Definition
An essential feature of expressive language disorder is a marked impairment in expressive language development that cannot be explained by mental retardation or inadequate learning and is not associated with pervasive developmental disorder, hearing impairment, or neurological disorder. A diagnosis should be made only if the disorder significantly interferes with success in school learning or normal daily life that requires expression in verbal (or signed) language.
The following are diagnostic criteria for developmental expressive language disorder.
- A. Scores obtained from a standardized measure of expressive language are significantly lower than scores obtained from nonverbal intellectual abilities (as measured by the Individually Administered Test 1(5).
- B. Disorder A significantly interferes with success in school and in everyday life that requires verbal (or sign) language expression. Evidence of this may include using a limited vocabulary, using only simple sentences, or using only the present tense. In less severe cases, there may be hesitations or errors in recalling some words, or errors in pronouncing long or complex sentences.
- B. Not associated with pervasive developmental disorders, hearing impairment, or neurological disorder (aphasia).
Reasons for the development of the disorder
The main reason for the development of the disorder is considered to be the occurrence of organic damage to certain areas of the brain that control the processes of speech formation.
These injuries can occur both before and after the baby is born .
In some cases, motor alalia is combined with other similar abnormalities. This occurs in cases where cerebral defects are quite significant.
Key reasons for the development of deviation:
- Prenatal adverse effects. These can be infectious diseases that a woman suffered during pregnancy (for example, rubella, cytomegalovirus infection, toxoplasmosis), acute and chronic poisoning with toxic substances, including drugs and alcohol, lack of oxygen, Rh conflicts (occur if the mother’s blood is negative). Rhesus, and the child’s blood is positive; the mother’s immune system begins to produce antibodies that harm the fetus), traumatic injuries, severe stress, taking medications that are not recommended during pregnancy.
- Birth injuries, suffocation. Traumatic brain injuries and hypoxia have an extremely adverse effect on a child’s health.
Most often they occur against the background of complications during labor: too slow or rapid labor, narrow hips of the woman in labor, strangulation by the umbilical cord, medical errors. - Traumatic brain injuries received in the first months after birth. When the baby begins to move quite actively, he may roll off a flat surface and hit his head. Therefore, it is important for parents not to leave it unattended for a long time on such surfaces.
- Complications after neuroinfections. Meningitis can leave behind many disorders and slow down the development process. It is important to vaccinate your child according to the calendar and go to the hospital when the first signs of infectious diseases appear in order to reduce the risk of meningitis. And in order to protect a growing child from encephalitis, it is important to avoid areas with encephalitis ticks or get vaccinated.
- Intracerebral neoplasms (tumors, cysts) affecting Broca's area: the area responsible for motor control of speech.
- Extremely poor nutrition. This cause occurs infrequently in developed countries of the world, but is widespread in undeveloped countries.
A lack of nutrients leads to the development of malnutrition, rickets and other diseases that can seriously slow down the development of a child. - Unfavorable psychosocial environment. If a child is often ignored by parents, does not talk to him, does not utter emotionally charged statements, or avoids physical contact, this will negatively affect the processes of speech formation. Motor alalia and other disorders are often found in children separated from their mothers and growing up in orphanages.
Some experts associate the development of motor alalia with heredity , but not everyone shares this point of view.
Clinical features
Severe forms of the disorder usually appear before age 3. Less severe forms may not be recognized until adolescence, when language typically becomes more complex. An essential feature of a child with expressive language disorder is a significant impairment in the development of age-appropriate expressive language, resulting in the child using verbal or signed language that is significantly below the expected level given the child's intellectual abilities. This child's understanding of language is not difficult; decoding remains relatively intact.
The disorder begins to be suspected around 18 months of age when the child does not spontaneously pronounce or even repeat certain words and sounds. Even simple words such as "mama" and "dada" are not in the child's active vocabulary, and the child uses gestures to express his desires. It is clear that the child wants to communicate, he maintains eye contact, treats his mother well, and enjoys games.
A child's vocabulary repertoire is very limited. At 18 months The child can at most understand simple commands and point to simple objects when they are named. When the child eventually begins to speak, the language deficit becomes more apparent. Articulation is usually immature. Numerous articulation errors occur, but they are not constant, especially with sounds such as r, s, z, which are either omitted or replaced by other sounds. By age 4, most children with this disorder can speak in short sentences, but they forget old words as they learn new ones. Once they start talking, they learn much more slowly than normal children. Their use of grammatical structures is significantly lower than would be expected at this age. Their developmental milestones are slightly delayed. Articulation development disorder is often observed. Developmental coordination disorder and functional enuresis in such children are often concomitant disorders.
