General speech underdevelopment code according to ICD 10. Delayed psycho-speech development

To correctly understand what signs indicate a delay in speech development, it is necessary to know the main stages and conventional norms of speech development in young children.
The birth of a child is marked by a cry, which is the baby’s first speech reaction. A child’s cry is realized through the participation of the vocal, articulatory and respiratory sections of the speech apparatus. The time at which the cry appears (normally in the first minute), its volume and sound can tell a neonatologist a lot about the condition of the newborn. The first year of life is a preparatory (pre-speech) period, during which the child goes through the stages of babbling (from 1.5-2 months), babbling (from 4-5 months), babbling words (from 7-8.5 months). ), first words (at 9-10 months for girls, 11-12 months for boys).
Normally, at 1 year of age, a child’s active vocabulary contains approximately 10 words consisting of repeated open syllables (ma-ma, pa-pa, ba-ba, dyad-dya); in the passive dictionary - about 200 words (usually the names of everyday objects and actions). Until a certain time, the passive vocabulary (the number of words whose meaning the child understands) greatly exceeds the active vocabulary (the number of spoken words). At approximately 1.6 - 1.8 months. The so-called “lexical explosion” begins when words from the child’s passive vocabulary suddenly flow into the active vocabulary. For some children, the period of passive speech can last up to 2 years, but in general their speech and mental development proceeds normally. The transition to active speech in such children often occurs suddenly and soon they not only catch up with their peers who spoke early, but also surpass them in speech development.
Researchers believe that the transition to phrasal speech is possible when a child’s active vocabulary contains at least 40–60 words. Therefore, by the age of 2, simple two-word sentences appear in the child’s speech, and the active vocabulary grows to 50-100 words. By the age of 2.5 years, the child begins to construct detailed sentences of 3-4 words. In the period from 3 to 4 years, the child masters some grammatical forms, speaks in sentences united by meaning (coherent speech is formed); actively uses pronouns, adjectives, adverbs; masters grammatical categories (changing words according to numbers and genders). Vocabulary increases from 500-800 words at 3 years to 1000-1500 words at 4 years.
Experts allow deviations from the normative framework in terms of speech development by 2-3 months in girls, and by 4-5 months in boys. Only a specialist (pediatrician, pediatric neurologist, speech therapist) who has the opportunity to observe the child over time can correctly assess whether the delay in the appearance of active speech is a delay in speech development or an individual characteristic.
Thus, signs of delayed speech development at different stages of speech ontogenesis may be:
abnormal course of the pre-speech period (low activity of humming and babbling, soundlessness, similar vocalizations).
lack of reaction to sound and speech in a child aged 1 year.
inactive attempts to repeat other people's words (echolalia) in a child aged 1.5 years.
inability to perform a simple task (action, demonstration) by ear at 1.5-2 years of age.
absence of independent words at the age of 2 years.
inability to combine words into simple phrases at the age of 2.5-3 years.
complete absence of his own speech at 3 years old (the child uses in speech only memorized phrases from books, cartoons, etc.).
the child’s predominant use of non-verbal means of communication (facial expressions, gestures), etc.

Disorders in which the normal acquisition of language skills is impaired already in the early stages of development. These conditions are not directly related to neurological or language impairments, sensory deficits, mental retardation, or environmental factors.

Specific speech and language disorders are often accompanied by related problems, such as difficulties with reading, spelling and pronunciation of words, disturbances in interpersonal relationships, emotional and behavioral disorders.

Development related:

• physiological disorder

Babbling [children's form of speech]

• aphasia NOS (R47.0)
• apraxia (R48.2)
• due to:
  • hearing loss (H90-H91)
• • expressive type (F80.1)
  • receptive type (F80.2)

Excluded:

• dysphasia and aphasia:
  • NOS (R47.0)
• selective mutism (F94.0)

Development related:

• Wernicke's aphasia

Excluded:

• autism (F84.0-F84.1)
• dysphasia and aphasia:
  • NOS (R47.0)
• selective mutism (F94.0)
• mental retardation (F70-F79)

Excluded: aphasia:

• NOS (R47.0)
• for autism (F84.0-F84.1)

Codification of speech disorders in ICD-10

Classification of speech underdevelopment in children (according to A.N. Kornev):

Principles for constructing the classification:

Multidimensional approach to diagnosis

A. Clinical-pathogenetic axis

1. Primary speech underdevelopment (PSD)

a) functional dyslalia

b) articulatory dyspraxia

c) developmental dysarthria

1.2. Total PNR

Alalic variant of the disorder (“mixed”)

a) motor alalia

b) sensory alalia

2. Secondary speech underdevelopment (SSD)

2.1. Due to mental retardation

2.2. Due to hearing loss

2.3. Due to mental deprivation

3. Speech underdevelopment of mixed origin

3.1. Paraallic variant of total speech underdevelopment (TSD)

3.2. Clinical forms with a complex type of disorder (“mixed”)

B. Neuropsychological axis (syndromes and mechanisms of impairment)

1. Neurological level syndromes

Syndromes of central polymorphic total disorder of sound pronunciation of organic origin (developmental dysarthria syndromes)

2. Gnostic-praxic level syndromes

2.1. Syndrome of functional disorders of certain phonetic characteristics of speech sounds (dyslalia)

2.2. Syndromes of central polymorphic selective disorders of sound pronunciation (articulatory dyspraxia syndromes)

Dysphonetic articulatory dyspraxia syndrome

Dysphonological articulatory dyspraxia syndrome

Dynamic articulatory dyspraxia syndrome

Syndrome of delayed lexical-grammatical development

3. Language level syndromes

3.1. Expressive phonological underdevelopment syndrome (as part of motor alalia)

3.2. Impressive phonological underdevelopment syndrome (as part of sensory alalia)

3.3. Syndromes of lexico-grammatical underdevelopment

a) with a predominance of violations of paradigmatic operations (morphological dysgrammatism)

b) with a predominance of violation of syntagmatic operations (syntactic dysgrammatism)

4. Disorders with a mixed mechanism (gnostic-praxic and linguistic levels)

4.1. Verbal dyspraxia syndrome

4.2. Impressive dysgrammatism syndrome

4.3. Polymorphic expressive dysgrammatism syndrome

4.4. Syndrome of immature phonemic representations and metalinguistic skills

B. Psychopathological axis (leading psychopathological syndrome)

1. Syndromes of mental infantilism

2. Neurosis-like syndromes

3. Psychoorganic syndrome

1. Constitutional (hereditary) form of HP

2. Somatogenic form of HP

3. Cerebral-organic form of HP

4. Form of NR of mixed origin

5. Deprivation-psychogenic form of HP

D. Functional axis (degree of maladjustment)

1. Severity of speech disorders

I degree – mild violations

III degree – violations of moderate severity

III degree – severe violations

2. Degrees of severity of socio-psychological maladjustment

a) mild b) moderate c) severe

Methodological recommendations for the use of the International Statistical Classification of Diseases and Related Health Problems, tenth revision in the diagnostic activities of centers of correctional and developmental training and rehabilitation / Ministry of Education Rep. Belarus. – Minsk, 2002.

Lopatina L.V. Methodological recommendations for diagnosing speech disorders in children of preschool and school age // Logopedic diagnostics and correction of speech disorders in children: collection. method. rec. – SPb., M.: SAGA: FORUM, 2006. – P. 4 – 36.

Lalaeva R.I. Methodological recommendations for speech therapy diagnostics // Diagnosis of speech disorders in children and organization of speech therapy work in a preschool educational institution: Sat. method. recommendations / Comp. V.P. Balobanova and others - St. Petersburg: Publishing house "CHILDHOOD-PRESS", 2000. - P. 5–14.

Prishchepova I.V. Speech therapy work on the formation of prerequisites for the acquisition of spelling skills in primary schoolchildren with general speech underdevelopment. Author's abstract. dis. ...cand. ped. Sciences: 13.00.03 / Russian. state ped. univ. – L., 1993. – 16 p.

Kornev A.N. Reading and writing disorders in children: Educational method. allowance. – St. Petersburg: Publishing House “MiM”, 1997. – 286 p.

Lalaeva R.I. Methodological recommendations for speech therapy diagnostics // // Diagnosis of speech disorders in children and organization of speech therapy work in a preschool educational institution: Sat. method. recommendations / Comp. V.P. Balobanova and others - St. Petersburg: Publishing house "CHILDHOOD-PRESS", 2000. - P. 5–14.

Lalaeva R.I. Problems of speech therapy diagnostics // Speech therapy today. – 2007. - No. 3. – P. 37 – 43.

Lopatina L.V. Methodological recommendations for diagnosing speech disorders in children of preschool and school age // Logopedic diagnostics and correction of speech disorders in children: collection. method. rec. – SPb., M.: SAGA: FORUM, 2006. – P. 4 – 36.

A.N. Kornev Fundamentals of speech pathology in childhood: clinical and psychological aspects. St. Petersburg, 2006.

Specific developmental disorders of speech and language

Disorders in which the normal acquisition of language skills is impaired already in the early stages of development. These conditions are not directly related to neurological or language impairments, sensory deficits, mental retardation, or environmental factors. Specific speech and language disorders are often accompanied by related problems, such as difficulties with reading, spelling and pronunciation of words, disturbances in interpersonal relationships, emotional and behavioral disorders.

Specific speech articulation disorder

A specific developmental disorder in which a child's use of speech sounds is below age-appropriate levels, but in which language skills are normal.

Development related:

• physiological disorder
• speech articulation disorder

Functional speech articulation disorder

Babbling [children's form of speech]

Excluded: insufficiency of speech articulation:

• aphasia NOS (R47.0)
• apraxia (R48.2)
• due to:
  • hearing loss (H90-H91)
  • mental retardation (F70-F79)
• in combination with a developmental language disorder:
  • expressive type (F80.1)
  • receptive type (F80.2)

Expressive language disorder

A specific developmental disorder in which a child's ability to use spoken language is significantly below age-appropriate levels, but in which language comprehension is within age-appropriate limits; Articulation anomalies may not always be present.

Developmental dysphasia or expressive aphasia

Excluded:

• acquired aphasia with epilepsy [Landau-Klefner] (F80.3)
• dysphasia and aphasia:
  • NOS (R47.0)
  • associated with the development of the receptive type (F80.2)
• selective mutism (F94.0)
• mental retardation (F70-F79)
• pervasive developmental disorders (F84.-)

Receptive language disorder

A developmental disorder in which a child's understanding of language is below age-appropriate levels. In this case, all aspects of language use noticeably suffer and there are deviations in the pronunciation of sounds.

