What Is Motor Alalia?

Has your child not started talking even after the age of 3-4? Do you want to find out what motor alalia is because you suspect this diagnosis? Contacting CSM Clinic will help you start treatment of motor alalia as early as possible and avoid severe consequences of speech development disorders. Our specialists have extensive experience working with such patients and use modern evidence-based methods to support children's social adaptation as much as possible.

Motor alalia is a neuropsychological syndrome in which the processes of speech expression are significantly impaired, and the child either does not speak at all or speaks very poorly. It develops more often in boys and occurs in approximately 2-3 children out of 1,000 before the age of 7. Motor alalia in children shows up as variable levels of speech delay: from minor problems with grammar and phonetics to a complete absence of verbal communication. At the same time, the child's intellectual development and hearing are not impaired.

Is your child not speaking or having difficulty speaking? Book a consultation with a speech therapist or speech therapy sessions at CSM Clinic in Kyiv.

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Classification of Motor Alalia

The form of motor alalia is determined by the location of the brain damage:

• The efferent type of alalia is caused by damage to the premotor areas of the central nervous system, Broca's area. These areas control the switching of articulatory movements. Damage to them leads to kinetic apraxia, and the child develops distortion of syllables in words and difficulty with the sequential movements of the speech apparatus.
• The afferent type of alalia is caused by damage to the postcentral area of the lower parietal region of the left hemisphere. This area controls the kinesthetic component of speech, and the child has difficulty choosing articulatory postures and voicing words and sentences.

Expressive alalia is classified according to the main linguistic disorders, and the condition is divided into four forms:

• with the type of articulatory apraxia;
• with changes in phonemic analysis;
• with underdevelopment of the system of speech phonemes;
• with distorted repetition.

The degrees of motor alalia are determined by the severity of symptoms:

• I: no generally understood speech;
• II: pronunciation of syllables is impaired, and sets of babbling, agrammatical words are used;
• III: inaccuracies of a phonetic-phonemic and lexical-grammatical nature appear in everyday communication.

This neuropsychological symptom complex occurs in the motor form, but with extensive damage to the speech centers it may be accompanied by sensory disorders and, depending on the predominance of certain components, show up in a sensorimotor or motor-sensory form. Given the variable nature of the syndrome, a multidisciplinary approach is used in its diagnosis and treatment, and specialists in neurology, psychology and speech therapy are involved in working with the patient.

Etiology of Motor Alalia

The causes of motor alalia are organic focal lesions of the brain centers responsible for motor function, of exogenous origin. These brain structures are very vulnerable in the early stages of ontogenesis, and various negative influences can damage them. Later, the child develops disorders of speech and non-speech processes.

Damage to the motor centers can be caused by various factors, whose effects may occur at different periods:

• prenatal (during pregnancy): viral infections (toxoplasmosis, cytomegalovirus, rubella, etc.), diabetes mellitus, severe toxicosis, psycho-emotional and physical trauma during gestation, smoking or abuse of alcohol and drugs, exposure to ionizing radiation, use of certain medications, Rh conflict, fetal hypoxia, etc.;
• intranatal (during childbirth): neonatal asphyxia, intracranial injuries, umbilical cord entanglement, use of obstetric forceps, premature rupture of membranes, rapid labor, drug stimulation of labor, complications during cesarean section;
• early postnatal (after birth): traumatic brain injury before the age of 1, tumors in Broca's area, meningitis, encephalitis, frequent infections, malnutrition, rickets.

The severity of motor alalia in children is largely determined by the timing of the negative impact on the speech centers. The disorders are most pronounced when harmful factors act during the first trimester of gestation. Signs of damage that occurs in the postnatal period are less pronounced.

Pathogenesis of Motor Alalia

There are several theories about the mechanism of development of motor alalia:

• Psychological.
  It is assumed that speech underdevelopment is caused by problems with memory, attention and perception. As a result, disorders arise in the transition from mentally formulating an utterance to pronouncing it.
• Sensorimotor (psychophysiological).
  Insufficient development of speech motor function is caused by kinetic and kinesthetic apraxia (disorders of motor functions during vocal communication).
• Psycholinguistic.
  Speech disorders are provoked by insufficient development of the functions of internal planning, selection of lexical-grammatical and phonetic means, and the verbal formulation of phrases and sentences.

Diagnosis of Motor Alalia

A comprehensive approach is used to diagnose motor alalia, and the child is seen by pediatricians, speech therapists and psychologists. The diagnosis may be made at the age of 4-5.

To identify the causes of the disorders, a pediatric neurologist consultation and an otolaryngologist consultation are prescribed. The specialists collect data on the course of pregnancy and childbirth, the history of the child's early development and past illnesses. The patient may be prescribed an EEG, otoacoustic emissions (OAE) testing and an audiogram, an ultrasound of the cerebral vessels, and a brain MRI.

A speech therapist consultation helps assess the degree of speech development and identify existing disorders. The specialist uses diagnostic tests that help determine vocabulary size, phonetic-phonemic processes and grammatical structure. The speech therapist examines articulatory praxis and switching, and the correctness of tongue and lip movements.

During the session with the psychologist, the cognitive and emotional-volitional components are assessed. The examination is conducted in the form of a game, during which the specialist can analyze the child's behavior.

To avoid a mistaken diagnosis, alalia is differentiated from pseudo-alalic syndrome, intellectual disability, autism and ASD, childhood aphasia, anarthria, developmental delay, mutism, deaf-mutism, and others.

Tips and Recommendations

To detect motor alalia in good time, it is necessary to:

• carefully observe the child's speech and see specialists promptly if speech development does not match age norms;
• have regular preventive checkups with a neurologist, an otolaryngologist and a pediatric psychotherapist.

Which Doctor Treats Motor Alalia?

Motor alalia is addressed with a comprehensive approach by a pediatric neurologist, a pediatric psychiatrist and a psychologist. At CSM Clinic, a plan of procedures and sessions that suits your child will be put together for you. To book an appointment, you can call the contact center or fill out the online booking form or the callback request form.