Foreword: Hello viewers and netizens, you are watching the Healthy Henan Program, I am the host xxx. The child is the crystallization of the parents' love, and with the cry of the baby landing on the ground, the growth of a new life has begun. When the baby begins to learn the language and make the first "ba ba" and "ma ma" sounds, we can always be moved to tears. The child's growth process is part of the parent's life, the process is long and hard, but full of happiness.
However, there is a special group of "autistic" children, they are "children from the stars", many of these children are unable to communicate normally in language, and all have speech and language development delays. Therefore, for parents of children with "autism", it is often difficult to experience the happiness of normal verbal communication with their children. Every year, "April 2nd" is World Autism Day, in order to help parents and friends learn more about the language rehabilitation of "autistic" children, today we invited Dr. Zhang Xi and Zhang Yu of the Children's Encephalopathy Diagnosis and Rehabilitation Center of the First Affiliated Hospital of Henan University of Traditional Chinese Medicine to talk to us about this topic.
Highlights of this issue:
Moderator: Today, our topic is mainly around the rehabilitation of language disorders in children with "autism". First of all, we asked Dr. Zhang to talk about the problems of language development in children with autism.
Zhang Xi: Okay, moderator. The premise of our problem is to first understand what the problem is. Therefore, the premise of wanting to promote the development of language ability in children with "autism" is to first help parents and friends understand what is the language problem of children. The language problems of children with autism are mainly in the following aspects:
1. Can't speak at all
In our clinic, some autistic children are completely speechless when they are diagnosed, the language level is in the pre-speech stage or in the language preparation period, occasionally send "baba, mama" syllables, but there is no practical meaning, self-talk, call out these syllables are not purposeful and directive, parents often say that we will call Dad, Mom, but when you let him call him he is not called, The reality is that the child may not know what the meaning of these syllables he is uttering to himself.
2. Can say simple things, but can not be used for socializing
Most children with autism actually have this question, can say a few words, but it is often non-social language, such as you ask the child, "What is your name", the child gives you the answer is "I have eaten", you ask "How old are you", and the answer is "I am great". These kids will say, but the problem is "won't work."
3. There are some languages that can carry out basic daily expressions, but there are problems with speech, intonation, grammar and so on.
The language problem of these children is not only "will not be used", but also "not used well", for example, if you ask a 3-year-old child, "Do you eat apples", the child's answer is "apples eat me"; For example, when children sing children's songs, "the tone is particularly high, the voice is particularly loud, the voice is particularly sharp, there is no pause between sentences", and there are still problems such as "some syllables are not pronounced clearly".
4. Can have basic dialogue, but often can not carry out back and forth dialogue, mainly one-way dialogue, often lack of emotion, the deep meaning of language can not be understood.
This kind of child's language level is basically can be normal expression, you ask the child's questions, he can also organize the language to use the correct grammar rules to answer, but the communication between the two people is basically in the form of you "ask" him "answer", is a one-way dialogue, and it is difficult to understand the feelings in the expression process into the emotions, emotions, it is difficult to understand the metaphors, exaggerations of these syntax. This kind of "autistic" children are often easily ignored by parents, because parents feel that children can talk is not "autism". In fact, this is the wrong idea.
In the usual process of receiving treatment, often encounter parents with children to come to the doctor, the main complaint is that my children understand everything, that is, do not speak or say less, in fact, the judgment of the language ability of autistic children is not only to see how much to speak or the length of sentences, not to speak children are autistic, talking children are not autistic.
Moderator: After listening to Dr. Zhang's professional explanation, I believe that all parents can have a preliminary understanding of the language problems of "autistic" children. In order to help parents and friends compare their children's language levels, we ask Teacher Zhang Yu to introduce the normal children's language development rules.
Zhang Yu: Okay, moderator. Although children develop language early and late. But it will generally follow the following development laws.
