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Methods of psychological correction
The methods of therapeutic and pedagogical correction outlined in this and subsequent chapters are classified primarily into two large groups: pedagogical and psychotherapeutic.
Of course, each of the therapeutic and pedagogical methods is, to a certain extent, both pedagogical and psychotherapeutic. But for convenience of presentation, we will assign them to one group or another according to the principle of greater affiliation.
Pedagogical methods, in turn, are divided into the following sections.
I. Methods of general pedagogical influence, containing therapeutic and pedagogical instructions concerning all types of character defects, and sometimes all categories of children's exceptionalism.
1. Correction of active-volitional defects.
Medical and pedagogical correction of willpower deficiencies in children is as follows. Strengthening a weak, sick will should be carried out systematically. For this, first of all, it is necessary that someone around him has a strong will; The educator of a child with a weak will must serve as a source of will from which he draws reinforcement, since the will is induced and transmitted from one person to another. People with unstable will cannot develop a strong will.
2. Correction of fears.
Fear is an affect, and, as with any affect, the task of correction is to develop the art of self-control in the child. This benefits him for life.
3. Method of ignoring.
In correcting the character defects of hysterical children, the method of ignoring gives especially good results - their panache, theatricality, painful desire to attract attention in every possible way, when all the staff carry out this method in a friendly manner, very quickly lend themselves to first softening, and then disappearing, which in turn co-educates , co-regulates other character defects.
4. Method of culture of healthy laughter.
The influence of joy is especially strong in relation to exceptional children. For example, we can refer to children who are prone to solitude, withdrawal, and autism. Here, both the doctor and the teacher, along with other activities, should use the method of creating a joyful atmosphere around the child. Jokes, jokes, and riddles are also cheerful and amusing and therefore very useful in correcting a child who deviates from the norm.
5. Actions when the child is very excited.
The most important thing when a child is very excited is the mental influence of the surrounding adults on him. Any educator who knows how to influence children with the power of his personality will be able to cope with the formidable manifestation of affect.
6. Correction of absent-mindedness.
Absent-mindedness in children with exceptional character is due to various reasons, of which the most important are the following:
Constant distraction by countless receptions, tireless change of thoughts, emotions, desires.
Intense focus.
Experiencing fears.
neurosis and psychopathy, in particular sexual abnormalities.
physical illnesses, ailments and weakness.
7. Correction of shyness.
The task of correcting shyness is to train the shy child in communicating with people. For this purpose, we are creating a whole system of orders. A gently implemented system of instructions, carefully and without forcing, gives very good results.
8. Correction of obsessive thoughts and actions.
Corrective education of children with this character flaw requires tactics of a firm, confident and at the same time caring attitude.
9. Method of Professor P.G. Belsky.
Belsky designed a very interesting method of individual influence on a difficult child.
10. Correction of vagrancy.
A very productive method of character development in normal children is self-education. Only by selflessly working on ourselves and for others, we have success in our social life.
11. Self-correction.
It includes the positive and negative sides of the same act of education.
12. Game method.
Games shape the child’s need to influence the world, to explore the world. The game creates personality.
II. Special or private pedagogical methods that are aimed at correcting certain specific and clearly identified abnormalities and character defects.
1. Correction of tics.
Special gymnastics is a very good way to correct tics, as it teaches you to gain control over your body and movements.
2. Correction of childhood precocity.
To correct children's precocity, it is necessary to eliminate the indicated shortcomings in upbringing and babysit the child less, “educate” him less.
3. Correction of hysterical character.
Corrective education of hysterics must be done in such a way as to distract them from the illness and at the same time instill in them that they are responsible for all their actions and that their mistakes and actions do not arise from painful reasons.
4. Correction of behavioral deficiencies in only children.
Only children need social measures, e.g. in creating a healthy physical and mental environment around them, which would gradually lead their character to alignment, correction, and the nervous system to hardening and calming. In this matter, individual pedagogical influence and a psychohygienic regime are required, prescribed in each individual case.
5. Correction of nervous character.
In this case, physical health comes first, with which proper neuropsychic development is so closely related.
6. Technique for dealing with abnormal reading.
Abundant reading, of a passionate and obsessive nature, which forces the child to violate his physiological needs and neglect the interests of his age, immense reading, completely absorbing and enslaving him - such reading leads to amazingly rapid, unnatural maturation - precocity and overmaturity of the child. In addition, it creates both general and neuropsychic exhaustion.
III. Method of correction through labor.
It is extremely important both for the general social education of a child with a difficult character, and for the correction of individual forms of his behavior.
IV. Method of correction through rational organization of children's teams.
The team serves as one of the sources of their overall development (it is understandable if it is superior to these children in mental development).
We divide psychotherapeutic methods into the following main types:
I. Suggestion and self-hypnosis.
II. Hypnosis.
III. Method of persuasion.
IV. Psychoanalysis.
There is also another classification of methods for correcting deviations in the behavior and development of children and adolescents:
suggestive and heterosuggestive methods of psychocorrection based on self-hypnosis and pedagogical suggestion;
didactic correction methods, including explanation, persuasion and other methods of rationally reasoned influence;
method of "Socratic dialogue";
methods of teaching sanogenic thinking, aimed at managing oneself, strengthening one’s neuropsychic health, and self-reflection;
group correction techniques, role-playing situations;
methods of congruent communication;
method of conflict destruction;
art therapy method;
social therapy method;
behavioral training method, etc.
All these methods and techniques for correcting the development and behavior of a child are an important tool in solving the main task of correctional pedagogical activities to overcome the child’s existing deficiencies, to rehabilitate his personality and to achieve successful adaptation and integration of the child into society.
It is also necessary to take into account the important method of play, especially in childhood.
The use of correctional pedagogy methods in the work of classes IV (children with visual impairments) and V types (children with speech impairments).
All children who study at school are different. Different by nature in their constitutional and psychophysiological characteristics, different in health and development. Teaching children under the same conditions is, to say the least, ineffective.
The increase in the number of children with speech and vision impairments and the increase in the number of students have led to the need to open an additional number of compensatory and correctional-developmental education classes.
Guided by this, on the basis of the school in 2004, a class of V type (for children with severe speech impairment) was first opened, and since 2005, classes of type IV (for the visually impaired) were opened. Today there are eight such classes in the school (five classes of the V type at the primary level, one class of the V type is taught at the middle level in the fifth grade, and two classes of the IV type).
The curriculum in classes of the V type provides, along with general education subjects, such subjects as logorhythmics, as part of the correctional linguistic course, subjects: pronunciation, speech development. Individual group and subgroup correctional classes for 6 – 7 hours per week. These courses are taught by speech therapists.
In classes of the IV type, correctional training is represented by such subjects as rhythm, exercise therapy, massage, protection and development of visual perception, development of touch and fine motor skills, development of facial expressions and pantomime, subject-matter practical activity (in 1st grade - 9 hours, in 3rd - 4th grades – 10 a.m. Classes are taught by a teacher-defectologist.
The structure and content of education in correctional and developmental classes have well-known features, and the nature of learning material by students in these classes is somewhat different from the cognitive capabilities of ordinary schoolchildren. This causes teachers working in correctional classes corresponding difficulties in organizing the pedagogical process and makes it difficult to carry out educational and cognitive activities and educational work with students. The current circumstances require adjustments to be made to the general pedagogical and professional activities of teachers when working with children and adolescents who have developmental and behavioral disorders and who experience difficulties in mastering school subjects.
In correctional classes, speech therapists, psychologists, sociologists, and medical workers work closely together with primary school teachers. In their teaching activities, they often encounter problems that require joint discussion and solution. Therefore, for the third year, a problem group has been working at the school: “The use of correctional pedagogy methods in the work of classes IV and V types.”
Main tasks of the group
1. Study the methods of correctional pedagogy and determine the main directions of correctional work;
2. Familiarize yourself with the features of organizing correctional work with children with speech impairment;
3. Consider modern educational technologies for the development of speech activity of primary school age.
4. To study the psychological and pedagogical characteristics of students in classes IV and V types.
5. Familiarize yourself with general pedagogical and special pedagogical methods of correction;
6. Study unconventional methods that ensure the creation of a personally oriented situation in the lesson
In implementing the assigned tasks, we examined the methods of correctional pedagogy.
Teaching methods -
Visual methods(students’ work with a textbook, book, demonstration) are aimed at enriching the content of speech and ensure the interaction of two signaling systems.
Verbal methods(oral, verbal) - for teaching retelling, conversation, story without relying on visual material, etc.
Practical methods used in the formation of speech skills through the widespread use of special exercises, games, dramatizations, excursions, observations and laboratory work, etc.
Particular importance in speech therapy is attached to the use of reproductive and productive methods and their combination, taking into account the specifics of speech disorders.
Reproductive methods effective in developing children’s imitation ability, developing skills for clear pronunciation of sound-syllable exercises, and in perceiving speech patterns. Their role is especially great in the formation of initial skills in pronunciation of sounds and correction of voice disorders. The effectiveness of these methods increases significantly if they are used in the context of activities that are interesting to the child.
Productive methods are more widely used in constructing coherent statements, various types of stories, and in creative tasks. The transition to the use of productive methods is determined each time by a speech therapist depending on the specific tasks of correcting the disorder and the level of the necessary prerequisites for the transition to independent speech.
Education methods –
1. Information methods (use of media, literature and art, conversation, excursion, description, explanations).
2. Practical - effective methods (training, exercises, games, manual labor. Non-traditional methods - art therapy, herbal medicine).
3. Incentive - evaluative methods (encouragement, censure, punishment).
The basic principle of special education is the principle of correctional orientation while observing the triune task - correctional education, correctional development, correctional education.
The main principle of organizing the educational process in classes of correctional and developmental education (leveling classes and compensatory education classes) is the principle of correctional orientation of education.
Correctional and developmental education is aimed at creating an integral system of comprehensive, dynamic, diagnostic and special correctional and developmental assistance, ensuring that the conditions and nature of the educational process correspond to the individual and age characteristics of children with developmental difficulties.
Modern practice of correctional and developmental education includes its various forms: individual and group correctional and developmental classes, correctional and developmental lesson.
Correctional and developmental lessons are lessons during which educational information is processed from the position of maximum activity of all analyzers and the mental functions of each student.
Lesson objectives:
Correctional - educational purpose determines what the teacher will teach in a given lesson. This goal determines the type of lesson.
Corrective and developmental goal involves the correction and development of higher mental functions, correction of gaps in knowledge. This goal should be extremely specific and focused on activating those mental functions that will be maximally involved in the lesson.
The implementation of the correctional and developmental goal involves the inclusion in the lesson of special correctional and developmental exercises for higher mental functions: memory, attention, perception, thinking, emotional-volitional sphere, etc., the inclusion of tasks based on several analyzers, etc.
Correction of thinking, memory and speech is carried out in almost all general education lessons. Correction of physical disabilities, motor sphere, general somatic development of the body - in physical education lessons. Development of phonemic hearing, rhythm, color perception, spatial perception - in the lessons of fine arts, manual labor, music
Corrective and educational goal First of all, it involves nurturing motivation for learning, as well as moral education, aesthetic, labor, etc.
Types of lessons:
lessons in mastering new knowledge;
lessons in the formation and improvement of skills and abilities;
lessons of repetition, consolidation of knowledge and skills;
test lessons;
lessons on generalizations and systematization of knowledge;
combined lessons.
The structure of a lesson is determined taking into account its type and place in the lesson system.
Possible lesson stages:
organizational moment, developmental (corrective) exercises (they can be included in other stages of the lesson), checking homework, setting goals and objectives of the lesson, preparatory stage for learning new material, physical education minutes, learning new material, consolidating and repeating the studied material, summing up lesson and assessment of student work, primary control of knowledge,
homework assignment.
Having selected methods for working in the lesson, the teacher must combine them in such a way that the types of activities of students are changed and, thereby, a protective mode of teaching is implemented.
In the lessons, a lot of attention is paid to repeating the material studied.
In order to achieve effective student performance, when developing notes, the teacher should think not about what he will do, but, first of all, about what the students will do during each technique and method.
Based on my experience in such a lesson as speech development in class V type (children with speech impairment). I would like to say that in my lessons the practical method predominates - these are speech game exercises.
But since the training is correctional - developmental and the tasks are solved during the lesson, it is correctional - educational. The word correctional means the development in the lesson of the teacher’s cognitive sphere (thinking, imagination, memory, attention). To solve this problem, there are a lot of games and exercises. Also, these game exercises can be selected according to the topic of the lesson. Using word games in the classroom, we solve the main task in the correctional class of type V - enrichment of vocabulary and speech development.
I bring to your attention games for the development of imagination, attention, thinking and speech.
