When you need a speech pathologist When Should You See a Speech Pathologist? Information for parents

General speech underdevelopment (OHP) is a common childhood pathology. This diagnosis can be made by a pediatrician to a baby after he is three years old. It is at this age that one can judge the main criteria for the formation of speech. However, children often begin to speak later than the due date; accordingly, all periods of the formation of this function subsequently come with a delay.

The general underdevelopment of speech can be successfully corrected if you consult a doctor in a timely manner and start treatment.

Also, an important role in the correct formation of the main links of the intellectual level of the baby is played by his parents, who should comprehensively help expand the vocabulary and learn about the world around him.

OHP characteristic

This pathology is characterized by an abnormal formation of the speech function in all its main aspects (semantic criterion, lexical, grammatical, sound) in children with normal intellectual development and hearing.

To fully diagnose ONR of varying severity, doctors succeed in children aged three to five years.

For example, a three-year-old child who does not have deviations in speech development should have the following skills:

• Use approximately 300-600 words in your vocabulary.
• Independently build sentences of 5-8 words, although errors in the sequence of formation are allowed.
• Must know your name, gender, age.
• He listens with interest and understands short tales and stories.
• He starts asking a lot of questions.
• Can perform simple tasks associated with the understanding of prepositions (in, under, on). In addition, he must use conjunctions in the construction of sentences (when, if, because).

At the age of five, the child has a significant expansion vocabulary(about 3500 words), the use of longer, more complex sentences.

There are words of a general nature. For example, such as: fruits, animals, shoes.

The kid has no difficulty in choosing words associated with the designation of time, space (day, night, month, right, left).

When forming sentences, he uses all parts of speech, pronounces words correctly, without gaps, structural and syllabic violations.

The characteristics of children with general underdevelopment of speech of any kind is determined by the following deviations:

• The child cannot accurately convey his thoughts.
• Poor vocabulary that is not age appropriate.
• Difficulties in the construction of simple and complex sentences are observed to varying degrees.
• Mispronunciation words, sounds.
• Hearing impairment associated with the distinction of sounds that create the semantic basis of speech (phonemic function). That is, as a result of the underdevelopment of this function, a distorted understanding of what is heard occurs.

In severe cases, there is a complete absence of speech.

Causes of underdevelopment of speech in a child

Often total OHP predetermined in the baby even before his birth, due to hereditary factors. Also due to negative influences on the fetus during pregnancy.

The main reasons contributing to the development of OHP include such pathological effects on the child's body as:

• Frequent infectious diseases in infancy.
• Head injury.
• Incompatibility of the Rh factor of the mother and fetus.
• Fetal hypoxia. The condition is characterized oxygen deficiency The child has. May occur due to various diseases of the expectant mother ( diabetes, heart disease, anemia), pathological childbirth, placental abnormalities, various other complications of labor and pregnancy. Subsequently, it can lead to a general underdevelopment of speech.
• Birth trauma.

Also, OHP can provoke such external factors as:

• Psycho-emotional overstrain in a child, stress.
• Lack of communication with peers.
• Lack of attention from parents.
• Minimum level of verbal communication.
• genetic predisposition.
• Physiological delayed onset speech activity. For example, a baby later than the due date began to walk (3 months), pronounce the first babble words (10-11 months). Accordingly, his speech will develop with a delay.

OHP classification

OHP is divided into 3 levels according to severity, short description which are shown in the table below.

Unsharply expressed general underdevelopment of speech

There is an additional, fourth level of anomalous speech development, which is present in babies with a not pronounced general underdevelopment of speech (NVONR).

Children with this pathology in communication make individual lexical and grammatical errors, the total amount of which causes difficulties in teaching them to read and spell.

A child with this level of speech disorder can hardly transform nouns into adjectives. For example, instead of the word wolf, which sounds like a wolf when forming an adjective, he is more likely to say like "wolkin".

Also, kids with NVONR often confuse the names of animals, plants, people's professions.

In addition, there is fuzziness in pronunciation, inexpressive, blurry diction.

Studying at school is given to children with a diagnosis - not pronounced general underdevelopment speech is difficult, due to the low degree of assimilation of the material.

OHP diagnostics

It reveals the general underdevelopment of speech and eliminates, as a rule, a speech therapist, however, full-fledged treatment is not possible without the help of a neurologist, a pediatrician, and in some cases a psychotherapist.

