Castaño J
Servicio de Neuropediatría, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
Rev Neurol. 2002 Feb;34 Suppl 1:S107-9.
By 'Dysphasias' we mean disorders of language development in children, as opposed to Aphasias which is the term used for loss of previously acquired language as a consequence of focal cerebral lesions. The definition of Dysphasia refers to alteration in the expression or comprehension of language which cannot be explained by deafness, motor deficit, mental retardation, brain damage, emotional disorders or insufficient exposure to language (DSM IV). Even within this definition there is room for different criteria for inclusion. This is shown by the lack of homogeneity in the populations studied by different authors, depending to some degree on the age of the children studied (the symptoms and signs of dysphagia are not the same in a 3 year old child as in one of school age) and the intellectual level required to rule out mental deficiency. Once the differential diagnosis with other conditions has been established, we should try to situate the dysphasia as being due to faulty reception, emission or both. Allen and Rapin have defined 4 categories of Dysphasia with subtypes which permit more specific classification within the two spheres mentioned above (reception and emission). In the sphere of emission, with characteristics of lack of fluency of speech and better comprehension than elocution are: syntactic phonological deficit syndrome, phonological programming deficit syndrome, verbal dyspraxia and lexical syntactic deficit syndrome. In the sphere of reception, with comprehension more affected than elocution are: verbal auditory agnosia and pragmatic semantic syndrome. Although the work of Allen and Rafin was done on a population of English-speaking children, this classification has also been shown to be useful in the Spanish language. We give a detailed description of these syndromes, illustrating them with video recordings of clinical cases.
我们所说的“发育性语言障碍”是指儿童语言发展方面的障碍,与之相对的是“失语症”,后者是因局灶性脑损伤导致先前已习得语言丧失的术语。发育性语言障碍的定义是指语言表达或理解能力的改变,这种改变无法用失聪、运动功能缺陷、智力发育迟缓、脑损伤、情绪障碍或语言接触不足来解释(《精神疾病诊断与统计手册》第四版)。即使在这个定义范围内,对于纳入标准也存在不同的考量。不同作者研究的人群缺乏同质性就表明了这一点,这在一定程度上取决于所研究儿童的年龄(三岁儿童的吞咽困难症状和体征与学龄儿童不同)以及排除智力缺陷所需的智力水平。一旦与其他病症的鉴别诊断得以确立,我们就应尝试确定发育性语言障碍是由于接收障碍、表达障碍还是两者皆有。艾伦和拉平定义了4类发育性语言障碍及其亚型,这使得在上述两个方面(接收和表达)能够进行更具体的分类。在表达方面,具有言语不流畅且理解能力优于表达能力特点的有:句法语音缺陷综合征、语音规划缺陷综合征、言语失用症和词汇句法缺陷综合征。在接收方面,理解能力比表达能力受影响更大的有:言语听觉失认症和语用语义综合征。尽管艾伦和拉芬的研究是针对说英语的儿童群体进行的,但这种分类在西班牙语中也被证明是有用的。我们将详细描述这些综合征,并用临床病例的视频记录进行说明。