KETERLAMBATAN BICARA

KETERLAMBATAN BICARA.

LATAR BELAKANG. Keterlambatan bicara->keluhan yang sering dijumpai pada praktik dokter anak 3- 10% anak ,lebih sering pada anak laki-laki Merupakan gejala dari kelainan : RM,gangguan pendengaran,gangguan bicara ekspresif,autis atau cerebral palsi 42,5% anak yang terlambat perkembangan bicaranya akan mengalami gangguan membaca dan kognitif di kemudian hari 1.

PERKEMBANGAN BICARA. pusat bicara pada anak right-handed dan 2/3 anak left handed terletak pada hemisfer otak kiri Maturasi sinaps bicara reseptif -> perkembangan area wernicke 8-24 bulan, bicara ekspresif -> area broca 15-24 bulan Anak di usia 2 tahun dapat berbicara dengan baik Gangguan hemisfer otak kiri di bawah 2 tahun-> gangguan bicara.

TAHAPAN PERKEMBANGANBICARA. Bentukan Perkembangan bicara normal -> cooing,babbling,echolalia,jargon,kata dan kombinasi kata dan pembentukan kalimat.

PERKEMBANGAN BICARA NORMAL. Pendengaran dan penegrtian Bicara 4-8 bulan Mata bergerak ke arah suara Respon terhadap suara Perhatian terhadap mainan yang mengeluarkan suara Perhatian terhadap musik Babbling dengan awal b,p,m Suara kegembiraan atau sedih Sura saat sendiri atau bermain 7 bulan- 1 tahun Mengerti ciluk ba Menoleh dan melihat ke arah suara Mendegarkan saat orang bicara Mengerti beberapa kata ( sepatu,,gelas Respon terhadap permintaan sederhana ( ke sini) Babbling denkata panjang dan pendek seperti tata,bibibi Menggunakan kata atau suara untuk mendapat pehatian Mengucapkan 1- 2 kata 1- 2 tahun Menunjuk anggota tubuh Mengikuti perintah dan permintaan yang mudah Mendengar cerita sederhana,lagu Kata – kata bertambah tiap bulan Menggunakan 1- 2 kata tanya Mengucapkan 2 kata bersamaan Mengucapkan 10 kata saat usia 19 bulan.

PERKEMBANGAN BICARA NORMAL. Pendengaran dan pengertian Bicara 2-3 tahun Mengerti perbedaan dengan artinya Mengikuti 2 tahap perintah : ambil buku itu dan letakan di meja Mempunyai kata untuk semua benda Berbicara dengan 2 -3 kata dalam kalimat.

DETEKSI DINI. Deteksi dini -> The early Language Milestone Scale Digunakan unyuk anak usia di bawah 3 tahun Menilai kemampuan ekspresif,reseptif dan visual Denver Developmental Screening test bila curiga adanya keterlambatan motorik kasar dan halus.

EARLY LANGUAGE MILESTONE SCALE.

Perlunya evaluasi lebih lanjut bila pada anak dijumpai keadaan : Tidak menunjukan babbling,menunjuk atau mimik yang baik pada umur 12 bulan Tidak ada kata pada umur 16 bulan Tidak ada 2 kata spontan pada umur 2 tahun.

Infants begin making sounds at birth. They cry, coo, and laugh…but in the first year they don’t really do much talking.

What is Language?. Think about your language…maybe you even speak more than one! What makes a language? This is a broad concept…language is a system that relates sounds or gestures to meaning. Language is expressed through speech, writing and gesture..

There are four distinct elements to language. -Phonology refers to the sounds of a language Semantics is the study of words and their meaning Grammar refers to the rules used to describe the structure of a language Which involves syntax or rules that specify how words are combined to form sentences Pragmatics is the study of how people use language to communicate effectively.

Children must learn to hear the differences in speech sounds and how to produce them; they must learn the meaning of words and rules for combining them into sentences and they must learn effective ways to talk with others.

Phonemes. The basic building blocks of language The unique sounds that can be joined to create words The sound of “p” in pin, pet, and pat The sound of “b” in bed, bat, and bird Infants can distinguish many of these sounds, some of them as early as 1 month after birth Can discriminate sounds they have never heard before such as phonemes from a foreign language.

The language environment for infants is not solely auditory. Much language exposure comes from face-to-face interaction with adults.

Infants use many tools to identity words in speech. They don’t understand the meaning of the word yet, but they can recognize a word as a distinct configuration of sounds.

Parents and adults help infants master language sounds by talking in a distinctive style.

Language development. Infants are equipped for language even before birth, partly due to brain readiness, partly because of auditory experiences in the uterus.

Adults Use Infant-Directed Speech. Adults speak slowly and with exaggerated changes in pitch and loudness and elongated pauses between utterances Also known as parentese, motherese, or child-directed speech Infant-direct speech may attract infants’ attention more than adult-directed speech because its slower pace and accentuated changes provide the infant with more salient language cues Helps infants perceive the sounds that are fundamental to their language.

When talking to girls, adults use more words like “doggie” and “blankie” whereas with boys, adults use more words like “dog” and “blanket”. Girls hear twice as many diminutives..

If infant-directed speech helps infants perceive sounds that are essential to the development of their language….

Deaf Children. About 1 in every 1,000 American infants is born deaf Over 90% of deaf children have hearing parents These children are often delayed in language and complex make-believe play.

Deaf infants and toddlers seem to master sign language in much the same way and at about the same pace that hearing children master spoken language. Deaf 10-month-olds often “babble” in signs: they produce signs that are meaningless but resemble the tempo and duration of real signs.

