Violation of speech understanding occurs in a number of different speech and neuropsychiatric syndromes: alalia, aphasia, autism, oligophrenia, dementia, etc. It is characterized by the lack of an adequate response to audible speech, the inability to follow instructions, increased exhaustion of attention. Sometimes understanding is broken partially. Own speech production may be preserved or absent. To establish the causes of the violation, a neurological, audiological, neuropsychological, speech therapy examination is carried out. Treatment is carried out within the framework of the identified syndrome.
Understanding of addressed speech is absent in children who do not have the experience of human communication - the so-called "Mowgli children". The development of the child's speech is imitative in nature based on the sounds that he hears around and the articulation that he observes in others. If a child from early childhood was isolated in a confined space or grew up among animals and never heard human speech, then he is not able to perceive and give an adequate response to words. Along with impaired understanding, children with Mowgli syndrome also lack their own speech.
Lack of understanding of speech is observed in deaf children from birth or early deaf children. They do not perceive even non-verbal sounds. The knowledge of the external world is limited, which is why an intellectual deficit develops for the second time, and difficulties in learning arise. Sometimes they may be able to access the rhythmic pattern of the word, certain intonations. Deaf-mute children do not speak and do not understand others.
The severity of receptive speech disorders varies in different forms of autism. The worst level of auditory perception is demonstrated by persons with low-functioning autism, the best - with high-functioning autism, Asperger's syndrome.
In general, speech understanding for people with autism spectrum disorders is available, but often involuntary, selective. The peculiarity of thinking in autism is such that the child reacts only to those topics that cause him emotions and keen interest. Autistic children do not pay attention to other verbal information, do not respond to the name, requests. At the same time, intonation and gestures are well perceived.
The disease is characterized by the decay of speech skills at the age of 3-7 years. First, the understanding of speech is lost, then the possibility of independent utterance. Regression of speech function occurs suddenly and quickly, within about six months. In Landau-Kleffner syndrome, a violation of the receptive side of speech is combined with epileptic seizures. Non-verbal intelligence is relatively preserved: patients retain the ability to self-service and manual labor.
Sensory alalia develops with perinatal damage to the speech-auditory area (Wernicke's center). A child with sensory alalia perceives the speech of others as background noise, devoid of any meaning. He does not differentiate by ear non-speech and speech sounds, he has no connection between the sound shell of the word and the object that it denotes. To facilitate understanding, children "read from the face."
In mild cases, understanding of individual words and household instructions is available, in severe cases, complete non-perception of verbal information is noted. Physical hearing is not impaired, active speech is present, intellect is primarily preserved. With sensorimotor alalia, children not only do not understand verbal appeal, but also do not speak themselves.
Impaired understanding of speech
Disorder of speech perception in various forms of aphatic syndrome has its own characteristics. In some cases, there is a complete misunderstanding of any verbal statements, in others - the difficulties are partial, selective. Speech comprehension disorders occur in the following forms of aphasia:
With motor aphasia (afferent, efferent), receptive speech is impaired only in severe forms of the disorder. At the same time, situational everyday statements are accessible to the understanding of patients, difficulties arise only with the perception of complex logical and grammatical structures. Aphasias are most often the result of stroke, traumatic brain injury, neurodegenerative diseases.
Students with semantic dyslexia demonstrate impaired understanding of written language. With a satisfactory reading technique and the absence of pronunciation problems, dyslexics do not catch the meaning of what they read. They find it difficult to retell the text, answer the questions posed, write essays on literary works. Reading is mechanical, non-informative.
With congenital oligophrenia, systemic underdevelopment of speech is noted: the scarcity of vocabulary, unformed grammar, and impaired sound pronunciation. There are difficulties with the analysis of the speech flow coming to the child. The level of impaired speech comprehension depends on the degree of MA.
In the most severe form - idiocy - the perception of speech information is practically inaccessible. With moderate idiocy, a relative understanding of facial expressions, gestures, elementary speech, recognition of faces and voices of loved ones is possible.
In persons with imbecility, understanding is limited to the range of certain everyday topics, it is of a specific situational nature. New information is perceived and comprehended with difficulty. Imbeciles do not understand the meaning of many words, cause-and-effect relationships, etc.
With debility, understanding of speech has an everyday character. Most patients can maintain a dialogue on everyday topics, but abstract and logical thinking is difficult. Understanding of idioms, phraseological units, metaphors, humor is not available.
Dementia occurs in the clinic of many diseases: Alzheimer's disease, cerebral atherosclerosis, Pick's disease, neuroinfections, in children - Heller's syndrome, etc. The weakening of the intellect is accompanied by a violation of all HMF, including speech. In severe stages, speech activity is sharply reduced or absent, the response to the appeal disappears. In general, speech disorders in severe dementia correspond to total aphasia.
Patients with impressive speech disorders require a comprehensive neurological, audiological, speech therapy, psychological and psychiatric diagnostics, consultations of relevant specialists:
Logotherapy
Therapeutic tactics depend on the etiology of impaired speech perception. With organic brain lesions, drug therapy with neuroprotectors, neuropeptides, vitamins, correctors of cerebral circulation is necessary. Physical rehabilitation methods are used: physiotherapy (darsonvalization, electrophoresis, magnetotherapy), therapeutic exercises, mechanotherapy.
Patients with dementia are prescribed pharmacotherapy by a psychiatrist. Most often, nootropics, antidepressants, antioxidants, cholinesterase inhibitors, antipsychotics are used to correct mental disorders.
Various types of hearing restoration can be recommended for patients with congenital hearing loss: electroacoustic correction (hearing aid fitting), cochlear implantation. In the future, to develop understanding of speech and active utterance, patients need classes with a deaf teacher.
Methods of neuropsychological correction are used in the complex therapy of alalia, aphasia, mental retardation, autistic disorders. As part of cognitive rehabilitation, work is underway to develop HMF, sensorimotor correction involves the formation of a body scheme, spatial representations, non-verbal expression of one's needs, etc. Various methods are used: neurogymnastics, exercises for interhemispheric interaction, cerebellar stimulation, sand therapy, various types of sensory integration. ABA therapy is recommended for autism.
An important role in the correction of speech comprehension disorders is played by speech therapy classes aimed at activating auditory perception. The main directions of logotherapy:
A positive effect for restoring speech understanding was noted from the use of finger games, mnemonics, auditory training according to the Tomatis method. In children with ASD, the choice may be made in favor of the development of verbal or alternative communication (using gestures, PECS cards).