on a word, the clinical manifestations of stuttering have the following eight characteristics.
1 There was tension and struggling in the beginning of the speech.
The word at the beginning of 2 has a sound extension.
The repetition of 3 words, the speech is full of ", en" and the first syllable of the word.
4 inserted another sound.
5 mouth, tremble around the cockroach.
6 The sound is adjusted and the loudness is increased and extended.
7 Avoid the use of special words and speech during the increase in the number of pauses.
8 Children are expected to have difficulty with certain words, so there is fear on their faces.
Examine
Examination of speech and language development disorders
There is currently no specific laboratory test for this disease. When other conditions, such as infection, occur, laboratory tests show positive results from other conditions.
Diagnosis
Diagnosis of speech and language development disorders
Diagnostic criteria
Language development disorder
(1) Diagnostic criteria for expressive language disorders: based on CCMD-3 diagnostic criteria.
1 Speech proficiency is significantly lower than the actual age.
2 language understanding ability is normal.
3 The standardized IQ is normal (the IQ and the IQ of the children's intelligence test are both 70).
4 Not due to hearing impairment, oral disease, nervous system disease, mental retardation or extensive developmental disorders.
(2) Diagnostic criteria for sensory language disorders: based on CCMD-3 diagnostic criteria.
1 speech comprehension ability is lower than the actual age should be.
2 accompanied by abnormal language expression and pronunciation.
3 Non-verbal intelligence test IQ is at normal level (Wei's children's intelligence test operation IQ 70).
4 Not due to hearing impairment, oral disease, nervous system disease, mental retardation or extensive developmental disorders.
(3) Diagnostic criteria for acquired aphasia (Landau-Kleffner syndrome) with epilepsy: according to CCMD-3 diagnostic criteria.
1 The pre-existing language function was normal. During the 2 years before and after the speech loss, there was a paroxysmal EEG abnormality or seizure involving one or both temporal lobe.
2 non-verbal intelligence and normal hearing.
3 The total course of expression or feeling of severe speech impairment is generally no more than 6 months.
4 is not caused by other neurological diseases, extensive sexual development disorders.
2. Speech development disorder
(1) Diagnostic criteria for specific speech dysarthria: based on the CCMD-3 diagnostic criteria.
1 The pronunciation is difficult, the pronunciation is incorrect when speaking, so that it is difficult for others to understand. The speech is omitted when the child speaks, and the severity of distortion or substitution has exceeded the variation range of children of the same age.
2 The language comprehension and expression ability is normal (Wei's children's intelligence test language IQ, operation IQ and total IQ are 70).
3 Not due to hearing defects, oral diseases, nervous system diseases, mental retardation or extensive developmental disorders.
(2) Diagnostic criteria for verbal fluency disorder (stuttering): According to the CCMD-3 diagnostic criteria.
1 Frequently repeated speech, syllables, repeated words, prolonged, frequent pauses, making speech not smooth, but the content of speech expression is barrier-free.
2 symptoms have been at least 3 months.
3 Not due to neurological diseases, tic disorder and disordered speech.
Differential diagnosis
Language development disorder
(1) Differential diagnosis of expressive language disorder: It must be differentiated from mental retardation, sensory language disorder, generalized developmental disorder, selective silence, language difficulties and aphasia.
(2) Differential diagnosis of perceptual language disorders:
1 must be differentiated from autism, people with sensation speech disorder have normal social interactions, participate in social activities, often use parents to comfort, can use gestures and so on.
2 must be differentiated from epileptic acquired aphasia, language difficulties, aphasia, selective mutism, deafness caused by language development retardation and mental retardation.
2. Speech development disorder
(1) Differential diagnosis of specific speech dysarthria: It must be differentiated from deafness, mental retardation and dysphonia caused by vocal organ lesions.
(2) Speech fluency disorder (stuttering) differential diagnosis: more stuttering occurs in 2 to 6 years old, many children with normal development have experienced periods of fluency when they are 2 to 4 years old, and must be differentiated from stuttering.
The obstruction of a smuggler's speech occurs at the level of "pronunciation and words", while the speech of normal children is blocked at the level of words and words.
Two stutterers were accompanied by muscle spasms of the vocal organs, which were not observed in normal children.
Three stutterers continue to stutter for more than one year, and normal children can improve themselves within one year.
4-seaters still have stuttering when they are over 6 years old, while normal children disappear on their own after the vocabulary increases.
3. Identification of normal variation in development The normal age at which children begin to learn to speak and the speed at which they can achieve a firm grasp of language skills vary widely, while children with most speech and language developmental disorders, although the final speech and language levels are normal, still There are many problems. Although there are no clear boundaries between this group of obstacles and the extreme forms of normal variation, there are four criteria that can help determine the clinical significance: severity, duration of disease, form of disorder, associated problems, if language development is more than 2 More than the standard deviation may be abnormal, but the severity of the statistics is less meaningful for the diagnosis of older children, because this group of disorders has a tendency to spontaneous remission, then the course of the disease is of great significance, if the current damage is light, but previously After a history of serious damage, the current functional state may be a residual condition of a developmental disorder, rather than a normal variation. Language developmental delay is often secondary to reading and spelling difficulties, abnormal interpersonal relationships, and emotional and behavioral disorders, if Language or language delay accompanied by school skill defects (such as reading or spelling Retardation), abnormal interpersonal, emotional or behavioral disorders, so that this growth retardation diagnosis.
4. Identifying intelligence with mental retardation, including language skills, so children with lower IQ than average, language skills development is also low, the diagnosis of specific developmental disorders means that this slow function can not keep up with the overall level of cognition, therefore, When language development delays are only part of a broader mental retardation or extensive developmental disorder, the latter two should be assigned, but mental retardation or generalized developmental disorders are often accompanied by an imbalance in the development of intelligent activities, especially language skills. Damage can be significantly more important than non-verbal skills. If this imbalance is obvious and prominent, the diagnosis of speech and language developmental disorders should be included after the diagnosis of mental retardation or generalized developmental disorders.
5. Identification of severe early deafness in severe early deafness or certain special neurological or other structural abnormalities can lead to secondary speech and language development disorders, not to the diagnosis classification of this group, however, heavier It is not uncommon for a sensory language development disorder to be associated with some selective hearing impairment. The principle of diagnosis is that if the severity of hearing loss is sufficient to explain language developmental delay, it should be excluded from the diagnostic classification of this group; if partial hearing loss is a concomitant factor, Insufficient to cause speech and language developmental disorders as a direct cause, and the diagnosis of speech and language development disorders should be added after the diagnosis of hearing impairment.