1. “What does it look like?” The student selects a geometric figure and suggests words - objects similar to this figure. For example, a circle is a button, a plate, a tablet, a watch, a ball, an apple; rectangle - suitcase, brick, briefcase, TV, book, house, window; triangle - the roof of a house, a hat made of newspaper, a funnel, a Christmas tree, an Egyptian pyramid; oval – cucumber, plum, egg, fish, leaf.
2. “Composing sentences” The teacher takes three words at random that are not related in meaning, for example, “lake”, “pencil”, “bear”. Students must make as many sentences as possible that include all three of these words. The answers may vary. For example, the Bear dropped a pencil into the lake. The boy took a pencil and drew a bear swimming in the lake. A boy, thin as a pencil, stood near a lake that roared like a bear.
3. “Search for common features” In two words taken at random, for example, plate and boat, you need to write down as common features as possible. (Products of human hands; have depth, etc.)
4. “Expressing thoughts in other words” Take a simple phrase, for example: “This summer will be very warm.” It is necessary to offer several options for conveying this idea in other words. However, none of the words in this sentence should be used in other sentences. It is important to ensure that the meaning of the statement is not distorted.
5. “List of possible reasons” Describes some unusual situation, for example: “Having returned from the store, you discovered that the door of your apartment is open.” It is necessary to name as quickly as possible more reasons for this fact and possible explanations. The reasons can be different: “I forgot to close the door,” “thieves broke in,” or even “Martians arrived,” etc.
6. “How can this be done?” The teacher names any word, for example, “newspaper.” Students must name the options: read, write, make a boat, a hat, lay it on the floor, use it as a toy for a cat, clean windows, etc.
7. “Counting with interference” The student names numbers from 1 to 20, while simultaneously writing them on a piece of paper or on the board in reverse order.
8. “Reading with interference” Students read the text while simultaneously tapping a rhythm with a pencil.
9. “Typewriter” Each student is assigned the name of a letter of the alphabet. Then a word or phrase of two or three words is invented. At a signal, children begin to print: the first letter of the word is clapped, the second, etc. When the entire word is typed, everyone claps their hands.
We consider all important issues of correctional and developmental education in the problem group. We also share interesting practical methods (games).
The work of the problem group brings certain results.
Members of our group take an active part in city pedagogical forums.
Republican and city workshops are held at the school, where problem group teachers share their experiences.
Children take an active part in all events, open lessons, local history conferences held at both the school and city levels.
Working in a problem group allowed teachers to systematize and generalize the experience of their work, as well as increase the efficiency of the teaching and educational process in correctional classes. In the future there are many ideas and plans for implementation that the members of the problem group will have to work on.
Statistics show that children studying in the correctional classes of our school are talented, creative, and efficient, which is proof of the high organization of training, development and education in these classes.
In order to diagnose and measure the results of innovation, the development of type V students' skills and abilities in sound pronunciation, syllabic structuring of words, word formation, lexical and grammatical formatting of speech, and the development of cognitive activity is monitored.
Measurements of the results of innovation are carried out on the basis of test-surveys compiled by candidates of psychological and pedagogical sciences Filicheva T.B., Chirkina G.V., Semago N.Ya., Gribova O.E.
The diagram shows indicators of the formation of the above skills and abilities among students of class V of the first and fifth years of study.
The diagram clearly shows the positive dynamics of the development of students’ speech competencies. Sound pronunciation skills increased from low to above average, amounting to 80%. The dynamics of cognitive activity and word formation amounted to 30%. The development of lexico-grammatical speech has reached an average level. It should be noted that the greatest difficulties for children with severe speech impairments are word formation and syllable structuring of words.
Monitoring is also carried out with students in classes IV. Indicators of preservation of the visual analyzer are monitored. The survey data showed that over the period of three years of schooling, 45% of students in 4G class IV type vision was preserved and remained at the same level, and in 55%, vision improved. Please note that not a single child’s vision deteriorated, despite the maximum load of the visual analyzer during the learning process.
Based on tests and examinations of candidates of pedagogical and medical sciences Kozlova S.A., Bolshakova S.E., Beletskaya V.I. etc. in classes of IV type, monitoring of such skills as social and everyday orientation, fine motor skills of the hands, development of the sense of touch, facial expressions and pantomime is carried out.
The diagram shows that in classes of IV type there is an increase in the level of formation
controlled skills, and the greatest difficulties for children with impaired vision are the development of the sense of touch.
The work experience of our correctional classes teachers is in demand in the city and in the republic. Since 2005 On the basis of our school, republican and city workshops are held for teachers of city schools and speech therapists of kindergartens.
Our teachers are constantly searching, trying and implementing various forms and methods of teaching with children.
Corrective education for children who have a deviation only from the phonetic side is carried out in the following areas: activation of the articulatory apparatus (with various techniques depending on the state of the congenital defect); formation of articulation of sounds; elimination of nasal tone of voice; differentiation of sounds in order to prevent disruption of sound analysis; normalization of the prosodic aspect of speech; automation of acquired skills in free speech communication.
Correctional education for children with phonetic-phonemic underdevelopment includes the areas listed above, as well as systematic exercises to correct phonemic perception, form morphological generalizations, and overcome dysgraphia.
Correctional education for children with general speech underdevelopment is aimed at the formation of a full-fledged phonetic aspect of speech, the development of phonemic concepts, mastery of morphological and syntactic generalizations, and the development of coherent speech. All this can be done in a special school for children with severe speech impairments.
In domestic speech therapy, methodological techniques have been developed to eliminate rhinolalia (E. F. Pay, 1933; F. A. Pay, 1933; 3. G. Nelyubova, 1938; V. V. Kukol, 1941; A. G. Ippolitova, 1955, 1963; 3. A. Repina, 1970; I. I. Ermakova, 1984; G. V. Chirkina, 1987; Volosovets T. V. 1995).
The system developed by A. G. Ippolitova is of great importance. This system is highly effective in correcting sound pronunciation in children who do not have deviations in phonemic development. A.G. Ippolitova was one of the first to recommend exercises in the preoperative period. Characteristic of her technique is a combination of breathing and articulation exercises, a sequence of sound training determined by articulatory interconnectedness.
The sequence of work on sounds is determined by the preparedness of the articulatory base of the language. The presence of full-fledged sounds of one group is an arbitrary basis for the formation of the following. So-called “reference” sounds are used.
Preparation of the articulatory base of sound is carried out using special articulatory gymnastics, which is combined with the development of the child’s speech breathing. The uniqueness of A.G. Ippolitova’s method is that when evoking a sound, the child’s initial attention is directed only to the articulum.
1. Formation of speech breathing when differentiating inhalation and exhalation.
2. Formation of a long oral exhalation when the articulation produces vowel sounds (without including the voice) and fricative voiceless consonants.
3. Differentiation of short and long oral and nasal exhalation in the formation of sonorant sounds and affricates.
4. Formation of soft sounds.
L. I. Vansovskaya (1977) proposed starting the elimination of nasalization not with the traditional sound a, a c front vowels And And uh, since it is they that allow you to focus the exhaled stream of air in the anterior part of the oral cavity and direct the tongue to the lower incisors. At the same time, the clarity of kinesthesia in contact with the lower incisors increases; When pronouncing a sound, the walls of the pharynx and soft palate are more actively involved.
The child is required to pronounce sounds in a low voice, with the jaw slightly pushed forward, with a half-smile, with increased tension in the soft palate and pharyngeal muscles. After eliminating the nasalization of vowels, work is carried out on sonorants (l, r), then fricative and stop consonants.
The improvement of methods for correcting speech defects in rhinolalia was influenced by radiographic research. It made it possible to predict the possibility of restoring the function of the palate with speech therapy techniques (N.I. Serebrova, 1969).
Analysis of radiographs revealed the dependence of the effectiveness of speech therapy work on the mobility of the soft palate and the posterior wall of the pharynx; on the distance between the back wall of the pharynx and the soft palate; from the width of the middle part of the pharynx.
Comparison of these data even before the start of speech therapy work makes it possible to resolve the issue of the degree of compensation for the speech defect using generally accepted means.
Techniques for differentiated speech therapy work, depending on the anatomical and functional features of the articulatory apparatus, were developed by T. N. Vorontsova (1966).
In relation to adults, the technique of S. L. Tap-tapova (1963) was developed, which offers a unique mode of silence - pronunciation of vowel sounds to oneself. This removes grimaces and prepares pronunciation without nasalization. Vocal exercises are recommended.
I. I. Ermakova (1980) developed a step-by-step method for correcting sound pronunciation and voice. She established age-related features of functional disorders of voice formation in children with congenital clefts and modified orthophonic exercises for them. Special attention is paid to the postoperative period and methods for developing mobility of the soft palate are recommended, preventing its shortening after surgical plastic surgery.
Elimination of speech sound disorders is based on careful speech therapy examination of children.
The presence and degree of velopharyngeal insufficiency, cicatricial changes in the hard and soft palate, and its length are established; nature of contact with the posterior wall of the pharynx (passive, active, functional); dental anomalies, features of motor skills of the articulatory apparatus; the presence of compensatory facial movements.
The effectiveness of speech therapy work is closely related to the anatomical and functional state of the speech apparatus. Great importance is also attached to the psychophysical state of the child, his behavior and personality as a whole.
The system of correctional work for the development of phonetically correct speech includes the following sections: development of movements of the soft palate, elimination of nasal connotation, production of sounds and development of phonemic perception.
A sound probe is used for massage With,(see Fig. 8, No. 2), which carefully moves back and forth along the hard palate. When stroking and rubbing the mucous membrane at the border of the hard and soft palate in the transverse direction, a reflex contraction of the muscles of the pharynx and soft palate occurs. Massage when pronouncing a sound is also effective A- at this time, light pressure is applied to the soft palate. It is useful to perform acupressure and jerking massage with your finger.
The massage should last 1.5-2 minutes, i.e. you need to make 40-60 quick rhythmic movements on the palate (2 times a day for 6-12 months, 2 hours before or after meals).
Work to activate the soft palate is essential in the postoperative period. To do this, use the following exercises.
Gymnastics for the palate.
Swallowing water in small portions, which causes the highest elevation of the soft palate. With successive swallowing movements, the time of holding the soft palate in a raised position increases. Children are asked to pour from a small glass or bottle. You can drop a few drops of water onto your tongue from a pipette.
Yawning with the mouth open; imitation of yawning.
Gargling with warm water in small portions.
Coughing, which causes vigorous contraction of the muscles of the roller of Passavan (at the back of the throat). The Passavan roller can increase up to 4-5 mm and largely compensates for velopharyngeal insufficiency. When coughing, a complete closure occurs between the nasal and oral cavities. Active movements of the palate and the back of the throat can be felt by children (the hand touches the muscles of the neck under the chin and “feels” the rise of the palate).
Voluntary coughing occurs two to three times or more in one exhalation. At this time, contact of the palate with the back wall of the pharynx is maintained, and the air flow is directed through the oral cavity. At first, it is recommended to cough with your tongue hanging out. Then - coughing with arbitrary pauses, during which the child is required to maintain contact of the palate with the back wall of the pharynx. Gradually, the child learns to actively lift it and direct the air stream through the mouth.
A clear, energetic, exaggerated pronunciation of vowel sounds (on a firm attack) is made in a high tone of voice. At the same time, the resonance in the oral cavity increases and the nasal tint decreases.
The listed exercises give positive results in the preoperative period and after surgery. Their systematic implementation over a long period of time in the pre-operative period prepares the child for operations and reduces the time of subsequent correctional work.
Working on breathing is necessary for developing correct vocal speech. Children with rhinolalia have a very short wasteful outlet, expended through the mouth and nasal passages. To cultivate a directed oral air stream, the following exercises are used: inhale and exhale through the nose; inhale through the nose, exhale through the mouth; inhale through the mouth, exhale through the nose; inhale and exhale through your mouth.
By systematically performing these exercises, the child begins to feel the difference in changes in phonation and learns to correctly direct the exhaled air. This also helps to develop the correct kinesthetic sensations of the movement of the soft palate.
When performing exercises, it is important to constantly monitor the child, as it is difficult for him to feel the leakage of air through the nasal passages. Various control techniques are used: a mirror, cotton wool, a strip of thin paper, etc. are placed on the nasal passages.
Exercises with blowing on cotton wool, on a strip of paper, on paper toys, etc. contribute to the development of the correct air stream.
A more difficult and not always justified exercise is playing children's wind instruments. Such exercises must be alternated with lighter ones, as they cause rapid fatigue.
At the same time, a series of exercises is carried out, the main goal of which is to normalize speech motor skills. Their daily use eliminates high elevation of the tongue root, insufficient labial articulation and increases the mobility of the tip of the tongue. In this regard, the excessive participation of the root of the tongue and larynx in the pronunciation of sounds is reduced.
