Alalia

Alalia is a gross underdevelopment or complete absence of speech caused by organic lesions of the cortical speech centers of the brain that occurred in utero or in the first 3 years of a child’s life. There is a late appearance of speech reactions, poor vocabulary, agrammatism, violation of syllabic structure, sound pronunciation and phonemic processes. A child needs neurological and speech therapy examination. Psychological, medical and pedagogical effects include drug therapy, the development of mental functions, lexico-grammatical and phonetic-phonemic processes, coherent speech.

ICD 10

A80.1 A80.2

General information

Alalia is a deep unformed speech function caused by organic damage to the speech areas of the cerebral cortex. The underdevelopment of speech is systemic, i.e. there is a violation of all its components – phonetic-phonemic and lexical-grammatical. Unlike aphasia, in which there is a loss of previously existing speech, disease is characterized by the initial absence or sharp restriction of expressive or impressive speech. Thus, alalia is spoken of in the event that organic damage to the speech centers occurred in the intrauterine, intranatal or early (up to 3 years) period of the child’s development.

Disease is diagnosed in about 1% of preschoolers and 0.6-0.2% of school-age children; at the same time, this speech disorder is 2 times more common in boys. Alalia is a clinical diagnosis, which in speech therapy corresponds to the speech conclusion of the GUS (general underdevelopment of speech).

Causes of alalia

Alalia is based on an organic lesion of the speech centers of the cerebral cortex that occurred in the prenatal period or after birth before the formation of coherent speech in the child. The factors leading to alalia are diverse and can affect different periods of early ontogenesis:

1. Antenatal period. Fetal hypoxia, intrauterine infection (TORCH syndrome), the threat of spontaneous termination of pregnancy, toxicosis, falls of a pregnant woman with fetal trauma, chronic somatic diseases of the expectant mother (arterial hypotension or hypertension, heart or lung failure) can lead to damage to the speech zones.
2. The intranatal period. Complications of childbirth and perinatal pathology serve as a natural result of the burdened course of pregnancy. Alalia can be a consequence of asphyxia of newborns, prematurity, intracranial birth trauma during premature, transient or prolonged childbirth, the use of instrumental obstetric aids.
3. Postnatal period. Some researchers point to a hereditary, familial predisposition. Frequent and prolonged illnesses of children in the first years of life (acute respiratory viral infections, pneumonia, endocrinopathy, rickets, etc.), operations under general anesthesia, unfavorable social conditions (pedagogical neglect, lack of speech contacts, hospitalism syndrome) aggravate the effect of the leading causes.

As a rule, the anamnesis of children shows the involvement of not one, but a whole complex of factors leading to minimal brain dysfunction – MBD.

Pathogenesis

Organic brain damage causes a slowdown in the maturation of nerve cells that remain at the stage of young immature neuroblasts. This is accompanied by a decrease in the excitability of neurons, inertia of the main nervous processes, functional depletion of brain cells. Lesions of the cerebral cortex are not pronounced, but multiple and bilateral in nature, which limits the independent compensatory possibilities of speech development.

Classification

Over the years of studying the problem, many classifications of alalia have been proposed, depending on the mechanisms, manifestations and severity of speech underdevelopment. Currently , speech therapy uses a classification according to which there are:

• Expressive (motor). The basis of its occurrence is an early organic lesion of the cortical part of the speech motor analyzer. In this case, the child does not develop his own speech, but the understanding of someone else’s speech remains intact. Depending on the damaged zone, afferent motor and efferent motor alalia are distinguished. With afferent motor alalia, there is a lesion of the postcentral gyrus (lower parietal parts of the left hemisphere), which is accompanied by kinesthetic articulatory apraxia. Efferent motor alalia occurs when the premotor cortex (Broca’s center, the posterior third of the inferior frontal gyrus) is affected and is expressed in kinetic articulatory apraxia.
• Impressive (sensory). Sensory alalia occurs when the cortical part of the speech-hearing analyzer (Wernicke’s center, the posterior third of the superior temporal gyrus) is affected. At the same time, the higher cortical analysis and synthesis of speech sounds are disrupted and, despite the preserved physical hearing, the child does not understand the speech of others.
• Mixed (sensorimotor or motor-sensory alalia with predominance of impaired development of impressive or expressive speech)

Symptoms of motor alalia

Neurological status

With motor alalia, there are characteristic non-verbal (neurological, psychological) and speech manifestations. Neurological symptoms in motor type are primarily represented by motor disorders: awkwardness, insufficient coordination of movements, poor development of finger motility. Children have difficulties with mastering self-service skills (buttoning, lacing shoes, etc.), performing small-motor operations (folding mosaics, puzzles, etc.).

Psychological status

Considering the psychological characteristics of children with motor alalia, it is impossible not to note violations of memory (especially auditory speech), attention, perception, emotional-volitional sphere. According to the peculiarities of behavior, children can be hyperactive, disinhibited or sedentary, inhibited. Most children have reduced performance, high fatigue, speech negativism. Intellectual development in Alalik children suffers a second time, due to speech insufficiency. As speech develops, intellectual disabilities are gradually compensated.

Speech status

With motor alalia, there is a pronounced dissociation between the state of impressive and expressive speech, i.e. the understanding of speech remains relatively intact, and the child’s own speech develops with gross deviations or does not develop at all. All stages of the formation of speech skills (walking, babbling, babbling monologue, words, phrases, contextual speech) occur late, and the speech reactions themselves are significantly reduced.

Despite the fact that a child with afferent motor alalia can potentially perform any articulatory movements (unlike dysarthria), sound reproduction is grossly impaired. At the same time, persistent substitutions and mixing of articulatively disputed phonemes occur, which leads to the impossibility of reproducing or repeating the sound image of the word.

