Bidder Tıp Bilimleri Dergisi

 

2010 • Cilt: 2 • Sayı: 2 • 31-37

 

 

 

ÇOCUKLARDA DİL VE KONUŞMA PROBLEMLERİ VE EĞİTİMİN ÖNEMİ: DERLEME

 

LANGUAGE AND  SPEECH PROBLEMS IN CHILDREN AND IMPORTANCE OF EDUCATION: A REVIEW

 

 

Nuray Bayar MULUK1, Fulya YALÇINKAYA2, Osman Kürşat ARIKAN3

ÖZET

 

Alıcı ve ifade edici dil, konuşmayı dinleme yoluyla öğrenilir. Dinlediğimizi anlamak için, dil ve konuşma oluşturulmuştur. Bu anlayış ve konuşma fonk- siyonu ile, cümle içindeki kelimeleri; kelimeler arasındaki boşlukları; ve her kelimede üretilen konuşma seslerinin süre, şiddet, frekans ve sırasını ayırt edebiliriz. Tüm gelişme bölgeleri normal fonksiyon gösterirse, duyduğumuz kelimelerin anlamı ve nasıl kullanılacağı; nerede ve ne zaman kullanılacağı öğrenilir. Bu şekilde, belirli dil ve konuşma becerileri belirli yaşlarda elde edilir. Ancak, bazı çocuklarda, herhangi bir nedenle akranlarına göre dil ve konuşma gelişiminde gecikme olmaktadır. Her ne kadar çocuğun görünür sorunları dilde gecikme ise de, dil gecikmenin nedenleri farklıdır. Önemli olan dilde gecikme nedenlerini bulmak ve bozuklukları doğru sınıflandır- maktır. Eğer sadece çocuğun dil gecikmesini kriter olarak alırsak ve dil ve konuşma eğitimi sağlarsak, eğitimde başarılı olamayız. Dil ve konuşma eğiti- minde başarı, dil gecikmesinin sebebinin bulunmasına bağlıdır.

Anahtar kelimeler: Dil gelişimi, değerlendirme, konuşma sesleri, dinleme, alıcı dil, ifade edici dil, çocuklar

ABSTRACT

 

Receptive and expressive language are won by hearing is learned through listening speak. To understand listening generates language and speak. This understanding and speech function shows that we can distinguish the words within  sentences, spaces between words; order,  frequency, loudness and duration of speech sounds which generates every words. If all development regions have normal function, the meaning of the words we heard and how to use, where and when use them are learned. In this way, certain language and speech skills are gained in certain ages. However, some children have language and speech development delay for any reason, according to coevals. Although every child’s visible problems are language delay, the reasons for language delay are different. The important thing is to find what causes lan- guage delay; and to classify the disorders correctly. If we only take the child’s language delay as criterion, and provide training in language and speech, we can not be successful in education. Success in language and speech training depends on to find the reason for language delay.

Key words: Language development, assessment, speech  sounds, listening, receptive language, expressive language, children

 

 

INDRODUCTION

 

Language is divided into receptive and expressive language. By receptive language, we understand what others speak.  By expressive language, we express our feelings and thoughts. Speaking is expression of mes- sage by sounds. Different language and speech skills are gained at different ages. If the child has gained

language skills, language development is normal.  In language development tests, language skills has been identified for a particular ages.

Key features of normal  language acquisition  are summarized as below (1):

•    1 to 6 months: Coos in response to voice

•    6 to 9 months: Babbling

Geliş Tarihi/Received: 10/02/2010  Kabul Tarihi/Accepted: 06/03/2010

 

İletişim:

 

Dr. Nuray Bayar MULUK

Birlik Mahallesi, Zirvekent 2. Etap Sitesi, C-3 blok, No: 62/43 06610   Çankaya / ANKARA TURKEY

Tel: +90 312 4964073 , +90 532 7182441  Fax: +90 318  2252819 e-mail: nbayarmuluk@yahoo.com   nurayb@hotmail.com

 

1    Professor, Kırıkkale University, Faculty of Medicine, ENT Department, Kırıkkale, Turkey

2    Doctor, Hacettepe University, Faculty of Medicine, ENT Department, Division of Audiology and Speech Pathology, Ankara, Turkey.

