By Dr. R. A. R. Perera MBBS (Cey) M.Sc. Psych (Col) FRACGP (Aus)
Consultant Psychologist
Language disorders in children may be congenital or acquired. A language disorder or congenital aphasia can be described as an inability total or partial, to understand or to use language in any one or all of its forms, such inability being independent of any other mental capacity or deformity or disease affecting the organs of articulation (speech). It is difficult to give exact criteria with which to differentiate between the two forms until linguistic levels of language have been reached, normally in the second year of life.
Parents fondly report the pre-language phase of initial babble as the first meaningful words – such as ‘mum mum’, ‘da da’ ‘nan’, etc. – not realizing that the baby is simply vocalizing and not using the babble as person specific labels. The pre-language phase disappears in normal development. The unwary doctor may be lulled into believe that a congenitally aphasic (language disorder) child has lost a true verbal skill and may misdiagnose an acquired language disorder. Children whose language is delayed as a part of mental retardation or whose overall development has been inhibited by unfavourable environmental circumstances, should not be included.
moreCongenital language disorders range from 1%-2% in Sri Lanka. And the prevalence of acquired language disorders, under the age of five years, is fairly small.
When a mother brings a child for language disorders a correct appraisal of past medical history, pediatric examination and a test of hearing should be performed before undertaking management. Correct diagnosis hastens the implementation of appropriate help the child, facilitates resolution of the disorder and minimizes secondary handicap. Careful assessment could reinstate the value of primary care screening and diagnosis in this area of child health.
Congenital language disorder could be primary or secondary. Primary are mainly due to constitutional (congenital brain damage) difficulties. Secondary is mainly due to severe environmental stress and due to brain damage (due to viral infection, rubella, difficult childbirth and jaundice) after conception and before the establishment of speech.
Other neurological difficulties are common in some of these children with speech problems.
Genetic advice for parents of a child with a primary disorder is very important; likewise, primary care personnel, especially speech therapists, should be alerted to the need to observe the language development of all other children of affected families. Earlier, it was thought that left-handed children were affected more in speech problems. But it has been scientifically proved now that there is no connection between left handedness and speech difficulties.
Severe deafness, when present alone or in combination with brain damage, always resulted in a uniform impairment of all aspects of language.
Non-uniform impairment of language occurred among brain damaged children with normal hearing. Non uniform patterns of impairment never occurred in the absence of brain damage.
Therefore the cause of language disability in a child presenting with a non-uniform pattern of impairment should not be attributed solely either to social factors or to deafness. Mild hearing losses and minor environmental pressures (speaking more than one language at home or less interaction between the child and the parent or caregiver) plays a contributor rather than a casual role. These stresses can cause the severity of the language disability to increase.
The prognosis of language disability depends upon the nature, severity and extent of the brain damage and the age of the child.
In Sri Lankan, to improve the prognosis of language development, we should introduce a language intervention program at pre-school level. A speech therapist should see the mother and the affected child over six weeks and demonstrate how the mother can bring language learning into the daily routine of her child. In the nursery class, the child should receive intensive help from the pre-school teacher. Both methods are developmentally based and flexible so that help is tailored to the child’s individual needs.
The period in which maximum language learning takes place in normal development is 1 1/2-4 1/2 years. From 3 1/2 years of age, language is increasingly integrated with other intellectual processes and becomes the main media of thinking. So inability to communicate will affect social and emotional development. If help is postponed, the opportunity to utilize the natural period for language learning will be lost, other intellectual processes will be jeopardized and a vicious circle of secondary disabilities and handicaps will be set up.
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