SPEECH AND LANGUAGE DISORDERS
Specific speech and language disorders include a range of conditions in which people have difficulty producing speech sounds, understanding language, or both, without an apparent cause such as hearing loss or intellectual disability.
TYPES OF SPECIFIC DISORDERS OF SPEECH AND LANGUAGE DEVELOPMENT
Speech sound disorders (SSD): problems with the correct articulation of sounds, resulting in incorrect pronunciation.
Language impairment (LI): difficulty understanding (receptive) or using (expressive) language appropriately.
Developmental Language Disorder (DLD): A primary speech impairment with no known medical cause that persists into school age and beyond.
Childhood apraxia of speech (CAS): A motor speech disorder in which children have trouble pronouncing sounds, syllables, and words due to problems with brain signals.
Stuttering: A disorder of speech fluency, such as repetition or prolongation of sounds.
THE ONSET OF SPECIFIC DISORDERS OF SPEECH AND LANGUAGE DEVELOPMENT
These disorders usually become apparent in early childhood, when speech and language skills emerge. Parents may notice delays in toddlerhood, often between 2 and 4 years of age.
CLINICAL MANIFESTATIONS OF SPEECH AND LANGUAGE DEVELOPMENT DISORDERS
Speech sound disorders: incorrect pronunciation of words, difficulty articulating certain sounds.
Language disorders: limited vocabulary, difficulty forming sentences, problems understanding instructions.
Language Development Disorder: Persistent language difficulties that impact academic and social interactions.
Childhood apraxia of speech: inconsistent sound errors, difficulty imitating speech, palpation of jaw movements.
Stuttering: repetition of sounds, prolongations, blocks and visible struggling behavior.
NEUROLOGICAL BASES OF SPEECH AND LANGUAGE DEVELOPMENT DISORDERS
Research shows that these disorders may involve structural and functional abnormalities in specific areas of the brain:
Left supramarginal gyrus: Associated with sensory feedback and integration; abnormalities here may be associated with speech disorders.
Corticostriatal dysfunction: seen in speech development disorders, affecting motor skills and speech processing pathways.
AFFECTED AREAS OF THE BRAIN
Broca's area: Associated with speech production; damage can lead to difficulties with expressive speech.
Wernicke's area: Associated with speech understanding; impairments can cause problems with receptive language.
Arcuate fasciculus: White matter fibers connecting Broca's and Wernicke's areas; damage can result in conduction aphasia affecting repetition and flow of speech.
MAIN CAUSES OF SPEECH AND LANGUAGE DISORDERS
Этиология таких патологий является многофакторной и включает в себя генетические, экологические и нейробиологические факторы. Генетическая предрасположенность, пренатальные воздействия и болезни в раннем детстве могут способствовать развитию этих нарушений.
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ГЕНЕТИЧЕСКИЕ ИЗМЕНЕНИЯ
Мутации в гене FOXP2 могут быть связаны с речевыми и языковыми расстройствами, особенно влияющими на производство речи и понимание.
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РОЛЬ ВОСПАЛЕНИЯ И НЕЙРОВОСПАЛЕНИЯ
Новые исследования показывают, что нейровоспалительные процессы могут влиять на развитие речевых и языковых расстройств. Тем не менее, необходимы дополнительные исследования, чтобы установить прямую связь.
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РОЛЬ ХРОНИЧЕСКИХ И ЛАТЕНТНЫХ ИНФЕКЦИЙ
В то время как некоторые пренатальные инфекции были связаны с задержками в развитии, прямое влияние хронических или латентных инфекций на конкретные речевые и языковые расстройства остается в стадии исследования.
Тем не менее, новые исследования показывают, что некоторые хронические и латентные инфекции могут способствовать развитию или обострению речевых и языковых расстройств. Хотя точные механизмы остаются в стадии изучения, несколько инфекций были связаны с этими нарушениями:
1. Инфекция Mycoplasma pneumoniae: Исследование с использованием общенационального лонгитюдного набора данных обнаружило значительную связь между инфекцией Mycoplasma pneumoniae и увеличением частоты нарушений речи и языка. Средний латентный период от первоначальной инфекции до начала этих нарушений составил примерно 1,96 года. Примечательно, что дети, инфицированные в возрасте до шести лет, демонстрировали более высокий риск развития последующих проблем с речью и языком.
Tsai CS, Chen VC, Yang YH, Hung TH, Lu ML, Huang KY, Gossop M. The association between Mycoplasma pneumoniae infection and speech and language impairment: A nationwide population-based study in Taiwan. PLoS One. 2017 Jul 3;12(7):e0180402. doi: 10.1371/journal.pone.0180402. PMID: 28672017; PMCID: PMC5495436.
2. Инфекция бета-гемолитического стрептококка группы А (GAS): Анализ показывает, что инфекции GAS были значительной основной причиной заикания до середины 20-го века, улучшения совпали с появлением пенициллина. Эта связь подчеркивает потенциальное влияние бактериальных инфекций на беглость речи.
Alm PA. Streptococcal Infection as a Major Historical Cause of Stuttering: Data, Mechanisms, and Current Importance. Front Hum Neurosci. 2020 Nov 9;14:569519. doi: 10.3389/fnhum.2020.569519. PMID: 33304252; PMCID: PMC7693426.
3. Хронический отит (инфекции среднего уха): постоянные или рецидивирующие инфекции среднего уха в раннем детстве могут привести к временной потере слуха, что может нарушить слуховую обработку и развитие речи. Исследования показывают, что дети с хроническим средним отитом в анамнезе могут испытывать дефицит слуховой обработки и языковых навыков, сохраняющихся в более позднем детстве.
