儿童语音障碍辅音错误222例病例系列报告

Consonant errors in 222 children with speech disorders:A case series report

背景语音障碍(SSD)是儿童期引起沟通障碍的常见病因,未经治疗的部分儿童症状可持续至成年,影响社交沟通。目的分析儿童SSD辅音错误的临床特征。设计病例系列报告。方法纳入2020年1月1日至2020年12月31日于成都市妇女儿童中心医院儿童保健指导中心因“发音不清”就诊、符合SSD诊断、语言发育≥4岁的连续儿童,排除合并影响语言功能的其他疾病者。语音评估采用图片命名法;辅音根据发音部位及发音方法进行分类分析;辅音正确率(PCC)=正确辅音个数/(正确辅音个数+错误辅音个数)×100%,<50%为重度,~65%为中重度,~85%为轻中度,~100%为轻度。从病历中截取SSD儿童的年龄、性别等人口学特征及语音评估结果。主要结局指标PCC和辅音错误类型。结果222名SSD儿童进入本文分析,女生67名、男生155名;4~5岁111名(50.0%)、~6岁66名(29.7%)、~15岁45名(20.3%)。男、女生的PCC分别为(43.3±20.9)%和(44.9±18.9)%,差异无统计学意义(P>0.05)。年龄与SSD严重程度呈线性关系(P<0.001),随年龄增长,重度辅音错误的占比降低;在各年龄段,发生替代错误的平均个数均高于省略和歪曲,替代错误的平均个数随儿童年龄增长而下降,呈低度相关(P<0.05,r=0.217);发音部位错误的平均个数从多到少依次为:舌尖后音、舌尖中音、舌尖前音、舌根音、舌面前音、双唇音、唇齿音;舌尖前音、舌尖中音和舌尖后音的平均错误个数均随年龄的增加而减少;发音方式错误的平均个数从多到少依次为塞擦音、擦音、塞音、鼻音和边音,4~5岁年龄段塞擦音、擦音、边音的平均错误个数高于~6岁和~15岁年龄段。结论各年龄段儿童中SSD均以中重度、重度为主,随年龄增长,儿童语音清晰度有提高的趋势。各年龄段错误类型均以替代为主,发音部位错误类型及发音方式错误类型均在~6岁和~15岁组别差异不明显,应引起重视。

Background Speech sound disorder(SSD)is a common cause of communication disorders in childhood with a high prevalence.For those untreated children the symptoms can persist into adulthood and affect the social communication eventually.Objective To analyze the clinical features of consonant errors in children with SSD.Design Case series report.Methods This study recruited the children who came to the department of Children's Healthcare in Chengdu Women's and Children's Central Hospital from January 1,2020 to December 31,2020 due to unclear pronunciation,who met the SSD diagnosis and whose language development was over 4 years old,and excluded other diseases that affected language function.Phonetic assessment was conducted by picture naming method.Consonants were classified and analyzed according to the pronunciation position and method.The formula for correct rate of consonants(PCC)was number of correct consonants/(number of correct consonants+number of wrong consonants)×100%.85%~100%were mild,65%~85%were mild to moderate,50%~65%were moderate to severe,and less than 50%were severe.Demographic characteristics such as age,gender and voice assessment results of SSD children were collected from the medical records.Main outcome measures PCC and consonant error types.Results A total of 222 SSD children were recruited in this study,including 67 females and 155 males.There were 111 children aged 4 to 5 years(50.0%),66 aged 5 to 6 years(29.7%)and 45 aged 6 to 15 years(20.3%).The average PCC of male and female students was 43.3%±20.9%and 44.9%±18.9%,respectively,with no significant difference(P>0.05).There was a linear relationship between age and the severity of SSD(P<0.001),and the proportion of severe consonant errors decreased with age.In each age group,the average number of substitution errors was higher than that of ellipsis and distortion,and the average number of substitution errors decreased with the age,showing a low degree of correlation(P<0.05,r=0.217).The average number of errors in pronunciation positions in a descending order was blade-palatal,blade-alveolar,supradental,velar,alveo-palatal,bilabial,and labiodental.The average number of labiodental,supradental,blade-alveolar and blade-palatal errors decreased with age.The average number of errors in pronunciation style in a descending order was affricate,fricative,plosive,nasal,and lateral.The average number of errors in affricate,fricative,and lateral in the 4-5 age group was higher than that in the other two age groups.Conclusion SSD in children was mainly moderate to severe and severe in all age groups,and children's speech intelligibility tended to improve with age.The types of errors in all age groups were mainly substitution.The types of errors in pronunciation parts and pronunciation methods were not significantly different between the groups of 5 to 6 and 6 to 15 years old,which should be paid attention to.