Delay in speech development

What is considered as delay in speech development?

Speech is one of complex higher mental functions. It has two important constituents such as impressive language (listening comprehension, speech act understanding) and expressive language (using spoken language).

Speech development is a basic feature of a child’s general development. Normal speech development requires a well formed speech apparatus, mature cerebral cortex with speech centers, preserved hearing and good environment speech from the first days of a child.

What causes delay in speech development?

The causes can include perinatal pathology (abnormal course of pregnancy and labor), disturbed function of the speech apparatus, hearing impairment, general mental underdevelopment, genetic effect and unfavorable social factors (insufficient communication and upbringing). Difficulty with speech is also typical of children with a lag in physical development, those who had severe diseases in childhood, debilitated children with malnutrition.

Hearing impairment is a common cause of isolated language delay. It is known that even a moderately pronounced and constantly progressing hearing impairment can result in delayed speech development. Thus,an audiologic examination is necessary if partial or complete hearing impairment is suspected in a child with isolated delay in speech development. Registration of auditory evoked responses is also a reliable method. The earlier hearing defects are found, the faster the respective therapy or acoustic aid can be given to the child.

Delay in speech development can be also associated with general delay in mental growth. In these cases, an extensive psychoneurological examination is recommended.

What are types of delay in speech development in children?

Neurological classification

Speech disturbances associated with an organic lesion of the central nervous system. Depending on the level of speech system affection, the following forms are distinguished:

• aphasia is violation of an already formed speech because of damage to cortical language areas;

• alalia is systemic speech underdevelopment because of damage to cortical language areas in pre-verbal children;

• dysarthria is motor speech disorder resulting from neurological injury of the motor component of the motor-speech system.

Speech disturbances associated with structural defects of the speech apparatus (disturbed pronunciation of sounds).

Delay in speech development of other origin (prematurity, severe diseases of internal organs, pedagogical neglect, etc.).

Logopedic classification

Spoken language impairment consists of external (disturbed speech sounding) and internal (speech structural failure) types.

Phonetic problems include as follows:

• dysphonia (aphonia) is disturbed power, pitch and quality of voice;

• bradylalia is abnormally slow utterance;

• tachylalia is abnormally rapid utterance;

• stuttering is a disturbance in the flow or rhythm of connected speech;

• dyslalia is a speech disorder involving normal hearing, but due to poor articulation;

• rhinolalia is a difficulty producing all sounds that make up words (unlike individual sounds as in dyslalia) due to anatomic features of the speech apparatus;

• dysarthria is a speech disorder resulting from injury of the speech system.

• alalia is a lack or underdevelopment of speech due to the lesion of cerebral cortex language zones during intrauterine or early (pre-speech) period (synonyms: dysphasia, early infantile aphasia, developmental dysphasia);

• aphasia is a complete or partial speech loss due to local changes of cerebral cortex language zones (resulting from craniocerebral traumas, cerebrovascular diseases, neuroinfections and other disorders accompanied by the CNS lesion).
  

According to this classification, speech disorders consist of two groups: disturbed communication and disturbed use of communication. Disturbed communication includes phonetic-phonematic underdevelopment and general underdevelopment of speech (GUS).

Phonetic-phonematic underdevelopment of speechis a disturbed process of speech in children due to defects in auditory language perception and defect in phoneme pronunciation. Phonematic hearing underdevelopment prevents from proper sound analysis of words. That’s why the children have not enough opportunities for writing and reading learning by the school age.

GUS includes different complex speech disorders affecting all components of the speech system referring to sounds and meaning. GUS is disturbed development of all speech system components (sound structure, phonematic processes, vocabulary, grammatical system, semantic language skills) in children with normal hearing and normal intelligence.

General signs of GUS include delayed speech, poor vocabulary, persistently impaired grammar comprehension, defects of pronunciation. There are different levels of underdevelopment from no speech or babbling to extensive speech with elements of incomplete development. Depending on the intensity of disorders observed in GUS, three levels are distinguished:

level 1 – lack of commonly used speech (the so-called speechless children);

level 2 – beginning of commonly used speech;

level 3 – extensive speech with the elements of underdevelopment.

Thus, ideas of GUS in children are developed to formulate methods of correction for children with similar manifestations of various forms of speech disorders. It is necessary to remember that GUS can be observed in various lesions of the CNS and deviations in the structure and functions of the speech apparatus i.e. in different clinical forms of spoken language disorders.

Treatment of speech language disorders in children

A complex approach and collaboration of different specialists (doctors, speech therapists, psychologists, teachers) are needed to provide an effective aid to a child with delayed speech development. The joint efforts must be aimed at early detection and timely correction of speech disturbances in children. In disturbances of speech development in children, the basic aspects of correction include working with a speech therapist, psychologist, teacher, correction activities, psychotherapeutic aid provided to a child and his/her family and drug therapy.

An integrated effect and continuity of working with different specialists are of primary importance for these children. Logopedic and psychological and pedagogical activities must be provided on a long-term and systematic basis. There is a certain positive trend in speech development for children with GUS. They shift from one level of speech development to a higher one. The acquire new speech skills and abilities. However, frequently their speech is still not developed enough. At school, the children have difficulties in written language comprehension. That is why children with speech problems often need not only logopedic, psychological and pedagogical correction but also retreatment with peptide agents several times a year as they can launch internal mechanisms of compensation and restore normal development in these children. These agents have different compositions and mechanisms of actions and a number of similar properties. Thus, they produce a positive effect on the higher integrative functions of the brain, improve memory, make education easier, stimulate intellectual activity, increase brain stability towards damaging factors and improve cortical and subcortical relations.

O. V. Bykova

Doctor of Med. Sc., Principal Researcher of the Centre for Applied Research in Pediatric Psychoneurology

of Moscow Health Department