First unconscious communication phase (0 to 4 months)
At this stage, babies use crying to express their discomfort or needs. Parents understand the crying or grunting of babies according to their own ideas. Babies are unaware of the effects of crying on parental behavior. • Can distinguish between male and female voices, sensitive to familiar sounds. • Can produce meaningless simple syllables, such as a, e
Conscious communication phase (4-9 months)
Children at 4 months of age can stare at what their parents are referring to with their eyes, and parents and children can focus on the same thing together. Children at 9 months of age can have communicative gaze, that is, not only look at things, but also turn to their parents and pay attention to their parents' reactions. Can distinguish some changes in tone, tone and timbre, understand simple words, gestures, such as "ball, dog", etc., but understand is situational. Continuous syllables, such as da-da-da, are often emitted, and these sounds are used to attract adult attention.
Word-sentence phase (9-18 months)
? At this stage, children's language comprehension ability increases greatly, but most of the syllables that can be produced are only monosyllabic words or two-syllable overlapping words, and the number is only about 50. At this time, babies often use one word to represent a sentence. For example, "mother" often means multiple meanings: mother hug; Mom I want to eat; Mom I want to play.
Two-word sentence stage (1.5-2 years old)
? At this stage, there is a "word explosion", which can express about 300 words, and in terms of sentences, there are sentences composed of two words, that is, two-word sentences. Such as "Daddy's Class", "Apple Cut".
Early sentence-building stage (2-3 years old)
? At this stage, children can describe situations with simple sentence structures such as nouns plus verbs, and can use sentences of 3-5 words for daily communication. By about 36 months, children can basically express themselves in short sentences, and begin to enter a complete sentence-making system, master the basic grammar, and begin to form a sense of language.
Sentence mastery stage (3-5 years old)
? At this stage, children master most of the grammatical structures, can use simple sentences and more complex sentences, and can understand the abstract relationships between words to a certain extent.
Full Grammar Stage (After 5 Years - Adult)
5 years old is a watershed in children's language development, and 5 years old children have established a basically complete grammar system. After that, children continue to expand their vocabulary, improve the use of language in different environments, and constantly develop the meaning of sentences and the use of language in a more advanced direction.
The above is the basic law of children's language development, and parents can combine the child's age to compare the child's language development level. However, there are individual differences in the development of different children, and there are morning and evening differences between a certain stage or a new feature, and the gap is either ten days and a half months, and some can reach 2-3 months.
Moderator: Yes, now we have a deeper understanding of children's language development as a gradual process, a process from scratch, from simple to complex. The level of language development of children of the same age is not completely consistent, so what factors affect language development? Next, we asked Dr. Zhang to answer you.
Zhang Xi: Well, okay, moderator.
Language acquisition and development is not a simple process, this process mainly involves physiological, cognitive, interpersonal interaction, social environment and other factors, in general, language acquisition to meet the following three basic conditions.
First of all, the acquisition of language must be based on a certain physiological basis. Our hearing system can be used to hear, receive, and give meaning to sounds. The organs of speech can produce speech. Children with hearing impairment, because the auditory system fails to effectively analyze and receive sounds, it is difficult to learn to speak through imitation, affecting the development of language. Some children with abnormal vocal organs, such as young children with cleft lip and palate, have excessive nasal sounds when speaking due to the different structure of the lips and the hard and soft palate. There is also our central nervous system, which is used to understand language and emit language actions.