Congenital hearing loss

Development related:

• dysphasia or receptive aphasia
• Wernicke's aphasia

Excluded:

• acquired aphasia in epilepsy [Landau-Klefner] (F80.3)
• autism (F84.0-F84.1)
• dysphasia and aphasia:
  • NOS (R47.0)
  • associated with the development of the expressive type (F80.1)
• selective mutism (F94.0)
• language delay due to deafness (H90-H91)
• mental retardation (F70-F79)

Acquired aphasia with epilepsy [Landau-Klefner]

A disorder in which a child who previously had normal language development loses receptive and expressive language skills but retains general intelligence. The onset of the disorder is accompanied by paroxysmal changes in the EEG and, in most cases, epileptic seizures. The onset of the disorder usually occurs between three and seven years of age, with loss of skills occurring within a few days or weeks. The temporal relationship between the onset of seizures and loss of language skills is variable, with one preceding the other (or cycling) from several months to two years. An inflammatory process in the brain has been suggested as a possible cause of this disorder. Approximately two thirds of cases are characterized by the persistence of more or less severe deficiencies in language perception.

Excluded: aphasia:

• NOS (R47.0)
• for autism (F84.0-F84.1)
• due to disintegrative disorders of childhood (F84.2-F84.3)

ICD 10 dyslalia

Disorders of psychological (mental) development

Disorders included in category F80 - F89 have the following characteristics:

a) the onset is obligatory in infancy or childhood;

b) damage or delay in the development of functions closely related to the biological maturation of the central nervous system;

c) constant course, without remissions or relapses, characteristic of many mental disorders.

In most cases, the functions affected include speech, visuospatial skills, and/or motor coordination. A characteristic feature of the damage is a tendency to progressively decrease as children get older (although milder deficits often persist into adulthood). Typically, developmental delay or damage appears as early as it can be detected, without a preceding period of normal development. Most of these conditions are observed in boys several times more often than in girls.

Developmental disorders are characterized by a family history of similar or related disorders, and there is evidence to suggest that genetic factors play an important role in the etiology of many (but not all) cases. Environmental factors often influence impaired developmental functions, but in most cases they are not of primary importance. However, although there is usually no significant disagreement in the overall conceptualization of disorders under this heading, in most cases the etiology is unknown, and uncertainty remains regarding the boundaries and specific subgroups of developmental disorders. Moreover, there are two types of conditions included in this section, which do not fully meet the broad conceptual definition given above. First, these are disorders in which there was an undoubted phase of previous normal development, such as disintegrative disorder of childhood, Landau-Klef syndrome.

nera, some cases of autism. These conditions are included here because

that although their beginnings are different, their characteristic features and course

have many similarities with the group of developmental disorders; in addition, it is unknown whether they differ etiologically. Second, there are disorders primarily defined as abnormalities rather than delays in the development of function; this is especially applicable to autism. Autistic disorders are included in this section because, although defined as disabilities, some degree of developmental delay is almost always found. In addition, there is overlap with other developmental disorders, both in terms of characteristics of individual cases and similar clustering.

/F80/ Specific developmental disorders of speech and language

These are disorders in which normal speech development is disrupted in the early stages. The conditions cannot be explained by neurological or speech pathology, sensory damage, mental retardation or environmental factors. The child may be more able to communicate or understand in certain, well-known situations than in others, but language ability is always impaired.

As with other developmental disorders, the first difficulty in diagnosis relates to differentiation from normal developmental patterns. Normal children vary considerably in the age at which they first acquire spoken language and in the rate at which speech skills are firmly acquired. Such normal variations in the timing of language acquisition are of little or non-clinical significance, since most late talkers continue to develop quite normally. Children with specific developmental disorders of speech and language differ sharply from them, although most of them ultimately achieve a normal level of development of speech skills. They have many associated problems. Delayed speech development is often accompanied by difficulties in reading and writing, disturbances in interpersonal relationships, and emotional and behavioral disorders. Therefore, early and thorough diagnosis of specific speech development disorders

very important. There is no clearly defined demarcation from extreme

variants of the norm, but for judging a clinically significant disorder

Four main criteria are used: severity; flow; type; and related problems.

As a general rule, speech delay can be considered pathological when it is severe enough to be a two standard deviation delay. In most cases of this level of severity, there are associated problems. However, in older children, the level of severity in statistical terms has less diagnostic value, since there is a natural tendency for steady improvement. In this situation, current is a useful indicator. If the current level of impairment is relatively mild, but there is nonetheless a history of severe impairment, then it is more likely that the current functioning represents a consequence of significant impairment rather than a variant of the norm. It is necessary to pay attention to the type of speech functioning; if the type of disorder is pathological (that is, abnormal and not simply a variant corresponding to an earlier phase of development) or if the child's speech contains qualitatively pathological features, then a clinically significant disorder is likely. Moreover, if delays in some specific aspects of language development are accompanied by deficits in school skills (such as specific delays in reading and writing), disturbances in interpersonal relationships, and/or emotional or behavioral disorders, then it is unlikely that this is a normal variant.

The second difficulty in diagnosis relates to differentiation from mental retardation or global developmental delay. Since intellectual development includes verbal skills, it is likely that if a child's IQ is significantly below average, then his speech development will also be below average. A diagnosis of a specific developmental disorder suggests that the specific delay is significantly out of proportion with the overall level of cognitive functioning. Accordingly, when speech delay is part of a general mental retardation or general developmental delay, the condition cannot be coded as F80.-. Mental retardation coding F70 - F79 should be used. However, mental retardation is characterized by a combination with uneven

loss of intellectual productivity, especially with a language impairment that is usually more severe than a delay in nonverbal skills. When this discrepancy manifests itself to such a marked degree that it becomes apparent in the child's daily functioning, the specific language impairment should be coded in addition to the mental retardation category (F70 -

The third difficulty concerns differentiation from secondary disorders due to severe deafness or certain specific neurological or other anatomical disorders. Severe deafness in early childhood virtually always leads to a noticeable delay and distortion of speech development; such conditions should not be included here as they are a direct consequence of hearing loss. However, often more serious disturbances in the development of receptive speech are accompanied by partial selective hearing damage (especially high-tone frequencies). These disorders should be excluded from F80 - F89 if the severity of the hearing impairment significantly explains the speech delay, but included if partial hearing loss is only a complicating factor and not the direct cause.

However, a strictly defined distinction cannot be made. A similar principle applies to neurological pathology and anatomical defects. Thus, articulation pathology due to cleft palate or dysarthria due to cerebral palsy should be excluded from this section. On the other hand, the presence of mild neurological symptoms that would not cause speech delay is not grounds for exclusion.

F80.0 Specific speech articulation disorder

A specific developmental disorder in which a child's use of speech sounds is below the level appropriate for his mental age, but in which there is a normal level of language skills.

The age at which a child acquires speech sounds and the order in which they develop are subject to considerable individual variation.

Normal development. At the age of 4 years, errors in the pronunciation of speech sounds are common, but the child can easily be understood by strangers. Most speech sounds are acquired by the age of 6-7 years. Although difficulties may remain in certain sound combinations, they do not lead to communication problems. By age, almost all speech sounds should be acquired.

Pathological development. Occurs when a child's acquisition of speech sounds is delayed and/or deviated, resulting in: disarticulation with associated difficulty for others to understand his speech; omissions, distortions or substitutions of speech sounds; changes in the pronunciation of sounds depending on their combination (that is, in some words the child can pronounce phonemes correctly, but not in others).

A diagnosis can only be made when the severity of the articulation disorder is outside the range of normal variations appropriate to the child's mental age; nonverbal intellectual level within normal limits; expressive and receptive speech skills within normal limits; articulation pathology cannot be explained by a sensory, anatomical or neurotic abnormality; incorrect pronunciation is undoubtedly anomalous, based on the characteristics of speech use in the subcultural conditions in which the child finds himself.

Developmental physiological disorder;

Developmental articulation disorder;

Functional articulation disorder;

Babbling (children's form of speech);

Phonological developmental disorder.

Aphasia NOS (R47.0);

Articulation disorders combined with a developmental disorder of expressive speech (F80.1);

Articulation disorders combined with a disorder of receptive speech development (F80.2);

Cleft palate and other anatomical abnormalities of oral structures involved in speech functioning (Q35 - Q38);

Articulation disorder due to hearing loss (H90 - H91);

Articulation disorder due to mental retardation (F70 - F79).

F80.1 Expressive language disorder

A specific developmental disorder in which a child's ability to use expressive spoken language is markedly below the level appropriate for his mental age, although speech comprehension is within normal limits. There may or may not be articulation disorders.

Although there is considerable interindividual variation in normal language development, the absence of single words or word-related language units by 2 years, or simple expressions or two-word phrases by 3 years, should be considered significant signs of delay. Late impairments include: limited vocabulary development; overuse of a small set of common words; difficulties in choosing suitable words and substitute words; abbreviated pronunciation; immature sentence structure; syntactic errors, especially omissions of word endings or prefixes; incorrect use or absence of grammatical features such as prepositions, pronouns, and conjugations or inflections of verbs and nouns. Overgeneralization of rules may occur,

as well as lack of fluency in sentences and difficulty in establishing

consistency when retelling past events.

Often, a lack of spoken language is accompanied by a delay or disturbance in verbal and audio pronunciation.

The diagnosis should be made only when the severity of the delay in expressive language development exceeds the normal range for the child's mental age; Receptive language skills are within normal limits for the child's mental age (although they may often be slightly below average). The use of nonverbal cues (such as smiles and gestures) and "inner" speech reflected in imagination or role-play is relatively intact; the ability to communicate socially without words is relatively intact. The child will strive to communicate, despite the speech impairment, and to compensate for the lack of speech with gestures, facial expressions or non-speech vocalizations. However, co-occurring disturbances in peer relationships, emotional disturbances, behavioral disturbances and/or hyperactivity and inattention are common. In a minority of cases, there may be associated partial (often selective) hearing loss, but this should not be so severe as to lead to speech delay. Inadequate conversational engagement or more general environmental deprivation may play an important or contributing role in the genesis of impaired expressive language development. In this case, the environmental causative factor should be noted through the appropriate second code from Class XXI of ICD-10. Impaired spoken language becomes evident from infancy without any long, distinct phase of normal speech use. However, it is not uncommon to see the use of a few isolated words appear normal at first, followed by speech regression or lack of progress.

Often similar expressive speech disorders are observed in adults; they are always accompanied by a mental disorder and are organically caused. In this regard, in such patients, the subheading “Other non-psychotic disorders caused by damage and dysfunction of the brain” should be used as the first code.

brain or somatic disease" (F06.82х). The sixth character is placed in

depending on the etiology of the disease. Structure of speech disorders

indicated by the second code R47.0.

Delayed speech development according to the type of general speech underdevelopment (GSD) level I - III;

Developmental dysphasia of expressive type;

Developmental aphasia of expressive type.