3    Associate professor, Kırıkkale University, Faculty of Medicine, ENT Department, Kırıkkale, Turkey

 

 

32      Bidder Tıp Bilimleri Dergisi

 

•    10 to 11 months: Imitation of sounds; says “mama/

dada” without meaning

•    12 months: Says “mama/dada” with meaning; often imitates two- and three-syllable words

•    13 to 15 months: Vocabulary of four to seven words in addition to jargon; <20% of speech understood by strangers

•    16 to 18 months: Vocabulary of 10 words; some echolalia and  extensive jargon;  20% to  25% of speech understood by strangers

•    19 to 21 months: Vocabulary of 20 words; 50% of

speech understood by strangers

•    22 to 24 months: Vocabulary >50 words; two-word phrases; dropping  out  of jargon; 60% to 70% of speech understood by strangers

•    2 to 2 1/2 years: Vocabulary of 400 words, includ- ing names; two- to three-word phrases; use of pro- nouns; diminishing echolalia; 75% of speech un- derstood by strangers

•    2 1/2 to 3 years: Use of plurals and past tense; knows age and sex; counts three objects correctly; three to five words per sentence; 80% to 90% of speech un- derstood by strangers

•    3 to 4 years: Three to six words per sentence; asks questions, converses, relates experiences, tells sto- ries; almost all speech understood by strangers

•    4 to 5 years: Six to eight words per sentence; names four colors; counts 10 pennies correctly

If a child has not gained language skills in expexted age range, there is delay in language development. A delay in language and speech development may be a symptom of many disorders. Such as, mental retarda- tion, hearing loss, an expressive language disorder, psy- chosocial deprivation, autism, attention disorders, dis- order of listening, speaking, distinctive voice disorders, etc. A delay in speech development may be not a symp- tom.  Child’s  hearing,  intelligence and  development may be normal.  However, either  only the receptive and/or expressive language can be found as delayed.

The purpose of evaluating language and speech and success in education are to determine the correct lan- guage development level; and if any delay is present, to find the reason what causes language delay. The causes of language delay are written below:

 

Maturation Delay

 

Maturation  delay (developmental language delay) accounts for a considerable percentage of late talkers. In this condition, a delay occurs in the maturation  of the  central  neurologic  process required  to  produce speech. The condition is more common in boys, and

a family history of “late bloomers” is often present (2). The prognosis for these children is excellent, however; they usually have normal speech development by the age of school entry (3). Maturation delay, however, is a much more common cause of speech delay than is expressive language disorder, which accounts for only a small percentage of cases. A child with expressive language disorder is at risk for language-based learn- ing disabilities (dyslexia). Because this disorder is not self-correcting, active intervention is necessary.

 

Developmental speech delay

 

The authors  followed 38  children  with  delayed speech development approximately two to four years after initial diagnosis, assessing and comparing their subsequent speech and language, and over-all develop- ment. Nearly all of the children had appropriate lan- guage levels for their general development. Just over half had less articulation competence than expected for their age, but this was not related to language achieve- ment or age. It appears that the prognosis for future language development is favorable for these children. The results suggest that articulation might be a devel- opmentally related process with a good prognosis, but further follow-up is necessary to determine ultimate competence of children in whom this is delayed (3).

[Prognosis of three-year-old children with devel- opmental speech delay: reading and writing abilities at eight years of age] Their results showed that reading or writing skill was delayed in many of them, especially in those with behavioral disorders, such as hyperkinetic behavior and poor personal relationship at 3 years (4).

 

Delay and disorder

 

Many clinicians make a distinction  between lan- guage delay and language disorder. The term ‘disorder’ implies an abnormal pattern of development not nor- mally seen in normal language acquisition. This is con- trasted to delay, which is regarded as language acqui- sition proceeding along normal lines but more slowly than expected. The distinction has proved very difficult to define in practice and children often show both. Se- vere delays may result in uneven progressions which resembles ‘disorder’. Some researchers have proposed that disorders are extremes of patterns found in normal development, e.g. very late talkers.