Gymnastics for lips and cheeks.
Inflating both cheeks at the same time.
Puffing out the cheeks alternately.
Retraction of the cheeks into the oral cavity between the teeth.
Sucking movements - closed lips are pulled forward by the trunk, then return to their normal position. The jaws are closed.
Grin: the lips are strongly stretched to the side, up, down, exposing both rows of teeth.
“Proboscis”, followed by a grin with clenched jaws.
A grin with opening and closing of the mouth, followed by closing of the lips.
A grin with an open mouth, followed by covering both rows of teeth with the lips (p, b, m).
Extending the lips into a wide funnel with the jaws open.
Stretching out the lips with a narrow funnel (imitation of whistling).
With the jaws wide open, the lips are drawn inside the mouth, pressing tightly against the teeth.
Raising tightly compressed lips up and down with tightly clenched jaws.
Lifting the upper lip exposes the upper teeth.
Pulling down the lower lip exposes the lower teeth.
Imitation of rinsing teeth (the air presses hard on the lips).
Vibration of lips.
Movement of the lips with the proboscis left and right.
Rotational movements of the lips with the proboscis.
Strong puffing of the cheeks (the lips retain air in the oral cavity, increasing intraoral pressure).
Holding a pencil or rubber tube with your lips.
Gymnastics for the tongue.
Sticking out the tongue with a shovel, sting.
Alternately protruding the tongue, flattened and pointed.
Turning the strongly protruding tongue left and right.
Raising and lowering of the back of the tongue - the tip of the tongue rests on the lower gum, and the root of the tongue either rises or falls.
Sucking the back of the tongue to the palate, first with the jaws closed, and then with the jaws open.
The protruding wide tongue closes with the upper lip and then retracts into the mouth, touching the back of the upper teeth and palate and curving the tip upward at the soft palate.
Suction of the tongue to the upper alveoli with opening and closing of the mouth.
Pushing the tongue between the teeth so that the upper incisors “scrape” the back of the tongue.
Circular licking of the lips with the tip of the tongue.
Raising and lowering the widely protruded tongue towards the upper and lower lips with the mouth open.
Alternately bending the tip of the tongue with a sting to the nose and chin, upper and lower lips, upper and lower teeth, hard palate and floor of the mouth.
The tip of the tongue touches the upper and lower incisors with the mouth wide open.
Hold the protruding tongue with a groove, a boat, a cup.
Hold the cup-shaped tongue inside the mouth.
Biting the lateral edges of the tongue with the teeth.
Resting the lateral edges of the tongue against the lateral upper teeth, while grinning, raise and lower the tip of the tongue, touching the upper and lower gums.
With the same position of the tongue, repeatedly drum the tip of the tongue on the upper alveoli (t-t-t-t).
Make movements one after another - tongue with a sting, a cup, up, etc.
In this way, the movements necessary for the correct pronunciation of sounds are developed.
Voice exercises are conducted on vowel sounds. Vowel sounds a, oh, uh, uh are put first and then regularly (daily) included in the exercises. Vowel sounds are first articulated without voice (silent). This is especially useful for children who have pronounced compensatory additional facial movements (retraction of the wings of the nose). These children should practice silent vowel articulation in front of the mirror every day, and then move on to loud pronunciation. The number of repetitions of vowels in one exhalation gradually increases.
For example:
The next stage is abrupt, clear pronunciation of vowels with two and three sounds in different sequences. In addition to articulatory training, this develops retention of a sequence of sounds and mastery of the syllabic structure of a word.
For example:
Then children are required to pronounce vowels with short pauses, during which the soft palate must remain in a high position. The pauses gradually increase from one to three seconds.
For example: A-; A--; A - - - etc.
Long continuous pronunciation of vowel sounds: a--e--a--u--i etc.
The development of correct sound pronunciation is carried out using the usual correctional methods. Specific is constant monitoring of the direction of the air stream. In difficult cases, you can use temporary pinching of the nasal passages for a more intelligible and sonorous pronunciation of sounds. The order of sound production is also specific. The first sound produced from consonants is f- a voiceless fricative sound, the pronunciation of which can be easily achieved from exercises involving blowing a stream of air through the mouth. The child is required to make a long, correct exhalation, during which the upper teeth touch the lower lip, producing a sound f. Students practice pronouncing sounds in isolation (f-, f-), in reverse syllables (af, ef, if), then in straight syllables (fa, fu, afa, afu). Towards the articulation of sound P Students are prepared with cheek puffing exercises that require a good velopharyngeal seal. Next, children must make a burst of lip closure to make sound. P. If they fail, then the speech therapist opens the child’s tightly compressed lips and moves the lower lip down. A sufficient explosion can only occur if there is no air leakage through the nasal passages, so further pronunciation of the sound P can be used for training exercises to eliminate nasality.
When setting the sound T The child’s attention is mainly focused on the correctness of the oral exhalation, during which the tip of the tongue is pressed against the upper teeth. All elements of sound articulation must be prepared and automated in advance in articulation exercises and are automatically activated in the presence of a sufficiently strong oral air stream.
Sound To presents a certain difficulty for children and is not always achieved by imitation, despite coughing exercises. Therefore, a mechanical method of staging from sound can be used T.
Speech therapy classes in the preoperative period prevent the occurrence of serious pathological changes in the functioning of the speech organs. At the same time, the activity of the soft palate is prepared; the position of the root of the tongue is normalized; muscle activity of the lips increases; directed oral exhalation is produced. This creates conditions for more effective results of the operation and subsequent correction.
Early speech therapy begins to reduce degenerative changes in the muscles of the pharynx (I. I. Ermakova, 1984).
After the operation (after 15-20 days), many special exercises are repeated. Their main goal in this period is the development of elasticity and mobility of the closure. In a significant number of cases, there is a need to “stretch” the soft palate, since it can decrease in length due to scarring in the postoperative period.
To stretch fresh scars, a technique that simulates swallowing is used. A massage is also carried out at the same time.
In the postoperative period, it is necessary to develop the mobility of the soft palate, eliminate the incorrect structure of the organs of articulation and prepare the pronunciation of all sounds without a nasal connotation.
Children with rhinolalia who attend a special kindergarten, under the guidance of a speech therapist, master the correct pronunciation of sounds. Classes are conducted both in groups and individually. In individual lessons, special exercises are used aimed at eliminating defects specific to this anomaly.
When drawing up an individual plan, the speech therapist must adhere to the following directions: normalization of the sound side of speech and elimination of lexical and grammatical underdevelopment.
A number of special sections are included:
I. Sounds subject to production, correction, clarification or differentiation. Attention is drawn to the violation of the actual articulation of sounds and the degree of nasalization when pronouncing them.
II. Rhythmic-syllable structure. Difficulties in pronouncing sounds in complex positions (such as SSG), as well as in polysyllabic words and at the end of a phrase are identified.
III. Phonemic perception and the state of auditory control of one’s own speech.
In the first period of study in kindergarten, individual lessons are used to clarify the pronunciation of vowel sounds. a, uh, o, y, s and consonants p, p; f, f; in, in; t, t; setting and initial consolidation of sounds: k, To; x, x; s, s; g, g; l, l; b, b.
In the second period the sounds are voiced: And; d, d; z, z; w; R.
In the third period, sound is practiced and, affricates and work continues to clarify the articulation of previously learned sounds. At the same time, intensive work is being done to eliminate the nasal tint.
Much attention is given to the differentiation of oral and nasal sounds: m - p; m - p; n - d; n - t; m - b; m - b.
At a school for children with severe speech impairments, specific defects are eliminated in individual speech therapy sessions.
In the process of correctional work on normalizing the phonetic aspect of speech, it is necessary to monitor the effectiveness of speech therapy exercises.
The criteria proposed by L.I. Vansovskaya make it possible to more clearly distinguish complex speech disorders in rhinolalia and evaluate the corrective effect in two aspects - elimination of nasalization and articulation defects.
The following speech assessments have been established:
1. Normal and close to normal, i.e. sound pronunciation is formed and nasalization is eliminated.
2. Significant improvement in speech - sound pronunciation is formed, there is moderate nasalization.
3. Improved speech - articulation of not all sounds is formed, there is moderate nasalization.
4. Without improvement - articulation of sounds is not formed, hypernasalization remains.
The effectiveness of correctional interventions is greatly influenced by the active participation of parents in the education of normal speech in children with clefts.
Among some factors that influence the results of correction (the age at which the operation was performed, its quality; the age at which speech therapy training began; duration of training), the factor of cooperation with the child’s family also stands out. The speech therapist instructs parents about the correction techniques used and recommends a significant part of well-developed exercises for systematic use at home.
CLOSED RHINOLALIA
Closed rhinolalia is formed when physiological nasal resonance is reduced during the production of speech sounds. The strongest resonance is in the nasals. m, m, n, n. When pronounced normally, the nasopharyngeal valve remains open and air enters directly into the nasal cavity. If there is no nasal resonance for nasal sounds, they sound like oral sounds. b, b, d, d. In speech, the opposition of sounds on the basis of nasal-non-nasal disappears, which affects its intelligibility. The sound of vowel sounds also changes due to the muffling of individual tones in the nasopharyngeal and nasal cavities. In this case, vowel sounds acquire an unnatural connotation in speech.
The reason for the closed form is most often organic changes in the nasal space or functional disorders of the velopharyngeal closure. Organic changes are caused by painful phenomena, as a result of which nasal breathing becomes difficult.
M. Zeeman distinguishes two kinds closed rhinolalia (rhinophonia): front closed- with obstruction of the nasal cavities and rear closed- with a decrease in the nasopharyngeal cavity.
Anterior closed rhinolalia observed with chronic hypertrophy of the nasal mucosa, mainly of the posterior inferior concha; for polyps in the nasal cavity; with a deviated nasal septum and tumors of the nasal cavity.
Posterior closed rhinolaliaat in children may be the result of adenoid growths, less commonly nasopharyngeal polyps, fibroids or other nasopharyngeal tumors.
Functional closed rhinolalia It is often observed in children, but is not always correctly recognized. It occurs with good patency of the nasal cavity and undisturbed nasal breathing. However, the timbre of nasal and vowel sounds may be more disturbed than with organic forms.
During phonation and when pronouncing nasal sounds, the soft palate rises strongly and blocks access to sound waves to the nasopharynx. This phenomenon is more often observed in neurotic disorders in children.
At organic closed rhinolalia First of all, the causes of nasal obstruction must be eliminated. As soon as correct nasal breathing occurs, the defect disappears. If, after eliminating the obstruction (for example, after adenotomy), rhinolalia continues to manifest itself, resort to the same exercises as for functional disorders.
The effectiveness of speech therapy to eliminate rhinolalia depends on the condition of the nasopharynx, the function of the uvula, and the age of the child. An important factor is the child’s ability to distinguish a nasal voice from a normal one. At the initial stage of training, breathing exercises are recommended, the purpose of which is to differentiate between nasal and oral inhalation and exhalation. This is achieved first by blowing exercises, and then by alternating short and long nasal exhalations. At the same time, the muscles of the soft palate and the back wall of the pharynx are activated. The next stage is to work on the differentiation of oral and nasal exhalations. This prepares the possibility of staging and automating nasal sounds: labiolabial stop m and anterior lingual occlusive k.
Children are taught to draw out an exaggerated pronunciation so that a strong vibration is felt on the wings and base of the nose. Vowels before nasal sounds are practiced in the same way. (am, om, um, an). When pronouncing these sounds and syllables, the soft palate is passive, the speech therapist controls the movement of the lips (with m) or tongue (at k) due to nasal exhalation. After this, nasal sounds are fixed in words. They must be pronounced forcefully and drawn out, with a strong nasal resonance. To correct the defect, school-age children can insert a thin rubber tube into the nasal passage, the other end into the external auditory canal, so that the child “hears through his nose” and controls the vocal vibrations during the formation of nasal sounds. The final stage is to work on the sonority of vowel sounds and on the contrast of sounds on the basis of nasality, non-nasality (p., b- m; d- n).
MIXED RHINOLALIA
Some authors (M. Zeeman, A. Mitronovich-Modrzejewska) identify mixed rhinolalia - a speech condition characterized by reduced nasal resonance when pronouncing nasal sounds and the presence of a nasal timbre (nasalized voice). The cause is a combination of nasal obstruction and insufficiency of the palato-pharyngeal contact of functional and organic origin.
The most typical are combinations of a shortened soft palate, its submucosal cleft and adenoid growths, which in such cases serve as an obstacle to air leakage through the nasal passages during the pronunciation of oral sounds.