Developmental dysphasia, receptive type (F80.2);

Developmental aphasia, receptive type (F80.2);

Pervasive developmental disorders (F84.-);

General disorders of psychological (mental) development (F84.-);

Selective mutism (F94.0);

F80.2 Receptive language disorder

A specific developmental disorder in which the child's understanding of speech is below the level appropriate for his mental age. In all cases, expansive speech is also noticeably impaired and a defect in verbal-sound pronunciation is not uncommon.

Inability to respond to familiar names (in the absence of nonverbal cues) from the first birthday; inability to identify

learn at least a few common items by 18 months, or

inability to follow simple instructions by age 2

should be accepted as significant signs of speech delay

development. Late impairments include: inability to understand

grammatical structures (negations, questions, comparisons, etc.), lack of understanding of more subtle aspects of speech (tone of voice, gestures, etc.).

A diagnosis can only be made when the severity of the delay in receptive language development is beyond normal variations for the child's mental age and when criteria for pervasive developmental disorder are not met. In almost all cases, the development of expressive speech is also seriously delayed, and violations of verbal-sound pronunciation are common. Of all the variants of specific speech development disorders, this variant has the highest level of concomitant socio-emotional-behavioral disorders. These disorders do not have any specific manifestations, but hyperactivity and inattention, social inappropriateness and isolation from peers, anxiety, sensitivity or excessive shyness are quite common. Children with more severe forms of receptive language impairment may experience quite significant delays in social development; imitative speech is possible with a lack of understanding of its meaning and a limitation of interests may appear. However, they differ from autistic children, usually showing normal social interaction, normal role-playing, normal looking to parents for comfort, nearly normal use of gestures, and only mild impairment in nonverbal communication. It is not uncommon to have some degree of high-pitched hearing loss, but the degree of deafness is not sufficient to cause speech impairment.

Similar speech disorders of the receptive (sensory) type are observed in adults, which are always accompanied by a mental disorder and are organically caused. In this regard, in such patients, the subheading “Other non-psychotic disorders due to brain damage and dysfunction or somatic illness” (F06.82x) should be used as the first code. The sixth character is placed depending on the etiology of the disease. The structure of speech disorders is indicated by the second code R47.0.

Developmental receptive dysphasia;

Developmental receptive aphasia;

Congenital auditory immunity;

Wernicke's developmental aphasia.

Acquired aphasia with epilepsy (Landau-Klefner syndrome) (F80.3x);

Autism (F84.0х, F84.1х);

Selective mutism (F94.0);

Mental retardation (F70 - F79);

Speech delay due to deafness (H90 - H91);

Dysphasia and aphasia of the expressive type (F80.1);

Organically caused speech disorders of the expressive type in adults (F06.82x with the second code R47.0);

Organically caused speech disorders of the receptive type in adults (F06.82x with the second code R47.0);

Dysphasia and aphasia NOS (R47.0).

/F80.З/ Acquired aphasia with epilepsy

A disorder in which a child, having previously normal speech development, loses both receptive and expressive language skills, while general intelligence is preserved; the onset of the disorder is accompanied by paroxysmal pathology on the EEG (almost always in the temporal lobes, usually bilaterally, but often with wider disturbances) and in most cases epileptic seizures. Onset is typical between 3 and 7 years of age but may occur earlier or later in childhood. In a quarter of cases, speech loss occurs gradually over several months, but more often there is a sudden loss of speech.

forged over several days or weeks. Time connection between

the onset of seizures and loss of speech is quite variable, one of

these signs may precede another by several months and

up to 2 years. It is very typical that receptive language impairment is quite

profound, often with difficulty in auditory understanding when the condition first appears. Some children become mute, others are limited to jargon-like sounds, although some show milder deficits in fluency, and speech production is often accompanied by articulation disorders. In a small number of cases, voice quality is impaired with loss of normal modulations. Sometimes speech functions appear in waves in the early phases of the disorder. Behavioral and emotional disturbances are common in the first months after the onset of speech loss, but tend to improve as children acquire some means of communication.

The etiology of the condition is unknown, but clinical data suggest the possibility of an inflammatory encephalitic process. The course of the condition is completely different; 2/3 of children retain a more or less serious receptive speech defect, and about 1/3 completely recover.

Acquired aphasia due to brain injury, tumor or other known disease process (F06.82x);

Aphasia NOS (R47.0);

Aphasia due to disintegrative disorders of childhood (F84.2 - F84.3);

Aphasia in autism (F84.0х, F84.1х).

F80.31 Psychotic variant of the course of acquired aphasia with epilepsy (Landau-Klefner syndrome)

F80.32 Non-psychotic variant of acquired aphasia with epilepsy (Landau-Klefner syndrome)

F80.39 Unspecified by type of acquired aphasia with epilepsy (Landau-Klefner syndrome)

/F80.8/ Other developmental disorders of speech and language

F80.81 Delayed speech development due to social deprivation

This group is represented by speech disorders, delayed formation of higher mental functions, which are caused by social deprivation or pedagogical neglect. The clinical picture is manifested in limited vocabulary, unformed phrasal speech, etc.

Delayed speech development due to pedagogical neglect;

Physiological delay in speech development.

F80.82 Speech development delays, combined

with delayed intellectual development and specific

learning skills disorders

In patients in this group, speech disorders are manifested by limited grammatical vocabulary, difficulties in making statements and the semantic design of these statements. Intellectual disability or cognitive impairment manifests itself in difficulties in ab-

structural-logical thinking, low level of cognitive ability, attention and memory disorders. In these cases, it is necessary to use the second code from the categories F70.xx - F79.xx or F81.x.

F80.88 Other developmental disorders of speech and language

F80.9 Speech and language developmental disorders, unspecified

This category should be avoided as much as possible and used only for unspecified disorders in which there is significant impairment in language development that cannot be explained by mental retardation or neurological, sensory, or physical abnormalities directly affecting speech.

Speech disorder NOS;

Speech disorder NOS.

/F81/ Specific developmental disorders of learning skills

The concept of specific developmental disorders of school skills is directly reminiscent of the concept of specific disorders of language development (see F80.-), and here there are the same problems in their definition and measurement. These are disorders in which normal skill acquisition is disrupted from the early stages of development. They do not result from a lack of educational opportunity or from any previous brain injury or illness. Rather, the disorders are thought to arise from impairments in the processing of cognitive information, which largely results from biological dysfunction. As with most other developmental disorders, this

The condition is significantly more common in boys than in girls.

Five types of difficulties arise in diagnosis. First, there is the need to differentiate disorders from normal schooling options. The problem here is the same as for speech disorders and the same criteria are proposed for judging the pathology of the condition (with the necessary modification, which is associated with the assessment not of speech, but of school achievements). Secondly, this is the need to take into account the dynamics of development. This is important for 2 reasons:

a) severity: a 1-year delay in reading at 7 years has a completely different meaning than a 1-year delay at 14 years;

b) change in the type of manifestations: usually speech delay in spoken language disappears in preschool years, but is replaced by a specific reading delay, which, in turn, decreases in adolescence, and the main problem in adolescence is severe spelling disorder; the condition is the same in all respects, but the manifestations change as one grows older; the diagnostic criterion must take into account this developmental dynamics.

The third difficulty is that school skills must be taught and learned; they are not only a function of biological maturation. It is inevitable that children's level of skill acquisition will depend on family circumstances and schooling, as well as on their individual character traits. Unfortunately, there is no direct and unambiguous way to differentiate school difficulties caused by a lack of adequate experience from those caused by certain individual impairments. There is good evidence to suggest that this difference has actual reality and clinical force, but diagnosis is difficult in individual cases. Fourth, although research evidence suggests an underlying cognitive processing pathology, it is not easy to differentiate in a given child what is causing reading difficulties from what is associated with poor reading skills. The difficulty arises from evidence that reading impairment can arise from more than one type of cognitive pathology. Fifthly,

uncertainty remains regarding the optimal subdivision

specific developmental disorders of school skills.

Children learn to read, write, spell, and improve arithmetic when they are exposed to these activities at home and at school. Countries vary widely in the age at which formal schooling begins, in the curricula of schooling, and therefore in the skills children are expected to have acquired at different ages. This discrepancy is greatest during the period of children's education in elementary or primary school (that is, up to 11 years old) and complicates the problem of developing current definitions of impaired school skills that have transnational adequacy.

However, within all educational systems it is clear that within each age group of schoolchildren there is variation in school achievement and some children show deficits in specific aspects of skills relative to their overall level of intellectual functioning.

Specific Disorders of School Skills (SDSD) encompass groups of disorders characterized by specific and significant deficits in the learning of school skills. These learning disabilities are not a direct consequence of other conditions (such as mental retardation, gross neurological defects, uncorrected visual or auditory damage, or emotional disturbances), although they may occur as comorbidities. SDD often occurs in association with other clinical syndromes (such as attention deficit disorder or conduct disorder) or other developmental disorders such as specific motor development disorder or specific language development disorder.

The etiology of SRSHL is unknown, but there is a hypothesis that biological factors play a major role, interacting with non-biological factors (such as the availability of learning opportunities and the quality of learning) to cause the condition. Although these disorders are associated with biological maturation, this does not mean that children with such disorders are

are simply at a lower level of the normal continuum and, therefore, will “catch up” with their peers over time. In many cases, signs of these disorders can continue into adolescence and persist into adulthood. However, a necessary diagnostic feature is that the disorders appear in certain forms during the early periods of schooling. Children may lag behind in their school improvement at a later stage of their education (due to lack of interest in learning; poor educational program; emotional disturbances; increasing or changes in task demands, etc.), but such problems are not included in the concept of SRRS.

There are several basic requirements for diagnosing any of the specific developmental disorders of school skills. First, there must be a clinically significant degree of impairment in any particular school skill. This can be judged: on the basis of severity, determined by school performance, that is, such a degree of impairment that could occur in less than 3% of the population of school-age children; by previous developmental disorders, that is, delay or deviation in development in the preschool years, most often in speech; for related problems (such as inattention, hyperactivity, emotional or behavioral disturbances); by type of disorder (that is, the presence of qualitative impairments that are not usually part of normal development); and by response to therapy (i.e., school difficulties do not immediately improve with increased help at home and/or school).

Secondly, the disorder must be specific in the sense that it cannot be explained solely by mental retardation or a less pronounced decline in general intellectual level. Since IQ and school achievement do not go directly in parallel, this determination can only be made on the basis of individually administered standardized tests of learning and IQ appropriate to a particular culture and educational system. Such tests should be used in conjunction with statistical tables with data on the average expected level of mastery of school material at a certain coefficient.

rate of mental development at a given age. This last requirement is necessary because of the importance of the effect of statistical regression: a diagnosis based on subtracting school age from the child's mental age is seriously misleading. However, in normal clinical practice these requirements will not be met in most cases. Thus, the clinical indication is simply that the child's level of scholastic knowledge should be substantially lower than that expected for a child of the same mental age.

