- 期刊
探討3-6歲音韻異常（phonological impairment）兒童口腔吸吮習慣與構音錯誤類型之相關性研究
An Investigation of the Relationship between Oral Sucking Habits and Types of Articulation Errors in Preschool Children with Phonological Impairment
摘要
目的：兒童語音障礙（Speech sound disorder, SSD）中音韻異常（phonological impairment）是最常見的。兒童的音韻歷程發展以替代歷程最為常見，替代歷程以前置、後置或不送氣化發音的異常最多。音韻異常的兒童，父母常抱怨說吃奶嘴或大拇指很難戒除。本研究目的為探討學齡前單純音韻異常兒童的吸吮習慣，及探討不同的吸吮習慣是否會影響音韻異常的錯誤類型？方法：研究對象為西元2020年5月至12月，來彰化基督教醫院復健部求診的36個月大到入小學前的兒童，評估後確定為單純音韻異常。構音錯誤類型分為四種包含：前置化、後置化、不送氣化和省略來記錄。第一次語言治療時請家長填寫問卷，內容包含有無吸吮奶嘴／大拇指和持續的時間。結果：共收案40位單純音韻異常兒童，平均年齡為55.2（±9.5）個月大，男生30位，女生10位。8（20%）位兒童完全沒有吸吮奶嘴或大拇指，28（70%）位兒童只有吸吮奶嘴習慣，1（2.5%）位兒童只有吸吮大拇指習慣，有3位兒童合併有吸吮奶嘴和大拇指，因此共有32（80%）位兒童有吸吮奶嘴或大拇指的習慣，吃奶嘴時間為21.1（±10.2）月，16（40%）位兒童吃奶嘴時間超過2歲，8（20 %）位兒童沒有吃奶嘴的習慣。在構音錯誤類型分析結果為：22.5%兒童合併有2種以上的錯誤類型，5%合併有3種的錯誤類型，77.5%兒童為單一構音錯誤類型，單一前置和後置構音錯誤類型發生率最高（30%）。吃奶嘴時間長短和構音嚴重度無關。構音錯誤類型和吸吮奶嘴時間並無相關，兩歲以上還維持有吸奶嘴、兩歲已戒除吸奶嘴和不吸奶嘴的兒童這3組其構音錯誤類型也無相關。結論：奶嘴使用與構音錯誤類型並無相關。長期使用奶嘴，是否是一個造成學齡前兒童音韻異常的危險因子，尚待釐清。另外，對於省略型態或多種的構音錯誤類型的音韻異常兒童需予以多加注意。
並列摘要
Background: Phonological impairment (PI) is the most common impairment in preschool children with speech sound disorder (SSD). In preschool children with phonological disorders, the most common process is substitution, including fronting, backing, and devoicing. The parents of children with PI always complain that it is difficult for them to abstain from pacifier use or thumb sucking. The purpose of this study was to investigate the oral sucking habits of preschool children with PI, and to explore whether different sucking habits affect different types of PI. Methods: Children aged from 36 months to 72 months, who visited the Physical Medicine and Rehabilitation Department of Changhua Christian Hospital from May 1, 2020 to December 31, 2020, were enrolled into this study. The children had PI alone, without developmental delay. PI was divided into 4 types: fronting, backing, devoicing and omission. A questionnaire on oral sucking habits was answered by the parents at the first visit. Results: Forty children with PI, 30 boys and 10 girls, with a mean age of 55.2±9.5 months, were included in the study. Eight (20%) children did not suck on pacifiers or their thumbs; 28 (70%) children had used the pacifiers only, 1 (2.5%) child sucked his thumbs only, and 3 (7.5%) children had used pacifiers and their thumbs. Thirty-two (80%) children in all had non-nutritive sucking habits. The mean length of using pacifiers was 21.1±10.2 months, including 16 (40%) children who used pacifiers for more than 2 years. Eight (20%) children had no non-nutritive sucking habit. The distribution of PI was as follows: 22.5% of children had more than 2 types of PI, 5% of children had 3 types of PI, and 77.5% of children had a single type of PI. The fronting and backing types of PI were the most common (30%) among those with a single type of PI. There was no correlation between the length of using pacifiers and the severity of PI, and there was no association between the length of using pacifiers and the type of PI. Also, we found no significant difference between the children categorized into 3 groups based on the length of pacifiers use (no use, ＜2 years, ＞2 years using pacifiers) and the type of PI. Conclusion: The use of pacifiers is not related to the type of PI. The impact of long-term sucking pacifiers on PI among preschool children has been contentious. In addition, more attention would be paid in children with omission type or multiple types of PI.