The Dislalia It is one of The alterations of the language Most common among children during the preschool and primary period. It is a disorder of the articulation of different phonemes or groups of phonemes.
In dyslalia, organs that intervene in speech, also called phonoarticulatory organs (lips, mandible, veil of the palate, tongue, etc.) are placed in an incorrect way resulting in an inappropriate pronunciation of certain sounds or phonemes.
The dyslalia is characterized by the presence of errors in the articulation of the speech sounds in people who do not show a pathology related to the Central Nervous System .
In some cases, this defect of pronunciation derived from bad articulation can become automated and normalized, this is evidenced in written language.
The dislalia can affect any consonant or vowel. However, the alteration of the pronunciation occurs more frequently in some sounds, for example, the / r /, since its articulation requires a greater agility and precision in its movements.
It also tends to occur in / k /, because the point of articulation is not visible and therefore imitation is more difficult, as well as in the / s /, where a deformation occurs in the articulatory position of the tongue.
Types of Dislalia
Following Pascual (1988), dyslalia can be classified according to its etiology. Thus, we distinguish between:
Evolutionary or physiological dyslalia
This type of dyslalia occurs in some stages of the development of children's speech where children still do not articulate well different sounds or distort some phonemes.
The causes of this phenomenon can be immaturity, absence of auditory discrimination, lack of control in the breath, respiratory alterations or inadequate movements in the articulatory organs.
Within the evolution of the maturity of the child these difficulties are overcoming them, only if they persist between the four or five years is when we would consider it as pathological.
The etiology of auditory dyslalia lies in the presence of an auditory deficit which is accompanied by other alterations of language, such as voice and rhythm.
To be able to articulate the sounds in a proper way, a correct hearing is essential.
Organic dyslalia arises due to an injury to the central nervous system (dysarthria) or due to an organic alteration of the peripheral speech organs without damage to the central nervous system (dysglossia).
Functional dyslalia is caused by an inadequate functioning of the articulatory organs, without evidence of damage or organic injury. Among functional dyslalia we distinguish phonetic disorders and phonological disorders.
Phonetic disorders are alterations in the production of phonemes. The alteration is focused on the motor aspect of the joint.
Errors are stable, and it is observable that errors in sound appear equally in the repetition of spontaneous language. There is no alteration in the processes of auditory discrimination.
Phonological disorders are alterations at the perceptual and organizational level, that is, in the processes of auditory discrimination, affecting the mechanisms of conceptualization of sounds and the relationship between meaning and signifier.
In these cases, the oral expression of language is deficient and depending on the severity may become unintelligible.
Errors tend to be fluctuating. Isolated sounds may well articulate, but the pronunciation of the word is affected.
Etiology of functional dyslalia
Among the most common causes of functional dyslalia are:
Poor motor skills
There is a difficulty in the articulation of language and in fine motor skills. There seems to be a direct relationship between motor retardation and the degree of language delay in pronunciation alterations.
This is the most frequent cause in cases of dyslalia. Children with dyslalia present clumsiness in the movements of articulatory organs and a deficit in general motor coordination, which is only observable in terms of fine motor .
Difficulties in the perception of space and time
In these cases, the person with dyslalia has difficulties in the perception and organization of space and time.
If the child has difficulty perceiving it and has not internalized the space-time notions language is difficult.
The development of this perception is important for language to evolve.
Lack of hearing compression or discrimination
The individual can not imitate sounds because he does not perceive them correctly, that is, he is not capable of discriminating.
Sometimes the child hears well, but analyzes or makes an inadequate integration of the phonemes he hears.
There are a variety of psychological factors that can affect language development such as affection-type disorder, family maladjustment, lack of affection, jealousy among siblings, trauma or over-protective environments.
Among the environmental factors have been highlighted situations of bilingualism, maternal overprotection, institutionalization of the child or learning by imitation, as well as low cultural level.
In these cases functional dyslalia would be secondary to the intellectual deficit.