Third, the impairment must be developmental in the sense that it must be present from the early years of education rather than acquired later in the course of education. Information about the child’s school success should confirm this.

Fourthly, there must be no external factors that can be considered as the cause of school difficulties. As stated above, in general, the diagnosis of SSD should be based on positive evidence of a clinically significant impairment in the assimilation of school material in combination with internal factors in the child’s development. However, in order to learn effectively, children must have adequate learning opportunities. Accordingly, if it is clear that poor school achievement is directly attributable to very long periods of non-attendance without homeschooling or grossly inadequate instruction, then these violations should not be coded here. Frequent absence from school or interruptions in education due to changes in school are usually not sufficient to lead to school delay to the extent required for a diagnosis of SRS. However, poor school performance may complicate the problem, in which case school factors should be coded using code X from ICD-10 Class XXI.

Fifthly, specific disorders in the development of school skills should not be directly caused by uncorrected visual or auditory disorders.

It is clinically important to differentiate between SRSNs that occur in the absence of any diagnosable neurological disorder,

and SRRSN secondary to certain neurological conditions such as

cerebral paralysis. In practice, this differentiation is often very

difficult to do (due to the uncertain meaning of multiple

"soft" neurological signs), and the research results are not

give a clear criterion for differentiation either in the clinical picture or in

dynamics of SRRS depending on the presence or absence of neurological dysfunction. Accordingly, although it does not constitute a diagnostic criterion, it is necessary that the presence of any associated disorder be coded separately in the appropriate neurological section of the classification.

Specific reading disorder (dyslexia);

Specific impairment of writing skills;

Specific impairment of arithmetic skills (dyscalculia);

Mixed school skills disorder (learning difficulties).

F81.0 Specific reading disorder

The main feature is a specific and significant impairment in the development of reading skills that cannot be explained solely by mental age, problems with visual acuity, or inadequate schooling. Reading comprehension skills and performance on tasks that require reading may be impaired. Spelling difficulties are often associated with a specific reading disorder and often persist into adolescence, even after some progress has been made in reading. Children with specific reading disorder often have a history of specific language development disorders, and comprehensive examination of language functioning at this time often reveals ongoing mild impairments in addition to lack of achievement in theoretical subjects. In addition to academic failure, poor school attendance and problems in social adjustment, especially in primary or secondary school, are quite common complications. The condition is found in all known linguistic cultures, but it is unclear how often the disorder is due to speech or script.

A child's reading performance should be significantly below the level expected based on the child's age, general intelligence, and school performance. Productivity is best assessed through individually administered standardized tests of accuracy and reading comprehension. The exact nature of the reading problem depends on the expected reading level and on the language and font. However, in the early stages of alphabetic learning, there may be difficulty in reciting the alphabet or categorizing sounds (despite normal hearing acuity). Later there may be errors in oral reading skills, such as:

a) omissions, replacements, distortions or additions of words or parts of words;

b) slow reading pace;

c) attempts to start reading again, prolonged hesitations or “losing space” in the text and inaccuracies in expressions;

d) rearrangement of words in a sentence or letters in words.

There may also be a lack of understanding of what is being read, for example:

e) inability to remember facts from reading;

f) inability to draw conclusions or conclusions from the essence of what was read;

g) answer questions about the story read using general knowledge rather than information from a specific story.

Typically, in later childhood and adulthood, spelling difficulties become more profound than reading deficits. Spelling disorders often involve phonetic errors, and it appears that reading and spelling problems may result in part from impairments in phonological analysis. Little is known about the nature and frequency of spelling errors in children who must read non-phonetic languages, and little is known about the types of errors in non-alphabetic text.

Specific disorders of reading skills are usually preceded by disorders of speech development. In other cases, the child may be experiencing normal language development milestones for age, but may still have difficulty processing auditory information, resulting in problems with sound categorization, rhyming, and possibly deficits in speech sound discrimination, auditory sequential memory, and auditory association. In some cases, there may also be problems in processing visual information (such as distinguishing letters); however, they are common among children who are just beginning to learn to read, and therefore are not causally related to poor reading. Attention disorders combined with increased activity and impulsivity are also common. The specific type of developmental disorder in the preschool period varies greatly from child to child, as does its severity, but such disorders are common (but not obligatory).

Also typical at school age are concomitant emotional and/or behavioral disorders. Emotional disorders are more common in the early school years, but conduct disorders and hyperactivity disorders are more likely in late childhood and adolescence. Low self-esteem and problems with school adaptation and relationships with peers are also often noted.

Specific reading delay;

Specific reading delay;

Read in reverse order;

Dyslexia due to impaired phonemic and grammatical analysis;

Spelling disorders combined with reading disorder.

Alexia BDU (R48.0);

Dyslexia NOS (R48.0);

Secondary reading difficulties in persons with emotional disorders (F93.x);

Spelling disorders not associated with reading difficulties

F81.1 Specific spelling disorder

It is a disorder in which the main feature is a specific and significant impairment in the development of spelling skills in the absence of a preexisting specific disorder in reading skills and which is not explained solely by low mental age, problems with visual acuity, and inadequate schooling. Both the ability to spell words orally and to write words correctly are impaired. Children whose problems consist solely of poor handwriting should not be included here; but in some cases, spelling difficulties may be related to writing problems. In contrast to the characteristics typically found in specific reading disorder, writing errors tend to be primarily phonetically correct.

The child's spelling performance should be well below the level expected based on his or her age, general intelligence, and academic performance. This is best assessed using individually administered standardized spelling tests. The child's reading skills (both accuracy and comprehension) should be within normal limits and there should be no history of significant reading difficulties. Difficulties in spelling should not be due primarily to

due to grossly inadequate training or defects in visual, auditory

or neurological functions. Also they cannot be purchased

due to any neurological mental or other

Although it is known that “pure” spelling disorder is differentiated from reading disorders comorbid with spelling difficulties, little is known regarding the antecedents, dynamics, correlates, and outcome of specific spelling disorders.

Specific delay in mastering spelling skills (without reading disorder);

Specific spelling delay.

Spelling difficulties combined with reading disorder (F81.0);

Dyspraxic dysgraphia (F82);

Difficulty in spelling, determined mainly by inadequate training (Z55.8);

Agraphia NOS (R48.8);

Acquired spelling disorder (R48.8).

F81.2 Specific arithmetic disorder

This disorder involves a specific impairment of numeracy skills that cannot be explained solely by general mental underdevelopment or grossly inadequate learning. The deficit concerns basic computational skills of addition, subtraction, multiplication, and division (preferred to more abstract mathematical skills, including

algebra, trigonometry, geometry or calculus).

A child's arithmetic performance should be significantly below the level expected for his or her age, general intelligence, and academic performance. This is best assessed on the basis of individually administered standardized numeracy tests. Reading and spelling skills must be within the normal range corresponding to his mental age, assessed by individually selected adequate standardized tests. Difficulties in arithmetic must not be due primarily to grossly inadequate learning, defects in vision, hearing or neurological function, and must not be acquired as a result of any neurological, mental or other disorder.

Numeracy disorders are less well studied than reading disorders, and knowledge about the disorder's antecedents, dynamics, correlates, and outcome is quite limited. However, it has been suggested that, unlike many children with reading disorders, auditory-perceptual and verbal skills tend to be within normal limits, whereas visuospatial and visual-perceptual skills tend to be impaired. Some children have co-occurring socio-emotional-behavioural problems, but little is known about their characteristics or frequency. It has been suggested that difficulties in social interaction may be particularly common.

Arithmetic difficulties that are noted usually vary, but may include: insufficient understanding of the concepts underlying arithmetic operations; lack of understanding of mathematical terms or symbols; non-recognition of numeric characters; difficulty performing standard arithmetic operations; difficulty in understanding which numbers related to a given arithmetic operation should be used; difficulty in mastering the ordering of numbers or in mastering decimal fractions or signs during calculations; poor spatial organization of arithmetic calculations; failure to learn the multiplication tables satisfactorily.

Developmental numeracy disorder;

Dyscalculia caused by a violation of higher mental functions;

Developmental specific numeracy disorder;

Developmental Gerstmann syndrome;

Arithmetic difficulties combined with reading or spelling impairments (F81.3);

Arithmetic difficulties due to inadequate training

Acalculia NOS (R48.8);

Acquired counting disorder (acalculia) (R48.8).

F81.3 Mixed learning disorder

This is a poorly defined, underdeveloped (but necessary) residual category of disorders in which both arithmetic and reading or spelling skills are significantly impaired, but in which the impairment cannot be directly explained by general mental retardation or inadequate learning. This should apply to all disorders that meet the criteria for

F81.2 and either F81.0 or F81.1.

Specific reading disorder (F81.0);

Specific spelling disorder (F81.1);

Specific numeracy disorder (F81.2).

F81.8 Other developmental disorders of learning skills

Developmental expressive writing disorder.

F81.9 Developmental disorder of learning skills, unspecified

This category should be avoided as much as possible and used only for unspecified disorders in which there is a significant learning disability that cannot be directly explained by mental retardation, visual acuity problems, or inadequate learning.

Inability to acquire knowledge NOS;

Learning disability NOS;

Learning disorder NOS.

F82 Specific developmental disorders of motor function

This is a disorder in which the main feature is a severe impairment in the development of motor coordination that cannot be explained by general intellectual disability or any specific congenital or acquired neurological disorder (other than what is suspected of coordination disorders). It is typical for motor clumsiness to be associated with some degree of impairment in performance on visuospatial cognitive tasks.

The child’s motor coordination during fine or large motor tests should be significantly below the level corresponding to his age and general intelligence. It is better to evaluate this on the basis of

new individually administered standardized tests of fine or

rough motor coordination. Difficulties in coordination must be present early in development (that is, they must not represent an acquired disability) and must not be directly caused by any visual or hearing impairment or any diagnosable neurological disorder.

The degree of impairment of fine or gross motor coordination varies considerably, and the specific types of motor incompetence vary with age. Motor developmental milestones may be delayed, and some associated speech difficulties (especially those involving articulation) may be noted. A young child may be clumsy in his normal gait and may be slow to learn to run, jump, and climb up and down stairs. You may have difficulty tying shoe laces, buttoning and unfastening buttons, and throwing and catching a ball. The child may be generally clumsy with fine and/or large movements - prone to dropping things, tripping, hitting obstacles, and having poor handwriting. Drawing skills are typically poor, and children with this disorder often perform poorly on tasks involving compound picture puzzles, construction toys, building models, ball games, and drawing (map comprehension).