The clinical picture of the disease in most cases is obvious, both for the parents of the baby and for the doctor. The exception is the OHP of the 4th level, which is determined in the process of a thorough analysis of all language components through special tasks that require the child to concentrate and perform accurately.

To determine the severity of ONR, the entire chain of the child's conversational function is also studied.

For example, the ability to correctly and meaningfully present a short text heard is assessed, or to independently talk about one's family, friends, or read a poem.

In the correction of ONR, it is important to correctly diagnose and differentiate it from other pathologies accompanied by speech dysfunction ( mental retardation, autism).

Also, the doctor should examine the condition oral cavity and nasopharynx of the child. Often, anomalies of the ENT organs and dental defects are the cause of difficult communication for the baby.

Treatment of general underdevelopment of speech

The elimination of such a pathology as general underdevelopment of speech involves the use of various methods aimed at the gradual development of the child's thinking, memory, attentiveness, and improving pronunciation.

For example, children with the first level of OHP on initial stage Treatments suggest repeating various sounds after the doctor, then syllables, then words with a minimum number of letters.

At the second level of speech correction, the baby must clearly understand what the answer and question are. For these purposes, he is taught not only to answer the questions posed, but also to independently formulate them and ask them.

The first attempts to teach short simple poems and stories are being made. Also, the kid is offered to carefully look at the picture, then describe it, with a detailed definition of objects - their shape, color, comparative size.

Therapy for general speech underdevelopment of the 3rd level involves listening and retelling of texts, self-construction of sentences and telling more complex stories.

Children are taught to tell not only in the first person, but also in the second, third.

In addition, the treatment process is often associated with the appointment of special exercises aimed at eliminating speech defects, learning games.

The fourth level of speech underdevelopment (NVONR), although it is the easiest speech pathology, cannot be ignored.

Early diagnosis and correction is needed. Underdevelopment oral speech is a serious obstacle to the further teaching of the child to read and write.

It poses a threat to his health, as it involves an increased load on the nervous system.

Important! Parents need to carefully monitor the development of speech in their child. Regularly visit a pediatrician and a neurologist. If at three years old the baby does not understand simple requests, or is simply silent, and at four years old he speaks in such a way that he cannot be understood, he needs the help of a specialist, it is impossible to cope with this anomaly on his own

Forecast and prevention of OHP

In order to avoid the occurrence of this pathology, parents need to monitor the development of their child's speech from the first months of life.

It is important to be vigilant if the baby has the following pathological signs:

• In the first month of life, the child, when he feels hungry and does not receive food on time, begins to scream loudly. The systematic absence of a cry is a deviation from the norm.
• By the beginning of the fifth month, he had not learned to smile.
• Not interested at six months environment does not listen to sounds.
• At the age of seven months, does not recognize loved ones, does not concentrate on rattles and other toys.
• At ten months, he does not utter babbling words at all.
• He does not speak for a year, does not respond to simple requests.
• At the age of one and a half, he cannot pronounce the words "mother" and "dad".
• At two years old, he does not understand the names of body parts, cannot show them.
• At three years old, a child is not able to learn a simple poem, retell a short story. Doesn't know his first and last name.

In general, the prognosis for treatment of ONR at any level is favorable.

Parents need to pay enough attention to their children. Play with them in educational games appropriate for their age, read poetry, fairy tales, expand their horizons.

At the first symptoms indicating problems with speech, you should consult a neurologist or speech therapist.

Main symptoms:

• Babble instead of words
• Violation in the construction of words
• Mental impairment
• Concentration disorder
• Mispronunciation of sounds
• Irrational use of prepositions and cases
• Inability to recognize similar sounds
• Limited vocabulary
• Lack of interest in learning new things
• Lack of understanding of the difference between numbers
• Disorder of logical presentation
• Difficulty connecting words into phrases
• Difficulty building sentences

General underdevelopment of speech is a whole complex of symptoms in which there is a violation of all aspects and aspects of the speech system, without any exception. This means that disorders will be observed both from the lexical, and from the phonetic and grammatical side.

Such a pathology is polyetiological, the formation of which is influenced by a large number of predisposing factors associated with intrauterine development of the fetus.

Symptoms of the disease will differ depending on the severity. In total there are four levels of underdevelopment of speech. In order to determine the severity of the disease, the patient must undergo a speech therapy examination.

Treatment is based on conservative methods and involves the work of a speech therapist with the child and parents at home.