In addition, from the perspective of neurodevelopmental factors, children's language is also affected by cognitive ability, and cognitive development affects children's recognition of speech sounds, speech understanding and organizational expression. Studies have shown that the development of brain nerves is the basis of children's cognitive and language development, when children are just born, the average weight of the brain is 390 grams, 3 years old is 1100 grams, 7 years old has been almost the same as the weight of adult brains. After the age of 1 and a half, the complexity of neural networks in the brain continues to increase, and children's cognitive abilities are further enhanced. According to Piaget's theory, children at this stage slowly begin to be able to connect words with concrete things. In the first three years of the fastest brain development, children's language skills also develop the fastest. Language level actually reflects the level of brain development to a certain extent. Because the areas of the brain responsible for language develop at different times. The order of maturation of the language center in the child's brain is: listening, reading, speaking, and writing. Children's language ability is consistent with the order of brain neurodevelopment. Children are responsible for hearing, discerning, and understanding the meaning of words, which predate the development of expression and pronunciation skills. Children's language accumulates to a certain amount, and the coordinated movements of the mouth can make speech, and they will only speak. If the brain neurodevelopment falls behind, the language ability will also be affected. Therefore, the doctor of children with autism and language delay will recommend doing a brain MRI examination to determine brain development.
In addition, the family environment, social environment, human cultural practices, etc. can all lead to differences in children's language levels. The learning and use of languages is often inseparable from life and communication with people. Therefore, in the process of examining children's language development, we must also pay attention to the social environment and the characteristics of interactors. For example, if a child living in a family that likes to read has been exposed to books at a very young age, his ability to read words may be better developed than that of ordinary children. It is worth emphasizing that the common phenomenon in contemporary society is the premature exposure of children to electronic products. Electronic video exposure in children is becoming more common and progressively younger. At present, there are many studies on the effect of early video screen exposure on children's language development, and the results show that long-term screen exposure will affect the family language environment and children's sleep, which is not conducive to children's language development and can also lead to attention deficits. In addition, with the development of the city, the elevator building has replaced the traditional open space for raising, and children lack contact with children of the same age, most of the time is around their parents and families, inadvertently separating children from the language environment. In addition, urban families often coexist in Mandarin and dialects, or expose children to multiple languages at the same time, confusing their language hearing and also affecting children's language development.
Therefore, a variety of factors can affect children's language development, specific to each child, should actively remove unfavorable factors, so that children can be in a healthy language environment.
Host: It turns out that there are so many factors that affect a child's speech. In fact, there are many children around us who are more than 2 years old and talk is not good, parents and friends are very anxious, in order to help children's language development, how can parents do at home to promote children's language skills? Please ask Teacher Zhang Yu to introduce it to parents and friends.
Zhang Yu: The development of children's language skills actually requires parents to provide a good environment. In the process of raising,
1. First of all, parents should seize every opportunity to interact with their children in life, and actively encourage children to express themselves, and children who cannot speak can also respond with actions and eyes. It is necessary to give positive reinforcement and strengthen the willingness to express it. When the child is not willing to express, do not be harsh, do not pay too much attention, and avoid the child's pressure on the expression itself.
2. Also, don't be satisfied immediately. Some families take care of their children "meticulously", children want to drink water, there is no squeak, the water has reached the mouth. In this way, of course, the child does not say it, and it will also affect the language development to a certain extent. Children should be encouraged to express their needs, even if it is not standard, it does not matter, really do not want to say it to point it out, so that children slowly realize the role and importance of communication.
3. At the same time, it is also necessary to find the right time and pay attention to the form. When we talk to children, we should talk about what the child is paying attention to or is interested in, such as seeing what the child is watching and listening to. For older children, you can observe what they are interested in in the near future. Two- and three-year-old boys will be very fond of toy cars, then we can find picture books about cars for children to read, go to the side of the road to recognize different car logos, teach children's songs related to cars, do car-related games, and so on. These can stimulate children's interest in active communication.
4. Also, give your child more stimulation of nonverbal information, such as the exercise of fine hand movements. Studies have shown that children's level of language development is highly correlated with fine finger movements. The reason may be that the cerebral cortex responsible for hand movement is close to the language center, and nerve impulses are transmitted to each other.
5. Finally, language skills include listening, speaking, reading and writing, and should promote their overall development. In young children, the first thing that should be trained is listening and speaking, and after school, we should pay attention to the skills of reading and writing. However, some parents think that they have to read in primary school, so they let children read prematurely, while ignoring the exercise of listening and speaking, from the perspective of developmental psychology, this practice is not advisable.
