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Kształtowanie się i rozwój mowy dzieci w normie intelektualnej a dzieci upośledzonych umysłowo            

Etapy kształtowania i rozwoju mowy


"Mowa to czynność złożona, w której realizację - poza sferą słuchową - zaangażowanych jest wiele struktur mózgowych kierujących oraz scalających pracę układów anatomicznych i funkcjonalnych biorących bezpośredni udział w odbiorze i nadawaniu mowy".
                                                                                                                      H. Nartowska

        Mowa nie jest umiejętnością wrodzoną. Człowiek nabywa tej umiejętności w ciągu całego swojego życia  w kontaktach z ludźmi. Prawidłowe kształtowanie się i rozwój mowy dziecka jest podstawą w kształtowaniu  i rozwoju jego osobowości. Dzięki rozumieniu poznaje otaczający je świat, a dzięki umiejętności mówienia potrafi wyrazić swoje spostrzeżenia, pragnienia, uczucia oraz przeżycia. Kształtowanie się mowy dziecka ma ścisły związek z jego rozwojem społeczno - emocjonalnym. Częste kontakty werbalne z otoczeniem bogacą słownictwo, uczą prawidłowych zasad gramatycznych, właściwego posługiwania się melodią, akcentem i rytmem wypowiedzi.

Tempo przyswojenia przez dziecko mowy i języka ojczystego jest różne. Pierwsze wyrazy pojawiają się w pierwszym lub drugim roku życia, ale w niektórych przypadkach rozwój ten może być opóźniony.
 
Rozwój mowy i języka ma charakter etapowy. Przykład periodyzacji rozwoju jest podany przez L. Kaczmarka.1 Autor wyróżnił następujące etapy kształtowania się i rozwoju mowy:

  •  Okres przygotowawczy (wstępny lub zerowy) . Obejmuje on przedział "wieku" od 3 do 9 miesiąca życia płodowego. W tym czasie u mającego przyjść na świat dziecka wykształcają się narządy mowne i rozpoczyna się ich funkcjonowanie.
  •  Okres melodii (0 - 1 roku życia). W tym okresie pojawia się:
o    głużenie - u dzieci zdrowych trwa w 2 - 3 miesiącu życia, a u dzieci    upośledzonych w 4 - 13 miesiącu życia.
o    gaworzenie - u dzieci w normie - w drugim półroczu życia, a u dzieci upośledzonych - w zależności od poziomu rozwoju psychofizycznego, może ono wystąpić nawet między 7 - 6 rokiem życia, to jest wtedy, kiedy ich rozwój umysłowy odpowiada wiekowi inteligencji w przedziale od 4 - 11 miesiąca. 

  • Okres zdania (sygnału dwuklasowego). U dzieci zdrowych obejmuje trzeci rok życia (tu widać ogromny postęp w rozwoju mowy), a u dzieci upośledzonych okres ten wyraźnie się wydłuża - (4 - 13,5 rok życia). W tym przypadku ważny jest wiek inteligencji, ponieważ wraz jego wzrostem rośnie zdolność wypowiadania coraz to dłuższych  zdań.  
  • Okres wyrazu (1 -2 rok życia). U dzieci w normie obejmuje drugi rok życia, natomiast u dzieci upośledzonych okres ten przypada na czas 18 miesiąca do 10 roku życia.
Etapy w kształtowaniu mowy obrazuje tabela 1.

 

Okresy rozwoju dziecka

Okres kształtowania mowy

Dźwięki

Słownictwo

forma wypowiedzi

Okres prenatalny

Etap przygotowawczy         0 – 9 miesiąca życia płodowego
 

 
Rozwój mózgu oraz narządów mowy ( nadawania i odbioru)

Okres niemowlęcy

Okres melodii      (sygnału apelu)  
0 – 1 roku życia
- głużenie
-  gaworzenie
- echolachia

a e i
m b p d t

 

 
- krzyk,
                - płacz

Okres poniemowlęcy

Okres wyrazu                           (sygnału jednoklasowego)
1- 2 rok życia

o u a e y
p b m t d n l k ś ć 

 

Wypowiedzenia:
- jednoczłonowe
- wyraz- zdanie
- pseudozdanie

Okres zdania
(sygnału dwuklasowego)
2 –3 rok życia

a o u e y ę ą
p b m w f p b m w f
s z c
t d n i r
ś ź ć
k g x
s z c   ń

800- 1500 wyrazów:
  -rzeczowniki
 -czasowniki
     -przymiotniki
        -liczebniki
        -przyimki
        -spójniki
        -zaimki
  -przysłówki
 

 - wypowiedzenia dwuczłonowe
 - zdanie z podmiotem        i  orzeczeniem
 - zdania: oznajmujące,
  rozkazujące,
  pytające,
  wykrzyknikowe

Okres przedszkolny

Okres swoistej mowy dziecięcej                                            ( swoistych form językowych)
3 – 7 rok życia

s z c   r
 
 
wymowa opanowana

3500 a nawet 7000 wyrazów               (w zależności od środowiska wychowawczego)

Pełna umiejętność budowania wypowiedzi     i posługiwania się formami, które obowiązują.