The state of speech may worsen after adenotomy, as velopharyngeal insufficiency occurs and signs of open rhinolalia appear. In this regard, the speech therapist should carefully examine the structure and function of the soft palate, determine which form of rhinolalia (open or closed) most disrupts the timbre of speech, discuss with the doctor the need to eliminate nasal obstruction and warn parents about the possibility of worsening the timbre of the voice. After surgery, correction techniques developed for open rhinolalia are used.
Conclusions and problems
Elimination of pathological nasalization of the voice in rhinolalia, despite the variety of techniques used, presents a certain difficulty. It is determined primarily by the severity of the defect and the nature of the surgical intervention, which does not always achieve a good anatomical and functional effect. Restoring timbre is complicated by the fact that with congenital clefts of the hard and soft palate, the mechanism of voice formation suffers, since the innervation of the soft palate affects the function of the vocal folds. Corrective work requires influence on the entire system of voice and speech formation. Pathophysiological studies that reveal the characteristics of breathing, phonation and articulation in this population expand the understanding of the structure of the defect and allow the choice of more substantiated and targeted methods of speech therapy work. Particularly important are early preventive and comprehensive corrective measures, which can weaken the development of the defect and contribute to the speedy social rehabilitation of persons with congenital anomalies of the palate.
Test questions and assignments
1. Describe the main forms of rhinolalia in children.
2. What is the effect of congenital cleft palate on a child’s speech development?
3. What are the specifics of oral and written speech disorders in school-age children with rhinolalia?
4. Describe methods for correcting the sound aspect of speech in children suffering from rhinolalia.
5. When visiting special preschool and school institutions, pay attention to children with rhinolalia. Compare them with children who have dysarthria and alalia.
Literature
1. Ermakova I. I. Speech correction for rhinolalia in children and adolescents. - M., 1984.
2. Ippolitova A. G. Open rhinolalia. - M., 1983.
3. Reader on speech therapy / Ed. - L. S. Volkova, V. I. Seliverstova. M., 1997. - Part I. - pp. 120-162
4. Chirkina G.V. Children with disorders of the articulatory apparatus. - M., 1969.
CHAPTER 8. DYSARTHRIA
Dysarthria - a violation of the pronunciation aspect of speech caused by insufficient innervation of the speech apparatus.
The leading defect in dysarthria is a violation of the sound pronunciation and prosodic aspects of speech associated with organic damage to the central and peripheral nervous systems.
Dysarthria is a Latin term, translated as a disorder of articulate speech - pronunciation (dis- violation of a sign or function, artron- articulation). When defining dysarthria, most authors do not proceed from the exact meaning of this term, but interpret it more broadly, referring to dysarthria as disorders of articulation, voice production, tempo, rhythm and intonation of speech.
Sound pronunciation disturbances in dysarthria manifest themselves to varying degrees and depend on the nature and severity of damage to the nervous system. In mild cases, there are individual distortions of sounds, “blurred speech”; in more severe cases, distortions, substitutions and omissions of sounds are observed, tempo, expressiveness, modulation suffer, and in general the pronunciation becomes slurred.
With severe damage to the central nervous system, speech becomes impossible due to complete paralysis of the speech motor muscles. Such violations are called anarthria(A- absence of a given sign or function, artron- articulation).
Dysarthric speech disorders are observed with various organic brain lesions, which in adults have a more pronounced focal nature. In children, the frequency of dysarthria is primarily associated with the frequency of perinatal pathology (damage to the nervous system of the fetus and newborn). Dysarthria is most often observed in cerebral palsy, according to various authors, from 65 to 85% (M. B. Eidinova and E. N. Pravdina-Vinarskaya, 1959; E. M. Mastyukova, 1969, 1971). There is a relationship between the severity and nature of damage to the motor sphere, the frequency and severity of dysarthria. In the most severe forms of cerebral palsy, when there is damage to the upper and lower extremities and the child remains practically immobile (double hemiplegia), dysarthria (anarthria) is observed in almost all children. A relationship has been noted between the severity of damage to the upper extremities and damage to the speech muscles (E. M. Mastyukova, 1971, 1977).
Less severe forms of dysarthria may be observed in children without obvious movement disorders, who have suffered mild asphyxia or birth trauma, or who have a history of other mild adverse effects during fetal development or childbirth. In these cases, mild (erased) forms of dysarthria are combined with other signs of minimal brain dysfunction (L. T. Zhurba and E. M. Mastyukova, 1980).
Dysarthria is often observed in the clinic of complicated mental retardation, but data on its frequency are extremely contradictory.
The clinical picture of dysarthria was first described more than a hundred years ago in adults as part of pseudobulbar syndrome (Lepine, 1977; A. Oppenheim, 1885; G. Pezitz, 1902, etc.).
Subsequently, in 1911, N. Gutzmann defined dysarthria as a violation of articulation and identified two of its forms: central and peripheral.
The initial study of this problem was carried out mainly by neuropathologists in the context of focal brain lesions in adult patients. The work of M. S. Margulis (1926), who was the first to clearly distinguish dysarthria from motor aphasia and divided it into boulevard and cerebral forms. The author proposed a classification of cerebral forms of dysarthria based on the location of the brain lesion, which was later reflected in the neurological literature, and then in speech therapy textbooks (O. V. Pravdina, 1969).
An important stage in the development of the problem of dysarthria is the study of local diagnostic manifestations of dysarthric disorders (works by L. B. Litvak, 1959 and E. N. Vinarskaya, 1973). E. N. Vinarskaya was the first to conduct comprehensive neurolinguistic study of dysarthria with focal brain lesions in adult patients.
Currently, the problem of childhood dysarthria is being intensively developed in clinical, neurolinguistic, psychological and pedagogical directions. It is described in most detail in children with cerebral palsy (M. B. Eidinova, E. N. Pravdina-Vinarskaya, 1959; K. A. Semenova, 1968; E. M. Mastyukova, 1969, 1971, 1979, 1983; I. I. Panchenko, 1979; L. A. Danilova, 1975, etc.). In foreign literature it is represented by the works of G. Bohme, 1966; M. Climent, T. E. Twitchell, 1959; R. D. Neilson, N. O. Dwer, 1984.
The pathogenesis of dysarthria is determined by organic damage to the central and peripheral nervous system under the influence of various unfavorable external (exogenous) factors acting in the prenatal period of development, at the time of childbirth and after birth. Among the causes, asphyxia and birth trauma, damage to the nervous system due to hemolytic disease, infectious diseases of the nervous system, traumatic brain injuries, and less often - cerebrovascular accidents, brain tumors, malformations of the nervous system, for example, congenital aplasia of the cranial nerve nuclei are important. (Moebius syndrome), as well as hereditary diseases of the nervous and neuromuscular systems.
Clinical and physiological aspects of dysarthria are determined by the location and severity of brain damage. The anatomical and functional relationship in the location and development of motor and speech zones and pathways determines the frequent combination of dysarthria with motor disorders of varying nature and severity.
Sound pronunciation disorders in dysarthria occur as a result of damage to various brain structures necessary to control the motor mechanism of speech. Such structures include:
Peripheral motor nerves to the muscles of the speech apparatus (tongue, lips, cheeks, palate, lower jaw, pharynx, larynx, diaphragm, chest);
The nuclei of these peripheral motor nerves are located in the brain stem;
Nuclei located in the brainstem and in the subcortical regions of the brain and carrying out elementary emotional unconditioned reflex speech reactions such as crying, laughing, screaming, individual emotional-expressive exclamations, etc.
The defeat of the listed structures gives a picture of peripheral paralysis (paresis): nerve impulses do not arrive to the speech muscles, metabolic processes in them are disrupted, the muscles become sluggish, flabby, their atrophy and atony are observed, as a result of a break in the spinal reflex arc, the reflexes from these muscles disappear, areflexia.
The motor mechanism of speech is also provided by the following brain structures located more highly:
Subcortical-cerebellar nuclei and pathways that regulate muscle tone and the sequence of muscle contractions of speech muscles, synchrony (coordination) in the work of the articulatory, respiratory and vocal apparatus, as well as the emotional expressiveness of speech. When these structures are damaged, individual manifestations of central paralysis (paresis) are observed with disturbances in muscle tone, strengthening of individual unconditioned reflexes, as well as a pronounced violation of the prosodic characteristics of speech - its tempo, smoothness, volume, emotional expressiveness and individual timbre;
Conducting systems that ensure the conduction of impulses from the cerebral cortex to the structures of the underlying functional levels of the motor apparatus of speech (to the nuclei of the cranial nerves located in the brain stem). Damage to these structures causes central paresis (paralysis) of the speech muscles with an increase in muscle tone in the muscles of the speech apparatus, strengthening of unconditioned reflexes and the appearance of reflexes of oral automatism with a more selective nature of articulatory disorders;
The cortical parts of the brain, which provide both more differentiated innervation of the speech muscles and the formation of speech praxis. When these structures are damaged, various central motor speech disorders occur.
Pathoanatomical changes in dysarthria have been described by many authors (R. Thurell, 1929; V. Slonimskaya, 1935; L. N. Shendrovich, 1938; A. Oppenheim, 1885, etc.).
A feature of dysarthria in children is often its mixed nature with a combination of various clinical syndromes. This is due to the fact that when a harmful factor affects the developing brain, the damage is often more widespread, and the fact that damage to some brain structures necessary for controlling the motor mechanism of speech can contribute to delayed maturation and disrupt the functioning of others. This factor determines the frequent combination of dysarthria in children with other speech disorders (delayed speech development, general speech underdevelopment, motor alalia, stuttering). In children, damage to individual parts of the speech functional system during a period of intensive development can lead to complex disintegration of the entire speech development as a whole. In this process, damage not only to the motor part of the speech system itself, but also to disturbances in the kinesthetic perception of articulatory postures and movements is of particular importance.
The role of speech kinesthesia in the development of speech and thinking was first shown by I.M. Sechenov and further developed in the studies of I.P. Pavlov, A.A. Ukhtomsky, V.M. Bekhterev, M.M. Koltsova, A.N. Sokolov and other authors. The great role of kinesthetic sensations in the development of speech was noted by N. I. Zhinkin (1958): “The control of the speech organs will never improve if they themselves do not report to the control center what they are doing when an erroneous sound that is not accepted by the ear is reproduced... Thus, kinesthesia is nothing more than feedback, by which the central control is aware of what has been accomplished from those orders that are sent for execution... The absence of feedback would stop any possibility of accumulating experience for controlling the movement of the speech organs. A person would not be able to learn speech. Increasing feedback (kinesthesia) speeds up and facilitates speech learning.”
The kinesthetic feeling accompanies the work of all speech muscles. Thus, in the oral cavity, various differentiated muscle sensations arise depending on the degree of muscle tension during the movement of the tongue, lips, and lower jaw. The directions of these movements and various articulatory patterns are felt when pronouncing certain sounds.
With dysarthria, the clarity of kinesthetic sensations is often impaired and the child does not perceive a state of tension, or, conversely, relaxation of the muscles of the speech apparatus, violent involuntary movements or incorrect articulatory patterns. Reverse kinesthetic afferentation is the most important link in the integral speech functional system, ensuring postnatal maturation of cortical speech zones. Therefore, a violation of reverse kinesthetic afferentation in children with dysarthria can delay and disrupt the formation of cortical brain structures: the premotor-frontal and parietal-temporal areas of the cortex - and slow down the process of integration in the work of various functional systems that are directly related to speech function. Such an example may be the insufficient development of the relationship between auditory and kinesthetic perception in children with dysarthria.
A similar lack of integration can be observed in the functioning of the motor-kinesthetic, auditory and visual systems.
CLINICAL AND PSYCHOLOGICAL CHARACTERISTICS OF CHILDREN WITH DYSARTHRIA
Children with dysarthria represent an extremely heterogeneous group in terms of their clinical and psychological characteristics. There is no relationship between the severity of the defect and the severity of psychopathological abnormalities. Dysarthria, including its most severe forms, can be observed in children with intact intelligence, and mild “erased” manifestations can occur both in children with intact intelligence and in children with mental retardation.
