Gisèle Lovenfosse
Logopède
505 , Bd Louis Mettewie
1070,Bruxelles

Current research and our experience with children with both specific language impairments with learning difficulties showed us the real difficulty of a differential diagnosis, especially when taking into account such important facets as language, psychology, and pedagogy. There is a real will amongst professionals who are convinced of the need to research more deeply into the knowledge of the brain, the way it works or does not work, the effect on neuropsychological and cognitive development and this is expanding every day.

Speech expresses itself through linguistic channels and is built up with the help of skills and knowledge. It is involved in the most simple and complex processes of the mind. The speech and language therapist is ever mindful of some fundamental aspects of language: for example:

• its own characteristics

- its usage and deviations demonstrated by people with disabilities.

The speech and language therapist has a main part to play in the research into specific difficulties and disorders which children diagnosed as dysphasic have. From his or her first contact with the parents, the speech and language therapist perceives through their logical intuition, the way they describe their child as being different without the use of painful words which would express their daily distress, and in spite of reassuring words from others. The speech and language therapist with the parent's help can go through the background of their child, through his language and their own language, their reactions and the useful and useless changes as well as the essential and crucial ones. The speech and language therapist can already make out the verbal and non-verbal understanding of the child without the latter having to speak.

From the first contacts, the speech and language therapist will be able to discuss with the other members of the team, the spontaneous and natural interaction or their non-existence. She will have more knowledge to grasp vital characteristics. Sometimes, some children combine several disorders like hyperactivity with or without concentration problems and others may be withdrawn. The mutual trust between them allows the dysphasic child to either not talk at all or show his lack of understanding during the first few meetings with the speech and language therapist.

During the next stage the speech and language therapist will evaluate:

voice quality, its intelligibility
articulation, the potential ear and mouth paralysis
the ability to repeat or not
fluency or hesitancy of speech.

These will appear as indicators of major problems that parents will recognise as recurrent. The speech and language therapist helps parents in their observation and helps them to make a better judgement.

Subsequent meetings, together with well known tests will help to pin point the specifics speech problems by comparing the tests results with verbal and non verbal IQ tests: This detailed analysis will help to see whether the symptoms are part of a deviant picture.

Too often, dysphasia is associated with severe language impairments in the re-education process .We know now that the dysphasias have their own particular attributes :

The speech and language therapist is the reference point in difficult times. Once parents have been to see different specialists, the speech and language therapist will abandon professional jargon, and will discuss over and over all aspects of the problem with the parents and will look for weaknesses , analyse mistakes. The speech and language therapist will take on the long process of improving the diagnosis by improving her working method.

Thus new clues will be understood.

- Does the child who cannot speak have a unique speech problem (we know cases where the dysphasic child is also epileptic and/or hyperactive?

- Has the child developed autistic behaviour due to comprehension disorders?

- In the event of apraxia, does it have an effect on understanding speech? (He is dysphasic and clumsy, he disconnects, he does not understand).

In agreement with other specialists, specific tests and experience allow a detailed description and if necessary to define dysphasia in a child in terms of a syndrome.

This is important, as it will determine the therapy programme for this child in its social and educational context.

The speech and language therapist has means and techniques to help dysphasic children:

- to understand better

• to communicate differently
• to better learn

It should be left for them to decide whether or not to intervene. Some question the value of speech therapy assistance to a child with substantial problems. Why deny specific assistance to a child who is so deprived of means to satisfy himself, query, react, and understand?

The speech and language therapist develops a specific clinical approach, based on an analysis of the child’s potential, she applies herself to the work by going around the areas of deficiency. It is therefore important not to trivialise this or to put it aside.

The speech and language therapist will act on the child’s strengths, in conjunction with psychomotricity, for example:

We now know well the benefit of multimodality and the results obtained thanks to the development of verbal communication coupled with non-verbal means. The various experiments in taking care of patients through use of augmentative communication systems are conclusive.

The ever-present oral language is accompanied by gestural and visual support:

The speech and language therapist fulfils her mediation role between the child and that "object language" which the child has not been able to develop spontaneously, or which the child’s implicit capacities have not been able to grasp through communicative interaction.

The speech and language therapist will help the child to make it his or her own and to make it live through tangible scenes and exercises calling for mental images.

It is the speech and language therapist who will concretely and morally assist the parents to accept and master new means and methods. Together, they will offer an often spectacular flourishing to that child who has long been acknowledged. He will gradually be able to understand better, to express himself more, to make himself memories and memory tools (mimes, gestures or signs, sentence words, drawings, pictures…) , to interact. The child will gradually learn to link its non-verbal thoughts, its verbal thoughts and its speech, as it knows it is respected in its dysphasic speech, in its search for language. The speech and language therapist will make sure that the desire to communicate remains present through a partnership with the parents who feel less "handicapped" in the understanding of their child.

In Belgium, the speech and language therapist takes part in the setting up of classes that are specifically for dysphasic children. These "language" classes are still considered experimental. Research has been undertaken at the request of the francophone Department of Education, in order to assess the educational requirements of dysphasic children.

The first class specific to dysphasic children opened at Jules Anspach Pedagogic centre in Brussels 20 years ago. Since then, several schools have followed in the country.

The research into learning strategies, and the development of the therapy techniques in phonology, syntax, semantics and pragmatics form part of the speech and language therapist‘s objectives.

He or she will measure their interest and apply them in harmony with the school curriculum. The speech and language therapist will be very active in the transfer of speech acquisition to other learning domains: links between memory and language, mind and language, strengthening of the visual and kinaesthetic channels, work on the sequential aspects of the language.

The speech and language therapist is a key link where transcoding, transfers of subject, speech improvement and the children’s daily life interact.

In conclusion, children with dysphasia need many sessions of speech and language therapy throughout their childhood and adolescence - they wish to speak, to communicate with language, but how are they to communicate , with whom and using which means? When the child does not have natural ways to express himself because of his disability, how could he be helped to take his place in the society, how could he be helped to develop language strategies that will help him to escape from isolation?

Speech and language therapy must last a long time because it helps to get the children out of the discomfort linked to the awareness of their problems in expressing themselves. It should provide for them the means of expressing their isolation in some cases and their rebellion in others, and in every case their desire to communicate and to learn. These are legitimate needs shared by all adolescents, including young people with dysphasia.

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Grondin Jerôme : http//pro.wanadoo.fr/jerome.grondin

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Lovenfosse-Dantinne G. ; La mimogestualité comme renforcement non verbal accompagnant le langage oral et le langage écrit. Colloque AQEA ; Montréal, Octobre 1997. Syllabus non publié, 20 p.

Mazeau, J. (1994) ; Dysphasies, troubles mnésiques, syndrome frontal chez l'enfant. Paris, Masson.

Monfort M. et Juarez Sanchez A. ; L'intervention dans les troubles graves de l'acquisition du langage et les dysphasies développementales : une proposition de modèle interactif : Ortho Edition, 1996, 271 p.

Szliwowski H. B. ; Enseignement aux enfants dysphasiques : expérience belge des classes de langage. Entretiens d'orthophonie. Paris : Expansion Scientifique Française, 1992, p. 36-38.