2010 • Cilt: 2 • Sayı: 2 • 27-31       

Expressive Language Delay or Disorder

 

Children with an expressive language disorder (de- velopmental expressive aphasia) fail to develop the use of speech at the usual age. These children have normal intelligence, normal hearing, good emotional relation- ships and normal articulation skills. The primary defi- cit appears to be a brain dysfunction that results in an inability to translate ideas into speech. Comprehension of speech is appropriate to the age of the child. These children may use gestures to supplement their limited verbal expression. While a late bloomer will eventually develop normal speech, the child with an expressive language disorder will not do so without intervention (2).  It is sometimes difficult, if not impossible, to dis- tinguish at an early age a late bloomer from a child with an expressive language disorder.

The notion  of expressive language disorder  has been formalized in classification systems and is im- plicit if not suggests that deficits in language expression are typically accompanied by limitations in language knowledge or difficulties processing language input. For this reason, the diagnostic category of expressive language disorder should be used with considerable caution. This view has implications for both research and clinical practice (6).

 

Receptive Language Delay or Disorder

 

Auditory Linguistic Processing problems are asso- ciated with poor auditory memory, poor vocabulary and grammar, speech sound problems, One distinc- tion which seems reasonably robust is between audi- tory processing/linguistic system problems, resulting in difficulties at the sound system (phonological) and grammar (syntactic) level (the forms of language) and the language problems of ‘context and use’, i.e. estab- lishing meaning (semantics) at either word (lexical) or sentence level. Neuro-anatomical  models would pre- dict that children, who have specific reading disorder which is not associated with movement or attention difficulties, would have lower receptive language skills than expressive. This study investigates the difference between expressive and receptive language skills in a sample of 17 children with specific reading difficulty aged between 7 and 12 years. They were administered a battery of two receptive and two expressive language measures. The results showed that as the neuro-ana- tomical model would predict, the children scored sig- nificantly lower on tests of receptive than on tests of expressive language skills (7)

Speech sound disorders (SSD)

 

It is very important  to understand  this disorder. Because, even for this reason, attention  disorder, lis- tening  and  receptive language  disorders;  and  later reading disorders occur. If the nature of the problem is not known, the child may have been mis-diagnosed and may receive wrong training. First, the problems in distinguishing speech sounds may be because of fre- quency, intensity and duration problems; in particular, in similar sounds. For example, / r / and / l / sound may be mixable when heard. Due to the difficulty of distin- guishing speech sounds, child may not be able to de- velop receptive language. For example, if the child can not distinguish speech sounds in speech, he can not understand the speech. If he distinguishes the sounds, he can understand.  There is no problem in learning to speak. However, many people think th6at the child does not understand th6e speech. Whereas, he can not distinguish voices in the ongoing conversation, he can not understand  speech. Besides specific phonological and linguistic processing problems it is postulated that efficient automatic motor programming is delayed.

Disorders of articulation  or speech-sound  disor- ders (SSD) are common in early childhood. Children with these disorders may be at risk for reading difficul- ties because they may have poor auditory, phonologic, and verbal memory skills.

A study compared parents with histories of speech sound disorders (SSD) to parents without known his- tories on measures of speech sound production, pho- nological processing, language, reading, and spelling. Familial aggregation for speech and language disorders was also examined. The results documented both re- sidual effects in adulthood of childhood SSD and fa- milial aggregation for SSD. These residual difficulties do not appear to affect educational and occupational (8). Other study, subjects were 125 children aged 3 to

6 years with moderate to severe SSD; 53% had co mor- bid language impairment (LI). Early reading and writ- ing scores were significantly lower for children with co morbid LI but were not related to SSD severity once language status was taken into account.  Below aver- age language skills in preschool place a child at risk for deficits in preliteracy skills, which may have implica- tions for the later development of reading disability. Preschool children with SSD and LI may benefit from instruction in preliteracy skills in addition to language therapy (9).