In most cases, careful clinical examination will reveal marked neurodevelopmental immaturity, particularly choreiform or mirror movements of the limbs and other associated motor symptoms, as well as signs of poor fine or gross motor coordination (usually described as "soft" neurological signs in young children ). Tendon reflexes may be increased or decreased on both sides, but not asymmetrically.

Some children may have school difficulties, sometimes quite serious; In some cases, socio-emotional-behavioral problems are comorbid, but little is known about their frequency or characteristics.

There is no diagnosable neurological disorder (such as cerebral palsy or muscular dystrophy). However, in some cases there is a history of perinatal complications.

abnormalities such as very low birth weight or significant

Infantile clumsiness syndrome is often diagnosed as “minimal brain dysfunction,” but this term is not recommended because it has so many different and conflicting meanings.

Child clumsiness syndrome;

Developmental coordination disorder;

Abnormalities of gait and mobility (R26.-);

Impaired coordination (R27.-);

Impaired coordination secondary to mental retardation (F70 - F79);

Impaired coordination secondary to a diagnosable neurological disorder (G00 - G99).

F83 Mixed specific disorders of psychological (mental) development

This is a poorly defined, underdeveloped (but necessary) residual group of disorders in which there is a mixture of specific developmental disorders of language, school skills, and/or motor functioning, but no significant predominance of any one of them to establish a primary diagnosis. What these specific developmental disorders have in common is an association with some degree of general cognitive impairment, and this mixed category should only be used when there is significant overlap among the specific disorders. Therefore, this category should be used when dysfunctions meeting the criteria of two or more categories F80.-, F81.x and F82 are encountered.

/F84/ General psychological disorders

A group of disorders characterized by qualitative abnormalities in social interaction and communication and a restricted, stereotyped, repetitive pattern of interests and activities. These qualitative impairments are common features of individual functioning in all situations, although they may vary in degree. In most cases, development is impaired from infancy and, with only minor exceptions, appears in the first 5 years. They usually, but not always, have some degree of cognitive impairment, but the disorder is defined by behavior that is abnormal in relation to mental age (regardless of the presence or absence of mental retardation). The subdivision of this group of pervasive developmental disorders is somewhat controversial.

In some cases, the disorders are combined and are believed to be caused by certain medical conditions, among which the most common are infantile spasms, congenital rubella, tuberous sclerosis, cerebral lipidosis, and fragility of the X chromosome. However, the disorder must be diagnosed based on behavioral findings, regardless of the presence or absence of underlying medical conditions; however, any of these comorbid conditions should be coded separately. If mental retardation is present, it is important to code it separately (F70 - F79), since it is not a necessary feature of pervasive developmental disorders.

/F84.0/ Childhood autism

A pervasive developmental disorder defined by the presence of abnormal and/or disrupted development that begins before age 3 years and abnormal functioning in all three domains of social interaction, communication, and restricted, repetitive behavior. Boys develop the disorder 3-4 times more often than girls.

There is usually no previous period of undoubtedly normal development, but if there is, then anomalies are detected before the age of 3 years. There are always qualitative disturbances in social interaction. They take the form of an inadequate assessment of socio-emotional signals, which is noticeable by the lack of reactions to the emotions of other people and/or the lack of modulation of behavior in accordance with the social situation; poor use of social cues and little integration of social, emotional and communicative behavior; Particularly characteristic is the lack of socio-emotional reciprocity. Qualitative disturbances in communication are equally obligatory. They appear in the form of a lack of social use of existing speech skills; violations in role-playing and social simulation games; low synchrony and lack of reciprocity in communication; insufficient flexibility of speech expression and relative lack of creativity and imagination in thinking; lack of emotional reaction to verbal and non-verbal attempts of other people to engage in conversation; impaired use of tonality and expressiveness of the voice to modulate communication; the same absence of accompanying gestures, which have an enhancing or auxiliary value in conversational communication. This condition is also characterized by restricted, repetitive and stereotyped behaviours, interests and activities. This manifests itself as a tendency to establish rigid and routine routines in many aspects of daily life, usually in new activities as well as old habits and play activities. There may be a special attachment to unusual, often hard objects, which is most typical for early childhood. Children may insist on a special order for performing rituals of a non-functional nature; there may be a stereotypical preoccupation with dates, routes or schedules; motor stereotypies are common; characterized by a special interest in non-functional elements of objects (such as smell or tactile qualities of a surface); The child may resist changes to routines or details of his environment (such as decorations or furnishings in the home).

In addition to these specific diagnostic features, children with autism often exhibit a number of other nonspecific problems, such as

such as fears (phobias), sleep and eating disorders, outbursts of anger and aggressiveness. Self-harm (eg, wrist biting) is common, especially if there is concomitant severe mental retardation. Most children with autism lack spontaneity, initiative, and creativity in leisure activities, and have difficulty using general concepts when making decisions (even when completing tasks is well within their abilities). The specific manifestations of the defect characteristic of autism change as the child grows, but throughout adulthood this defect persists, manifesting itself in many ways with a similar type of problems in socialization, communication and interests. To make a diagnosis, developmental anomalies must be noted in the first 3 years of life, but the syndrome itself can be diagnosed in all age groups.

Autism can occur at any level of mental development, but about three-quarters of cases have a distinct mental retardation.

In addition to other variants of general developmental disorder, it is important to consider: specific developmental disorder of receptive language (F80.2) with secondary socio-emotional problems; reactive attachment disorder in childhood (F94.1) or attachment disorder in childhood of the disinhibited type (F94.2); mental retardation (F70 - F79) with some associated emotional or behavioral disorders; schizophrenia (F20.-) with unusually early onset; Rett syndrome (F84.2).

Autistic psychopathy (F84.5);

F84.01 Childhood autism caused by organic brain disease

Autistic disorder caused by an organic disease of the brain.

F84.02 Childhood autism due to other causes

/F84.1/ Atypical autism

A type of pervasive developmental disorder that is distinguished from childhood autism (F84.0x) either by age of onset or by the absence of at least one of three diagnostic criteria. Thus, one or another sign of abnormal and/or impaired development first appears only after the age of 3 years; and/or there is no sufficiently distinct impairment in one or two of the three psychopathological domains required for a diagnosis of autism (namely, impairments in social interaction, communication, and restricted, stereotyped, repetitive behavior) despite characteristic abnormalities in the other domain(s). Atypical autism most often occurs in children with profound mental retardation, in whom the very low level of functioning provides little scope for the specific abnormal behavior required for a diagnosis of autism; it also occurs in individuals with severe specific receptive language development disorder. Atypical autism is therefore a condition that is significantly different from autism.

Mental retardation with autistic features;

Atypical childhood psychosis.

F84.11 Atypical autism with mental retardation

The first code is this code, and the second is the mental retardation code (F70.xx - F79.xx).

Mental retardation with autistic features.

F84.12 Atypical autism without mental retardation

Atypical childhood psychosis.

F84.2 Rett syndrome

A condition so far described only in girls, the cause of which is unknown, but which is identified on the basis of the characteristics of the onset of the course and symptomatology. In typical cases, apparently normal or nearly normal early development is followed by partial or complete loss of acquired manual skills and speech along with slowing of head growth, usually with onset between 7 and 24 months of age. Loss of intentional hand movements, handwriting stereotypies, and shortness of breath are especially common. Social and play development is delayed in the first two or three years, but there is a tendency to maintain social interest. During middle childhood, there is a tendency to develop trunk ataxia and apraxia, accompanied by scoliosis or kyphoscoliosis, and sometimes choreoathetoid movements. As a result of the condition, severe mental disability constantly develops. Epileptic seizures often occur during early or middle childhood.

The onset of the disease in most cases is between 7 and 24 months of age. The most characteristic feature is the loss of intentional hand movements and acquired fine motor manipulative skills. This is accompanied by loss, partial loss or absence of speech development; characteristic stereotypical movements of the hands are noted - painful wringing or “washing of hands”, the hands are bent in front of the chest or chin; stereotypical wetting of hands with saliva; lack of proper chewing of food; frequent episodes of shortness of breath; there is almost always an inability to establish control over bladder and bowel functions; Excessive drooling and tongue protrusion are common; inclusion in social life is lost. Typically, the child maintains the appearance of a "social smile", looking "behind" or "through" people, but not interacting with them socially in early childhood (although social interaction often develops later). The posture and gait are wide-legged, the muscles are hypotonic, trunk movements usually become poorly coordinated, and scoliosis or kyphoscoliosis usually develops. In adolescence and adulthood, approximately half of the cases develop special atrophies with severe motor disability. Later, rigid muscle spasticity may appear, usually more severe in the lower extremities than in the upper extremities. Most cases involve epileptic seizures, which usually involve some type of petit mal seizure and usually begin before the age of 8 years. In contrast to autism, both intentional self-harm and a set of stereotypical interests or routines are rare.

Rett syndrome is primarily differentiated on the basis of lack of purposeful runic movements, slowing of head growth, ataxia, stereotypic movements, hand washing, and lack of proper chewing. The course, expressed by a progressive deterioration in motor functions, confirms the diagnosis.

F84.3 Other disintegrative disorders of childhood

Pervasive developmental disorders (other than Rett syndrome) that are defined by a period of normal development before their onset, a distinct loss over several months of previously acquired skills in at least several areas of development, with the simultaneous appearance of characteristic abnormalities in social, communication, and behavioral functioning. There is often a prodrome of unknown illness; the child becomes wayward, irritable, anxious and hyperactive. This is followed by impoverishment, and then loss of speech, accompanied by disintegration

Speech is one of the most important psychological processes that a person masters throughout life. The formation of speech skills occurs on an individual basis, and this process is influenced by many factors. But if by the age of 3-4 years the baby is not able to clearly say even the simplest words, the ICD recognizes ZRR in children unconditionally. In this case, active therapy with the participation of a neurologist, psychiatrist/psychologist, and speech pathologist is indicated.

ZRR in children

Forecast and preventive measures

Early initiation of corrective measures often leads to good results. If the main cause of the disease can be eliminated, the child quickly catches up with his peers in terms of development. During treatment, it is important for all specialists to comply with the same speech requirements - in this case, it is easier for the child to remember new information.

Prevention consists of proper management of pregnancy, the expectant mother giving up bad habits, and a balanced diet. After birth, the child requires adequate microsocial conditions and the right speech environment. All toys must be educational in nature and appropriate for the child’s age.

Video

The mental development of a child is a complex, genetically determined process of sequential maturation of higher mental functions, realized under the influence of various environmental factors. The main mental functions include: gnosis (recognition, perception), praxis (purposeful actions), speech, memory, reading, writing, counting, attention, thinking (analytical and synthetic activity, the ability to compare and classify, generalize), emotions, will, behavior, self-esteem, etc.

