Pediatric Speech and Language Disorders
Introduction
Introduction to speech and language barriers in children Language is an important ability in learning, social interaction, and personality development. In a broad sense, children's speech and language disorder (languagedisorder) is also known as communication barriers and affects future reading and writing. Therefore, early detection, early diagnosis and timely treatment are particularly important. In recent years, the clinical diagnosis and treatment of children's speech and language barriers has been carried out. basic knowledge The proportion of sickness: 0.01% Susceptible people: children Mode of infection: non-infectious Complications: cleft palate
Cause
Causes of speech and language disorders in children
(1) Causes of the disease
Hearing impairments affecting speech disorders for various reasons; intelligent retardation for various reasons is the most common cause of speech disorders; suffering from neuropsychiatric diseases such as neurological diseases, autism, anxiety, etc., or the impact of social environmental problems Can cause speech barriers.
(two) pathogenesis
1. Children's language development language includes both verbal and non-verbal components, which are dynamic and interactive processes. This process begins in the early development of children. Language development is influenced by biological factors and environment, individual differences. Large, language development and language-related brain functions have gender differences. Recent studies using functional magnetic resonance to language have shown that in language information processing, women have more activation in the nervous system than men; activation of the male brain It has one side advantage, mainly in the left anterior and posterior frontal horn area, while women have active areas in both sides of the brain, which explains why boys have more language problems than women in early childhood, and the language development process is as follows:
(1) Pre-linguistic period (born ~ 12 months): When the child speaks, he already has the use of language, and the way of communication is non-verbal, such as eye contact, smile, etc. In the communication of the way, gradually learn the rules of language communication. For example, adults and children play the "peek-and-cat" game, which reflects the common participation, and cultivates the "rotation" behavior of children in the interaction. The children in this period are mainly Beginning to pronounce, about 3 to 4 months, the child has repeated squeaking sounds. At 8 months, the vocalization has a combination of consonants and vowels. When 12 months, one word is used, and the posture is used to express meaning. If you wave goodbye, use your little finger to click on the picture.
(2) The initial language period (1 to 3 years old): At this time, the children use words to express what they already know, and use words to communicate with others, but they embody the self-centered characteristics. However, the children continue to use non- The way of speech, and the way of talking and communicating together, 12 to 18 months of children will use words, the vocabulary will increase to 20; 18 to 24 months of children enter the stage of 2 word combination, if the child is When a certain thing is very familiar, they can combine words according to the rules in the communication, so the sentence begins to appear. The number of words at this stage increases to hundreds, the ability to imitate increases, the number of topics in communication increases, showing better flexibility; Children aged 24 to 36 months have significantly increased vocabulary, and can apply previously learned vocabulary to communication, such as expressing intention and quantity. At this time, pediatrics are more appropriate and can express themselves in a special way. Emotions, hopes, interests, etc., 3 years old children can name their own, age, gender, recognize common items, pictures, follow two or three consecutive instructions.
(3) Pre-school period (3 to 5 years old): Children begin to have more complicated language forms, such as prepositions (above, below, etc.), conditional sentences (if... then), conjunctions (because... So, however, the children at this time are more proficient in expressing their intentions and meanings, using appropriate communication in different situations, preschool children will tell stories, follow three consecutive instructions, and know what to expect in the future. For example, "Tomorrow we go...", they can respond to the question "Who, Where, What", but it is difficult to answer the question "How and why" (although they often ask others why), even 4 years old children even Speaking in front of strangers is also clear and easy to understand.
(4) Early school age (5-12 years old): When children enter school, the environment requirements for children are all expressed in language. For example, children are required to remain quiet in the classroom, teachers are taught to impart knowledge, and assignments are arranged. In the group, children are required to abide by the "ruling" rules, appropriate and flexible use of language, to ensure academic success, and to adapt to the school environment, in the process of developing children's semantics, this period, children's learning and academics The new words, get new information and instructions, master a specific subject, when children are 7 to 8 years old, children use abstract language to think about problems. By the age of 12, many aspects of their cognitive and language skills are like adults.