Chronic childhood ear infections delay language development: https://news.ufl.edu/2023/12/ear-infection-language-development
4. Инфекции центральной нервной системы (ЦНС): Инфекции, непосредственно поражающие ЦНС, такие как энцефалит или менингит, могут привести к приобретенным нарушениям речи. Эти инфекции могут вызывать воспаление и повреждение областей мозга, критически важных для обработки речи, что приводит к трудностям в понимании и в разговорных способностях.
Rofes, A., van de Beek, D., & Miceli, G. (2021). Language impairments and CNS infections: a review. Aphasiology, 36(10), 1206–1248.
https://doi.org/10.1080/02687038.2021.1937922
Понимание этих взаимосвязей имеет решающее значение для разработки целевых вмешательств и профилактических стратегий.
THE ROLE OF THE IMMUNE SYSTEM IN SPEECH AND LANGUAGE DISORDERS
Some research suggests that immune system disorders may play a role in neurodevelopmental disorders, potentially affecting speech and language development.
INFLUENCE OF THE MICROBIOME IN SPEECH AND LANGUAGE DISORDERS
The gut-brain axis is a growing area of interest, with research exploring how gut microbiota may influence neurological development and function, possibly influencing speech and language outcomes.
DISORDERS OF ENDOCRINE SYSTEM REGULATION IN SPEECH AND LANGUAGE DEVELOPMENT DISORDERS
Hormonal imbalances, such as thyroid hormone deficiency, can affect brain development and may contribute to problems with language acquisition.
METABOLIC SYSTEM DYSREGULATION IN SPEECH AND LANGUAGE DISORDERS
Interventions are typically interdisciplinary and include:
Speech therapy: Individual exercises to improve articulation, speech comprehension and expression.
Occupational therapy: assistance in developing fine motor skills that support speech, such as oral motor exercises.
Behavioural interventions: methods for working with associated behaviour and improving communication skills.
ANTI-INFLAMMATORY AND ANTI-INFECTIOUS THERAPY
There is currently limited evidence to support the use of anti-inflammatory or anti-infective treatments specifically for speech and language disorders. Most therapeutic approaches focus on behavioral and educational interventions.
However, new research suggests that anti-inflammatory and anti-infective treatments may have a role in treating certain speech and language disorders, particularly when these disorders are associated with underlying inflammatory processes or infections.
ANTI-INFLAMMATORY METHODS:
Studies have examined the use of various anti-inflammatory agents to treat the core symptoms of neurodevelopmental disorders, which often include speech and language impairment. A narrative review highlighted several agents:
Prednisolone: a corticosteroid with potential benefits in reducing stereotypic behavior.
Celecoxib: A nonsteroidal anti-inflammatory drug (NSAID) that may relieve irritability and hyperactivity.
Omega-3 fatty acids: Known for their anti-inflammatory properties, they have been linked to reduced lethargy and hyperactivity.
The mechanisms by which these agents exert their effects are not fully understood, but may involve suppression of microglial activation and modulation of immune cell imbalances, leading to reduced levels of proinflammatory cytokines in the brain.
Arteaga-Henríquez G, Gisbert L, Ramos-Quiroga JA. Immunoregulatory and/or Anti-inflammatory Agents for the Management of Core and Associated Symptoms in Individuals with Autism Spectrum Disorder: A Narrative Review of Randomized,
Placebo-Controlled Trials. CNS Drugs. 2023 Mar;37(3):215-229. doi:10.1007/s40263-023-00993-x. Epub 2023 Mar 13. PMID: 36913130; PMCID: PMC10024667.
ANTI-INFECTIOUS DRUGS:
In cases where speech and language disorders are associated with infections, antimicrobial treatments have been considered:
Antibiotic therapy for Lyme disease: Some children diagnosed with Lyme disease and ASD show improvements in speech and communication after long-term antibiotic therapy. A study found that after six months of antibiotic therapy, participants showed significant improvements in speech and language skills.
Kuhn M, Grave S, Bransfield R, Harris S. Long term antibiotic therapy may be an effective treatment for children co-morbid with Lyme disease and autism spectrum disorder. Med Hypotheses. 2012 May;78(5):606-15. doi: 10.1016/j.mehy.2012.01.037. Epub 2012 Feb 22. PMID: 22361005
Treatment of otitis: Chronic middle ear infections can lead to hearing loss, which subsequently affects speech and language development. To prevent these complications, appropriate antibiotic treatment for otitis media is necessary.
KALYANAKRISHNAN RAMAKRISHNAN, MD, FRCSE, RHONDA A. SPARKS, MD, AND WAYNE E. BERRYHILL, MD. Diagnosis and Treatment of Otitis Media. Am Fam Physician. 2007;76(11):1650-1658. https://www.aafp.org/pubs/afp/issues/2007/1201/p1650.html
CONSIDERATIONS AND FUTURE DIRECTIONS
While these results are promising, it is important to approach anti-inflammatory and anti-infective treatments with caution:
Individualized assessment: Not all speech and language disorders have an inflammatory or infectious etiology. A thorough medical examination is necessary to identify the underlying causes before initiating such treatment.
Potential side effects: Long-term use of anti-inflammatory drugs and antibiotics may have side effects.
Need for Further Research: Larger, controlled studies are needed to establish the effectiveness and safety of these treatments specifically for speech and language disorders.
In conclusion, while anti-inflammatory and anti-infective treatments offer potential for treating certain speech and language disorders, their use must be based on careful diagnosis and consideration of individual patient factors.
Collaboration between professionals, including speech therapists and physicians, is essential to developing comprehensive and effective treatment plans.