According to clinical and psychological characteristics, children with dysarthria can be divided into several groups depending on their general psychophysical development:
Dysarthria in children with normal psychophysical development;
Dysarthria in children with cerebral palsy (the clinical and psychological characteristics of these children are described within the framework of cerebral palsy by many authors: E. M. Mastyukova, 1973, 1976; M. V. Ippolitova and E. M. Mastyukova, 1975; N. V. Simonova, 1967, etc.);
Dysarthria in children with oligophrenia (clinical and psychological characteristics correspond to children with oligophrenia: G. E. Sukhareva, 1965; M. S. Pevzner, 1966);
Dysarthria in children with hydrocephalus (clinical and psychological characteristics correspond to children with hydrocephalus: M. S. Pevzner, 1973; M. S. Pevzner, L. I. Rostyagailova, E. M. Mastyukova, 1983);
Dysarthria in children with mental retardation (M. S. Pevzner, 1972; K. S. Lebedinskaya, 1982; V. I. Lubovsky, 1972, etc.);
Dysarthria in children with minimal brain dysfunction. This form of dysarthria occurs most often among children of special preschool and school institutions. Along with the insufficiency of the sound-pronunciation side of speech, they usually have mildly expressed disturbances of attention, memory, intellectual activity, emotional-volitional sphere, mild motor disorders and delayed formation of a number of higher cortical functions.
Motor disorders usually appear in later stages of the formation of motor functions, especially such as the development of the ability to sit up independently, crawl with alternate simultaneous extension of the arm and the opposite leg forward and with a slight turn of the head and eyes towards the forward arm, walk, grab objects with the tips of the fingers and manipulate them.
Emotional-volitional disorders manifest themselves in the form of increased emotional excitability and exhaustion of the nervous system. In the first year of life, such children are restless, cry a lot, and require constant attention. They experience sleep and appetite disturbances, a predisposition to regurgitation and vomiting, diathesis, and gastrointestinal disorders. They do not adapt well to changing meteorological conditions.
At preschool and school age, they are restless motorly, prone to irritability, mood swings, fussiness, and often show rudeness and disobedience. Motor restlessness increases with fatigue; some are prone to hysterical reactions: they throw themselves on the floor and scream, trying to get what they want.
Others are fearful, inhibited in a new environment, avoid difficulties, and do not adapt well to changes in the environment.
Despite the fact that children do not have pronounced paralysis and paresis, their motor skills are characterized by general clumsiness, lack of coordination, they are awkward in self-care skills, lag behind their peers in dexterity and accuracy of movements, they are delayed in developing the readiness of their hand for writing, so it takes a long time There is no interest in drawing and other types of manual activities; poor handwriting is noted at school age. Violations of intellectual activity are expressed in the form of low mental performance, memory impairment, and attention.
Many children are characterized by a delayed formation of spatio-temporal concepts, optical-spatial gnosis, phonemic analysis, and constructive praxis. The clinical and mental characteristics of these children are described in the literature (E. M. Mastyukova, 1977; L. O. Badalyan, L. T. Zhurba, E. M. Mastyukova, 1978; L. T. Zhurba, E. M. Mastyukova, 1980, 1985).
PSYCHOLINGUISTIC ASPECTS OF DYSARTRIA
Determining the structure of the defect in dysarthria at the current level of scientific development is impossible without the use of psycholinguistic data on the process of speech production. With dysarthria, the implementation of the motor program is disrupted due to the immaturity of the operations of the external design of the utterance: vocal, tempo-rhythmic, articulatory-phonetic and prosodic disturbances. In recent years, the attention of many linguists has been drawn to the prosodic means of utterance (pausing, highlighting individual elements of the utterance with emphasis, including the necessary intonation) in the aspect of studying the relationship between semantics and syntax. In dysarthria, prosodic disturbances can cause peculiar semantic disturbances and impede communication.
The difficulty of making a detailed statement with dysarthria may be due not only to purely motor difficulties, but also to violations of linguistic operations at the level of processes associated with choosing the right word. Disturbances in speech kinesthesia can lead to insufficient strengthening of words, and at the moment of speech utterance the maximum probability of the emergence of exactly the right word is disrupted. The child experiences severe difficulty in finding the right word. This is manifested in the difficulties of introducing a lexical unit into the system of syntagmatic connections and paradigmatic relations.
With dysarthria, due to general disorders of brain activity, specific difficulties may arise in isolating significant and inhibiting side connections, which leads to insufficient formation of a general scheme of utterances, which are enhanced due to insufficient selection of the necessary lexical units.
In dysarthria, combined with a more local lesion (or dysfunction) of the parietal-occipital regions of the left hemisphere, there is insufficient formation of simultaneous spatial syntheses, which makes it difficult to form complex logical-grammatical relations. This manifests itself in difficulties in forming a statement and decoding it.
CLASSIFICATION OF DYSARTHRIA
It is based on the principle of localization, syndromological approach, and the degree of intelligibility of speech for others. The most common classification in Russian speech therapy was created taking into account the neurological approach based on the level of localization of damage to the motor apparatus of speech (O. V. Pravdiva and others).
The following forms of dysarthria are distinguished: bulbar, pseudobulbar, extrapyramidal (or subcortical), cerebellar, cortical.
The most complex and controversial in this classification is cortical dysarthria. Its existence is not recognized by all authors. In adult patients, in some cases, cortical dysarthria is sometimes confused with the manifestation of motor aphasia. The controversial issue of cortical dysarthria is largely associated with terminological inaccuracy and the lack of one point of view on the mechanisms of motor alalia and aphasia.
According to the point of view of E. N. Vinarskaya (1973), the concept of cortical dysarthria is collective. The author admits the existence of its various forms, caused by both spastic paresis of articulatory muscles and apraxia. The latter forms are designated as apraxic dysarthria.
Based on the syndromological approach, the following forms of dysarthria are distinguished in relation to children with cerebral palsy: spastic-paretic, spastic-rigid, spastic-hyperkinetic, spastic-atactic, ataxic-hyperkinetic (I. I. Panchenko, 1979).
This approach is partly due to the more widespread brain damage in children with cerebral palsy and, in connection with this, the predominance of its complicated forms.
Syndromological assessment of the nature of articulatory motor disorders poses a significant challenge for neurological diagnosis, especially when these disorders manifest themselves without clear motor disorders. Since this classification is based on a subtle differentiation of various neurological syndromes, it cannot be carried out by a speech therapist. In addition, a child, in particular a child with cerebral palsy, is characterized by a change in neurological syndromes under the influence of therapy and the evolutionary dynamics of development, and therefore the classification of dysarthria on a syndromic basis also presents certain difficulties.
However, in a number of cases, with a close relationship in the work of a speech therapist and a neurologist, it may be advisable to combine both approaches to identifying various forms of dysarthria. For example: complicated form of pseudobulbar dysarthria; spastic-hyperkinetic or spastic-atactic syndrome, etc.
A classification of dysarthria according to the degree of speech intelligibility for others was proposed by a French neurologist. G. Tardier (1968) in relation to children with cerebral palsy. The author identifies four degrees of severity of speech disorders in such children.
The first, mildest degree, when sound pronunciation disorders are detected only by a specialist during the examination of the child.
The second is that pronunciation violations are noticeable to everyone, but speech is understandable to others.
Third, the speech is understandable only to the child’s loved ones and partially to those around him.
The fourth, most difficult - absence of speech or speech is almost incomprehensible even to the child’s loved ones (anarthria).
Under Anarthria refers to the complete or partial inability to produce sounds as a result of paralysis of the speech motor muscles. According to the severity of its manifestations, anarthria can vary: severe - complete absence of speech and voice; moderate - the presence of only vocal reactions; easy - the presence of sound-syllable activity (I. I. Panchenko, 1979).
Symptoms. The main signs (symptoms) of dysarthria are defects in sound pronunciation and voice, combined with disturbances in speech, especially articulation, motor skills and speech breathing. With dysarthria, unlike dyslalia, the pronunciation of both consonants and vowels may be impaired. Violations of vowels are classified according to rows and elevations, violations of consonants - according to their four main characteristics: the presence and absence of vibration of the vocal folds, the method and place of articulation, the presence or absence of additional elevation of the back of the tongue to the hard palate.
Depending on the type of violation, all sound pronunciation defects in dysarthria are divided into: a) anthropophonic (sound distortion) and b) phonological (lack of sound, replacement, undifferentiated pronunciation, confusion). With phonological defects, there is a lack of opposition of sounds according to their acoustic and articulatory characteristics. Therefore, written language disorders are most often observed.
All forms of dysarthria are characterized by disturbances in articulatory motor skills, which are manifested by a number of signs. Muscle tone disorders, the nature of which depends primarily on the location of the brain lesion. The following forms of it in the articulatory muscles are distinguished: spasticity of the articulatory muscles - a constant increase in tone in the muscles of the tongue, lips, facial and cervical muscles. The increase in muscle tone may be more local and spread only to individual muscles of the tongue.
With a pronounced increase in muscle tone, the tongue is tense, pulled back, its back is curved, raised upward, the tip of the tongue is not pronounced. The tense back of the tongue, raised towards the hard palate, helps soften consonant sounds. Therefore, a feature of articulation with spasticity of the tongue muscles is palatalization, which can contribute to phonemic underdevelopment. So, pronouncing the same words fervor And dust, they say And mole, the child may find it difficult to differentiate their meanings.
An increase in muscle tone in the orbicularis oris muscle leads to spastic tension of the lips and tight closure of the mouth. Active movements are limited. The inability or limitation of the forward movement of the tongue may be associated with spasticity of the genioglossus, mylohyoid and digastric muscles, as well as the muscles attached to the hyoid bone.
All muscles of the tongue are innervated by the hypoglossal nerves, with the exception of the glossopalatine muscles, which are innervated by the glossopharyngeal nerves.
An increase in muscle tone in the muscles of the face and neck further limits voluntary movements in the articulatory apparatus.
The next type of muscle tone disorder is hypotension. With hypotonia, the tongue is thin, spread out in the oral cavity, the lips are flaccid, and there is no possibility of their complete closure. Because of this, the mouth is usually half-open, pronounced hypersalivation.
A feature of articulation in hypotonia is nasalization, when hypotonia of the muscles of the soft palate prevents the velum from moving sufficiently upward and pressing it against the posterior wall of the pharynx. The air stream comes out through the nose, and the air stream out through the mouth is extremely weak. The pronunciation of labiolabial stop noisy consonants is impaired p, p, b, b. Palatalization is difficult, and therefore the pronunciation of voiceless stop consonants is impaired; in addition, the formation of voiceless stops requires more energetic lip work, which is also absent in hypotonia. Labiolabial stop nasal sonatas are easier to pronounce m, m, a also labiodental fricative noisy consonants, the articulation of which requires loose closure of the lower lip with the upper teeth and the formation of a flat gap, f, f, v, v.
The pronunciation of front-lingual stop noisy consonants is also impaired t, t, d, d; articulation of anterior lingual fricative consonants is distorted w, f.
Various types of sigmatism are often observed, especially interdental and lateral.
Disturbances in muscle tone in the articulatory muscles during dysarthria can also manifest themselves in the form of dystonia (changing nature of muscle tone): at rest, low muscle tone in the articulatory apparatus is noted, when attempting to speak, the tone increases sharply. A characteristic feature of these disturbances is their dynamism, inconstancy of distortions, substitutions and omissions of sounds.
Impaired articulatory motor skills in dysarthria are the result of limited mobility of articulatory muscles, which is aggravated by disturbances in muscle tone, the presence of involuntary movements (hyperkinesis, tremor) and discoordination disorders.
With insufficient mobility of the articulatory muscles, sound pronunciation is impaired. When the lip muscles are damaged, the pronunciation of both vowels and consonants is affected. The pronunciation of labialized sounds is especially impaired (oh, y), when pronouncing them, active movements of the lips are required: rounding, stretching. The pronunciation of labiolabial stop sounds is impaired p, p, b, b, m, m. The child finds it difficult to stretch his lips forward, round them, stretch the corners of his mouth to the sides, raise his upper lip up and lower his lower lip, and perform a number of other movements. Restricted lip mobility often impairs articulation as a whole, since these movements change the size and shape of the vestibule of the mouth, thereby affecting the resonance of the entire oral cavity.
There may be limited mobility of the tongue muscles and insufficient lifting of the tip of the tongue upward in the oral cavity. This is usually due to impaired innervation of the styloglossus and some other muscles. In these cases, the pronunciation of most sounds suffers.
Limitation of downward movement of the tongue is associated with impaired innervation of the claviohyoid, thyroid-hyoid, mylohyoid, genioglossus and digastric muscles. This can interfere with the pronunciation of hissing and whistling sounds, as well as front vowels (i, uh) and some other sounds.
Limitation of the backward movement of the tongue may depend on disturbances in the innervation of the hypoglossopharyngeal, omohyoid, stylohyoid, digastric (posterior belly) and some other muscles. In this case, the articulation of posterior lingual sounds is impaired. (g, k, x), as well as some vowels, especially the middle and lower ones (uh, oh, a).
With paresis of the tongue muscles, disturbances in their muscle tone, it is often impossible to change the configuration of the tongue, lengthen it, shorten it, extend it, or pull it back.