2. Pathogenesis
(1) Hearing impairment: Hearing is an important channel for language experience. When children's hearing is impaired, whether it is conductive or sensory, they cannot correctly detect the sound signal and produce language of varying degrees. Delayed, the severity of its delay is affected by many factors, such as the degree of hearing impairment, the age at which it occurs, the age at which the hearing is corrected, the appropriateness of the correction, etc., conductive hearing impairment with repeated and long-term otitis media, and Exudation, which can have adverse effects on early speech and language development, although conductive hearing impairment generally does not exceed 20 ~ 30dB, the maximum can be about 50dB, but significantly affect the recognition of children's speech, long-term middle ear exudation in early childhood It can cause delay in language expression and language problems in the early school age. In addition, it also studies the influence of auditory perception and auditory recognition on language, indicating that the central auditory information processing problem makes it difficult for children to identify, analyze and store auditory stimuli. It is more difficult to have similar sounds.
(2) Intelligent retardation: The most common cause of language development retardation is mental retardation. Although the language development process is in the order of normal children, its speed is slower than that of normal children. When the environment requires children's language to increase, the language problem is More obvious, some chromosomes and hereditary diseases are accompanied by language barriers. For example, children with 21-trisomy syndrome have varying degrees of language problems; language disorders in children with fragile X syndrome are special in rhythm and language content. form.
(3) Autism: An important feature of autism is communication disorder, accompanied by communication disorders and stereotyped repetitive movements. The language barriers of autistic children can be expressed as completely incomprehensible, without language, or speech is too rigid, scholastic There are exaggerated rhythms, problems in language application, echo-like or non-verbal communication, almost no eye contact, facial expressions and postures are limited.
(4) Nervous system diseases: children with cerebral palsy are affected by the obstacles of the nerve movement pathway, and often have dysarthria. Their ability to sense language is much better than that of children. The left side of the brain is affected by language, reading, The influence of writing is more important than that of right brain lesions. Some children with left brain lesions in clinical practice often preserve the original language ability, because the right brain replaces the function of the left brain, which indicates that the right brain has plasticity function, the brain The injury or tumor causes the child to acquire acquired aphasia, that is, after the child develops the language ability to speak into sentences, because the brain lesion causes the language damage, clinically different types of aphasia occur, for example, children's auditory comprehension disorder but speech fluency It is called sensory aphasia; it is called nomenclature aphasia for the target; it is difficult to find the expression of appropriate words called express aphasia; speech is not fluent and laborious is called sports aphasia, in recent years The language barrier caused by some rare neurological factors has attracted people's attention. This is acquired aphasia syndrome with convulsions. Or called Landau-Kleffer syndrome, a syndrome that causes a normal language proficiency in children to experience a reversal of language perception and/or expression, the severity of which can achieve complete auditory agnosia, that is, the voice of the environment cannot be identified. Children with abnormal EEG performance, there are sharp waves on both sides, at least 2 / 3 children have various types of epilepsy, some children's language ability can be restored, but 50% of children have serious language defects, some The characteristics of children with hydrocephalus in language development are: using long compound sentences, the vocabulary is more sophisticated, but there is no substantive content.
(5) Behavioral disorders: There is a close relationship between language barriers and behavioral problems. The two can be mutually causal. From the perspective of reasons, obvious emotional trauma or psychosocial adverse factors can affect children's language development or cause language barriers. For example, selective mutism is a language disorder that usually occurs before the age of 5, and children do not speak in certain situations, such as schools. These children generally have normal language, but may be caused by communication disorders. It often takes several months of treatment.
(6) Environmental deprivation: Children's language development is related to the environment. The vocabulary used by parents in dealing with children, how to repeat and expand vocabulary in verbal communication is directly related to the growth of children's vocabulary and the speed of language development. Children The good development of language skills does not come from television or radio. If children live in a lack of language stimulation and the environment can cause language development retardation, and when these children give therapeutic intervention, their language function will be significantly improved.
Prevention
Pediatric speech and language barrier prevention
After birth, children should live in a rich language environment, and regularly conduct hearing screening and developmental monitoring. Once an abnormality is found, it is very important to intervene immediately. In the clinic, it is very important to recognize the warning signs of language dysplasia early. Further confirm the existence of the problem and intervene early.
Warning signal for abnormal language development:
Within 1.12 months
(1) Two months of no smile on the familiar voice and face.
(2) No smile for others in 3 months.
(3) Can't try to imitate the sound for 4 months.
(4) 8 months of edema.
(5) You can't play the "peek-and-cat" game for 8 months or have no interest in it.