In short, parents should not let the whole communication process become boring, but should interact with children in a fun and age-appropriate way. Enhance children's initiative in communication and promote the all-round development of language skills. There is also the fact that in the contemporary social environment, it is recommended that children under the age of 2 try not to touch electronic screens, children aged 2-5 years old do not exceed 1 hour of high-quality programs per day, if possible, parents should watch with their children, and children over 6 years old limit the use of screens in quantity and quality.
Host: Yes, I believe that through the method explained by teacher Zhang Yu, the child's language skills will definitely improve, but parents and friends are still not at ease, how to judge that language development is delayed and need to go to the hospital for treatment? Dr. Zhang, please give us a trick.
Zhang Xi: If the 2-year-old child can actively say less than 50 words, and the 2-and-a-half-year-old can say less than 5 sentences, it is a suspicious object of language delay, that is to say, the child's language level has lagged far behind that of children of the same age. Parents and friends must be vigilant.
It is recommended that parents actively pay attention to the child's language level, do not wait until the gap between the child is lagging behind and think of going to the hospital for treatment, because the plasticity of the brain of 0-6 years old is very high, even if there is a problem found in time, it can be remedied to the greatest extent. In fact, in clinical work, it is often found that many parents and other children can not speak until the age of 4-5 years old to intervene. Often many children are older when they visit the doctor, missing the best time for treatment, which is painful. Because in our Chinese there is a saying called "noble people speak late", many people mistakenly understand that children do not speak is "noble", and the elderly in the family often say "it will be good when you are old". Some parents are holding a wait-and-see attitude, holding a fluke mentality on the one hand, and at the same time are very contradictory. A few years passed, and when it was found that the child's language was still backward, he made up his mind to go to the hospital, thus losing the opportunity for early diagnosis and early intervention.
In fact, it is understandable for the old man in the family to say such a thing. Because of the obvious individual differences in children's language development, most children will begin to speak other words besides dad and mom at the age of 1 and a half, but some children start to speak at the age of 1. In addition, the clarity of pronunciation is also different, and the sensitivity to surrounding language stimuli is also different. For example, some children, parents tell stories they love to listen to, some are not interested. Because the level of maturity of the language center in the child's brain will vary from person to person, some mature earlier and some later. However, for two- and three-year-old children who cannot speak, parents must implement more proactive and rich and diverse educational activities with language communication as the core for their children, and at the same time go to the hospital as early as possible to diagnose and treat, and give certain guidance on language intervention. Parents should go to the hospital to seek professional guidance and diagnosis and treatment when they find problems, if the degree of language lag is light, in addition to the language development of backwardness of other indicators of normal development, you can carry out family intervention under the guidance of doctors, and regularly follow up in the hospital. If there is severe language delay, parents and friends must be vigilant, can not report luck, must go to the hospital for further diagnosis and treatment. Because only by clarifying the cause can the right intervention be implemented. The language skills development of children with autism is not only an intervention in speech, but a comprehensive treatment plan that includes social skills training, behavioral intervention, cognitive level and so on.
Moderator: Yes, it is important to pay attention to the early detection of language development delay in children with autism, early recognition and early diagnosis, regular monitoring, and early intervention to promote the recovery of children. Just now there are parents and friends to consult the problem, autistic children's language ability is not good, etc. will it get better? Do parents want to send their children to kindergarten and learn from other children?