Deaf Children. Compared to hearing children, babbling of deaf children is delayed However, if they are exposed to sign language development will be right on schedule with normal-hearing children’s speech development Hearing “dog”, infants in the middle of the first year of life may first say “dod” then “gog” before finally saying “dog” correctly The same gradual progression will occur with sign language – infants will make mistakes at first before making the correct sign for dog.

Speech Production. At 2 months, infants begin making sounds that are language-based Starts with cooing They begin by producing vowel-like sounds, such as “ooooo” and “ahhhh” At 5 to 6 months, infants begin making speech-like sound that have no meaning Cooing turns into babbling.

“Baby Talk”. Babbling is the extended repetition of certain single syllables, such as “ma-ma-ma, da-da-da, ba-ba-ba” that begins at 6-7 months of age..

“Babbling”. Over the next few months, babbling incorporates sounds from their native language..

First Words. Infants first recognize words, then they begin to comprehend words At about 4 ½ months of age, infants will listen longer to a tape repeating their own name than to a tape of different but similar name At about 7-8 months of age, infants readily learn to recognize new words and remember them for weeks.

At 6 months – if an infant hears either “mommy” or “daddy”, they look toward the appropriate person..

By their 1 st birthday, infants usually say their first words, usually an extension of babbling..

The Importance of Symbols. Children begin using gestures, which are symbols shortly before their first birthday. Gestures and words convey a message equally well…sometimes gestures pave the way for language In one study, 50% of all objects were referred to first by gesture and, about 3 months later, by word (Iverson & Meadow, 2005).

After children know that objects have names, a gesture is a convenient substitute for pronouns like “it” or “that” and often cause the adult to say the object’s name.

Names for everything!. Once an infant’s vocabulary reaches about 50 words it suddenly begins to build rapidly, at a rate of 50-100+ words per month, mostly nouns. This language spurt occurs around 18 months and is sometimes called the Naming explosion ..

Productive Vocabulary. Early productive vocabularies of children in the US include names for people, objects, and events from the child’s everyday life. Frequent events or routines are also labeled, such as “up” or “bye-bye” Nouns predominate the early productive vocabularies of children.

The rate of children’s vocabulary development is influenced by the amount of talk they are exposed to The more speech that is addressed to a toddler, the more rapidly the toddler will learn new words.

Word Comprehension. Fast Mapping is the process of rapidly learning a new word simply from the contrastive use of a familiar word and an unfamiliar word The children’s ability to connect new words to familiar words so rapidly that they cannot be considering all possible meaning for the new word.

Example of Fast Mapping. In a preschool classroom, an experimenter drew a child’s attention to two blocks – asking the child to “get the celadon block not the blue one” From this simple contrast, the child inferred that the name of the color of the requested object was “celadon” After a single exposure to this novel word, about half the children showed some knowledge of it a week later by correctly picking the celadon color child from a bunch of paint chips.

Give Fast-Mapping a try…. Answer the following questions on you own..

This is a snurk. It walks on its flaxes. How many flaxes does a snurk have?.

These questions put you back in toddlers shoes listening to adults speak. Like toddlers, you all must rely on context to comprehend the strange vocabulary to describe the snurk..

Early Errors in Language. One common inaccuracy is underextension –using a word too narrowly. Using the word “cat” to refer only to the family cat Using the word “ball” to refer only to a favorite toy ball.

Sarah refers to the blanket she sleeps with as “blankie”. When Aunt Ethel gives her a new blanket Sarah refuses to call the new one a “blankie” – she restricts that word only to her original blanket..

Overextension. The use a given word in a broader context than is appropriate Common between 1 and 3 years of age More common than Underextension Toddlers will apply the new word to a group of similar experiences “Open” – for opening a door, peeling fruit, or undoing shoelaces.

Language Errors. Children overextend because they have not acquired another suitable word or because they have difficulty remembering a more suitable word Examples: Ball referring to ball, balloon, marble, egg, or apple Moon referring to moon, half-moon shaped lemon slice, or half a Cheerio Car referring to a car, bus, truck, or tractor Daddy referring to dad or any man Doggie referring to dog or any four-legged animal.

Making Sentences. Most children begin to combine words into simple sentences by 18 to 24 months of age Children’s first sentences are two-word combinations referred to as Telegraphic speech Words directly relevant to meaning Words not critical to the meaning are left out – similar to the way telegrams were written such as: Function words: a, the in Auxiliary words: is, was, will be Word endings: plurals, possessives, verb tenses.

These sentences are brief and to the point, containing only vital information.

By about 2 ½ years of age, children have the ability to produce more complex sentences (four or more words per sentence). The longer sentences are filled with grammatical morphemes (words or endings of words that make sentences more grammatical). A 1 ½-year-old might say “kick ball” but a 3-year-old would be more likely to say “I am kicking the ball”.

Overregularization. Speech errors in which children treat irregular forms of words as if they were regular. Applying rules to words that are exceptions to the rule This leads young children to talk about foots, tooths, sleeps, sheeps and mouses. Although technically wrong, Overregularization is a sign of verbal sophistication because it shows children are applying the rules to grammar..

Between 3 and 6 Years of Age. Children learn to use negation “That isn’t a butterfly” Children learn to use embedded sentences “Jennifer thinks that Bill took the book” Children begin to comprehend passive voice as opposed to active voice “The ball was kicked by the girl” as opposed to “The girl kicked the ball” By the time most children enter kindergarten, they use most of the grammatical forms of their native language with great skill.

The development of language in children is amazing, but how do they do it?.