Absence of speech is the inability to implement an oral statement, due to a low level of speech development or the breakdown of speech. This condition is characteristic of infancy, as well as a number of pathologies: motor alalia, ZRR, severe dysarthria, aphasia, mutism, deaf-mutism. The diagnostic complex includes speech therapy and psychological examination, EFI methods (electroencephalography, auditory EP), neuroimaging (MRI of cerebral structures). Therapeutic tactics is aimed at stimulating speech activity, combines pedagogical tools, drug therapy, psychocorrection, physiotherapy.
Normally, the absence of speech is observed in children of the first year of life. This stage of ontogenesis is called preverbal. However, the speech development of the child during this period is very active. The first vocal reaction of a newborn - a cry - is associated with the birth of a baby. By the nature of the cry (loudness, purity of voice, the ratio of inhalation and exhalation), one can judge the prospects for further speech development.
In the first 2-3 months, the cry of a healthy baby undergoes changes: it gets intonation, the child signals hunger, colic in the stomach, wet diapers in different ways. Approximately by the 3rd month, humming appears - separate sounds and sound complexes that serve as a means of communication with others. By 6 months, cooing develops into babbling - chains of syllables that eventually become modulated, melodious. And only by 12-14 months the child begins to consciously pronounce his first words.
In the anamnesis of children with speech underdevelopment, prematurity, birth trauma, and asphyxia are often traced. Future problems with speech may be indicated by a weak painful cry or its absence, monotonous crying, nasal tone of the voice. Abnormal course of cooing and babbling (delay, intonational inexpressiveness, monotony, rare repetitions), lack of speech activity, as a rule, serves as a marker of damage to the central nervous system or auditory analyzer.
A necessary condition for the normal development of children's speech, along with full-fledged physical hearing, intact intelligence, and the absence of damage to the speech centers of the brain, is a favorable speech environment. If a child does not hear human speech from birth, then his own verbal activity does not develop. This explains the lack of speech in "Mowgli children". Instead of words, they use onomatopoeia, copy the habits of animals, and are unable to communicate with other people.
Sensitive for the development of speech is considered to be between the ages of 6 years. At this stage, the child learns oral speech especially productively. Therefore, a favorable speech environment is so important for a preschooler. If, from birth, children are among animals, away from human society, then after returning to society, they are unable to master speech and develop social skills.
Lack of speech before the age of 3-4 years is regarded as a delay in speech development. A slowdown in the rate of speech ontogenesis occurs in children with perinatal encephalopathy, severe diseases of an early age (neuroinfections, TBI), and hospitalism syndrome. In this case, the child's oral speech (words, phrases, coherent statement) is absent or appears at a later date, has a lag in qualitative and quantitative indicators.
The diagnosis of RRR is valid only for early childhood. If, despite active treatment, developmental and speech therapy classes fail to overcome speech underdevelopment by the age of 4, a child with normal intelligence is given the conclusion “ONR level 1”, and a patient with intellectual disability - “systemic underdevelopment of speech”. Further tactics require establishing the type of logopathology and the structure of the speech defect.
The lack of expressive speech is the basis of the motor alalia clinic. The structure of the speech defect is represented by articulatory apraxia. Motor alalia develops as a result of damage to the speech motor areas of the brain in utero or at the preverbal stage of development.
Expressive speech in motor alalik develops with gross distortions. For a long time, the active vocabulary consists only of individual sounds, sound combinations, and babble words. In the absence of commonly used speech, children use gestures and facial expressions. Understanding of the addressed speech is satisfactory.
Anartria is an extremely severe degree of dysarthria, in which there is no articulate speech. Bilateral paralysis of the articulatory muscles, caused by damage to the nuclei or roots of the cranial nerves, leads to anarthria. It occurs with cerebral palsy, syringobulbia, bulbar palsy, ALS. The patient cannot utter a sound or emits inarticulate sound complexes that are incomprehensible to others. Nasalization and hoarseness of voice are noted. The patient's intellect is preserved, speech understanding is not impaired.
