jueves, 16 de abril de 2009

TGD Vs. TEL

Ante el aluvión de interconsultas efectuadas en relación a niños diagnosticados con TGD, les sugiero ver las diferencias con el Trastorno Semántico Pragmático dentro de la clasificación de TEL ( Trastornos específicos del lenguaje).

Clasificaciones del TEL


Los numerosos y variados nombres que ha recibido este trastorno, así como su delimitación y amplitud ciertamente imprecisas, sugieren que el TEL debe estar constituido por diversos trastornos relacionados, pero con características distintivas. Es importante distinguirlos para confeccionar programas de intervención más eficaces. (Aguado, G., 1999).

Criterio Clínico- Lingüístico


La clasificación aceptada por casi toda la comunidad científica es la que propusieron Rapin y Allen (1987,1988). Esta tiene una base clínica, está aceptablemente bien delimitada y su capacidad para recoger de una manera organizada los síntomas vistos en los niños con TEL es también aceptable. (Aguado, G., 1999).


A continuación se hace una reseña de esta clasificación:


Agnosia verbal auditiva: el sujeto no comprende el lenguaje, aunque puede comunicarse con gestos naturales, y su expresión es nula o casi nula, incluso en repetición: es un cuadro asimilable a los descritos bajo las denominaciones de afasia congénita mixta o sordera verbal (Monfort, M., Juárez, A., 1997).


Dispraxia verbal: el sujeto presenta una comprensión normal, o casi normal, pero con enormes dificultades en la organización articulatoria de los fonemas y de las palabras. Afecta también a la prosodia. En su límite extremo, el sujeto es completamente mudo: en ese caso sería asimilable a los cuadros de afasia congénita expresiva o audio-mudez dispráxica (Monfort, M., Juárez, A., 1997)


Déficit en la programación fonológica: la comprensión es relativamente normal, existe una cierta fluidez en la producción, aunque con muy poca claridad, lo que hace casi inteligible a estos niños. Es notable la mejoría de la calidad articulatoria en tareas de repetición de elementos aislados (Monfort, M., Juárez, A., 1997)


Déficit fonológico sintáctico: Corresponde al cuadro clásicamente descrito como disfasia (término ya no utilizado por la comunidad científica) Estos sujetos tienen una mejor comprensión que expresión, pero les cuesta entender cuando el enunciado es largo, incluye estructuras complejas, resulta ambiguo, se presenta descontextualizado, o, simplemente se emite con rapidez. En expresión destacan sus dificultades de articulación, fluidez, y sobre todo de aprendizaje y uso de nexos y marcadores morfológicos. En algunos casos, la propia formación secuencial de los enunciados resulta ser laboriosa. .(Monfort, M., Juárez, A., 1997)


Déficit léxico-sintáctico: Dentro del retraso van superando sus alteraciones de pronunciación, pero presentan grandes dificultades de evocación y estabilidad del léxico. La comprensión de palabras sueltas puede ser normal, o casi normal, pero no así la de frases. Se registra una abundancia de "muletillas", interrupciones, parafasias, perífrasis y reformulaciones, dentro de una gran dificultad para mantener el orden secuencial y utilizar correctamente los marcadores morfológicos cuando tienen que expresar enunciados más complejos que los simples diálogos cotidianos (Monfort, M., Juárez, A., 1997).

Déficit semántico pragmático: En este caso, el sujeto puede presentar un desarrollo inicial del lenguaje dentro de límites relativamente normales y carecer de problemas importantes de habla. Sus enunciados también pueden aparecer como bien estructurados. Sin embargo, sufren grandes dificultades de comprensión. Llegando al caso de que su nivel expresivo sea superior al comprensivo. Sobretodo, destaca la falta de adaptación de su lenguaje al entorno interactivo: los ajustes pragmáticos a la situación o al interlocutor son deficientes, la coherencia temática inestable y puede existir ecolalia o perseveraciones (Monfort, M., Juárez, A., 1997).



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