Kształtowanie się i rozwój mowy u dzieci upośledzonych umysłowo jest zwykle opóźniony niż u dzieci w normie rozwojowej. Sygnalizowany jest przez późniejsze pojawienie się gaworzenia, pojawienie się pierwszych słów, ubogi zasób słownictwa, opóźnienie w zakresie gramatycznej budowy zdań, artykulacji głosek, itp.
Przyczyny opóźnionego rozwoju mowy można podzielić na zewnętrzne i wewnętrzne.
Do przyczyn zewnętrznych zalicza się:
"     oddziaływanie wychowawcze środowiska, np.: słabe zainteresowanie się dzieckiem i jego potrzebami;
"    pozbawienie dziecka kontaktu z matką;
"    nadmiar wzorców językowych, których dziecko nie jest w stanie opanować.
                                                                                              
Wśród przyczyn wewnętrznych można wyróżnić:

"    zaburzenie słuchu;
"    upośledzenie umysłowe;
"    organiczne uszkodzenie ośrodkowego układu nerwowego (OUN);
"    zaburzenia metabolizmu (wadliwa przemiana materii wymiernie blokująca działanie na rozwój komórek nerwowych, istotnych dla procesu rozwoju mowy).

Mniej ważnymi przyczynami mogą być:

"    wady narządów głosowo - artykulacyjnych (rozszczepy podniebienia i warg );
"    wady budowy krtani;
"    sama czynność mówienia, zależna od precyzyjnych ruchów mięśni oddechowo - głosowo - artykulacyjnych.
                                   

 
Opóźnienie rozwoju mowy niesie za sobą niekorzystne następstwa, a mianowicie:

"    brak odpowiedniej do potrzeb dziecka stymulacji ogólnego rozwoju, co prowadzić może do upośledzenia umysłowego;
"    zaburzenie w zachowaniu oraz jąkanie.



Dzieci z opóźnionym rozwojem mowy zaczynają mówić około 3 lub 4 roku życia, ich artykulacja jest na ogół słaba. Muszą być one pod stałą kontrolą i opieką foniatry lub logopedy, oczywiście przy wydatnej współpracy rodziców.              


Zaburzenia mowy u dzieci upośledzonych umysłowo


"Zaburzenia mowy są pewnym odstępstwem od ustalonej przez zwyczaj społecznej normy i polega na tym , że albo nie umiemy właściwie zbudować wypowiedzi, albo też jej percypować''.

Innym terminem pochodnym jest wada wymowy. Termin ten stosowany jest do określania wadliwych realizacji fonemów, odbiegających  od ustalonej przez tradycje normy. Wada wymowy dotyczy zaburzeń dźwiękowej strony wypowiedzi (elizje, zniekształcenia głosek , substytucje, itp.)
U dzieci upośledzonych umysłowo występują takie same zaburzenia mowy co u pełnosprawnych i zdrowych, lecz są "bardziej złożone i nawarstwione". A. Szuniewicz pisze, że "kiedy różne rodzaje wad są ze sobą sprzężone to mowa jest zupełnie zniekształcona. Zdaniem autorki, im upośledzenie głębsze, tym wada wymowy jest na ogół cięższa, bardziej skomplikowana i trudniejsza do usunięcia".  Należy więc postawić pytanie: co jest przyczyną tych wad?

Liczne nieprawidłowości w rodzaju mowy u upośledzonych umysłowo spowodowane są uszkodzeniami neurologicznymi tych układów, których prawidłowa budowa i funkcjonowanie decyduje o normalnym rozwoju mowy. Najpoważniejsze przyczyny wad wymowy to choroby przebyte we wczesnym dzieciństwie (np.: zapalenie opon mózgowych), wadliwa budowa narządów mowy oraz zaniedbania środowiska. Mowa jest wzorem, według którego kontaktuje się mowa małego dziecka.
W logopedii spotyka się różne klasyfikacje wad i zaburzeń mowy. Zaburzenia mowy mogą być rozpatrywane z dwóch punktów widzenia: etiologii i symptomatologii (objawy). Te oparte na kryterium etiologicznym i patomechanizmach, mają na celu ustalenie źródła powstawania nieprawidłowości utrudniających porozumiewanie się.