Violations of sound pronunciation are aggravated by limited mobility of the muscles of the soft palate (tightening and lifting it: palatopharyngeal and palatoglossus muscles). With paresis of these muscles, the lifting of the velum at the time of speech is difficult, air leaks through the nose, the voice acquires a nasal tint, the timbre of speech is distorted, and the noise characteristics of speech sounds are not sufficiently expressed. The muscles of the soft palate are innervated by branches of the trigeminal, facial and vagus nerves.
Paresis of the facial muscles, often observed with dysarthria, also affects sound pronunciation. Paresis of the temporal muscles and masticatory muscles limit the movements of the lower jaw, as a result of which the modulation of the voice and its timbre are disrupted. These disturbances become especially pronounced if there is an incorrect position of the tongue in the oral cavity, insufficient mobility of the velum palate, disturbances in the tone of the muscles of the floor of the mouth, tongue, lips, soft palate, and the posterior wall of the pharynx.
A characteristic sign of articulatory motor impairment in dysarthria is discoordination disorders. They manifest themselves in a violation of the accuracy and proportionality of articulatory movements. The performance of fine differentiated movements is especially impaired. Thus, in the absence of pronounced paresis in the articulatory muscles, voluntary movements are performed inaccurately and disproportionately, often with hypermetry (excessive motor amplitude). For example, a child may move his tongue upward, almost touching the tip of his nose, but at the same time cannot place his tongue above the upper lip in the place precisely designated by the speech therapist. These disorders are usually combined with difficulties in alternating movements, for example, proboscis - grin, etc., as well as with difficulties in maintaining certain articulatory postures due to the appearance of violent movements - tremor (small trembling of the tip of the tongue).
With discoordination disorders, sound pronunciation is no longer upset at the level of pronunciation of isolated sounds, but when pronouncing automated sounds in syllables, words and sentences. This is due to the delay in the activation of some articulatory movements necessary to pronounce individual sounds and syllables. Speech becomes slow and scanned.
An essential link in the structure of articulatory motor impairments in dysarthria is the pathology of reciprocal innervation.
Its role in the implementation of voluntary movements was first experimentally demonstrated by Sherington (1923, 1935) in animals. It was found that in voluntary movement, along with the excitation of nerve centers leading to muscle contraction, an important role is played by inhibition that occurs as a result of induction and reduces the excitability of the centers that control the group of antagonist muscles - muscles that perform the opposite function.
In many muscles of the tongue, along with the fibers that perform the main movement, there are antagonistic groups; the joint work of both ensures the accuracy and differentiation of movements necessary for normal sound pronunciation. So, in order to protrude the tongue from the oral cavity and especially to raise the tip of the tongue upward, the lower bundles of the genioglossus muscle must be contracted, but its fibers, which pull the tongue back and down, must be relaxed. If this selective innervation does not occur, then the execution of this movement and the sound pronunciation of a number of anterior lingual sounds are disrupted.
When moving the tongue backwards and downwards, the lower bundles of this muscle should be relaxed. The middle bundles of the genioglossus muscle are antagonists of the fibers of the superior longitudinal muscle, which arches the back of the tongue upward.
In the downward movement of the tongue, the hyoglossus muscle is an antagonist of the styloglossus muscle, but in the backward movement of the tongue, both muscles work synchronously as agonists. Lateral movements of the tongue in one direction occur only when the paired muscles of the other side are relaxed. For symmetrical movements of the tongue along the midline in all directions (forward, backward, up, down), the muscles of the right and left sides must work as agonists, otherwise the tongue will deviate to the side.
Changing the configuration of the tongue, such as narrowing it, requires contraction of the fibers of the transverse muscles of the tongue while relaxing the fibers of the vertical muscles and the bundles of hyoglossus and styloglossus muscles involved in compaction and expansion of the tongue.
The presence of violent movements and oral synkinesis in the articulatory muscles is a common sign of dysarthria. They distort sound pronunciation, making speech difficult to understand, and in severe cases, almost impossible; usually intensify with excitement and emotional stress, therefore, disturbances in sound pronunciation vary depending on the situation of speech communication. In this case, twitching of the tongue and lips are noted, sometimes in combination with facial grimaces, slight trembling (tremor) of the tongue, in severe cases - involuntary opening of the mouth, throwing the tongue forward, a forced smile. Violent movements are observed both at rest and in static articulatory postures, for example, when holding the tongue in the midline, intensifying with voluntary movements or attempts at them. This is how they differ from synkinesis - involuntary accompanying movements that occur only with voluntary movements, for example, when the tongue moves upward, the muscles that raise the lower jaw often contract, and sometimes the entire cervical muscles tense and the child performs this movement at the same time by straightening the head. Synkinesis can be observed not only in the speech muscles, but also in the skeletal muscles, especially in those parts of it that are anatomically and functionally most closely related to speech function. When the tongue moves in children with dysarthria, accompanying movements of the fingers of the right hand (especially the thumb) often occur.
A characteristic sign of dysarthria is a violation of proprioceptive afferent impulses from the muscles of the articulatory apparatus. Children have little sense of the position of the tongue, lips, and the direction of their movements; they find it difficult to imitate and maintain articulatory structure, which delays the development of articulatory praxis.
Children's fears are children's emotional reactions to a situation of threat (real or imaginary) or to an object that is dangerous in children's minds, which they experience as discomfort, a desire to run away or hide. The primary emotion of fear is already observed in newborns. Fears are then socialized and arise as reactions to new objects and situations. The consolidation of primary fear in the child’s emotional sphere expands the zone of his social fears and increases sensitivity to carriers of the threat. Children's fears develop with a lack of parental acceptance and warmth, when children do not feel protected. Such children often develop a fear of school. Children's fears can manifest themselves in neurotic reactions and psychosomatic diseases.
Night terrors - arise during night sleep, manifest as a rich affect of fear with shallow changes in consciousness (narrowing, rudiments of the twilight state). Unlike sleepwalking (sleepwalking), night terrors themselves are not accompanied by motor activity with the performance of habitual, automated actions. However, they can be combined with sleep talking and sleep walking. They occur predominantly in children of preschool and primary school age.
There are 4 options for night terrors:
1. Night terrors of a delusional nature. They are an age-related modality of hallucinatory or delusional syndromes and are similar to daytime fears of this nature. As a rule, at the moment of awakening at night, the child experiences frightening (usually visual) hallucinations (sees “burning eyes”, hears frightening sounds) or experiences diffuse pointless fear with a feeling of diffuse threat. He cries, shouts: “Drive him away!”, “Scary!”, sometimes calls his mother, but, as a rule, he does not recognize her and does not answer questions or gets scared, pushes him away, drives him away, calling him “evil aunt”, “witch” , which indicates the presence of false recognitions. Consciousness is altered according to the delirious-oneiroid type. Upon full awakening with the emergence of wakefulness, partial amnesia is observed - memories of fears are fragmentary, like memories of dreams. Night fears of a delusional nature develop most often in the initial stages of paroxysmal schizophrenia.
2. Night terrors undifferentiated. They resemble night terrors of an epileptic nature, but are distinguished by a greater simplicity of the picture, lack of rhythm and stereotyping. Occurs in somatic diseases with toxicosis and fever, as well as in the subacute and long-term period of brain infections and injuries.
3. Paroxysmal night terrors- in the structure of temporal lobe epilepsy. They arise and stop suddenly without any connection with dreams. Consciousness is deeply altered according to the type of twilight darkness, contact with children is impossible. Often this variant of night fears is combined with automated actions, movements, incoherent statements, and sometimes accompanied by involuntary urination or defecation. The entire complex picture is characterized by stereotypic development, repeating each time in the same “set” at a certain time of night sleep and with a certain rhythm. The condition is completely amnesic. By puberty (adolescence), paroxysmal night terrors, as a rule, disappear or are replaced by more typical convulsive seizures.
4. Night terrors (conditionally) of an overvalued nature, arising by a reactive mechanism after experiencing psychotrauma. The sleep of such a child is restless, filled with exciting, painful dreams. Fears are the emotional culmination of experiences and, as it were, a continuation of sleep with a decrease in its depth and a transition to a state of altered consciousness. The child becomes restless, screams, cries. The statements reflect a traumatic situation and are psychologically understandable (“Don’t hit your mom,” “I’ll learn my lessons!”, “Save yourself!”). Sometimes it is possible to establish partial contact with the child and get an answer to the question. In the morning, the child, as a rule, has amnesia for the fear itself and his behavior, but can convey the content of dreams.
Anxiety
According to another point of view, fear is a reaction to a threat to a person as a biological being, when a person’s life is in danger (vital threat), his physical integrity, etc., while anxiety is an experience that arises when a person as a social subject is threatened, when his values, self-image, and position in society are at risk. Related to this is the description of anxiety as an emotional state associated with the possibility of frustration of a social need.
The concept of anxiety was introduced into psychology by 3. Freud (1925), who distinguished between fear as such, specific fear and vague, unaccountable fear - anxiety that is of a deep, irrational, internal nature. A similar distinction was introduced into philosophy by S. Kierkegaard and consistently carried out in the philosophical system of existentialism. In psychopathology, according to K. Jaspers (long before Z. Freud), anxiety is not necessarily associated with the experience of a threat, it “... is not attached to anything” and is “.. a primary mental state ... affecting the actual existence of the subject in general" with a wide range of manifestations - "from a pointless, powerful anxious feeling... to mild anxious tension." It is usually associated with a feeling of anxiety.
Thus, anxiety is a special painful uncomfortable feeling, which is often, but not necessarily, recognized as an expectation of threat, loss, and often specified in the imagination. But in the case of anxiety, such awareness represents the subject's need to rationalize a painful, uncomfortable feeling.
The presentation of anxiety as the experience of pointless fear is also debatable because fear can be both objectified and pointless, diffuse, but, nevertheless, remains fear, but not anxiety.
At the physiological level, anxiety reactions manifest themselves in increased heart rate, increased breathing, increased minute volume of blood circulation, increased blood pressure, increased general excitability, and decreased sensitivity thresholds.
At the psychological level, anxiety manifests itself in a feeling of helplessness, powerlessness, insecurity, difficulty making decisions, and ambivalence (duality) of feelings. A distinction is made between situational anxiety, which characterizes the subject’s state at a certain moment, and anxiety as a relatively stable personal formation. Depending on the presence of an objective threat in the situation, “objective”, “associated”, “real” anxiety and anxiety itself (“inappropriate anxiety”) in neutral, non-threatening situations are also distinguished.
Anxiety is an affect characterized by a painful feeling of internal causeless, meaningless anxiety, which is usually experienced as an unclear threat, expectation of danger and is described in the form of anxious fears of various contents.
Anxiety manifests itself at the level of vital feelings as a painful vague feeling of “restlessness,” “seething,” “boiling,” “trembling,” etc., in various parts of the body, often in the chest, and is also often accompanied by various somatovegetative disorders (tachycardia, sweating , increased frequency of urination, skin itching, dyssomnia, etc.).
In young children, due to the weakness of verbalization, the predominance of anxious affect is established on the basis of peculiar behavior: a restless look, fussiness, tension, crying or a desperate cry when the situation changes. In older children, complaints correspond to the following definitions: “no peace,” “somehow uneasy,” “internal trembling,” “restless.” Anxious fears have different shades, covering only the familiar sphere of a child’s life with everyday worries relating to school and family, or rushing into the future, which promises adversity, danger, world catastrophes, one’s own unsuitability for the difficulties of life, and material disadvantage.
Anxiety, as a rule, increases in the evening and at night and is accompanied by motor restlessness, the maximum severity of which is achieved in a state of anxious raptus (raptus is frantic motor restlessness with increased depression). Anxiety in childhood and adolescence is observed as part of endogenous anxious depression, schizoaffective psychosis and some neuroses.
Anxiety is an individual psychological feature that manifests itself in a person’s tendency to experience anxiety. It is considered as a personal formation and/or as a property of temperament, due to the weakness of nervous processes. It was first described by 3. Freud (1925), who, to describe “free-floating”, diffuse anxiety, uses a term that literally means “readiness for anxiety” or “readiness in the form of anxiety.”
Anxious suspiciousness- a tendency to form ideas about an unfavorable attitude towards oneself from others or about danger to oneself or loved ones emanating from people or from a situation. Anxious suspiciousness often also consists of a tendency to have unreasonable fears for the health of one’s own or those of loved ones.
Impulsivity is a behavioral feature that consists of acting on the first impulse, under the influence of external random circumstances or strong emotions. In stable forms it represents a character trait. An impulsive person does not think about his actions - he reacts quickly, directly (often to insignificant, secondary factors) and often just as quickly repents of his actions.
Physiologically, impulsivity is determined by the weakness of inhibitory control on the part of the second signaling system.
