The term dysphasia has been agreed by different authors and efforts have focused in making diagnoses by exclusion of disorders that may not fit within this category. Dysphasia, then, " generally applies to children with severe language disorder, and whose causes are not due to obvious reasons such as: deafness, mental retardation, a motor impairment, emotional disorders or personality disorders. "(Seron and Aguilar, 1992, p.331).
The dysphasia is characterized by severely impaired language development in intellectually normal children older than 5 years, both in the understanding and the language issue, not possible to explain and intellectual problems, sensory, motor or neurological damage, along with associated problems (wandering attention, isolation, emotional lability). The deficit in oral language is characterized not only by chronological delay in the acquisition of language (Aidex, 2000b)
Differential characteristics .
is necessary to make differential diagnosis, mental retardation, autism, hearing impairment, neurological disorders (aphasia).
is difficult to establish the boundary between language delay and dysphasia, many times, the diagnosis is determined by the lack of evolution before the intervention and the level of symptom severity. Dysphasic disorders have worse outcomes with a systematic intervention. Be considered as criteria of differentiation, increased severity of the indicators and the persistence of this severity. In the speech delay, although at one time could be found and the same gravity as dysphasia, find a better outcome, therefore, not only intervention but also because environmental factors associated dificultantes, are losing ground compared to intervention and guidance that good school and family.
The dysphasic problem is further complicated by the greatest difficulty in basic learning and greater and more persistent educational failure.
diagnostic criteria dysphasia
According to DSM-IV (1995), the criteria for diagnosis of dysphasia are:.
· persistent deficit in the language at all levels, understanding and expression.
· chronological delay deviation from normal patterns of acquisition and development.
· Serious communication problems.
· difficulties in school learning.
· All in all it is because a sensory, intellectual or severe motor.
Descriptive characteristics of dysphasia.
Country language
1. expressive deficiency: can range from near silence to dyslalia tables. In general, the communicative purpose is poor and have great difficulty adapting to the speaker, in relation to language itself, there are difficulties to repeat phrases and properly structured syntactic structures (agrammatism) and there is deficiency in auditory integration and vocabulary (Aidex, 2000b). According Ajuriaguerra (1975, in Aguilar, and Seron, 1992, p.331), the dysphasic, in terms of production, can be classified into those who are frugal and simple phrases occupy - producing emissions that can go from a word- telegraphic sentence to expression (Aidex, 2000b) - and those who are poorly controlled, which do not respect the order of the words and present gap between understanding and expression.
2. Deficiencies in the receptive field, can occur from a severe impairment in recognizing sound with meaning, to milder forms where there is confusion in the discrimination of phonemes or the semantic (Seron and Aguilar, 1992), in general, you can see difficult to repeat and remember to extended speech and problems with recall, reflected in expressions interrupted by substitutions of words, using words and catch phrases. (Aidex, 2000b)
Country nonlinguistic.
According Monfort and Juárez (1997), dysphasic children presented the following non-linguistic field:
Cognitive Aspects
· difficulties in the development of symbolic play and other symbolic functions
· Difficulties in the construction of mental images
· sequential memory deficit, auditory verbal short-term and
· Alterations in the structure of time and space
· Heterogeneity results in different scales subtests of nonverbal intelligence.
perceptual aspects
· discrimination Difficulties auditory stimuli.
· longer latency time required for auditory perception.
· Problems lateralization in the processing of auditory stimuli.
psychomotor aspects
· praxical Difficulties.
· lateralization process disturbances.
· immaturity of motor skills.
behavioral aspects
· Impaired attention span, hyperactivity.
· Altered relationships and control of emotions.
social and emotional world of dysphasic children.
According Monfort and Juárez (1997), difficulties in the progress in language development, along with a lack of clear justification for them, created within the family situation of great stress and anxiety, guilt feelings expressed toward yourself or another member of the couple parents. The alteration in normal patterns of family interaction, produces a quantitative alteration of external stimulation (less spontaneous interactions) and qualitative (policy interventions, less flexible and not set the level of development of the child).
is important to consider that parents adjust their level of language to the child's level, although in severe cases presents a very large gap between the complexity of the content you want to communicate and the ability of children to assimilate, which greatly limits the possibility of interaction.
abnormalities of social interaction can also be seen in the child's contact with their peers, receiving fewer requests for establishing communication and shorter interactions.
Etiology.