 
J. Styczek wyróżnia zaburzenia pochodzenia:

"    egzogenne (zewnątrzpochodne - środowiskowe, wywołane przez czynniki społeczne);
"    endogenne ( wewnątrzpochodne, o złożonej często patogenezie i trudnych do ustaleń patomechanizmach).
                                                                                                                                                            

Autorka wymienia następujące rodzaje wad wymowy, są to:

"    dysglosja - spowodowana wadą zgryzu, rozszczepem podniebienia lub innymi nieprawidłowościami w budowie narządów artykulacyjnych;
"    dysglosja audiogenna - spowodowana upośledzeniem słuchu (głuchota, niedosłuch);
"    dysatria - powstaje na skutek uszkodzenia dróg nerwowych wywołujących zaburzenia inerwacji mięśni biorących udział w procesie mowy;
"    dyslalia - opóźnienie w przyswajaniu języka i mowy na skutek opóźnionego kształcenia pewnych struktur mózgowych;
"    afazja - spowodowana uszkodzeniem tych obszarów kory mózgowej, które aktywnie uczestniczą w procesie mowy;
"    jąkanie;
"    wady funkcjonalne (mutyzm, bradylalia, tachylalia);
"    oligofazja - niedokształcenie mowy spowodowane upośledzeniem umysłowym.                                              

Bardziej rozbudowaną klasyfikację zaburzeń mowy opracował L. Kaczmarek. Klasyfikacja  ta uwzględnia nie tylko objawy, ale i przyczyny powstałych zaburzeń. Zdaniem autora punktem wyjścia do ustalenia rodzaju zaburzeń jest wypowiedź, a przede wszystkim treść, forma językowa i substancja foniczna. W następstwie tego, daje się wyróżnić zniekształcenia treści, formy językowej oraz substancji fonicznej w obu płaszczyznach: suprasegmentarnej i segmentalnej.
Zniekształcenia treści obejmują zaburzenia procesu uogólniania i abstrakcji, brak logiki w budowanych tekstach oraz zaburzenia ukierunkowania w myśleniu. Mogą być spowodowane chorobami psychicznymi i epilepsją, chorobami naczyniowymi mózgu. Mają one  związek z nieprawidłowościami w funkcjonowaniu języka oraz ze zniekształceniami substancji graficznej.
Zniekształcenia w zakresie formy językowej obejmuje pierwotny brak mówienia i rozumienia, czasem również utratę obu tych zdolności przy nabytych uszkodzeniach mózgu, np.:
"    afazja - utrata zdolności budowania tekstów słownych;
"    agramatyzm - budowanie wypowiedzi z samych symboli bez uwzględnienia reguł gramatycznych;
"    przejęzyczenia - pomyłka w wypowiedzi słownej i pisanej.


Zaburzenia substancji obejmują nieprawidłowości zarówno w płaszczyźnie suprasegmentalnej, przejawiające się w płynności wypowiedzi np.: jąkanie, tachylalia, bradylalia, giełkot, zaburzenia głosu (afonia, dysfonia, fonasteria, rynolalia, utrata lub zatracenie zdolności postrzegania i odtwarzania układów rytmicznych), jak w płaszczyźnie segmentalnej, powodujące różnorodne wady artykulacyjne (wady wymowy).
U jednostek upośledzonych umysłowo często występuje niedorozwój mowy. Powstaje on na ogół na tle ogólnego niedorozwoju dziecka, a więc fizycznego i niedorozwoju umysłowego. Niedorozwój mowy jest tym głębszy, im głębszy jest niedorozwój umysłowy. W niedorozwoju umysłowym głębokim opanowanie mowy waha się w granicach od niemocy do zdolności wypowiadania kilku słów. W niedorozwoju znacznym mowa opiera się na zdaniach prostych lub składa się z wyrazów wspomaganych gestami. Słownictwo dzieci z diagnozą znacznej i umiarkowanej niepełnosprawności jest na ogół bardzo ubogie. W niedorozwoju umiarkowanym występuje zwolnione tempo rozwoju mowy. Natomiast w niedorozwoju lekkim wypowiedzi są ubogie pod względem leksykalnym - przeważa w nich słownictwo bierne. Dzieci młodzież mają trudność w przyswajaniu słownictwa i bezsensownym rozumieniu wypowiedzi.

U dzieci z normą intelektualną, mowa jest ośrodkiem pośredniczącym w procesie rozwoju myślenia i wyobraźni. Dzięki niej, łatwiej orientuje się w nowych sytuacjach, a poprzez słowa rozwiązują zadania. Natomiast dzieciom upośledzonym umysłowo, mowa pomaga jedynie przy najprostszych zadaniach. Dlatego też nieopanowanie mowy wraz z prawami rozwojowymi osłabia wyuczone reakcje spostrzeżeniowo - ruchowe.
Ocena rozwoju mowy i jej zaburzeń u dzieci upośledzonych jest trudna. Korekta wad wymowy zależy od wczesnej diagnozy oraz intensywnej i właściwie organizowanej pomocy logopedycznej przy współudziale rodziców i nauczyciela. Kształtowanie się mowy dzieci upośledzonych jest procesem znacznie wolniejszym niż dzieci w normie intelektualnej. Praca ta wymaga od logopedy rzetelności, systematyczności, a przede wszystkim umiejętności postępowania z dzieckiem, o specjalnych potrzebach edukacyjnych.

Literatura:
G. Tkaczyk (1998): Rehabilitacja mowy u dzieci upośledzonych umysłowym - studium przypadku, "Logopedia",
L.Kaczmarek (1975): Korekcyjna klasyfikacja zaburzeń słownego i pisemnego porozumiewania się, Logopedia,
J. Styczek (1979): Logopedia, PWN, Warszawa.

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