V.V. Lebedinsky (2003) identifies six main types of mental development disorders in children:

1. Irreversible mental underdevelopment (oligophrenia).
2. Delayed mental development (reversible - fully or partially).
3. Damaged mental development - dementia (the presence of a previous period of normal mental development).
4. Deficient development (in conditions of visual impairment, hearing impairment, somatic pathology).
5. Distorted mental development (early childhood autism).
6. Disharmonious mental development (psychopathy).

Mental development delays in children and their correction are an urgent problem in pediatric psychoneurology. The term “mental retardation” was proposed by G. E. Sukhareva back in 1959. Mental retardation (MDD) is understood as a slowdown in the normal rate of mental maturation compared to accepted age norms. ZPD begins in early childhood without a previous period of normal development, is characterized by a stable course (without remissions and relapses, unlike mental disorders) and a tendency to progressive leveling as the child grows older. You can talk about mental retardation until primary school age. Persistent signs of underdevelopment of mental functions at an older age indicate oligophrenia (mental retardation).

Conditions classified as mental retardation are part of the broader concept of “borderline intellectual disability” (Kovalev V.V., 1973). In the Anglo-American literature, borderline intellectual disability is partly described within the framework of the clinically undifferentiated syndrome “minimal brain dysfunction” (MMD).

The prevalence of mental development delays among the child population (as an independent group of conditions) is 1%, 2% and 8-10% in the general structure of mental illnesses (Kuznetsova L. M.). Mental development delays as a syndrome are naturally much more common.

The pathogenesis of ZPR is poorly understood. According to Pevser (1966), the main mechanism of mental retardation is a violation of maturation and functional failure of younger and more complex brain systems, related mainly to the frontal regions of the cerebral cortex, which ensure the implementation of creative acts of human behavior and activity. There are currently no uniform forms of systematically borderline forms of intellectual disability. The most detailed classification of borderline states of intellectual disability presented by V. V. Kovalev (1973).

There is a division of ZPR into primary and secondary. In this case, secondary mental retardation occurs against the background of a primary intact brain in chronic somatic diseases (heart defects, etc.) accompanied by cerebral insufficiency.

In the first years of life, due to the immaturity of the nervous system, children often experience dysfunction in the maturation of motor and general mental functions. Therefore, usually in early childhood we are talking about a general delay in psychomotor development with a greater severity of mental function lag.

In children over three years of age, it becomes possible to identify more defined psychoneurological syndromes. The main clinical signs of mental retardation (according to M. Sh. Vrono) are: delayed development of basic psychophysical functions (motor skills, speech, social behavior); emotional immaturity; uneven development of individual mental functions; functional, reversible nature of the disorders.

If intellectual disability in preschool age is masked by speech disorders, then at school age it manifests itself clearly and is expressed in a poor supply of information about the environment, the slow formation of concepts about the shape and size of objects, difficulties in counting, retelling what has been read, and a lack of understanding of the hidden meaning of simple stories. In such children, a concrete-figurative type of thinking predominates. Mental processes are inert. Exhaustion and satiety are expressed. The behavior is immature. The level of visual-figurative thinking is quite high, but the abstract-logical level of thinking, inextricably linked with inner speech, turns out to be insufficient.

V.V. Kovalev distinguishes intellectual disability resulting from defects in analyzers and sensory organs in cerebral palsy and early childhood autism syndrome as separate forms of intellectual disability.

ZPR syndrome is polyetiological, the main reasons are:

The most important clinical characteristic of Encephabol is its safety, which is especially important given the specificity of the population - the main consumers of this drug - pediatrics, where safety problems are not inferior in importance to the evaluation of effectiveness. Adverse reactions when taking Encephabol occur rarely and, as a rule, are associated with its general stimulating effect (insomnia, increased excitability, mild forms of dizziness) or, in extremely rare cases, with individual intolerance (allergic reactions, dyspeptic manifestations). All of the above symptoms are almost always transient and do not always require discontinuation of the drug.

On the Russian pharmaceutical market, the drug Encephabol is presented in the form of an oral suspension of 200 ml in a bottle and film-coated tablets of 100 mg.

The dosage of Encephabol is usually, depending on the stage of the pathological process and individual reaction:

• for adults - 1-2 tablets or 1-2 teaspoons of suspension 3 times a day (300-600 mg);
• for newborns - from the 3rd day of life, 1 ml of suspension per day in the morning for a month;
• from the 2nd month of life, the dose should be increased by 1 ml every week to 5 ml (1 teaspoon) per day;
• for children from 1 year to 7 years - 1/2-1 teaspoon of suspension 1-3 times a day;
• for children over 7 years old - 1/2-1 teaspoon of suspension 1-3 times a day or 1-2 tablets 1-3 times a day.

Although the first results of the clinical action of Encephabol may appear after 2-4 weeks of taking the drug, optimal results are usually achieved with a course duration of 6-12 weeks.

Literature

1. Amasyants R. A., Amasyants E. A. Clinic for Intellectual Disabilities. Textbook. M.: Pedagogical Society of Russia, 2009. 320 p.
2. Current problems in diagnosing mental retardation in children / Ed. K. S. Lebedinskaya. M., 1982.
3. Bazhenova O. V. Diagnosis of mental development of children in the first year of life. M., 1987.
4. Bruner J., Olver R., Greenfield P. Research on the development of cognitive activity. M., 1971.
5. Burchinsky S. G. Modern nootropic drugs // Journal of a practical doctor. 1996, no. 5, p. 42-45.
6. Burchinsky S. G. Ancient brain and age-old pathology: from pharmacology to pharmacotherapy // Bulletin of pharmacology and pharmacy. 2002, No. 1, p. 12-17.
7. Voronina T. A., Seredenin S. B. Nootropic drugs, achievements and prospects // Experimental and clinical pharmacology. 1998, no. 4, p. 3-9.
8. Voronina T. A. The role of synaptic transmission in memory processes, neurodegeneration and the mechanism of action of neurotropic drugs // Experimental and clinical pharmacology. 2003, No. 2, p. 10-14.
9. Dolce A. Review of experimental studies on Encephabol (pyritinol). In the book: Encephabol: aspects of clinical application. M., 2001, p. 43-48.
10. Zavadenko N. N. Nootropic drugs in the practice of pediatricians and child neurologists. M., 2003, 23 p.
11. Zozulya T. V., Gracheva T. V. Dynamics and prognosis of the incidence of mental disorders in older people // Journal of Neuropathology and Psychiatry. 2001, v. 101, no. 3, p. 37-41.
12. Kovalev G.V. Nootropic drugs. Volgograd, Nizhne-Volzhskoye book. ed., 1990, 368 p.
13. Kryzhanovsky G. N. Dysregulation pathology // Dysregulation pathology. 2002, p. 18-78.
14. Lebedeva N.V. Encephabol and its analogues in the treatment of neurological diseases. In the book: Encephabol: aspects of clinical application. M., 2001, p. 27-31.
15. Lebedeva N.V., Kistenev V.A., Kozlova E.N. and others. Encephabol in the complex treatment of patients with cerebrovascular diseases. In the book: Encephabol: aspects of clinical application. M., 2001, p. 14-18.
16. Lebedinsky V.V. Mental development disorders in children. M., 1985.
17. Lebedinsky V.V. Mental development disorders in childhood: Proc. aid for students psychol. fak. higher textbook establishments. M.: Publishing center "Academy", 2003. 144 p.
18. Markova E. D., Insarov N. G., Gurskaya N. Z. and others. The role of Encephabol in the treatment of extrapyramidal and cerebellar syndromes of hereditary etiology. In the book: Encephabol: aspects of clinical application. M., 2001., p. 23-26.
19. Maslova O. I. Rehabilitation tactics for children with neuropsychic development delays. Russian medical journal. 2000, vol. 8, no. 18, p. 746-748.
20. Maslova O. I., Studenikin V. M., Balkanskaya S. V. and others. Cognitive neurology // Russian Pediatric Journal. 2000, No. 5, p. 40-41.
21. Mnukhin S.S. About time delays, slow tempo of mental development and mental infantilism in children. L., 1968.
22. Notkina N. A. et al. Assessment of the physical and neuropsychic development of children of early and preschool age. St. Petersburg: Detstvo-Press, 2008. 32 p.
23. Petelin L. S., Shtok V. N., Pigarov V. A. Encephabol in the neurological clinic // Encephabol: aspects of clinical application. M., 2001, p. 7-11.
24. Pshennikova M. G. Stress: regulatory systems and resistance to stress damage // Dysregulation pathology. 2002, p. 307-328.
25. Brain aging / Ed. V. V. Frolkis. L., Nauka, 1991, 277 p.
26. Amaducci L., Angst J., Bech O. et al. Consensus conference on the methodology of clinical trial of “Nootropics” // Pharmacopsychiatry. 1990, v. 23, p. 171-175.
27. Almquist & Wiksell. Scientific studies in mild mental retardation: Epidemiology; a. prevention: Proc. of the 2nd Europe. symp. on scientific studies in Mental Retardation, U Sweden, June 24-26, 1999. - 240 p.
28. Bartus R., Deen O., Beer T. Cholinergic hypotheses of memory dysfunction // Science. 1982, v. 217, p. 408-417.

A. P. Skoromets 1, 2, 3, Doctor of Medical Sciences, Professor
I. L. Semichova 4
I. A. Kryukova 1, 2, 3, Candidate of Medical Sciences
T. V. Fomina 6
M. V. Shumilina 3, 5

1 SPbMAPO, 2 SPbGPMA, 3 Children's City Hospital No. 1, 4 SPbGC "Child Psychiatry",
5 SPbSMU, Saint Petersburg
6 MSCh 71 FMBA RF, Chelyabinsk

For quotation: Zavadenko N.N., Suvorinova N.Yu. Speech development delays in children: causes, diagnosis and treatment // RMJ. 2016. No. 6. pp. 362-366

The article is devoted to the causes, diagnosis and treatment of speech delay in children

For citation. Zavadenko N.N., Suvorinova N.Yu. Speech development delays in children: causes, diagnosis and treatment // RMJ. 2016. No. 6. pp. 362–366.