Lack of speech
Lack of speech is the leading symptom in the clinic of some forms of aphasia (motor, total, child). With afferent motor aphasia, the dynamic stereotype of articulation breaks down, the ability to pronounce sounds and words consisting of them is lost. With severe lesions, the patient has only a speech embolus. Receptive speech suffers secondarily.
The absence of spontaneous speech with intact automated sequences is observed in severe efferent motor alalia. Global (total, mixed) aphasia syndrome is the most severe form of aphasia. The inability for independent verbal production is combined with a disorder in understanding addressed speech.
In childhood, the regression of speech function is observed in Landau-Kleffner syndrome - acquired epileptic aphasia. The disease manifests itself at the age of 2-8 years. Against the background of normal psychomotor development, epileptic seizures occur, sensorimotor aphasia, cognitive and behavioral disorders develop. Speech skills decay within a few weeks or months. Children cease to perceive speech and talk.
Speech inactivity is characteristic of a number of autism spectrum disorders. In the preverbal period, children may not babble, react to their own name, or pointing. The appearance of words is delayed up to 1.5 years, sometimes longer (up to 3-4 years). Echolalia, lack of response to addressed speech, inability to establish communicative contact with others are typical. Some children with autism do not develop spoken language at all.
At an early age in children with oligophrenia, there is a lack or delay in babbling. The formation of the first words and phrases is significantly delayed. The rudiments of expressive speech appear closer to 4-5 years, speech understanding is reduced. With deep mental retardation - idiocy - there is no coherent speech, patients pronounce only individual sounds, as well as a semblance of words.
Mutism is a psychopathological syndrome in which the patient has all the physiological prerequisites for normal speech, but the absence of any verbal reactions is noted. Mutism can develop as a result of mental trauma, organic pathologies of the brain, schizophrenia, autism, dissociative disorders.
A person does not answer questions, does not independently enter into verbal contact, but can use written and signed speech, communicate using instant messengers. Selective mutism occurs in children, when the child is silent only in certain situations.
Surdomutism is characterized by deafness and lack of speech. A child deaf from birth cannot master oral speech due to the fact that he has never heard the speech of others. Sometimes, trying to imitate adults, the child copies articulations and makes separate sounds. Voice defects are noted: nasality, deafness. If deafness occurs at the age of 2-3 years, after the formation of the speech function, then speech ceases to develop and is gradually lost altogether.
The absence of speech is a polyetiological condition, therefore, it requires an examination of the functioning of those systems that can lead to communicative speech inactivity. Neurologists, audiologists, psychiatrists, speech therapists, neuropsychologists participate in the construction of a diagnostic hypothesis.
Restorative learning in aphasia
In cases where the absence of speech is due to damage to the central nervous system, therapy is prescribed aimed at stimulating the development or restoration of speech function. To activate the activity of the nervous system, nootropic drugs, antioxidants, cerebroprotectors, vitamin complexes are shown. With destructive forms of behavior, neuroleptics, antidepressants are prescribed.
At the stage of medical rehabilitation, patients undergo exercise therapy, occupational therapy, physiotherapy (electromyostimulation, drug electrophoresis, magnetotherapy). With surdomutism, in some cases, hearing aids with the help of hearing aids, cochlear implantation are effective.
Children with tempo retardation need classes with a defectologist and a psychologist. Art therapy, play therapy, neuropsychological correction help to overcome the lack of speech. As part of the complex therapy of ASD, sensory integration, ABA-therapy is used. Since the role of the family in the development of a child's speech is extremely large, it is important to conduct psychological counseling for parents.
Patients with various disorders that led to the lack of speech receive differentiated speech therapy assistance. Corrective education of children with RDD, motor alalia is aimed at stimulating speech; includes fine motor training, phonetic rhythm, Tomatis therapy and other methods. In order to develop communication skills, non-verbal autistic children are taught according to the PECS system.
In the complex correction of dysarthria, an important place is occupied by speech therapy massage, respiratory and articulatory gymnastics. Classes to overcome motor aphasia involve work on the disinhibition of oral speech, conducting sound-letter analysis of the word, overcoming articulatory apraxia. Deaf and dumb children are shown classes with a teacher of the deaf.