The symptoms of dyslalia vary depending on the degree of involvement. The difficulty of articulation can range from a particular phoneme to many phonemes, making the language unintelligible.
The symptomatology consists in the commission of errors. The most frequent errors in the dislalia are:
The substitution error consists of replacing one sound with another.
For example, the individual is unable to pronounce the / r / sound so he replaces it with another phoneme that is simpler, such as the / l / sound, ie"brass"instead of"mouse".
Sometimes the child makes this substitution error because of the auditory discrimination deficit, that is, the child improperly perceives a word and emits this sound as perceived.
For example, the child perceives"van"instead of"van." Substitution can occur at the beginning, in the middle or at the end of the word.
The distortion error is when we give it an incorrect or deformed shape trying to approximate it more or less to the proper joint.
They are mainly due to inadequate positioning of the articulation organs. For example, the child says"forgive"instead of"dog."
The individual omits the phoneme that does not know how to pronounce, but does not substitute it.
Sometimes this omission is of a single phoneme such as"osquilleta"instead of"rosquilleta"and other times the omission is of a complete syllable"lota"instead of"pelota".
If two consonant groups are to be pronounced"bla","cri", etc., the liquid consonant is omitted.
The addition error is to add a phoneme to the word to facilitate pronunciation.
For example"tigers"instead of"tigers","four"instead of"four"or say"aratón"instead of"mouse".
The problem with this type of error is that it can become automated and turns it into one more word.
The inversion error consists in changing the order of the sounds. For example, it says"cacheta"instead of"jacket".
For the evaluation of functional dyslalia in children, we must take into account the following aspects:
A) Interview with parents
The interview with the parents is of great relevance in order to obtain an anamnesis of the problem, both personal and family.
This interview is the first necessary step in any diagnosis. Not only will the strictly linguistic data be explored, but also those referring to general maturation.
This interview will collect information related to personal data such as personal history, motor development, personality , Schooling, as well as family data.
To carry out the evaluation in dislalias, it is necessary to examine the joint to know exactly what the defects that the subject presents.
This evaluation of the pronunciation must be exhaustive and systematic so that it does not lead to a misdiagnosis.
It is therefore necessary to detail the situation of the phoneme-problem, whether it is initial, intermediate or final and to what kind of expression it is referred, whether to repeated, directed or spontaneous language, depending on the frequency, will vary their articulation difficulties from one to other.
It is necessary to consider that those difficulties that arise in repeated language will also appear in directed and spontaneous language, since we assume that if the child can not imitate, it can not spontaneously.
However, sometimes when we value directed language and spontaneous language, we will observe that when it must imitate repetition it does so in an appropriate way.
Those sounds that the child is unable to repeat by imitation will in some cases be the only sounds that involve a difficulty.
However, in the case of more widespread dyslalia, it is very common for spontaneous language to appear more errors, referring to those joints that, although they are able to imitate them, are not automated and therefore are not integrated in spontaneous language.
The habit of erroneous pronunciation is reinforced and therefore automated, so it is very important the intervention of a professional at an early stage.
It is also important to note if the emission difficulty is greater depending on where the sound is (beginning, end or middle of speech).
For the evaluation of the repeated language a list of words is used in which the examined sound is contained in all the mentioned situations
To evaluate the directed language we present some objects or drawings known by the child, whose names contain the phoneme to be examined.
To evaluate spontaneous language, informal conversation, questions, etc. are used. Thus, a psychological evaluation might be considered if there is a disparity between repeated and spontaneous language, the former being elaborated correctly, while spontaneous speech becomes unintelligible.
This could lead us to consider an emotional-emotional problem, in which case a psychological exploration of the child would be necessary.
In many cases, motor retardation can be a causative factor that favors the onset of functional dyslalia.
Sometimes the motor delay is at a generalized level and in other cases the difficulty is concretely in the movement of the articulatory organs.
It is important to evaluate the capacity of auditory perception that has in reference to that of the discrimination of environmental sounds, joints and words.