Seeman (1965, in Aguilar, and Seron, 1992, p.332) considers that early in the onset of dysphasia indicate that the constitutional factor would be important, perhaps not a cause, but as a predisposing factor, on the other hand, different authors suggest that dysphasia is a product of both inherited factors and environmental.
auditory perceptual component is essential in the development of dysphasia. You can find children with word deafness (hearing sounds without verbal stimulus discrimination perception problems at central level).
Evaluation of dysphasia
As Seron and Aguilar (1992), the diagnosis of dysphasia only be done after 6-7 years because if done in early confused with simple box of language delay.
An evaluation of a case of dysphasia should consider the following points:
1. The evaluation of production processes and language comprehension should be assessed in qualitative and quantitative not be distinguished from the tables do not dysphasic.
2. should consider the cognitive processes that act on the acquisition of language and that we can shed light on the etiology of this disorder:
or Sustained attention , imitation generalized symbolization habits that are seen as prerequisites for language.
or formal language requirements, spontaneous vocalizations (babbling), auditory discrimination and tracking of rhythmic sequences.
or social requirements, early settlement patterns of social interaction with children or adults. Eye contact, social smile.
3. study the processes of production speech exploring the oral-facial praxis and the articulation of the child.
4. Study of the general behavior of the child and see behavioral alterations or isolation.
5. perform complementary: audiometric (to rule out hearing impairment) and neurological tests.
6. Exploration with psychometric tests, since in many cases the child presents dysphasic related psychomotor disorders such as alterations of space, knowledge of left, right, altered body image and gestural expression.
Intervention dysphasic children.
Early intervention
According Monfort and Juárez (1997), there 10 general principles of intervention for children with dysphasia. These are:
· Top intensity and long duration: it is, essentially, to allow and facilitate access to communication and language in spite of a deficiency in base , which usually remain throughout the process of language development. Thus, the intervention should take place in an intensive, continuous and stable, especially in the early years.
· earliness principle: the intervention should be made as early as possible and that learning is best done in the critical period, the earlier changes occur the child will have greater flexibility and control brain more effectively the potential ineffective interactions of the child's environment.
· Top etiologic be taken into account the child's family and hacérsele participate in the intervention, since its role is essential in the development of oral language.
· Top priority to communication: it is necessary to keep each activity and each learning process the highest possible level of communication functionality.
· attitudes empowerment principle: they must register those aspects that present the highest levels of development to maximize, and its usefulness in the construction project
· multi-sensory principle: it is preferable from the beginning to the best possible chance of success the child and do not restrict the use of augmentative sensory reinforcements to cases that fail to strictly intervention stimulation via normal audio-oral.
· principle reference to normal language development: the contents of the intervention programs and their sort sequence must be guided by what is known about the child's language development normal, provided that specific characteristics presented dysphasia in a particular case do not indicate otherwise.
· Top of enabling systems dynamics: the idea is to provide maximum assistance to the child who is in trouble from the start, and then lowering them to As the child becomes more independent of them.
· continuous review principle: it must conduct a regular evaluation of each case adapt the guidelines to its characteristics at each point in its evolution.
· time adjustment principle: data generally recommended in slowing the pace of interaction and greater clarity in the presentation of the initial relationship between the referent and verbal models, so not only with regard to speak slower and clearer, but mainly to lengthen the waiting times of the responses.
intervention strategies
According to the statement by Monfort and Juárez (1997), intervention in children dysphasia can be divided into three levels:
1. enhanced level of stimulation: the model is to shore up natural language acquisition, within its own dynamic performance. It is present communicative and verbal stimuli in an enabling environment, increasing the intensity of dual interactions with adults, increasing their intensity, controlling behavior that adults have over the process of language acquisition.
This level of stimulation includes stimulation sessions functional models aimed at providing clear and stable enabling environment, and family programs, which aim to inform the child's language disorder and train them new ways of interacting with the child.
2. Level restructuring: it is necessary to modify certain aspects of linguistic communication and the acquisition process itself that is trying to develop despite the deficit using, if necessary, and for some time, unreleased tracks and underused in normal child, with the introduction of visual, tactile, or motor to normal linguistic communication, this must be combined with the Level One guidelines, since the introduction of these systems should not only exercise sessions.
3. alternative communication system: the system chosen must be inserted into the open interaction, following the principles of natural stimulation enhanced the level one. The overall objective is to get the child to achieve adequately communicate with their environment occupying, if necessary, alternative to oral language.
4. Family programs: it consists of information and training. In the first family are informed of the nature of the condition of their children, changes to expect and the importance of their role in their education.
The formation consists of six main points:
· develop observational skills.
· reduce the tendency of directors.
· Learning to better align our language.
· Learn how to create active communicative situations.
· Eliminate negative behaviors.
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