Speech development delays usually mean a lag in speech formation from age standards in children under the age of 3–4 years. Meanwhile, this formulation implies a wide range of speech development disorders that have different causes.
The period from the first year of life to 3–5 years is decisive for the formation of speech. At this time, the brain and its functions intensively develop. Any disturbances in speech development are a reason for immediate contact with specialists - a doctor (pediatrician, child neurologist, ENT doctor, child psychiatrist), speech therapist, psychologist. This is all the more important because it is in the first years of life that deviations in the development of brain functions, including speech, are best amenable to correction.
Speech and its functions. Speech is a special and most perfect form of communication, inherent only to humans. In the process of verbal communication (communication), people exchange thoughts and interact with each other. Speech is an important means of communication between a child and the world around him. The communicative function of speech contributes to the development of communication skills with peers, develops the ability to play together, which is invaluable for the formation of adequate behavior, the emotional-volitional sphere and personality of the child. The cognitive function of speech is closely related to the communicative function. The regulatory function of speech is formed already in the early stages of child development. However, the adult’s word becomes a true regulator of the child’s activity and behavior only by the age of 4–5, when the child’s semantic side of speech is already significantly developed. The formation of the regulatory function of speech is closely related to the development of internal speech, purposeful behavior, and the ability for programmed intellectual activity.
Speech development disorders affect the overall development of children’s personality, their intellectual growth and behavior, and make it difficult to learn and communicate with others.
Forms of speech development disorders. Specific language development disorders include those disorders in which normal language development is affected in the early stages. According to the ICD-10 classification, these include disorders of the development of expressive language (F80.1) and receptive language (F80.2). In this case, disturbances appear without a previous period of normal speech development. Specific speech development disorders are the most widespread disorders of neuropsychic development; their frequency of occurrence in the child population is 5–10%.
Alalia(according to modern international classifications - “dysphasia” or “developmental dysphasia”) is a systemic underdevelopment of speech, it is based on an insufficient level of development of the speech centers of the cerebral cortex, which can be congenital or acquired in the early stages of ontogenesis, in the pre-speech period. In this case, first of all, children’s ability to speak suffers; expressive speech is characterized by significant deviations, while speech understanding can vary, but, by definition, is much better developed. The most common variants (expressive and mixed expressive-receptive disorders) are manifested by a significant delay in the development of expressive speech compared to the development of understanding. Due to difficulties in organizing speech movements and their coordination, independent speech does not develop for a long time or remains at the level of individual sounds and words. Speech is slow, poor, vocabulary is limited. There are many slips of the tongue (paraphasias), permutations, and perseverations in speech. Growing up, children understand these mistakes and try to correct them.
In modern literature, both terms are used - “specific speech development disorders” and “developmental dysphasia” - and they refer to the same group of pediatric patients. But “developmental dysphasia” is considered a more accurate formulation of the diagnosis, since this term reflects both the neurological and developmental aspects of this disorder.
Complete or partial loss of speech caused by local lesions of the speech areas of the cerebral cortex is called aphasia. Aphasia is the decay of already formed speech functions, so this diagnosis is made only after 3–4 years. With aphasia, there is a complete or partial loss of the ability to speak or understand someone else's speech.
Dysarthria– a violation of the sound-pronunciation side of speech as a result of a violation of the innervation of the speech muscles. Depending on the location of the lesion in the central nervous system (CNS), several variants of dysarthria are distinguished: pseudobulbar, bulbar, subcortical, cerebellar.
Depending on the leading disorders underlying speech disorders in children, L.O. Badalyan proposed the following clinical classification.
I. Speech disorders associated with organic damage to the central nervous system. Depending on the level of damage, they are divided into the following forms:
1. Aphasia - the collapse of all components of speech as a result of damage to the cortical speech areas.
2. Alalia is a systemic underdevelopment of speech as a result of damage to the cortical speech zones in the pre-speech period.
3. Dysarthria - a violation of the sound pronunciation side of speech as a result of a violation of the innervation of the speech muscles. Depending on the location of the lesion, several variants of dysarthria are distinguished.
II. Speech disorders associated with functional changes in the central nervous system (stuttering, mutism and surdomutism).
III. Speech disorders associated with defects in the structure of the articulatory apparatus (mechanical dyslalia, rhinolalia).
IV. Delayed speech development of various origins (due to prematurity, severe diseases of internal organs, pedagogical neglect, etc.).
In domestic psychological and pedagogical classification alalia (dysphasia), along with other clinical forms of speech retardation in children, is considered from the perspective of general speech underdevelopment (GSD). This classification is based on the principle “from particular to general”. OHP is heterogeneous in its developmental mechanisms and can be observed in various forms of oral speech disorders (alalia, dysarthria, etc.). Common signs include a late onset of speech development, a poor vocabulary, agrammatisms, pronunciation defects, and phoneme formation defects. Underdevelopment can be expressed to varying degrees: from the absence of speech or its babbling state to extensive speech, but with elements of phonetic and lexico-grammatical underdevelopment.
The three levels of OHP differ as follows: 1st – absence of common speech (“speechless children”), 2nd – the beginnings of common speech and 3rd – extensive speech with elements of underdevelopment in the entire speech system. The development of ideas about OSD is focused on creating correction methods for groups of children with similar manifestations of various forms of speech disorders. The concept of ONR reflects the close relationship of all components of speech during its abnormal development, but at the same time emphasizes the possibility of overcoming this lag and moving to qualitatively higher levels of speech development.
However, the primary mechanisms of ANR cannot be elucidated without a neurological examination, one of the important tasks of which is to determine the location of the lesion in the nervous system, i.e., making a topical diagnosis. At the same time, diagnostics is aimed at identifying the main disrupted links in the development and implementation of speech processes, on the basis of which the form of speech disorders is determined. There is no doubt that when using the clinical classification of speech development disorders in children, a significant part of cases of OSD are associated with developmental dysphasia (alalia).
For normal speech development it is necessary so that the brain, and especially the cortex of its cerebral hemispheres, reaches a certain maturity, the articulatory apparatus is formed, and hearing is preserved. Another indispensable condition is a complete speech environment from the first days of a child’s life.
Causes of speech retardation There may be pathology during pregnancy and childbirth, dysfunction of the articulatory apparatus, damage to the hearing organ, a general lag in the mental development of the child, the influence of heredity and unfavorable social factors (insufficient communication and education). Difficulties in mastering speech are also typical for children with signs of retarded physical development, those who suffered serious illnesses at an early age, those who are weakened, or those who receive malnutrition.
Hearing impairment represent the most common cause of isolated speech delay. It is known that even moderately pronounced and gradually developing hearing loss can lead to delays in speech development. Signs of hearing loss in a baby include a lack of response to sound signals and an inability to imitate sounds, while in an older child there is excessive use of gestures and close observation of the movements of the lips of speaking people. However, the assessment of hearing based on the study of behavioral reactions is insufficient and is subjective. Therefore, if partial or complete hearing loss is suspected in a child with isolated speech delay, it is necessary to conduct an audiological examination. The method of recording auditory evoked potentials also provides reliable results. The sooner hearing defects are detected, the sooner it will be possible to begin appropriate corrective work with the baby or equip him with a hearing aid.
The causes of delayed speech development in a child may be autism or general mental retardation, which is characterized by uniform incomplete formation of all higher mental functions and intellectual abilities. To clarify the diagnosis, an in-depth examination is carried out by a pediatric psychoneurologist.
On the other hand, it is necessary to distinguish tempo delay in speech development, caused by a lack of stimulation of speech development under the influence of unfavorable social factors (insufficient communication and education). A child’s speech is not an innate ability; it is formed under the influence of the speech of adults and largely depends on sufficient speech practice, a normal speech environment, and on upbringing and training, which begin from the first days of a child’s life. The social environment stimulates speech development and provides a speech pattern. It is known that in families with poor speech impulses, children begin to speak late and speak little. A delay in speech development may be accompanied by a general lack of development, while the natural intellectual and speech abilities of these children correspond to the norm.
Neurobiological factors in the pathogenesis of speech development disorders. Perinatal pathology of the central nervous system plays a significant role in the formation of speech disorders in children. This is due to the fact that it is in the perinatal period that the most important events occur that have a direct and indirect impact on the processes of the structural and functional organization of the central nervous system. Taking this into account, it is advisable to identify risk groups for disorders of psycho-speech development already in the 1st year of life. The high-risk group should include children who, in the first 3 months. life as a result of the examination, structural changes in the central nervous system were revealed, premature infants (especially with extremely low body weight), children with analyzer disorders (auditory and visual), insufficiency of cranial nerve functions (in particular V, VII, IX, X, XII), children with a delay in the reduction of unconditioned automatisms, long-lasting disorders of muscle tone.
In premature newborns, especially those with a short gestation period, an important period of development of the central nervous system (interneuronal organization and intensive myelination) occurs not in utero, but under difficult conditions of postnatal adaptation. The duration of this period can vary from 2–3 weeks. up to 2–3 months, and this period is often accompanied by the development of various infectious and somatic complications, which serves as an additional factor causing disturbances in psychomotor and speech development in immature and premature children. One of the main consequences of prematurity – hearing loss – plays a negative role. Studies have shown that approximately half of very premature children have delayed speech development, and at school age - learning difficulties, problems with reading and writing, concentration and behavior control.
In recent years, the role of genetic factors in the formation of speech development disorders has also been confirmed.
Development of speech skills is normal. For timely and accurate diagnosis of speech disorders in children, it is necessary to take into account the patterns of normal speech development. Children pronounce their first words by the end of the first year of life, but they begin to train their speech apparatus much earlier, from the first months of life, so the age of up to one year is a preparatory period in the development of speech. The sequence in the development of pre-speech reactions is shown in Table 1.

