Analysis Of The Status Of Initial Diagnosis And Speech Characteristics Of Children With Speech Sound Disorder In Department Of Child Health Care

ObjectiveTo study the understanding of speech sound disorder(SSD)among children's health practitioners,and to explore the possibility of judging the etiology of SSD from the characteristics of speech.MethodsPart 1: Analyze the clinical data of 506 newly diagnosed SSD children in the department of Child Health Care in Affiliated Children's Hospital of Chongqing Medical University from January 2017 to May2019,and analyz the attention of children's health care doctors to the causes of hearing loss,neurodevelopmental disorders,structural abnormalities of voice organs and other causes during the process of medical history collection,physical examination and implementation of auxiliary examination,so as to understand the initial diagnosis status of SSD with different causes.Part 2: 91 SSD children who have completed the diagnostic hearing test were divided into four groups: hearing loss group(HL),developmental behavior abnormality group(DA),hearing loss simultaneous developmental behavior abnormality group(HL + DA),normal hearing and developmental behavior group(FAD).Compare the characteristics of consonant errors in each group,and analyze the changes of consonanterrors with age.91 SSD children who have completed the diagnostic hearing test were divided into four groups: hearing loss group(HL),developmental behavior disorder group(DA),hearing loss and developmental behavior disorder group(HL + DA),normal hearing and developmental behavior group(FAD).Compare the number of consonant errors,the rate of consonant errors and the incidence of consonant error types in each group,and analyze the changes of consonant errors with age.ResultsPart 1:(1)The sex ratio of male and female children with SSD is2.9: 1,and 85.97% are preschool children.(2)90.51% of the SSD children have recorded developmental behavior in the history of present illness.97.63% of the SSD children have performed developmental behavior evaluation,mainly of which being intelligence developmental screening tests(485,95.85%).116 of the SSD children(22.92%)were diagnosed with neurodevelopmental disorders,the most common of which were language disorder,global developmental delay and intellectual disability.45.69%(53/116)of the SSD children with neurodevelopmental disorders were without a record of manifestations concerning abnormal developmental behavior in their history of present illness.Comparing to the groups with normal communication performance,the incidence of neurodevelopmental disorders was higher in groups whose communication performance were evaluated as poor by family members or through physical examinations(P < 0.05).(3)The proportion of SSD children whose hearing condition were ignored in the history of their present illness or physical examination reached respectively to 33.20% and 31.23%.92 SSDchildren(18.18%)performed the diagnostic hearing test,and the detection rate of hearing loss was 11.96%(11/92).Among the 11 SSD children with hearing loss,3 passed the newborn hearing screening,3 and 7of them had normal communication performance evaluated by their family members and doctors respectively.(4)All children with SSD had no structural abnormality of voice structures.Part 2:(1)There was no difference in the number of consonant errors,the rate of 21 consonant errors and the incidence of various types of consonant errors among the four groups;(2)The number of consonant errors in the four groups did not decrease with age.The error rate of all consonants in DA group and 20 consonants in FAD group did not decrease with age.The incidence of labiodental replacement decreased with age in DA group,the incidence of omission error and blade-palatal replacement decreased with age in FAD group,and the incidence of other error types did not decrease with age.Conclusions(1)The majority of SSD children are pre-school boys.(2)SSD children could be combined with a variety of neurodevelopmental disorders.Paying attention to their communication performance is helpful to the diagnosis of neurodevelopmental disorders,but a simply inquired history may be omitting.Attention has been paid to the neuropsychological development of SSD children by children's health practitioners.The completion rate of developmental behavior assessment is high,but with most of them being intelligence developmental screening test.(3)SSD children have a high detection rate of hearing loss.Children's health practitioners have insufficient understanding of their hearingmatter,and diagnostic hearing test is underestimated.Moreover,in clinical practice,the evaluation of SSD children's hearing should not be based on their communication behaviors in daily life or results from a screening test.(4)The abnormal structure of articulation organs in SSD children is relatively rare in Child care clinic.(5)SSD children with developmental behavior and hearing disorders do not have a unique consonant error form.(6)With the increase of age,the speech of SSD children can not improve to normal level.