The International Classification of Diseases divides such a disorder into several ailments, which is why they have several meanings. OHP has an ICD-10 code - F80-F89.

Etiology

General underdevelopment of speech in children preschool age is a fairly common ailment, occurring in 40% of all representatives of this age category.

Several factors can lead to such a disorder:

• intrauterine, which leads to damage to the central nervous system;
• conflict of Rh factors in the blood of the mother and fetus;
• fetal asphyxia during birth - this condition is characterized by a lack of oxygen and can lead to suffocation or imaginary death;
• the child is injured directly during labor;
• Pregnant woman's addiction to bad habits;
• unfavorable working or living conditions for female representatives during the period of gestation.

Such circumstances lead to the fact that even during prenatal development, the child experiences violations in the formation of organs and systems, in particular the central nervous system. Such processes may lead to a wide range functional pathologies, including speech disorders.

In addition, such a disorder can develop after the baby is born. This can be facilitated by:

• frequent acute diseases various etiologies;
• the presence of any chronic ailments;
• suffered traumatic brain injury.

It is worth noting that OHP can occur with such ailments:

• rhinolalia;

In addition, the formation of speech abilities is affected by insufficient attention or lack of emotional contact between the baby and parents.

Classification

There are four degrees of speech underdevelopment:

• OHP level 1 - characterized by a complete lack of coherent speech. In the medical field, this condition is called "speechless children." Toddlers communicate using simplified speech or babble, and also actively gesticulate;
• OHP level 2 - observed initial development common speech, but the vocabulary remains poor, and the child makes a large number of mistakes during the pronunciation of words. In such cases, the maximum that the child can do is to say a simple sentence, which will consist of no more than three words;
• level 3 speech underdevelopment - differs in that children can make sentences, but the semantic and sound load is not sufficiently developed;
• OHP level 4 is the easiest stage of the disease. This is due to the fact that the child speaks quite well, speech practically does not differ from peers. Nevertheless, there are violations during pronunciation and the construction of long phrases.

In addition, clinicians distinguish several groups of this disease:

• uncomplicated ONR - diagnosed in patients with minor pathology of brain activity;
• complicated ONR - observed in the presence of any neurological or psychiatric disorder;
• general underdevelopment of speech and delayed speech development - diagnosed in babies with pathologies of those parts of the brain that are responsible for speech.

Symptoms

The characteristics of children with general underdevelopment of speech will differ depending on the severity of the impairment inherent in the patient.

However, despite this, such children begin to pronounce their first words relatively late - at three or four years. At the same time, speech is almost incomprehensible to others and incorrectly framed. This becomes the reason that the child's verbal activity begins to be disturbed, and sometimes it can be observed:

• memory impairment;
• decrease in mental activity;
• lack of interest in learning new things;
• loss of attention.

In patients with the first level of OHP, the following manifestations are observed:

• instead of words, there is babble, which is complemented by a large number of gestures and rich facial expressions;
• communication is carried out by sentences consisting of one word, the meaning of which is rather difficult to understand;
• limited vocabulary;
• violation in the construction of words;
• disorder in the pronunciation of sounds;
• The child cannot distinguish sounds.

Underdevelopment of speech of the 2nd degree is characterized by the following disorders:

• there is a reproduction of phrases consisting of no more than three words;
• the vocabulary is very poor compared to the number of words used by the child's peers;
• children are unable to understand the meaning of a large number of words;
• lack of understanding of the difference between numbers;
• irrational use of prepositions and cases;
• sounds are pronounced with multiple distortions;
• phonemic perception insufficiently formed;
• child's unpreparedness sound analysis speech addressed to him.

Third level OHP parameters:

• the presence of conscious phrasal speech, but it is based on simple sentences;
• difficulty with the construction of complex phrases;
• increased vocabulary of used words, compared with children with second-degree OHP;
• making mistakes with the use of prepositions and agreement various parts speech;
• minor deviations in pronunciation and phonemic perception.

Description clinical picture general speech underdevelopment of the fourth level:

• the presence of specific difficulties with sound pronunciation and repetition of words in which there are a large number of syllables;
• the level of phonetic understanding is lowered;
• making mistakes during word formation;
• wide vocabulary;
• disorder of logical presentation - minor details come to the fore.

Diagnostics

Identification of this violation is carried out by communication of a speech therapist with a child.