To carry out this evaluation, pairs from each of the three areas to be examined will be proposed:
- Discrimination of environmental sounds:
To evaluate the discrimination of environmental sounds, familiar sounds are used, for example newspaper sheets.
The stimulus A will be the"ripping of a newspaper sheet"and the stimulus B will"wrinkle a sheet of newspaper", the subject with his back to the professional must say what sound belongs to which action.
- Discrimination of joints:
To evaluate joint discrimination we will choose three similar syllables as"ba","da","ga".
These stimuli are presented in pairs and the individual has to be able to discriminate what each sound is.
- Discrimination of words:
To evaluate word discrimination, words are chosen to be able to evaluate the ability to discriminate articulate sounds inserted within words.
To do this you are asked to repeat the words you are presenting in pairs, if they are different or if it is the same words, such as"little","mouth"/"cat","duck".
Breathing is necessary for the emission of voice and articulation of language.
It is important to know the respiratory capacity of the individual, if there are defects in the respiratory process and the control and directionality of the exhaled air.
F) Muscle tone and relaxation
Muscle tension plays a role in the articulation of language. Especially in the mouth area, since it sometimes blocks the agility to articulate the words.
Intervention in functional dyslalia
The psychology of learning proposes a model of intervention of the articulatory alterations, thus intervening from the behavioral model.
The psychology of learning is based on the fact that these alterations are the product of poor learning of the joints.
It is based on the fact that these behaviors are observable and can be modified based on the principles of behavior modification.
In order to establish a program of articulation from the behavioral model we must first have made a thorough evaluation of those aspects in which there is a difficulty. To do this, we will observe the behavior of articulation.
During the evaluation we will analyze the behavior and decompose it into its essential parts so that, afterwards, we can teach the parts separately.
On the other hand, it is important to detect what is the essential component, that is, what differentiates and defines the behavior and teach it first, then teach those secondary elements.
To develop a program of articulation we must establish:
- The goal we want to achieve, In our case, the correct articulation of a phoneme or group of phonemes that is not spontaneously possible.
- Define Behavior: correct articulation of one or several phonemes in Spanish.
- Previous requirements: That the child is able to pay attention, imitate and follow the oral instructions. The ear and the speech apparatus should function normally.
Molding is an operant technique that is used to increase behaviors. This technique is indicated when the behavior we want to achieve does not exist.
To do this we will reinforce the approximations (the parts in which we have divided the behavior) until reaching the final goal.
The reinforcer must be contingent and must be delivered immediately upon the issuance of the conduct
To apply the molding it is necessary:
- A) Define the final behavior that we want to achieve.
- B) Select the reinforcers to be used.
- C) Establish the baseline or starting point.
- D) Establish successive approximations.
- E) Be able to use other behavioral techniques such as instructions, modeling, physical guidance or situational induction.
- F) Reinforce immediately
The phases that we are going to follow will be:
- Base line : In the evaluation phase we will be able to know which phonemes are the ones that cause problems and in which position of the word cause greater difficulty.
- Molding of the phoneme joint : The professional acts as a model articulating the phoneme on two occasions.
To achieve the articulation of the phoneme, we will present and shape the desired joint reinforcing the successive approximations, we will also shape the proper position of the articulatory organs involved in the phoneme.
- Molding of the phoneme in repeated language . A list of words and phrases is made with the phoneme we are dealing with.
- Molding of the phoneme in tacts . We present objects, photos or drawings that contain the treated phoneme. We move on to the next phase after 10 adequate responses.
- Molding of the phoneme in intraverbal . We make a list with ten questions whose answer involves the intervened phoneme.
- Final evaluation . We present the words that we had presented to establish the baseline and thus, to know if there are differences between the test-retest.
- Generalization . We evaluate other environments of the child and train teachers, parents, etc. To act as co-therapists of the intervention.
- Tracing . Approximately twice a month we will pass the baseline test again to see if the intervention is optimal.
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