Decisiveness should be distinguished from impulsiveness, which also involves an immediate energetic reaction, but is associated with quickly thinking about the situation and making the most appropriate and informed decisions.
Impulsivity is predominantly characteristic of children of preschool and partly primary school age due to the inherent weakness of behavioral control at this age. Children's games together, which require restraining immediate impulses, obeying the rules of the game, and taking into account the interests of other participants, contribute to overcoming impulsiveness. In the future, educational activities play an even greater role in this regard. In adolescents, impulsivity is often a consequence of age-related emotional excitability. In older schoolchildren and adults, impulsivity is observed with great fatigue, in the structure of affective reactions or certain mental illnesses.
Impulsivity is a behavioral disorder based on the pathology of the volitional sphere. The patient’s actions and actions are realized unexpectedly for the patient himself under the influence of a suddenly emerging pathological impulse, are inappropriate, meaningless, do not lend themselves to any awareness and, accordingly, attempts to restrain them, and are committed in a violent manner.
Impulsivity manifests itself most clearly in the pathology of drives, when the patient’s behavior suddenly changes under the influence of an acute, irresistible desire for something. Actions are taken instantly, without thinking or hesitation. Often they do not have any motivation at all, and after implementing the action and achieving the goal, the motivation is perceived by the patient himself as incomprehensible, alien to their personality.
Manifestations of impulsive drives include pyromania (an irresistible urge to set fires with satisfaction from the sight of fire), dromomania (a periodically occurring irresistible urge to run away from home, change places, travel, wandering), kleptomania (an irresistible urge to steal, not caused by everyday necessities or material gain), etc.
Impulsivity can manifest itself in the form of auto- and hetero-aggression. In the first case, the patient commits unexpected and psychologically incomprehensible suicidal acts, in the second - suddenly, out of the context of the situation, he inflicts injuries on others. An impulsive aggressive action is carried out with lightning speed, unexpectedly not only for the environment, but also for the patient himself; upon completion, it often causes horror and repentance of the patient.
Impulsive drives can occur with schizophrenia, organic brain damage (epidemic encephalitis), and nuclear psychopathy. In children and adolescents, impulsivity is rarely observed in the form of a full-blown syndrome of drive pathology. Impulsive actions are characteristic of catatonic and catatonic-hebephrenic excitation. At the same time, the clinical picture of the main syndrome is supplemented by behavioral disorders specific to impulsiveness: the child may suddenly scream without any connection with the situation and just as suddenly calm down, suddenly jump up and uncontrollably try to leave the room, instantly tear off his clothes and be naked, suddenly spit at his interlocutor, scratch or strike a random person with a strong blow, etc.
Attempts to hold the child while performing these actions cause active resistance and an uncontrollable desire to implement the action. Depending on the depth of the defect against which the painful condition developed, upon completion of the impulsive discharge, criticism with perfection may be restored, remorse for the deed and a feeling of guilt appear (the initial stages of organic brain damage in adolescents), but may be absent (young children with schizophrenia and etc.).
Hyperdynamic syndrome(hyperactive disorder, hyperkinetic disorder, hyperkinetic disorder with attention deficit disorder, attention deficit hyperactivity disorder, attention deficit disorder) is a disorder characterized by severe impairment of concentration, hyperactivity and impulsivity.
Hyperactivity is manifested by excessive motor activity in situations that require calm behavior, which is especially noticeable during learning. Children cannot sit or stand still. They constantly fidget, spin, sway, move their arms or legs, jump up from their seats, aimlessly grab various objects, and run around the classroom. In addition, they cannot behave calmly when spending leisure time, they make too much noise and move for their age, and often prefer destructive games. Their hyperactivity is constant and depends little on the situation and environment.
Attention disorders are characterized by low ability to concentrate and absent-mindedness. They are expressed in constant distractibility, rapid loss of interest in tasks and games, and a reduced ability (compared to peers) to plan and complete tasks. Children, as a rule, are not capable of activities that require prolonged mental effort. They are disorganized, careless, make many mistakes due to inattention, have difficulty listening to the teacher, and often lose their things.
They also have increased distractibility to external stimuli (sounds and visual stimuli). These violations are less pronounced in individual communication or in the absence of strict disciplinary frameworks.
Impulsivity is manifested in the tendency to react quickly and rashly to external stimuli. When teaching, this leads to an “impulsive style of work,” when children answer questions thoughtlessly, cannot wait for their turn to answer, and interrupt others during conversations. In terms of behavior, impulsiveness leads to unjustifiably risky actions, often leading to accidents.
Children with hyperdynamic syndrome tend to have poor academic performance. The sphere of communication also suffers. These children are often outcasts in their group, despite the fact that they strive for friendship; they are perceived by others (including teachers) as dissolute and ill-mannered. Many children with hyperdynamic syndrome have concomitant mental disorders in the form of persistent behavioral and emotional disorders (a tendency to violate accepted rules and norms, aggressive tendencies, frequent outbursts of anger, increased sensitivity), as well as specific disorders in the acquisition of school skills. Psychologically, children with hyperdynamic syndrome suffer from low self-esteem; they are also characterized by increased anxiety.
According to epidemiological data, the prevalence of hyperdynamic syndrome ranges from 3% to 20%. Most often, hyperdynamic syndrome is diagnosed with the beginning of schooling, although its signs appear already from the first years of life. In boys, hyperdynamic syndrome occurs 3 to 5 times more often than in girls.
There is no unified concept of the etiology and pathogenesis of hyperdynamic syndrome; Obviously, the decisive role belongs to constitutional factors. In some cases, the hyperdynamic syndrome may also have an exogenous origin as a consequence of organic minimal brain dysfunction; the latter can be combined with a hereditary predisposition.
Despite the congenital nature of hyperdynamic syndrome, the degree of its severity and the characteristics of its course are also influenced by environmental factors, primarily the characteristics of upbringing.
Differential diagnosis of hyperdynamic syndrome is quite difficult. It should be noted that there is a tendency towards overdiagnosis of this condition in healthy children with individual temperamental characteristics, in whom the development of attention and other cognitive functions corresponds to the age norm. (It is known that attention is inextricably linked with motivation, and in the absence of interest, a healthy child can behave as “hyperactive”).
On the other hand, similar symptoms may be external signs of other neurological and psychopathological conditions other than hyperdynamic syndrome, which occurs in post-traumatic syndrome after traumatic brain injury, neuroinfection, schizophrenia, neuroses, sensory deprivation, psychopathy, Gilles de la syndrome Tourette, in chronic hypomanic conditions, in hereditary Williams, Smith-Magenis, Beckwith-Wiedemann syndromes, in hypertoxicosis. The main conditions for correct differential diagnosis are a thorough analysis of the symptoms, dynamics of the disorder, the level of social adaptation of the child, his personal characteristics, and the characteristics of his upbringing.
Symptoms of the disease are most pronounced in primary and secondary school age. In the future, the manifestations of hyperdynamic syndrome are gradually reduced, with the manifestations of hyperactivity decreasing first, and then attention disorders. In 1/5 of patients, subclinical manifestations of the syndrome persist throughout their lives; they are characterized by impulsiveness, impatience, and restlessness. In adults, the risk of social and family dysfunction, secondary depression, alcoholism and drug addiction, and illegal behavior is significantly higher than in the general population.
Restlessness is the inability to engage in purposeful activities for a long time. The child cannot maintain a sedentary posture for a long time or perform monotonous physical and/or mental work. In addition, weakness of the volitional sphere in the form of the inability to maintain active attention for a long time on uninteresting work takes part in the formation of the phenomenon of restlessness.
If the child is restless, interested in the proposed task, he willingly undertakes to complete it and at first works successfully, but after 15-20 minutes he begins to fidget, get distracted by random stimuli, chat with others, tries to get up and pass something to a neighbor or lift something from the floor, etc. As a result, the focus of the activity is lost.
When providing “motor relaxation” in the form of outdoor games, physical exercises, etc., with a complete switching of attention to another object or activity after a short interval of time, the ability to concentrate and purposeful work is restored, but the duration of active concentration and motor calm remains the same remains small.
Forcing a child to comply with disciplinary requirements (a 45-minute lesson, a ban on walks and games until homework is completed, etc.) leads to exhaustion and a sharp drop in productivity. As a result, even children with good intelligence may fail or stubbornly refuse lessons.
It should be noted that in children of preschool and primary school age, as well as in adolescents with residual organic inferiority of the central nervous system, fatigue and exhaustion may not manifest themselves as lethargy and drowsiness, but as excessive excitement and even greater restlessness.
Restlessness is observed in hyperdynamic syndrome, motor disinhibition due to residual organic damage to the central nervous system, psychoorganic syndrome, and less often in anxiety states.
Aggression is destructive behavior that contradicts the norms and rules of coexistence of people in society, harms the objects of attack (animate and inanimate), causes physical harm to people or causes them psychological discomfort (negative experiences, a state of tension, fear, depression, etc.) . The following types of A. are distinguished:
1) physical(assault) - the use of physical force against another person or object;
2) verbal- expression of negative feelings both through form (quarrel, screaming, screeching) and through the content of verbal reactions (threat, curses, swearing);
3) straight- directly directed against any object or subject;
4) indirect- actions that are directed in a roundabout way at another person (malicious gossip, jokes, etc.), and actions characterized by lack of direction and disorder (outbursts of rage manifested in screaming, stomping feet, beating the table with fists, etc.) ;
5) instrumental, which is a means to achieve a goal;
6) hostile- expressed in actions the immediate purpose of which is to cause harm to the object of aggression;
7) self-aggression- manifested in self-accusation, self-humiliation, self-harm, even suicide.
Aggressive behavior is one of the forms of response to various unfavorable physical and mental life situations that cause stress, frustration, etc. conditions.
Psychologically, aggression is one of the main ways to solve problems associated with the preservation of individuality and identity, with the protection and growth of a sense of self-worth, self-esteem, level of aspiration, as well as maintaining and strengthening control over the environment that is significant for the subject. Aggression acts as:
1) means of achieving any significant goal;
2) a method of psychological relaxation;
3) a way to satisfy the need for self-realization and self-affirmation.
In children, aggressive actions and behavior are usually associated with overly restrictive, cold or cruel treatment by significant adults, or rejection by peers. At the same time, such actions at certain stages of development should be considered as a natural manifestation of natural aggressiveness - a necessary mechanism of self-preservation and self-defense.
Aggression as a trait of an emerging personality that cannot be expressed in socially acceptable forms, as well as a behavioral manifestation of psychopathological disorders, can manifest itself in the structure of deviant or delinquent behavior.
In the formation of the ability to control aggressive impulses and actions, the development of ideas about another person as a unique value, the ability to sympathize and empathize play an important role.
Auto-aggression is aggressive actions directed at oneself. The range of manifestations is very wide - from self-abasement and self-blame to self-harm, pain and, in extreme cases, suicidal acts. Views on auto-aggression fluctuate in a very wide range of opinions and theories: from understanding it as an exclusively pathological phenomenon to existential interpretations without connection with diseases. In pronounced forms, it occurs more often in depression of various origins, psychoses, psychogenic reactions, states of alcoholic or drug intoxication. The younger the child, the more prosperous his microenvironment is, and the more severe and regular the form of auto-aggression takes, the more reason there is to think about a severe mental disorder.
With children with rhinolalia
There are several methods. Methodology A.G. Ipollitova provides for starting classes with children in the preoperative period: a combination of articulation and breathing exercises and consistent practice of sounds. The work is carried out based on the child’s preserved sounds. The methodology includes several sections:
1) speech breathing is formed during differentiated exhalation and inhalation;
2) a long exhalation is formed through the mouth, and articulomes of vowels and voiceless consonants are pronounced without voice;
3) differentiated short and long exhalations are produced through the mouth and nose during the formation of sonorants and affricates;
4) soft sounds are formed.
Methodology I.I. Ermakova involves step-by-step correction of voice and sound pronunciation. Special attention is paid to the postoperative period and the use of techniques to develop mobility of the soft palate.
Great importance is attached to the psychological state of the child.
The system of correctional work includes the development of movements of the soft palate, the elimination of nasal connotations in speech, the production of sounds and the development of phonemic perception.
At the first stage, much attention is paid to massage of the soft palate. For this, a speech therapy probe for sound [s] is used. The speech therapist carefully moves it back and forth across the hard palate. The massage lasts about 2 minutes and is performed 2 times a day throughout the year.
Additionally, classes are conducted to activate the soft palate. This is a special gymnastics for the palate, which includes exercises such as swallowing water in small portions, which causes the greatest elevation of the soft palate; gargling with warm water in small portions; random coughing; exaggerated pronunciation of vowel sounds. These exercises are useful both preoperatively and postoperatively.