The definition of pathology and its severity consists of:

• determining the possibilities of oral speech - to clarify the level of formation of various aspects of the language system. Such a diagnostic event begins with the study of coherent speech. The doctor assesses the patient's ability to compose a story from a drawing, retell what he heard or read, as well as to compose an independent short story. In addition, the level of grammar and vocabulary is taken into account;
• assessment of the sound aspect of speech - is based on how the child pronounces certain sounds, on the syllabic structure and the sound content of the words that the patient pronounces. Phonetic perception, as well as sound analysis, does not go unnoticed.

In addition, it may be necessary to carry out diagnostic methods for assessing auditory memory and other mental processes.

During the diagnosis, not only the severity of ONR is clarified, but also there is a differentiation of such an ailment from ZRR.

Treatment

Since each degree of general underdevelopment of speech formation is divided into several stages, then, accordingly, the therapy will also differ.

Directions for the correction of general underdevelopment of speech in preschoolers:

• Level 1 ailment - activation of independent speech and development of processes for understanding what is said to the child. In addition, attention is paid to thinking and memory. The education of such patients does not set itself the goal of achieving a normal phonetic formation of speech, but takes into account grammar part;
• OHP of the second level - work is carried out not only on the development of speech, but also on the understanding of what is being said. The therapy is aimed at improving sound pronunciation, the formation of meaningful phrases and the clarification of grammatical and lexical subtleties;
• Disease of the 3rd degree - the conscious coherent speech is corrected, the aspects related to grammar and vocabulary are improved, the pronunciation of sounds and phonetic understanding are mastered;
• OHP level 4 - therapy is aimed at correcting age-related speech for subsequent trouble-free education in educational institutions.

Therapy for children with varying degrees of severity of such a violation is carried out in various conditions:

• OHP levels 1 and 2 - in specially designed schools;
• OHP level 3 - in general education institutions with the condition of remedial education;
• unsharply expressed general underdevelopment of speech - in secondary schools.

Complications

Ignoring the signs of such an ailment can lead to the following consequences:

• complete lack of speech;
• emotional isolation of a child who notices that he is different from his peers;
• further difficulties in learning, work and other social spheres that will be observed already in adults with untreated ONR.

Prevention and prognosis

In order to avoid the development of such an ailment, it is necessary:

• women during pregnancy avoid bad habits and pay special attention to your health;
• parents of babies to treat infectious diseases in a timely manner;
• devote as much time as possible to children, not to ignore them, and also to engage in their development and education.

Because the corrective work is a time consuming and laborious process, it is best if it is started as early as possible - when the child is three years old. Only in this case can a favorable prognosis be achieved.

The third level of speech development is characterized by the presence of extended phrasal speech with elements of lexical-grammatical and phonetic-phonemic underdevelopment.

Characteristic is the undifferentiated pronunciation of sounds (mainly whistling, hissing, affricates and sonoras), when one sound simultaneously replaces two or more sounds of a given or close phonetic group.

For example, soft sound With, itself not yet clearly pronounced, replaces the sound With("boots"), sh("syuba" instead of fur coat). c("syalya" instead of heron), h("syaynik" instead of kettle), w("grid" instead of brush); replacing groups of sounds with simpler articulations. Unstable substitutions are noted when the sound in different words pronounced differently; mixing sounds, when the child pronounces certain sounds correctly in isolation, and interchanges them in words and sentences.

Correctly repeating three or four syllable words after a speech therapist, children often distort them in speech, reducing the number of syllables. (Children made a snowman.- “Children hoarse Novik”). Many errors are observed in the transmission of the sound-filling of words: permutations and replacements of sounds and syllables, reductions in the confluence of consonants in a word.

Against the background of relatively extended speech, there is an inaccurate use of many lexical meanings. The active vocabulary is dominated by nouns and verbs. There are not enough words denoting qualities, signs, states of objects and actions. The inability to use word-formation methods creates difficulties in using word variants, children do not always succeed in selecting words with the same root, forming new words with the help of suffixes and prefixes. Often they replace the name of a part of an object with the name of the whole object, right word others that are similar in meaning.

In free statements, simple common sentences predominate, complex constructions are almost never used.

Agrammatism is noted: errors in agreeing numerals with nouns, adjectives with nouns in gender, number, case. A large number of errors are observed in the use of both simple and complex prepositions.

Understanding of addressed speech is developing significantly and is approaching the norm. There is an insufficient understanding of the changes in the meaning of words expressed by prefixes, suffixes; there are difficulties in distinguishing morphological elements expressing the meaning of number and gender, understanding logical-grammatical structures expressing causal, temporal and spatial relationships.