Sample work plan
The disorder is based on problems with all parts of speech. Therefore, at the first stage, it is important not only to practice sound pronunciation, but also to evoke any response speech. Even in the form of elementary onomatopoeia.
Be sure to develop the child’s perception. To do this, he is introduced to different materials. For example, they let you sort through cereals, beads, and sand. You can show fruits and vegetables, offering to smell, touch, and taste them.
The development of fine motor skills directly affects speech, since these two areas of the cortex are located nearby in the brain.
The more impressions there are in the baby’s life, the better. The main thing is not to overdo it. Excessive emotions provoke stuttering.
At the first stage, the speech therapist’s task is to create a desire to contact and interact. To do this, they use finger theater, toys and simple onomatopoeia, like “Who says what?”
In severe cases, children do not use the pointing gesture. In this case, they forcefully take the hand, fold their fingers and point at the toy or picture with the index finger.
The Novikova-Ivantsova technique has proven itself well. It is based on singing vowel sounds. With motor alalia, it is sometimes difficult for children to make a certain arrangement of the organs of articulation. In this case, it is done forcibly. The adult uses his fingers to purse his lips and move the child’s jaw.
Don't be afraid of crying or other negative emotions. This is a normal reaction due to the immaturity of the cerebral cortex.
After you manage to get the first words, you need to try to build phrases. For example, showing a picture and saying: “Mom, go.” Be sure to achieve not only the reproduction of the phrase, but also the understanding of what was said.
The child must be able to correlate the image and the phrase. Only then will his speech develop. Work is definitely underway to practice sound pronunciation. To begin with, they work on the sounds of early ontogenesis: vowels, back-lingual (“K”, “G”, “X” and soft pairs), labials (“V”, “F” and others).
Articulation gymnastics in front of a mirror is mandatory. From the first lessons, the speech therapist teaches the child to control himself. Only after this will you be able to achieve results.
Correctional work to eliminate expressive speech disorder lasts 2-3 years. In severe cases, it takes up to five years. Parents also need help, since only they are able to conduct classes every day and do homework with the child.
Sometimes at school age there may be difficulties with writing and reading, which are expressed in specific errors. In this case, a speech therapist will help.
Complications
School-aged children may develop low self-esteem, frustration and depression. Children with this disorder may also exhibit a learning disability manifested by reading delays, which can result in serious problems with academic performance. Most learning difficulties lie in the area of perceptual skills or the ability to recognize and process symbols in appropriate sequence.
Other behavioral problems and symptoms that may appear in children with expressive language disorder include hyperactivity, short attention spans, autistic behavior, thumb sucking, mood swings, accident proneness, bedwetting, and disobedience. and conduct disorder. Many children have neurological pathology. It includes mild organic disorders, decreased vestibular reactions and pathological EEG changes.
Course and prognosis
Overall, the prognosis for expressive language disorders is good. The speed and extent of recovery depend on the severity of the disorder, the child's motivation to participate in therapy, and the timely administration of speech and therapy interventions. 50% of children with mild expressive language disorders recover spontaneously without any signs of language impairment, but children with severe expressive language disorders may continue to show signs of mild or moderate impairment.
Alternative interpretation of the term
The term “expressive speech” refers not only to the types of speech and the features of its formation from the point of view of neurolinguistics. It is the definition of the category of styles in the Russian language.
Expressive styles of speech exist in parallel with functional ones. The latter include bookish and conversational. Written forms of speech are journalistic style, official business and scientific. They belong to book functional styles. Conversational is represented by the oral form of speech.
Means of expressive speech increase its expressiveness and are designed to enhance the impact on the listener or reader.
The word “expression” itself means “expressiveness”. The elements of such vocabulary are words designed to increase the degree of expressiveness of oral or written speech. Often, several expressive synonyms can be selected for one neutral word. They may vary depending on the degree of emotional stress. There are also often cases when for one neutral word there is a whole set of synonyms that have exactly the opposite connotation.