Zhang Yu: Okay. Let's answer the first question first, if children with autism do not have a language environment with intensive input, and lack effective interventions such as demonstration, shaping and reinforcement, then their language skills will not improve with age. Just like the first grade grade is not good, will it get better until the second grade, today is the foundation of tomorrow, so don't take chances, and intervene in time. Many parents have consulted with me about whether sending autistic children to kindergartens and learning and interacting with ordinary children can help children learn languages. In fact, not all autistic children, will be able to get better naturally in kindergarten, parents hope that children can learn from their peers, which requires children to have a certain ability to imitate and observe learning, this ability is difficult to develop naturally, many children need special training to obtain. In addition, although the kindergarten gets more stimulation, it does not mean that the child learns more. How much a child can learn depends not only on the child's own ability, but also on the way of teaching. If a child lacks concentration, comprehension, imitation, self-management ability, learning motivation, etc., even if the child's class is rich, it is difficult for the child to enter the learning situation. Secondly, if the learning content or guidance method cannot be adjusted in a timely manner for the child, the learning efficiency will be greatly reduced, but the pace of the kindergarten is too fast, and it is difficult to do individualized teaching for the child. Do not know whether it is appropriate to choose kindergarten, parents can try it in a 1-month period, within 1 month, significant progress, indicating that the choice is correct, within 1 month, obvious regression or no progress, but also need to continue to intervene.
Host: Some parents also mentioned a question, our children talk to the teacher in class, and when they come home, they don't talk to us.
Zhang Yu: In fact, this problem is also a place where many parents have doubts in their work, this child can talk, but he just does not open his mouth. This is the child's lack of active expression ability. Many parents have encountered this problem, and here are a few practical tips. If we want to let children take the initiative to express themselves, first of all, we must interact with children more and create a good language environment. To choose the topic of the moment, it is the natural topic that is happening now, the sight of the present, and the easy to understand. Especially children are interested. Try to cater to the child's interests and participate in the activities at the child's pace. If the child is very interested in the car, parents can accompany the child to play with the car, such as taking turns to push the car, basket to pick up the car, the car to build blocks high, use the car as a paintbrush to draw the lane and so on. In play, make high-quality language input. Parents can describe what the child is doing on the basis of the child's language ability and actively respond to the sound language actions made by the child. In addition, you can deliberately take away what the child wants, and then return the toy to him after he expresses the request he wants. Practice your child's ability to make demands. Secondly, although letting children take the initiative to express themselves is our ultimate goal. But before that, you can first train your child's ability to answer questions. For example, parents can take what their child wants (fruits, toys, etc.) and take one in one hand. Ask what you want, apple or banana, if the child has the ability to speak, it will say, at this time, parents can immediately reward the child with what they have in hand, and give praise and affirmation in time. If your child can't express it yet or simply doesn't want to answer, ask your child to point out what he wants. If the child still does not respond, the parent can tell the child what he wants. Give things to the child later. In addition, parents should learn to demonstrate to their children. For example, when taking a child, when hungry, the mother says "I want to eat xx" in front of the child's father, and uses the child's imitation ability to train his active expression ability. Let the child also follow the father to say "I want to eat xx", over time, after many exercises, gradually reduce the number of auxiliary demonstrations, so that when the child feels hungry, he will also take the initiative to express the needs of "I want xx". This process may take dozens or even hundreds of exercises, and it is normal to encounter setbacks in the middle, as long as you are willing to face the problem, care and be patient with the child, and then cooperate with appropriate care and training. They can thrive happily.
Moderator: Okay, thank you two teachers for sharing professionally. Some netizens also said that in the rehabilitation process of autistic children, parents are eager to treat, but also through some detours, the end of the program, please Dr. Zhang to do some guidance for everyone to help children achieve the fastest and best treatment effect.
Zhang Xi: This is the focus of my emphasis. Because the treatment of autism is based on comprehensive rehabilitation treatment, there is no specific drug that can treat the core symptoms of autism, so in the process of rehabilitation, many parents will feel anxious, and often have a lot of doubts, ask a variety of questions, today I will answer it for parents and friends.
