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Comment traiter et appréhender la dysphasie ?

Publié le 6 juillet 2017 à 0:45

Trouble sévère, spécifique et primitif du développement du langage oral. C’est un trouble structurel, c’est à dire que le langage s’établit avec du retard mais aussi de façon déviante (il ne suit pas l’évolution classique d’acquisition du langage d’un jeune enfant). Enfin c’est un trouble durable qui perdure bien après 6 ans et laisse souvent des séquelles (répercussions au niveau du langage écrit).

Comme pour les autres dys, le diagnostic se fait par exclusion. Différentes pathologies doivent être éliminées :

un déficit auditif

une malformation des organes phonatoires

une déficience intellectuelle

un trouble envahissant du développement

une carence éducative ou affective importante

Avant 5/6 ans, il est difficile de distinguer une dysphasie d’un retard de langage.

Dans le cas du retard de langage, le langage se développe lentement mais normalement. Un suivi orthophonique permet la plupart du temps de rapides progrès. C’est un trouble fonctionnel.

En cas de dysphasie nous sommes face à un trouble durable et PRIMAIRE. Ce sont les structures cérébrales mises en jeu lors du traitement de l’information langagière qui sont atteintes. Cela entraîne des difficultés d’expression et de compréhension du langage oral. Les enfants atteints peuvent ne pas comprendre ce qui leur est dit mais aussi avoir du mal à formuler ce qu’ils veulent dire (même s’ils disposent du vocabulaire appropriés).

Il est possible de distinguer plusieurs troubles spécifiques de la dysphasie :

-trouble de l’évocation lexicale: L’enfant cherche ses mots, manifeste une lenteur d’évocation. Il y a un temps de latence avant qu’il parle, un décalage.

-trouble de l’encodage syntaxique: Ce sont les phrases qui sont difficiles à formuler. La syntaxe est désorganisée, il manque des pronoms, des articles, des mots de liaison.

-trouble de la compréhension: le contenu du langage en réception est difficilement analysé.

-trouble de l’informativité: L’enfant va préférer utiliser d’autres moyens que le langage oral déficient pour se faire comprendre : il mime, adopte une gestuelle personnelle par ex.

-Dissociation automatico-volontaire: C’est une difficulté phonologique et praxique (sphère bucco-faciale). l’élève ne parvient pas à répéter les sons ou les mots par ex.

Concrètement quelles difficultés peuvent être repérées ?

Le diagnostic de dysphasie est assez long. Il nécessite la consultation et l’avis de plusieurs spécialistes : orthophoniste, médecin, psychologue, neuropsychologue ou neuropédiatre.

Les enfants dysphasiques sont souvent excellents dans toutes les activités où le langage n’est pas en jeu comme la géométrie.

Difficultés linguistiques :

pour parler, formuler des phrases

emploi de l’infinitif (pas d’inflexions verbales ni adjectivales)

échanges laborieux, peu fluides (manque de mots, latences…;)

pour manier les pronoms

pour employer les connecteurs (donc, alors, puis…;)

pour mettre en ordre les mots

pour respecter les règles de communication

pour nommer les mots nombres, les transcoder

pour comprendre les énoncés, les consignes

Difficultés phonologiques :

pour discriminer les sons proches

pour encoder

dysorthographie

pour contrôler ses productions

Difficultés cognitives :

pour se repérer dans le temps

pour comprendre ce qui n’est concret (les métaphores etc..)

pour mémoriser les éléments entendus à court terme

pour planifier, anticiper, maintenir ses objectifs

pour stabiliser ses acquis

Comment les aider à apprendre et créer des conditions d’accès aux apprentissages en adéquation avec leurs potentialités ?

Une fois les difficultés clairement identifiées et diagnostiquées par un spécialiste voici quelques pistes d’aménagement possible pour aider l’élève à compenser et à mieux accepter ses troubles.

D’une manière générale, ces enfants ont des difficultés de mémorisation auditive donc :

Eviter de lui proposer d’apprendre des poésies ou de répéter des leçons. Ils retiendront mieux : les dessins, les schémas simples (cartes heuristiques personnelles..).

Ne pas les faire répéter mais les aider à préciser leurs pensées (en reformulant à leur place, en leur donnant le vocabulaire qui leur manque). On peut aussi pratiquer l’ébauche orale : lui fournir la première syllabe du mot qui lui manque.

Contrôler le bruit ambiant

S’assurer du contact visuel et physique : poser une main sur son épaule en soutenant son regard…

Préférer les phrases courtes et simples.

Parler lentement en exagérant légèrement l’articulation.

Ne donner qu’une consigne à la fois.

Utiliser les pictogrammes plutôt que les mots pour les consignes.

Proposer prioritairement des QCM.

Apprendre à l’élève à respecter son tour de parole (bâton de parole par ex) tout en restant bienveillant car il leur faut parfois de longues minutes pour élaborer mentalement une réponse et ils peuvent être débordés par leurs émotions et vouloir intervenir dès qu’elle est prête.

Informer (avec accord de l’élève et de ses parents) les autres élèves des difficultés de l’enfant dysphasique pour éviter l’isolement.

Aménagements spécifique liés à l’apprentissage de la lecture /écriture:

Se servir des gestes Borel-Maisonny, de la méthode raconte-moi les sons

Favoriser l’apprentissage haptique des lettres (toucher)

Ne pas retarder l’entrée Au CP : l’écrit permet d’enrichir le langage oral et de fixer le vocabulaire. L’enfant comprend mieux la représentation graphique de la structure phonémique de la parole et peut s’y appuyer pour structurer son langage oral.

Entrainer à la conscience phonologique quotidiennement

Développer le champ sémantique : proposer des exercices de catégorisation, d’expansion.



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