34      Bidder Tıp Bilimleri Dergisi

 

Language impairments (LI)

 

It is defined as difficulty in learning language.  A generalised mild clumsiness may be associated par- ticularly with expressive and speech delay. The most important influence on the rate of language acquisition is that of general (cognition) learning. Children with general learning difficulties have delayedl anguage to varying degrees.  Many of the children with language impairment have subtle difficulties in high level prob- lem-solving and thinking and it is difficult to know whether it is these problems rather the language im- pairment per se which might be responsible for some of the later deficits in educational skills. Children with language impairments are likely to display reading def- icits in word decoding and reading comprehension. It is not clear what role early literacy interventions play in the amelioration of reading difficulties in these popula- tions (10).

 

A ‘specific’ language problem?

 

The specific language impairment (SLI). SLI is a de- velopmental language disorder in the absence of frank neurological, sensori-motor,  non-verbal  cognitive or social emotional deficits. One of the hallmarks of SLI is a delay or deficit in the use of function morphemes (e.g., the, a, is) and  other  grammatical morphology (e.g., plural -s, past tense -ed). They omit function mor- phemes from their speech long after age-matched chil- dren with typical language development show consis- tent production of these elements (11). These children have a deficit in processing brief and/or rapidly- chang- ing auditory information, and/or in remembering the temporal order of auditory information. For example, Paula Tallal has found that some children with SLI have difficulty reported the order of two sounds when these sounds are brief in duration and presented rapidly (12)

 

Language-learning impaired children

 

Language-based learning  skills are comprised  of three broad areas, including auditory processing, oral language, and reading and writing. Children with lan- guage-based learning impairments (LLIs) have major deficits in their recognition of some rapidly (timing cues)  successive phonetic  elements  and  nonspeech sound stimuli (13). Timing cues present in the acous- tic waveform of speech provide critical information for the recognition and segmentation of the ongoing speech signal. Research has demonstrated  that  defi- cient temporal perception rates, that have been shown

to specifically disrupt  acoustic processing of speech, are related to specific language-based learning impair- ments (LLI) (14).

 

An auditory processing disorders (APD)

 

An auditory processing disorder (APD) is defined as difficulties in hearing and understanding speech in the presence of normal peripheral hearing. Children with APD appear to be uncertain about what they hear, and  have difficulties listening in  background  noise, following oral instructions, and understanding  rapid or degraded speech. Suspect behaviors include: “not listening,” “unable to follow direction,” or “unable to learn from information  they hear”. The diagnosis of APD is presently complicated because other types of childhood disorders may exhibit similar behaviors. Some children who perform poorly on an APD assess- ment battery have no evidence of speech or language problems. Conversely, some children with APD child have significant speech or language difficulties (15). Approximately 2-3% of children are thought to be af- fected by handicapping disorders known as APD, with a 2:1 ratio between boys and girls (16). Auditory pro- cessing problems can affect both comprehension and expressive language. For example, a problem in pho- nemic segmentation (dividing up words into different component sounds) can result in difficulty in acquiring vocabulary, inconsistent speech and poor phonologi- cal awareness (knowledge of sounds linking to writ- ten symbols) which is linked to reading problems. The ability to work out meaning from the relationships of words within a sentence depends upon the speed and efficiency with which a child can process that informa- tion.

 

Listening Disorders

 

Listening to  speech requires  the  recognition  of speech duration (17).  There are the words in speechs and the duration of th6e spaces between words. When child can distinguish the frequency, loudness and du- ration in speech, he can listen to the speech. Speech sounds can be distinguished. Listening skill is impor- tant  to gain the language. Listening disorders cause language and speech delay. For example, children can not listen when they talk, talk to people who can not take care of the entire speech. Therefore, attention will create a mess. This is different as children are observed in the behavioral. Like, attention disorders, such as lis- tening is observed due to disorganization. For example, when children can not listen to talk, he can not notice