(Volkova)

Unsharply expressed general underdevelopment of speech. This group includes children with mild manifestations of lexical-grammatical and phonetic-phonemic underdevelopment of speech. There are some irregularities in their speech. syllabic structure words and sound content. Elysions predominate, and mainly in the reduction of sounds, and only in isolated cases - omissions of syllables. Paraphasias are also noted, more often - permutations of sounds, less often syllables; a small percentage - perseveration and addition of syllables and sounds.

Insufficient intelligibility, expressiveness, somewhat sluggish articulation and fuzzy diction leave the impression of a general blurred speech. The incompleteness of the formation of the sound-syllabic structure, the mixing of sounds characterize the insufficient level of differentiated perception of phonemes. This feature is an important indicator of the process of phoneme formation that has not yet ended. Along with shortcomings of a phonetic-phonemic nature, these children also had individual violations of the semantic aspect of speech. So, with a fairly diverse subject dictionary, there are no words denoting some animals and birds, plants, people of different professions, parts of the body. When answering, generic and specific concepts are mixed.

When denoting actions and features of objects, some children use typical names and names of approximate meaning. Character lexical errors manifests itself in the replacement of words that are close in the situation, in the confusion of signs. Having a certain vocabulary denoting different professions, children experience great difficulties in differentiated designation for male and female faces. female: some children call them the same, others offer their own form of word formation, which is not characteristic of the Russian language. The formation of words with the help of magnifying suffixes also causes considerable difficulties.

Persistent errors remain when used:

- diminutive nouns;

- nouns with singularity suffixes;

- adjectives formed from nouns with different meanings correlations (downy - downy; cranberry - cranberry; pine - pine);

- adjectives with suffixes characterizing the emotional-volitional and physical state objects (boastful - boastful; smiley - smiling);

–possessive adjectives(Volkin - wolf, fox - fox).

A significant number of errors fall on the formation of nouns with suffixes of emotional evaluation, singularity, and figure. Persistent difficulties are found in the formation of denominative adjectives (with meanings of correlation with food, materials), verbal, relative adjectives (-chiv-, -liv-), as well as compound words.

Children with the fourth level of speech development quite easily cope with the selection of commonly used antonyms indicating the size of an object (large - small), spatial contrast (far - close), evaluative characteristic (bad - good). Difficulties are manifested in the expression of antonymic relations of the following words: running - walking, running, walking, not running; greed is not greed, politeness is evil, kindness is impoliteness.

The correctness of naming antonyms largely depends on the degree of abstractness of the proposed pairs of words. So, the task of selecting words that are opposite in meaning is completely inaccessible: youth, light, ruddy face, front door, various toys. In the responses of children, the original words with the particle not are more common (an unruly face, not young, unlight, non-different), in some cases variants that are not characteristic of the Russian language are called. Insufficient level lexical means language is especially pronounced in these children in the understanding and use of words, phrases, proverbs with figurative meaning. For example: ruddy, like an apple, the child interprets how many apples he ate; collided nose to nose - hit their noses; hot heart - you can get burned;

An analysis of the features of the grammatical design of children's speech makes it possible to identify errors in the use of genitive nouns. accusative cases plural, complex prepositions. In addition, in some cases there are violations of the agreement of adjectives with nouns, when in one sentence there are masculine and feminine nouns (I paint the ball with a red felt-tip pen and red manual), singular and plural (I lay out books on large tables and small chairs instead of I arrange books on large tables and small chairs), violations in the agreement of numerals with nouns persist (the dog saw two cats and ran after two cats).

At the fourth level, there are no errors in the use of simple prepositions, difficulties are slightly manifested in the use of complex prepositions, in coordinating numerals with nouns. Of particular difficulty for these children are the constructions of sentences with different subordinate clauses:

- omissions of unions;

- replacement of unions;

- inversion (finally everyone saw which kitten they were looking for for a long time - they saw the kitten they were looking for for a long time).

next distinctive feature children of the fourth level is the originality of their coherent speech:

- in a conversation, when compiling a story according to given topic, a picture, a series of plot pictures, violations of the logical sequence, “getting stuck” on minor details, omissions of main events, repetition of individual episodes are ascertained;

- talking about events from his life, making up a story on free theme with elements of creativity, they use mostly simple uninformative sentences;

– difficulties remain in planning their statements and selecting appropriate language tools.