Working on breathing is carried out using the following exercises: inhaling and exhaling through the nose; inhale through the nose and exhale through the mouth; inhale through the mouth and exhale through the nose; inhale and exhale through the mouth. The child needs to be constantly monitored, because... it is still difficult for him to feel how air passes through his nose. You can bring cotton wool or strips of paper closer to the nasal passages so that the child sees that air is coming through the nose, and because of this, the cotton wool or paper is deflected.
Simultaneously and additionally, exercises and classes are conducted to develop speech motor skills. Gymnastics are performed for the lips, cheeks, and tongue.
In gymnastics for the lips and cheeks, you can use the following exercises: puffing out the cheeks alternately or together, retracting the cheeks, “Smile”, “Proboscis”, raising and lowering the upper lip, vibrating the lips, holding an object with the lips, etc.
Tongue gymnastics includes the same exercises as for dyslalia: “Spatula”, “Needle”, “Slide”, “Mushroom”, “Swing”, “Tasty Jam”, “Cup”, “Tube”, “Drummer” and others.
First, the vowels “a”, “u”, “o”, “e” are used. At first, the child pronounces one vowel at a time, then gradually increases their number. Subsequently, these vowels are pronounced in twos and threes: “au”, “ao”, “aoe”. During these exercises, you must constantly monitor the direction of the air stream. Sometimes the speech therapist may pinch the child's nose to make sounds more clear.
Of the consonant sounds, the first is [f], which is pronounced first in isolation, then in reverse syllables, then in forward syllables. After this, the sound [p] is set, then the sound [t]. When making the sound [t], the main thing is to draw the child’s attention to the correct oral exhalation, during which the tip of the tongue is pressed against the upper teeth.
The sound [k] can be placed by imitation or mechanically from the sound [t].
All exercises are repeated in the postoperative period. Additionally, massage is used to develop the mobility of the soft palate.
Children with rhinolalia usually attend special kindergartens and schools, where they receive group and individual speech therapy classes.
The speech therapist must cooperate with the child’s family, explain, and show various exercises so that the child can constantly exercise at home. All this contributes to better correction of the child’s speech.
Closed rhinolalia - this type of rhinolalia is formed if the child has a physiologically reduced nasal resonance. Nasal sounds [m], [n] are pronounced as [b], [d]. in the child’s speech there is no opposition “nasal - non-nasal”. Speech becomes unintelligible, vowel sounds sound disturbed.
The cause of closed rhinolalia is usually organic changes in the nasal space or violations of the velopharyngeal closure.
M. Zeeman distinguishes two types of closed rhinolalia: anterior and posterior.
With anterior closed rhinolalia, obstruction of the nasal cavities occurs due to polyps of the nasal cavity, hypertrophy of the nasal mucosa, and curvature of the nasal septum.
With posterior closed rhinolalia, the nasopharyngeal cavity decreases due to the proliferation of adenoids and nasopharyngeal tumors.
Functional closed rhinolalia is not always correctly recognized in children. It can occur with good nasal patency, nasal breathing may not be impaired. But when pronouncing nasal consonants and vowels, the timbre may be disrupted. The soft palate rises higher and blocks access to the air stream to the nasopharynx.
With organic closed rhinolalia, the cause of obstruction in the nasal cavity is eliminated, and the defect goes away on its own. If pronunciation remains impaired, then the same methods are used as for functional rhinolalia. First, it is important to teach the child to distinguish the nasal timbre from the usual one. Then breathing exercises are carried out to differentiate nasal and oral inhalation and exhalation. After this, children learn to pronounce exaggerated sounds [n], [m]. During this, vibration is felt on the wings of the nose. Then there are exercises with vowel sounds before nasal consonants, after which the pronunciation of these sounds in words that are pronounced strongly and drawn-out is reinforced. At the final stage of the work, the sonority of vowel sounds is worked out and consonant sounds are contrasted on the basis of nasality - non-nasality.
Some authors distinguish mixed rhinolalia. With this disorder, there is reduced nasal resonance when pronouncing nasal sounds, and the voice has a nasalized tone. The reason for this is obstruction of the nasal cavity and insufficient velopharyngeal closure of an organic or functional nature. After a thorough examination, surgery may be indicated. If the operation has been performed, corrective techniques are used - the same as for open rhinolalia.
10. Tahilalia- pathologically accelerated rate of speech. Instead of 10-12 sounds per second, 20-30 sounds are pronounced, but speech is not distorted phonetically and syntactically. In this case, speech attention disorders, hesitations, repetitions, rearrangements of syllables, words, and the like are observed. If attention is drawn to the speaker’s speech, then patients restore speech, although its pace still remains fast.
External speech disorders are complemented by reading, writing and internal speech disorders. When writing and reading, there are substitutions and rearrangements of sounds, syllables, and words. Sometimes whole words can be replaced by others that are similar in spelling or sound.
Non-speech symptoms manifest themselves in disorders of general motor skills, mental processes, emotional-volitional sphere, or behavioral deviations.
In patients with tachylalia, movements are fast, rapid, these manifestations can be observed even in sleep; Their attention is unstable, the volume of visual, auditory and motor memory is reduced. In a child, the flow of thought is ahead of its articulation; children are quick-tempered and irritable.
Tachylalia is often combined with other speech disorders, such as battarism and polternism.
Battarism is a speech disorder expressed in incorrect formulation of a phrase due to impaired speech attention or severe speech disorders. The causes can be considered somatic and psychogenic factors.
These can be supplemented by the predominance of the excitation process over the inhibition process, as a result of disorders of the central nervous system. Considering battarism from a linguistic point of view, it can be regarded as a syntactic disorder.
Poltern (stumbling) is a pathologically accelerated speech rate with a predominance of non-convulsive tempo disturbances. These include hesitations, pauses, and stumbles. General and speech motor skills are also impaired. Sometimes stumbling is confused with stuttering, but these disorders have their own differences: when stumbling, there is no awareness of their defect, but when stuttering, children become aware of it; when drawing attention to speech in children with tachylalia, speech noticeably improves, and when stuttering, speech, on the contrary, worsens; in a casual conversation, the speech of children with tachylalia worsens, and with stuttering it improves; writing with tachylalia is hasty, the handwriting is unclear, but with stuttering, on the contrary, the writing has condensed forms, it is inhibited.
When stumbling, speech is unclear in terms of semantic statements and is abstract in nature. Agrammatisms and syntax violations appear; speech is inexpressive, choking.
There are several groups of stumbling: the first group is combined with motor disorders. Accelerated speech with deviations in the articulation of sounds predominates. The second group is combined with sensory disorders. Children have difficulty finding the right words and have difficulties with auditory attention. The third group has difficulty formulating speech, although children have the necessary vocabulary. The fourth group is children with stumbling, in which some vowels are stretched or constant exclamations are inserted into speech, arising from existing difficulties in choosing words or general wording of speech.
With battarism and polternism, disturbances are observed in external, internal and written forms of speech. Oral speech is characterized by excessive haste, omission of sounds, syllables, and words. Sometimes entire sentences may disappear from speech. The sentences of these children are characterized by a lack of details; they are short and unrelated to each other. Additionally, there are breathing, diction, and voice disorders. Children both speak and read: they divide long phrases into shorter ones, which is why they lose the meaning of what they read and cannot remember the text they read. When writing, sudden stops, omissions, rearrangements of letters, and incorrect spellings are observed.
With these disorders, both sides of speech suffer - expressive and impressive, the tempo, rhythm of speech, and logical stress are impaired; the voice is weak, monotonous, sometimes with a nasal tint; speech breathing and speech motor skills are impaired; the lexical and grammatical side of speech suffers; Children find it difficult to find the right words to express their thoughts.
Non-speech symptoms in battarism and polternium manifest themselves in disorders of general motor skills, attention, and thinking. Speech may be accompanied by accompanying movements of the face, hands, and body. The attention of such children is unstable, it is difficult for them to listen to other people. Thinking is illogical. Children do not feel their defect.
The examination of such children is carried out comprehensively by doctors, teachers and psychologists. The presence of somatic and infectious diseases, various injuries, and brain tumors is determined. Additionally, the state of general and manual motor skills, facial expressions, the state of speech motor skills, the performance of various isolated movements, their tempo are studied; expressive speech is studied, namely, sound pronunciation, the ability to retell and narrate, ask and answer questions; the tempo, rhythm of speech, its intonation, voice, its strength and timbre are examined. Written speech is also analyzed: to what extent the child can copy text and write independently. Dictations are conducted on writing words, syllables, phrases, letters. The speed and quality of writing is noted.
Particular attention should be paid to the state of vocabulary, semantics and grammatical structure of speech.
Based on the comprehensive examination carried out, tachylalia is differentiated from other disorders and, on the basis of this, therapeutic and pedagogical intervention is carried out.
This influence is carried out based on connections between various analyzers, on the connection between external and internal speech.
Elements of psychotherapy can be used, for example, rational psychotherapy and autogenic training. Rational psychotherapy involves collective and individual conversations, and autogenic training is carried out when the first positive results appear during rational psychotherapy. First, patients are introduced to the concept of autogenic training, then they learn the basic techniques of self-regulation, relaxation, and self-hypnosis.
For tachylalia, gymnastics are performed aimed at developing inhibition, attention, and the ability to switch from one movement to another. All exercises are performed with counting, melodic music, calmly and at a smooth pace.
Overcoming tachylalia is facilitated by the development of slow, calm and smooth breathing; slow and rhythmic reading; calm, smooth speech; attention to the speech of others and the possibility of normal communication in a team in the process of communication, including speech.
The method of overcoming tachylalia involves going through several stages.
The first stage is silent mode. At this stage, the speech therapist gets acquainted with the peculiarities of children’s speech in collective classes and recommends that they limit their speech communication at home and outside of class as much as possible. Thanks to this technique, children calm down and tune in to classes with a speech therapist, which begin with simple speech material and include techniques of conjugate, reflected speech and answers to simple questions.
The second stage involves mastering a slow tempo of speech through loud reading. First, the speech therapist shows a speech sample, then the children read conjugately, reflectedly, or in turn. Independent subgroup or individual work of children is carried out. Children, under the guidance of one of the students, achieve continuous speech, which is pronounced and practiced at a slow pace. At the end of this stage, results are summed up in the group and at home.
The third stage of work involves editing statements. Exact retellings of what was read with or without a plan are used; children practice pronouncing the same phrase in different editions.
Fourth stage: at this stage, work on a collective story takes place. Children listen to the story of their friend; at any moment the speech therapist can interrupt the speaker and ask another child to continue the story. Slow reading to oneself is introduced, which disciplines children. You can use the techniques of conjugate reading, reading to the beat, recording and then listening to speech recorded on a tape recorder. At this time, additional training is carried out outside of class, on the street, in a store, where children learn to communicate with people at the right and slow pace. Children prepare speech material in advance and rehearse in class and at home.
The fifth stage is the final one and prepares children for public speaking. Speech material is selected strictly individually. The performance is practiced in individual and group lessons; the performance is recorded on a tape recorder, then listened to and analyzed for all its manifestations.
The course of treatment lasts 2-3 months. After its completion, the speech therapist gives instructions for independent consolidation of acquired speech skills.
When working with children of preschool and primary school age, methods that are used to eliminate stuttering are recommended, taking into account the characteristics of the manifestation of tachylalia.
Additionally, speech therapy rhythms are used, with rhythmic loads increasing gradually. Classes include breathing, voice exercises, exercises that improve motor memory, coordination of movements, and activate attention. Singing, listening to music, and playing exercises are used.
The course of speech therapy work with young children and preschoolers lasts somewhat longer and ranges from 6 months to 1 year.
Speech therapy work to overcome battarism and polternism involves, first of all, the formation of specific concepts and their correct verbal expression. To do this, it is recommended to work not on individual elements of speech, but on holistic speech products, namely, retellings, dialogues, prepared stories, reports. It is imperative to focus the child’s attention on speech. It is necessary to cultivate logical thinking in various tasks: arrange plot pictures in the right order, remove unnecessary ones, combine according to some criterion.
To overcome inner speech disorders, first the statement is made with the help of plot pictures, additional questions, and then independently. A retelling plan is drawn up, the text is written down, then read, and the child retells it from memory.
To develop auditory attention, tape recordings are used, when the child can listen to the text and read it at the same time.
In order to develop the correct tempo of speech, speech can be pronounced first in syllables or with rhythmic tapping. After correctional work, strengthening exercises at home must be carried out. Working to overcome battarism and polternism is often the prevention of stuttering.
Chapter 6
RETARDED MENTAL DEVELOPMENT (RD)
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