Developmental dysphasia

Developmental dysphasia, also known as a specific language impairment (SLI), is characterized by a reduced ability or complete inability to learn to communicate verbally, even when the conditions for speech development are adequate.

In developmental dysphasia, there is a disruption in the central processing of speech signals. This means that while the child can hear and see properly and has no auditory or visual impairments, their central nervous system and brain are unable to adequately process auditory and visual signals from their environment. Delayed speech development and language disorders are more commonly observed in boys.

Main characteristics of the disorder

• Delayed speech development: The child's vocabulary does not match their age, they may not form complete sentences or may only use short, simple sentences with grammatical errors. They may leave out prepositions, distort words, misuse word endings, fail to use all parts of speech, rearrange word order, or struggle to use reflexive pronouns like "se" and "si".

• Speech sound disorders (dyslalia): The child speaks unclearly, or their speech may be difficult for others to understand. They may replace certain sounds in words, omit sounds or syllables within words, and have difficulty pronouncing certain phonemes.

• Uneven development: There is a significant discrepancy between the child's verbal and non-verbal abilities (this difference can be identified by a clinical psychologist).

• Impairment of memory functions: Developmental dysphasia is often associated with deficits in short-term verbal memory. For example, the child may struggle to repeat long words without distortion or repeat multi-word sentences. At two years of age, a child should be able to repeat a two-word sentence, at three years a three-word sentence, and so on.

• Impairment of visual perception: This is often seen in the child's drawings, where the human figure may have disproportionate body parts. Their drawing skills are often significantly delayed compared to their peers.

• Impairment of auditory perception: Children with developmental dysphasia have difficulty distinguishing between individual phonemes and may struggle to differentiate between similar-sounding words (e.g., "dog" vs. "dock", "coat" vs. "goat", or "pear" vs. "bear").

• Impairment of spatiotemporal orientation: These children may struggle with concepts such as left and right, or the understanding of time concepts like yesterday, tomorrow, morning, evening, etc. They may also struggle to understand family relationships (e.g., uncle, aunt, cousin, brother).

• Impairment of gross and fine motor skills: Children with developmental dysphasia may have difficulty coordinating the movements of their arms and legs (e.g., standing on one leg, hopping on one foot, alternating hand movements, weaving through cones, or learning to ride a scooter, bicycle, or skis).

• Laterality issues: Laterality refers to the dominance of the right or left hand or eye. Children with developmental dysphasia often exhibit cross-dominance (for example, left-hand dominance but right-eye dominance, or vice versa). Some children may have mixed laterality, using both hands interchangeably when drawing or writing.

Primary reflexes and developmental dysphasia

Many symptoms of developmental dysphasia are similar to those caused by persistent primary reflexes. Let’s take a closer look at the impact of these reflexes.

Moro reflex

• Increased sensitivity to sensory stimuli: The child cannot focus properly unless they "shut themselves off" from their environment — but if they do this, they may no longer be aware of what is happening around them.

• Difficulty filtering background noise from relevant sounds (like speech). During normal development, grammar is learned naturally when children interact with their peers and adults (especially in preschool). Children with a persistent Moro reflex, however, may struggle to focus on the speech of others because they are constantly distracted by other sounds. As a result, they may not fully register the grammatical changes in words and endings.

• Impairment of short-term memory: This further affects their ability to follow instructions or learn new words and grammatical rules.

Imagine a child with these challenges in a noisy preschool classroom. After a short time, they may become agitated, as they cannot process the multitude of sensory inputs. Alternatively, they might retreat into themselves and play alone in a corner. If the teacher announces a transition to a new activity, the child may not hear or process the instruction. These children often rely on routines to compensate — for example, if they see that the other children have left to go to the changing area, they will follow.

These behaviors (playing alone, being unresponsive, disliking change) might be mistaken for signs of autism. Unfortunately, children with persistent Moro reflexes and/or developmental dysphasia are sometimes misdiagnosed as having autism spectrum disorder (ASD).

Tonic labyrinthine reflex (TLR)

• Gross motor difficulties: The child may try to move their whole body when performing simple movements (known as holokinetic movement). For instance, if they bend one leg, the change in muscle tone may cause them to also bend the other leg and arms. Skills like hopping on one foot or learning to ride a bicycle are especially challenging.

• Impairment of spatial perception and balance: This affects the child’s ability to understand left/right, up/down, front/back spatial concepts, as well as temporal concepts like today, yesterday, tomorrow, in an hour.

Asymmetrical tonic neck reflex (ATNR)

• Fine motor issues: This includes not only difficulties with hand movements but also issues with the fine motor movements of the speech organs (which impacts articulation) and eye movements.

• Reduced interhemispheric cooperation: If the two brain hemispheres do not communicate effectively, the brain requires more energy to function. This can result in slower responses, mental fatigue, and inattention.

• Delayed lateralization: This refers to the preference for using one of the paired organs (like the hands, feet, eyes, or ears) for specific tasks. Poor lateralization means that dominance is not established, and the child may alternate hands or feet for different tasks.

Sucking and rooting reflex

• Oral sensitivity and motor issues: These children may experience unusual sensitivity around the mouth and may struggle with the motor movements of the speech organs.

• Motor control issues in the hands: The Babkin reflex connects hand movements with mouth movements, so this reflex may also affect hand coordination.

• Unusual oral habits: Children may lick their lips (leading to chapped lips), drool, smack their lips, or spit. Speech articulation is affected, and the coordination of breathing, speaking, and eating can be problematic.

Palmar reflex

• Poor pencil grip: When a child holds a pencil, the palmar reflex causes their fingers to reflexively curl into a fist. This is why children often grip pencils with their whole hand.

• Hypersensitivity of the hand: The hand may be oversensitive to touch, leading to discomfort or awkwardness during writing or drawing activities.

In addition to speech therapy, it is advisable to check for persistent primary reflexes in children with developmental dysphasia. Reflex persistence is common in these children. If present, the reflexes should be inhibited through Neuro-Developmental Stimulation (NDS).

Author of the article: PhDr. Marja Volemanová, PhD.

Sources used

• Volemanová, Marja (2019). Primary Reflexes: An Overlooked Factor in Learning and Behavioral Problems in Children. 2nd expanded edition. Statenice: INVTS. ISBN 978-80-907369-0-0.