The expressive coloring of speech can have a rich range of different stylistic shades. Dictionaries include special symbols and notes to identify such synonyms:
- solemn, high;
- rhetorical;
- poetic;
- humorous;
- ironic;
- familiar;
- disapproving;
- dismissive;
- contemptuous;
- derogatory;
- sulgaric;
- abusive.
The use of expressively colored words must be appropriate and competent. Otherwise, the meaning of the statement may be distorted or take on a comical sound.
Diagnosis
The quality of language, verbal or signed, is significantly below average, accompanied by low scores on standardized tests of verbal and nonverbal intelligence, indicating a diagnosis. This disorder is not due to pervasive developmental disorder because the child expresses a desire to communicate. If there are any fragments of language, they are very reduced; vocabulary is small, grammar is too simple, articulation is variable. There is internal language or adequate use of toys and household items.
To confirm the diagnosis, the child must undergo standardized expressive language and nonverbal intelligence testing. Observing the child's patterns of verbal and sign language in a variety of settings (eg, schoolyard, classroom, home, and play areas) and his interactions with other children can help determine the severity and specific areas of impairment in the child and may help in early recognition of behavioral and emotional complications.
A thorough family history should include the presence or absence of expressive language disorders in relatives. An audiogram is recommended for young children and children suspected of having hearing loss.
Sequence of the examination process
Thanks to the correct formulation of the examination process, it is possible to identify various skills and abilities by studying one type of activity. This organization allows you to fill out more than one item on the speech card at one time over a short period of time. An example is a speech therapist’s request to tell a fairy tale. The objects of his attention are:
- pronunciation of sounds;
- diction;
- skills in using the vocal apparatus;
- the type and complexity of sentences used by the child.
The information received is analyzed, summarized and entered into certain graphs of speech cards. Such examinations can be individual or carried out for several children at the same time (two or three).
The expressive side of children's speech is studied as follows:
- Studying the volume of vocabulary.
- Observation of word formation.
- Study of the pronunciation of sounds.
Also of great importance is the analysis of impressive speech, which includes the study of phonemic awareness, as well as monitoring the understanding of words, sentences and text.
Differential diagnosis
With mental retardation, there is a complete impairment of intelligence, determined by a low level of intellectual tests in all areas. Nonverbal intelligence and achievement in other areas of children with expressive language disorder are within normal limits.
In receptive language disorder, language comprehension (decoding) is significantly reduced compared to the average level expected for a given age, whereas in expressive language disorder, language comprehension remains at the normal level.
In pervasive developmental disorder, in addition to the main characteristics, affected children lack internal language, symbolic or imaginary play, adequate use of gestures, or the ability to maintain warm and meaningful social relationships. In contrast, all of these characteristics are preserved in children with expressive language disorder.
Children with acquired aphasia or dysphasia showed normal language development at an earlier age, but language impairment developed after head trauma or other neurological disorders (eg, seizures).
Children with selective mutism also initially showed normal language development, and their speech was limited to communication with only one or a few surrounding family members (eg, mother, father, and siblings). Selective mutism affects girls more often than boys, and affected children are almost always shy and withdrawn outside the family.
Expressive speech styles
Representatives of modern science of language classify the following styles as:
- Solemn.
- Familiar.
- Official.
- Jocular.
- Intimately affectionate.
- Mocking.
The contrast to all these styles is neutral, which is completely devoid of any expression.
Emotionally expressive speech actively uses three types of evaluative vocabulary as an effective means of helping to achieve the desired expressive coloring:
- The use of words that have a clear evaluative meaning. This should include words that characterize someone. Also in this category are words that evaluate facts, phenomena, signs and actions.
- Words with significant meaning. Their main meaning is often neutral, however, when used in a metaphorical sense, they acquire a rather bright emotional connotation.
- Suffixes, the use of which with neutral words allows you to convey a variety of shades of emotions and feelings.
In addition, the generally accepted meaning of words and the associations attached to them have a direct impact on their emotional and expressive coloring.
Treatment
Corrective and developmental classes should begin immediately after the diagnosis of the disorder is established. Classes consist of behaviorally reinforced exercises and hands-on mastery of phonemes (blocks of sounds), vocabulary, and sentence construction. Typically, such classes are conducted by a speech therapist or speech pathologist. Psychotherapy is not usually prescribed unless a child with a language disorder shows evidence of a secondary or co-occurring behavioral or emotional disorder.