So, in the first year of life, the child’s speech apparatus is preparing to pronounce sounds. Humming, “flute”, babbling, modulated babbling are a kind of game for the baby and give the child pleasure; for many minutes he can repeat the same sound, training in a similar way in the articulation of speech sounds. At the same time, the active formation of speech understanding occurs.
An important indicator of speech development up to one and a half to two years is not so much the pronunciation itself, but the understanding of addressed speech (receptive speech). The child must listen carefully and with interest to adults, understand speech addressed to him well, recognize the names of many objects and pictures, and follow simple everyday requests and instructions. In the second year of life, words and sound combinations already become a means of verbal communication, that is, expressive speech is formed.
Main indicators of normal speech development from 1 year to 4 years:
The appearance of clear, meaningful speech (words) – 9–18 months.
At first (up to one and a half years), the child mainly learns to understand speech, and from 1.5–2 years, he quickly develops active speech and his vocabulary grows. The number of words that the baby understands (passive vocabulary) is still greater than the number of words that he can pronounce (active vocabulary).
The appearance of phrases of 2 words – 1.5–2 years, of 3 words – 2–2.5 years, of 4 or more words – 3–4 years.
Volume of active dictionary:
– by the age of 1.5 years, children pronounce 5–20 words,
– 2 years – up to 150–300 words,
– 3 years – up to 800–1000 words,
– 4 years old – up to 2000 words.
Early signs of trouble in speech formation. Children who do not try to speak at 2–2.5 years should be a cause for concern. However, parents may notice certain prerequisites for problems in speech development earlier. In the first year of life, one should be alarmed by the absence or weak expression at appropriate times of humming, babbling, first words, reaction to adult speech and interest in it; at one year - the child does not understand frequently used words and does not imitate speech sounds, does not respond to speech addressed to him, and resorts only to crying to attract attention to himself; in the second year - lack of interest in speech activity, replenishment of passive and active vocabulary, the appearance of phrases, inability to understand the simplest questions and show an image in a picture.
At 3–4 years of life, signs of dysfunctional speech formation should cause high alertness in comparison with the normal characteristics of its development, which are given in Table 2.
The lack of assistance at an early age for children with speech underdevelopment leads to a number of consequences: communication disorders and the resulting difficulties of adaptation in the children's group and contacts with other people, immaturity in the emotional sphere and behavior, and insufficient cognitive activity. This is confirmed by the data of our study to assess the indicators of age-related development of children with dysphasia.
We examined 120 patients aged from 3 to 4.5 years (89 boys and 31 girls) with developmental dysphasia - a disorder of the development of expressive speech (F80.1 according to ICD-10) and a picture of level 1-2 ODD according to psychological pedagogical classification. Children whose speech development delay was caused by hearing loss, mental retardation, autism, severe somatic pathology, malnutrition, as well as the influence of unfavorable social factors (insufficient communication and education) were excluded from the study group.
We studied indicators of age-related development using the Developmental Profile 3 (DP-3) methodology in five areas: motor skills, adaptive behavior, social-emotional sphere, cognitive sphere, speech and communication abilities.
A structured interview form was used, conducted by a specialist with parents. Based on the data obtained, it was determined what age the child’s development corresponds to in each of the areas and at what age interval he lags behind the normal indicators for his calendar age.
When studying the anamnesis, many parents indicated that already at an early age they paid attention to the absence or limitation of babbling in children. Parents noted silence and emphasized that the child understood everything, but did not want to speak. Instead of speech, facial expressions and gestures developed, which children used selectively in emotionally charged situations. The first words and phrases appeared late. Parents noted that, apart from speech delays, in general the children were developing normally. The children had a poor active vocabulary and used babbling words, onomatopoeia, and sound complexes. There were many reservations in the speech, which the children paid attention to and tried to correct what was said incorrectly. At the time of the examination, the volume of the active vocabulary (stock of spoken words) in children with level 1 SLD did not exceed 15–20 words, and with level 2 SLD – 20–50 words.
Table 3 presents the results of the examination, showing at what age interval there was a lag from normal indicators in three groups of children with developmental dysphasia, divided by age: (1) from 3 years 0 months. up to 3 years 5 months; (2) from 3 years 6 months. up to 3 years 11 months; (3) from 4 years 0 months. up to 4 years 5 months

It seems logical that the most significant lag was in the formation of speech and communication abilities, but at the same time the degree of this lag increased - from 17.3 ± 0.4 months. in the 1st group to 21.2±0.8 in the 2nd and 27.3±0.5 months. in the 3rd group. Along with the increase in the severity of differences from healthy peers in speech development, the lag in all other areas not only persisted, but also increased with each six-month age period. This indicates, on the one hand, the significant influence of speech on other areas of the child’s development, and on the other, the close relationship and inextricability of various aspects of individual development.
The main directions of complex therapy for developmental dysphasia in children are: speech therapy work, psychological and pedagogical correctional measures, psychotherapeutic assistance to the child and his family, drug treatment. Since developmental dysphasia is a complex medical, psychological and pedagogical problem, the complexity of the impact and continuity of work with children by specialists of various profiles are of particular importance when organizing assistance to such children.
Speech therapy assistance is based on the ontogenetic principle, taking into account the patterns and sequence of speech formation in children. In addition, it is individual, differentiated, depending on a number of factors: the leading mechanisms and symptoms of speech disorders, the structure of the speech defect, the age and individual characteristics of the child. Speech therapy and psychological-pedagogical correctional activities are a purposeful, complexly organized process that is carried out over a long period of time and systematically. Under these conditions, correctional work gives most children with developmental dysphasia the means sufficient for verbal communication.
The most complete correction of speech development disorders is facilitated by the timely use of nootropic drugs. Their prescription is justified based on the main effects of this group of drugs: nootropic, stimulating, neurotrophic, neurometabolic, neuroprotective. One of these drugs is acetylaminosuccinic acid (Cogitum).
Cogitum is an adaptogenic and general tonic that normalizes nervous regulation processes and has immunostimulating activity. Cogitum contains acetylaminosuccinic acid (in the form of dipotassium salt of acetylaminosuccinate) - a synthetic analogue of aspartic acid - a non-essential amino acid found mainly in the tissues of the central nervous system.
For pediatricians and pediatric neurologists, such properties of aspartic acid are important, such as participation in DNA and RNA synthesis, influence on increasing physical activity and endurance, normalization of the balance between the processes of excitation and inhibition in the central nervous system, immunomodulatory effect (acceleration of antibody formation processes). Aspartic acid is involved in a number of metabolic processes, in particular, it regulates carbohydrate metabolism by stimulating the transformation of carbohydrates into glucose and the subsequent creation of glycogen reserves; along with glycine and glutamic acid, aspartic acid serves as a neurotransmitter in the central nervous system, stabilizes nervous regulation processes and has psychostimulating activity. In neuropediatric practice, the drug has been used for many years for indications such as delayed psychomotor and speech development, consequences of perinatal lesions of the central nervous system, neuroinfections and traumatic brain injuries, cerebrasthenic and astheno-neurotic syndromes.
Release form. Oral solution in ampoules of 10 ml. 1 ml of the drug contains 25 mg of acetyl-aminosuccinic (aspartic) acid, and 1 ampoule (10 ml) – 250 mg. The composition of the drug includes: fructose (levulose) - 1.0 g, methyl parahydroxybenzoate (methyl-n-hydroxybenzoate) - 0.015 g, aromatics (banana flavor) - 0.007 g, distilled water - up to 10 ml per 1 ampoule. The drug does not contain crystalline sugar or its synthetic substitutes, therefore it is not contraindicated in diabetes mellitus.
Dosage regimens. The drug is given orally undiluted or with a small amount of liquid. For children aged 7–10 years, it is recommended to take 1 ampoule (250 mg) orally in the morning, for children over 10 years old – 1–2 ampoules (250–500 mg) in the morning. For patients from 1 year to 7 years, the dose is determined by the doctor individually. In our experience, it is preferable for children under 7 years of age to take 5 ml (1/2 ampoule) 1 or 2 times a day. The duration of treatment is usually 2–4 weeks. For a single dose, the drug is prescribed in the morning, for a double dose, the second dose is prescribed no later than 16–17 hours. Before prescribing Cogitum, it is necessary to obtain written informed consent from parents/legal representatives for treating a child with acetylaminosuccinic acid, indicating that they are familiar with the indications, contraindications and side effects and do not object to prescribing the drug to a child.
Side effects. Although hypersensitivity reactions (allergic reactions) to individual components of the drug are possible, they are rare. There are no reports of drug overdoses in the literature.
If necessary, children with delays in speech development may be prescribed repeated courses of treatment with nootropic drugs. An open controlled study confirmed clinical effectiveness for developmental dysphasia in children aged 3 years to 4 years 11 months. two-month therapeutic courses of hopantenic acid, pyritinol and a drug containing a complex of peptides obtained from pig brain. To objectively assess the effectiveness of the therapy, parents are recommended to monitor the growth of vocabulary, improvement in the pronunciation of sounds and words, and the emergence of new phrases in the child’s speech. It is advisable to record the results of these observations in the form of special diary entries, which will be discussed with specialists during repeat visits to them. Constant contact with specialists (doctor and speech therapist), conducting consultations over time is an important condition for the success of the treatment.

Literature

1. Kornev A.N. Fundamentals of speech pathology in childhood: clinical and psychological aspects. St. Petersburg: Rech, 2006. 380 p.
2. Nyokiktien Ch. Child behavioral neurology. T. 2. M.: Terevinf, 2010. 336 p.
3. ICD-10 – International Classification of Diseases (10th revision). Classification of mental and behavioral disorders. Research diagnostic criteria. St. Petersburg, 1994. 208 p.
4. Aicardi J., Bax M., Gillberg K. Diseases of the nervous system in children. Per. from English edited by A.A. Skoromets. M.: Panfilov Publishing House, BINOM, 2013. 1036 p.
5. Beesems M.A.G. Developmental Dysphasia. Theory Diagnosis and Treatment. Amsterdam: Developmental Dysphasia Foundation, 2007. 11 p.
6. Badalyan L.O. Child neurology. M.: MEDpress-inform, 2010. 608 p.
7. Volkova L.S., Shakhovskaya S.N. Speech therapy. 5th ed., M.: Vlados, 2009. 703 p.
8. Sapozhnikov Ya.M., Cherkasova E.L., Minasyan V.S., Mkhitaryan A.S. Speech disorders in children // Pediatrics. Journal named after G.N. Speransky. 2013. T. 92. No. 4. pp. 82–87.
9. Simashkova N.V. Autism spectrum disorders. Scientific and practical guide. M.: Author's Academy, 2013. 264 p.
10. Asmolova G.A., Zavadenko A.N., Zavadenko N.N., Kozlova E.V., Medvedev M.I., Rogatkin S.O., Volodin N.N., Shklovsky V.M. Early diagnosis of speech development disorders. Features of speech development in children with consequences of perinatal pathology of the nervous system. Method. recommendations, M.: Union of Pediatricians of Russia, Ros. assoc. specialists in perinatal medicine, 2014. 57 p.
11. Zavadenko N.N., Efimov M.S., Zavadenko A.N., Shchederkina I.O., Davydova L.A., Doronicheva M.M. Disorders of neuropsychic development in premature infants with low and extremely low birth weight // Pediatrics. Journal named after G.N. Speransky. 2015. T. 94. No. 5. pp. 143–149.
12. Zavadenko N.N., Kozlova E.V. Assessment of development indicators in children with dysphasia (alalia) and comprehensive correction of their disorders. Doctor.ru / Neurology Psychiatry. 2014. T. 94. No. 6. pp. 12–16.
13. Alpern G.D. Developmental Profile 3, DP-3 Manual. Western Psychological Services, Los Angeles, 2009. 195 p.
14. Studenikin V.M., Balkanskaya S.V., Shelkovsky V.I. On the use of acetylaminosuccinic acid in neuropediatrics. Issues of modern pediatrics. 2008. T. 7. No. 3. P. 91–94.
15. Zavadenko N.N., Kozlova E.V. Drug therapy of developmental dysphasia in children with nootropic drugs // Questions of practical pediatrics. 2013. T. 8. No. 5. pp. 24–28.