With efferent motor alalia, the leading 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. The lack of formation of a dynamic speech stereotype can lead to the appearance of stuttering against the background of motor alalia.

The vocabulary of motor alalia significantly lags behind the age norm. New words are assimilated with difficulty, there are mainly everyday terms in the active dictionary. A small lexical stock causes an inaccurate understanding of the meanings of words, their inappropriate use in speech, substitutions by semantic and sound similarity. A characteristic feature of motor alalia is the absolute predominance of nouns in the nominative case in the dictionary, a sharp restriction of other parts of speech, difficulties in the formation and differentiation of grammatical forms.

Phrasal speech in motor alalia is represented by simple short sentences (one- or two-part). As a consequence, with alalia there is a gross violation of the formation of coherent speech. Children cannot consistently state events, highlight the main and secondary, determine temporal connections, cause and effect, convey the meaning of phenomena and events.

With gross forms of motor alalia, the child has only onomatopoeia and individual babbling words, which are accompanied by active facial expressions and gestures.

Symptoms of sensory alalia

Speech status

In sensory alalia, the leading defect is a violation of perception and understanding of the meaning of the reversed speech. At the same time, the physical hearing of sensory alalics is preserved, and they often suffer from hyperacusis – increased susceptibility to various sounds.

Against the background of auditory agnosia, the speech activity of children with sensory alalia is increased. However, their speech is a set of meaningless sound combinations and fragments of words, echolalia (unconscious repetition of other people’s words). In general, with sensory alalia, speech is incoherent, meaningless and incomprehensible to others (logorrhea). In the speech of children with sensory alalia, there are numerous perseverations (obsessive repetitions of sounds, syllables), syllable elision (omissions), paraphasias (sound substitutions), contamination (combining parts of different words with each other). Children with sensory alalia are not critical of their own speech; facial expressions and gestures are widely used for communication.

With gross forms of sensory alalia, there is no understanding of speech at all; in other cases, it is situational in nature. However, even if the meaning of the phrase is available to the child in a certain context, when the word form, the order of words in the sentence, and the pace of speech change, understanding is lost. Often, in understanding speech, children with sensory alalia are helped by “lip reading” of the speaker.

The insufficiency of phonemic hearing in sensory alalia leads to the indistinguishability of words-paronyms; the unformed correlation of the audible and spoken word with a particular object or phenomenon.

Psychological status

Gross distortion of speech development in sensory alalia leads to secondary personality disorders, behavior, and intellectual development delay. Psychological features of children with sensory alalia are characterized by difficulty in turning on and holding attention, increased distractibility and exhaustion, instability of auditory perception and memory. Children with sensory alalia may have impulsivity, chaotic behavior, or, on the contrary, inertia, isolation.

In its pure form, sensory alalia is observed infrequently; mixed sensorimotor alalia is usually found, which indicates the functional continuity of the speech-hearing and speech-motor analyzers.

Diagnostics

Children with alalia need to consult a pediatric neurologist, a pediatric otolaryngologist, a speech therapist, a child psychologist.

• Neurological examination. It is necessary to identify and assess the nature and extent of brain damage. For this purpose, EEG, echoencephalography, X-ray of the skull, MRI of the brain can be recommended to the child. To exclude hearing loss in sensory alalia, otoscopy, audiometry, and other studies of auditory function are necessary. Neuropsychological examination includes diagnostics of auditory-speech memory.
• Speech therapy examination. It begins with finding out the perinatal anamnesis and features of the early development of the child. Particular attention is paid to the timing of psychomotor and speech development. Diagnostics of oral speech (impressive speech, lexical and grammatical structure, phonetic and phonemic processes, articulatory motor skills, etc.) is carried out according to the examination scheme for GUS.

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

Correction of alalia

General treatment

The method of corrective action in all forms of alalia should be of a complex psychological, medical and pedagogical nature. Children with alalia receive the necessary assistance in specialized preschool institutions, hospitals, correctional centers, sanatoriums.

Work on speech is carried out against the background of drug therapy aimed at stimulating the maturation of brain structures; physiotherapy (laser therapy, magnetotherapy, electrophoresis, hydrotherapy, electropuncture; transcranial electrical stimulation, etc.). With alalia, it is important to work on the development of general and manual motor skills, mental functions (memory, attention, representations, thinking).

Correction of motor alalia

Given the systemic nature of the violation, speech therapy classes for the correction involve work on all sides of speech. With motor alalia , the child is working on:

• stimulation of speech activity;
• formation of active and passive vocabulary,
• phrasal speech,
• grammatical design of the utterance;
• development of coherent speech,
• sound reproduction.

The outline of speech therapy classes includes logorhythmics and speech therapy massage.

Correction of sensory alalia

With sensory alalia , tasks are set to master:

• distinguishing non-speech and speech sounds,
• differentiating words, correlating them with specific objects and actions,
• understanding phrases and speech instructions,
• grammatical structure of speech.

With the accumulation of vocabulary, the formation of subtle acoustic differentiations and phonemic perception, it becomes possible to develop the child’s own speech. With various forms of alalia, it is recommended that children learn to read relatively early, since writing and reading allows them to better consolidate the acquired material, as well as control oral speech.

Prognosis and prevention

The key to the success of correctional work with alalia is its early (from 3-4 years) onset, complex nature, systemic effect on all components of speech, the formation of speech processes in unity with the development of mental functions. With motor alalia, the speech prognosis is more favorable; with sensory and sensory alalia, it is uncertain. To a large extent, the prognosis is influenced by the degree of organic brain damage. In the process of school education, children with alalia may have writing disorders (dysgraphy and dyslexia).

Prevention in children includes providing conditions for a favorable course of pregnancy and childbirth, early physical development of the child. Correctional work to overcome alalia allows you to prevent the occurrence of secondary intellectual disability.