(6) A word cannot be said for 12 months.
(7) No gestures for 12 months, such as waving "goodbye" or shaking his head.
(8) You cannot point to any item or picture for 12 months.
2.12 to 24 months
(1) 15 words cannot be used for 18 months.
(2) 18 months using gestures instead of speaking to indicate demand.
(3) 18 months are not willing to imitate the sound, or use consonants and vowels in a limited way.
(4) If you can't speak 2 words when you are 2 years old.
(5) 2 years old can not imitate words or actions.
(6) 2 years old can't follow simple instructions.
3.24 to 36 months
(1) 3 years old cannot form words into sentences or sentences.
(2) 3 years old can not communicate spontaneously with people.
(3) 3 years old can not correctly send "b, p, m, d, t, n, l, g, k, h".
(4) Frequent expression of frustration when communicating with people.
(5) Limited to playing certain toys or playing some toys repeatedly.
(6) The vocabulary is limited.
(7) Can't interact or play with others.
4.4 years old
(1) Outsiders (non-family members) do not understand what they say.
(2) It is impossible to repeat simple stories or to clearly recall recent events.
(3) The sentence is incorrectly pronounced, or some sound is replaced or omitted.
Complication
Pediatric speech and language barrier complications Complications
There may be pharyngeal papilloma, congenital glottic sputum, or vocal cord nodules, vocal cords and palsy manifestations; upper respiratory tract infection or rhinitis, adenoid hyperplasia hypertrophy affects vocalization; children with cleft palate, submucosal cleft palate, neurological dysfunction, etc. It affects the closure of the glottis; the school age can cause the academic performance to be significantly backward, and it is difficult to communicate with others.
Symptom
Symptoms of speech and language disorders in children Common symptoms Consonant vocal cords are unclear and vocal. Words can't be continuous. Language development is slow.
1. The articulation is abnormal, that is, the speech is not clear. Some children are mistakes in individual pronunciation, while others are many mistakes, so that others can't understand them. The common articulation abnormalities are as follows:
(1) Tongue root sounding: that is, the tongue root sounds such as g, k, h replace most of the voices, for example, the "ears" are said to be "ears", "strawberry" is said to be "cao berry", "hair is too long" Into the "hair cover", these children often use the tongue root friction to replace the pronunciation of the front position of the tongue.
(2) Pre-tongue phonation: that is, the pre-tongue sound d, t replaces some voices, for example, "turtle" is said to be "wudui", "park" is said to be "dongyuan", and "pants" are said to be "rabbit" .
(3) Non-aspirated sound: There are many sounds in Chinese such as p, t, k, c, s, etc., which are aspirating sounds. When children substitute the sound of aspirating air with a sound that is not deflated, it is an error, such as "mother-in-law" Into "", "bubble" is said to be "hug", indicating the problem of children's airflow and voice coordination.
(4) omitting the sound: that is, omitting some parts of the voice, for example: "airplane" omits the consonant "fly" and then changes to "fly one"; or omits or simplifies the complex vowels ao, ie, iu, ang, etc. "Mosquito" is said to be "no child" and "Wang Wang" is said to be "doll".
2. Voice problem The voice problem can be functional or organic, and it can be expressed as tone, loudness, and sound quality resonance. These anomalies can exist separately, but often there are problems of speech or language, thus forming a compound. Communication barriers.
The most common sound quality problems are hoarseness, persistent or progressive hoarseness, especially with wheezing or audible breath sounds, which require further fiberoptic examination to detect pharyngeal papilloma, congenital sound. Thresholds, or vocal cord nodules, children's vocal cord nodules are often caused by loud voices or non-stop speech, vocal cords and numbness are expressed as soft or absent, weak, gasping crying.
Resonance abnormalities are characterized by excessive or too low nasal tone, cleft palate in children, submucosal cleft palate, neurological dysfunction affecting glottic closure caused by nasal overload; severe upper respiratory tract infection or rhinitis can cause nasal hypoglycemia, adenoid hypertrophy in children Chronic, nasal-free sounds can occur.
3. Fluency problems Children's fluency in speech is characterized by pauses, repetitions, prolongation and obstruction in speech, often starting in children between 2 and a half to 4 years old.