Summary mainly has the following aspects: First of all, parents are very anxious, thinking that the child has diagnosed autism, very worried about the child's future, so I hope that the child will make great progress in a short period of time, but language learning is not a short-term process, from the moment the newborn is born, it begins the preparation process before the language, until the age of 3 years old kindergarten can communicate with adults, after 6-7 years old to primary school to use language to learn cultural knowledge, so long process is accompanied by language learning, We parents and friends can combine their own language learning experience, such as the study of English, we began to learn English from primary school when we were young, but how is your English learning now? Some parents will feel that my English level is still not good, so we should abandon the attitude of "seedlings and growth" and actively cooperate with rehabilitation treatment, and our doctors and rehabilitation teachers will work together with parents to improve their children's social language skills as much as possible.
Also, some parents will ask me a question, "We don't talk, is it because the tongue tie is short?" Do you use the tongue tie to cut the tongue?", the short tongue tie does affect the pronunciation of some syllables, but clinically I have also seen that the language of children after cutting the tongue tie still has no improvement, and finally the hospital visit has made significant progress through rehabilitation training language. Even if the child is really short of tongue ties, some conditions can be corrected by early training and do not require surgery; So to say: the problem of speaking is not solved by cutting the tongue tie, in fact, the relationship between the two is very small.
Another very common phenomenon is the problem of screen exposure. When I see a child in the hospital, I often hold a mobile phone, you call him, he also ignores you, take the mobile phone away The child will lose his temper and roll around, which is really a problem that I have to tell my parents every time I check the room. In fact, we strongly recommend that young children try to avoid contact with electronic products, especially smart phones, and the American Pediatric Association recommends that contact with electronic products is prohibited within 2 years of age. Some parents think that children can "learn knowledge" by looking at mobile phones, in fact, it is not so, early contact with electronic products will affect the child's development level, can reduce learning ability, because the process of looking at mobile phones is a one-way input process, no output process, summed up is that there is no language communication interaction between children and mobile phones, which is an unfavorable language learning environment. And after a long time, because the mobile phone picture, sound, content, storyline is more attractive than the real world, the child will be immersed in the virtual world, the interaction with reality is more lacking, when the parents take away the mobile phone, the child begins to show emotional behavior problems, such as relying on the mobile phone, tantrums, hitting people or self-harm, inattention, sitting still and so on.
Finally, or a strong appeal, in addition to giving enough social attention to "autistic" children, parental care, high-quality companionship guidance is the most important, parents should adjust their mentality, because the normal children's language learning process is also a long-term, persistent, step-by-step process, parents and friends to learn to master some basic training skills, must start from the daily life of self-care ability training, social skills mastery, more interaction with children, do not play with mobile phones while taking children, to do a good companionship, High-quality companionship is the focus of family intervention. At the same time, the doctors and rehabilitation teachers in our department will work together with parents to help children recover faster.
Guests in this issue:
Zhang Xi
Master of Medicine, Attending Physician of The First Affiliated Hospital of Henan University of Traditional Chinese Medicine, Pediatric Encephalopathy Diagnosis and Rehabilitation Center, specializes in the diagnosis and treatment of children's autism, language development delay, mental retardation, attention deficit hyperactivity disorder, tic disorder, cerebral palsy, brain injury and other diseases.
Zhang Yu
Master of Supervisor Rehabilitation Therapist
The First Affiliated Hospital of Henan University of Traditional Chinese Medicine
Leader of speech therapy team at the Children's Encephalopathy Diagnosis and Rehabilitation Center
Deputy Leader of speech therapy team of Henan Rehabilitation Medicine Association
Member of Speech Therapy Branch of Henan Rehabilitation Medicine Association
Graduated from Henan University of Traditional Chinese Medicine with a major in rehabilitation medicine, he is engaged in the prevention, evaluation, diagnosis and treatment of children's speech, language, social communication, cognitive communication and swallowing disorders. He has participated in domestic professional training for many times, studied in the Speech Therapy Department of Shenzhen Children's Hospital for half a year, is good at the assessment and intervention of children's language delay, autism children's language disorder, speech disorder, swallowing disorder and feeding, and has rich clinical experience in the pronunciation, logical expression and treatment plan course design of various speech disorders.