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What is expressive alalia?
Last reviewed: 04.07.2025
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Among the many speech disorders in children, one form of language development disorder stands out: expressive alalia (from the Greek lalia – speech).
This disorder manifests itself in the fact that children who understand speech experience difficulties with active oral statements and expressions (in Latin - expressio), that is, in a persistent disruption in the acquisition of the system of linguistic units of spoken language.
Epidemiology
According to epidemiological surveys conducted in North America and Western Europe, 5-7% of preschool children (up to 5-6 years old) have varying degrees of speech development disorders.
Causes expressive alalia
In the course of many years of interdisciplinary research and in the process of streamlining the terminology used in the field of childhood speech disorders, international experts have come to the conclusion that motor or expressive alalia can be diagnosed in a child when his or her vocabulary, as well as the ability to pronounce complex sentences and remember words, are below the generally accepted age level, and – at the same time – these speech problems are not associated with either delayed general development, or with anatomical features of the speech apparatus, or with autism and autism spectrum disorder, or with motor apraxia of the facial muscles, or with acquired brain damage or hearing loss.
The main causes of this pathology are rooted in underdevelopment and/or intrauterine damage to the speech zones (centers) of the brain. That is, in the dysfunction of the Broca's area or zone - a section of the cerebral cortex that plays a primary role in speech function and the formation of algorithms for using the grammatical and syntactic systems of language. [ 1 ]
More details in the publication - Speech and language development disorders in children
Risk factors
When determining the most likely risk factors for expressive alalia, experts note the possibility of a combination of various factors, including:
- teratogenic effects on the fetus of chemicals and drugs used during pregnancy;
- brain injuries and intracerebral hemorrhages during difficult or complicated births;
- cerebral inflammatory processes of bacterial or viral etiology; [ 2 ]
- intrauterine and/or neonatal metabolic disorders;
- genetically determined predisposition.
Pathogenesis
Broca's area, responsible for motor speech, includes Brodmann's cytoarchitectonic areas 44 and 45 (pars opercularis and pars triangularis) in both hemispheres of the brain. In right-handed (dextral) people, Broca's area is located in the inferior frontal gyrus (inferior gyri frontalis) of the left hemisphere, directly in front of the facial motor cortex (cortex motorius) and slightly above the Sylvian groove (sulcus lateralis). [ 3 ]
As experts note, motor alalia is more often detected in senestrals, that is, in left-handed children - with a dominant right hemisphere of the brain, while the left hemisphere is responsible for language and speech in right-handed people. And the pathogenesis of deviations in the development of speech function in children can be caused by a disproportion in the development and disruption of the spatial organization of speech structures in the left and right hemispheres - with lateralization of speech function in the right hemisphere and its increased activity. [ 4 ] It is also possible to disrupt the conduction of impulses along the neuronal tract (arcuate fasciculus), which connects Broca's area with other areas of the brain, including Wernicke's area.
Wernicke's area is located next to Broca's area - in the upper part of the posterior temporal lobe (lobus temporalis); it is considered the center of perception and understanding of speech. Motor or expressive and impressive alalia (or sensory) is possible, and in the second case, it is Wernicke's area that is affected. And when both areas are affected, motor-sensory alalia is detected. [ 5 ], [ 6 ]
The mechanisms of expressive alalia are also discussed in the articles:
Symptoms expressive alalia
Parents should keep in mind that the first signs of delayed speech development in a child are the absence of cooing (and other sounds other than screaming) by two months, which is considered the initial stage of preverbal development in infants.
Common symptoms of expressive alalia include no babbling by 12 months and no simple words by 18 months.
It is necessary to suspect a violation of speech development if:
- by the age of two, the child does not speak or does not use at least 25 words);
- by two and a half years of age does not pronounce two-word phrases (noun + verb);
- by age three does not use at least 200 words and is unable to speak in short sentences;
- has difficulty pronouncing previously learned words, as well as putting words together into sentences.
A child with motor alalia, in addition to an insufficient vocabulary (compared to other children of the same age), lacks fluency of speech, may have articulation defects, violations of the syllabic structure of the language and agrammatism. In addition, children with this disorder often have signs of psychoorganic syndrome of varying severity, which are manifested by a decrease in performance in combination with defects in intellectual development, impaired attention, motor disinhibition. [ 7 ]
Complications and consequences
Language development disorders in early childhood can have complications and consequences for school performance and everyday social interactions in adult life. [ 8 ]
However, according to the American Academy of Family Physicians, up to 75% of two- to three-year-old children with motor alalia have normal speech skills by the time they enter school. [ 9 ]
Diagnostics expressive alalia
Experts acknowledge that diagnostics, that is, formal assessment of expressive alalia, has many difficulties.
It is necessary to promptly contact a pediatric neurologist and conduct a study of the child’s neuropsychiatric sphere, as well as a study of cognitive functions.
Instrumental diagnostics can be performed: CT or MRI of the brain, electroencephalography (EEG).
Differential diagnosis
It is necessary to exclude orofacial myofunctional disorders with articulation disorders, bulbar dysarthria in cerebral palsy, receptive speech disorders in autism, psychogenic mutism, and mental retardation, for which differential diagnostics are necessary.
Treatment expressive alalia
The basis of treatment for a child’s language development disorder is the work of an experienced speech therapist and, if necessary, a child psychologist or psychiatrist.
And the methods for overcoming this disorder are chosen by speech therapists individually, but are necessarily aimed at developing the so-called phonemic hearing and perception of words, their syllabic structure, understanding the lexical and grammatical structure of speech, etc. [ 10 ]
Prevention
There are no specific measures to prevent language development disorder, but risk factors for its development can be avoided.
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