(1) Repetition: In children's speech and language development, repetition can be regarded as a normal phenomenon, but when the repetition is too frequent, more than 50 repetitions per 1000 words require intervention.
(2) Extension: prolonging a certain sound when speaking a word.
(3) Joint action: When the child speaks fluently, it is accompanied by some movements such as facial distortion, open mouth, tongue sticking, blinking, jaw twitching and so on.
(4) Language problems: Children's language problems are commonly used in terms of language slowness and language barriers. Language delay refers to children's language development following the order of normal children, but the speed is slow. Language barrier refers to children's language development deviating from the normal order, language learning methods There are often differences.
The clinical manifestations are linguistic expression problems. Some children are slow to speak, some are significantly less than children of the same age. Children's language problems are generally divided into three types:
1 language expression disorder: the understanding of children's language is normal, but the expression is particularly difficult, and the pronunciation is not difficult due to physiological defects.
2 mixed feelings of language feeling and expression: children can hear the sound, but do not understand it; can understand the gesture or posture, can learn to read but not express.
3 language information processing problem: children speak fluently, but the content is very superficial, and in language communication, it is difficult to maintain the topic, children only focus on the topic of their choice.
Examine
Pediatric speech and language barrier examination
There are no special findings in the general examination, and chromosomal abnormalities can be found due to genetic factors.
EEG, brain CT, etc. should be performed to understand whether there are intracranial lesions and injuries.
Diagnosis
Diagnostic and differential diagnosis of speech and language disorders in children
diagnosis
1. The medical history is mainly provided by parents and dependents to understand the current language situation of children, speech clarity, vocal status, fluency of expression, etc., should also understand children's cognitive, social and behavioral performance, the past situation including birth history , developmental history, disease history, family history, etc.
2. Physical examination General physical examination, and pay attention to abnormalities of the oral organs, such as orthodontics, cleft palate, tongue ligament problems, etc. The examination of oral motor function includes whether the position of the lower jaw is centered, the movement of the lips, the position and movement of the tongue, The rotation of the mouth, the sounding situation, etc.
3. Behavioral observations Behavioral observations often obtain information in games with children. The observations include game skills, eye-hand coordination, big movements, attention, spontaneous language and communication skills, and understanding children's cognitive and verbal skills.
4. Hearing test children with abnormal articulation, speech is not clear, delay in speaking should be routine for hearing test, available acoustic impedance measurement, otoacoustic emission, brainstem evoked potential to exclude hearing impairment for children's speech and language influences.
5. Speech assessment Children's vocalization has a certain developmental process. The phoneme development process of Mandarin is shown in Table 1. According to this process, children's speech assessment is made accordingly.
6. Language Assessment Language assessment includes language understanding and language expression.
(1) Language understanding: In children's language development, understanding precedes expression. If a child only speaks a small number of words, in fact he should know more. When assessing children's language comprehension ability, pay attention not to give any hints, but also avoid some Situational contact, the assessment should be consistent with the child's overall development level, the smaller children can be tested with physical objects or toys, the larger children can see the picture to answer, to understand whether they understand the subject, movement, positioning, attributes and other words.
(2) Language expression: In assessing the language expression ability of children, a very important condition is to give children the opportunity to express rather than ask too many questions. Young children can be induced through gamification situations. Its ability to express, fluency of language, etc., and recorded.
Because the language treatment in China has not been carried out for a long time, there is no complete standardized language assessment test yet. However, non-standardized tests and observations can also objectively reflect the children's language level. The application is more casual and natural, and can be reliably obtained. Information is more realistic in the present
7. Standardized testing
(1) Picture vocabulary test: This test was standardized in the late 1970s. It was originally used as a tool for children's intelligence screening. Because the test uses pictures and vocabulary links, it reflects the children's language ability, so it is often used. Assessment of language delay or disorder in children
(2) Denver development screening test: This is a developmental screening. It has long been used in China to understand the developmental level of infants and young children, to find language-related developmental delays, and to provide suitable development for language therapy. A viable option for age.
(3) Webster Intelligence Test: Includes two pre-school and early-age, two-year Wechschild intelligence tests, mainly used to understand the cognitive level of older children, the language status of cognition, and the IQ based on the operation. Language barriers are distinguished from intelligent retardation.
Differential diagnosis
Different from mental retardation, depression and attention deficits, which affect learning and communication.
