基于ICF的智力残疾儿童言语功能障碍和沟通活动受限特征与康复干预

doi:10.3969/j.issn.1006-9771.2025.04.004

Abstract

Abstract:

Objective To systematically analyze the characteristics of impairment of speech function and activity limitation of communication in children with intellectual disabilities, and to develop comprehensive rehabilitation interventions.
Methods An in-depth analysis of impairments of speech functions and activity limitation of communication in children with intellectual disabilities across multiple dimensions was conducted using International Classification of Functioning, Disability and Health (ICF) framework, from the aspects of body structures and functions, activities and participation, and environmental factors. Integrated intervention methods were implemented within speech rehabilitation and special education settings.
Results Speech function impairments often manifested as deficits in the mental functions of language, articulation functions, and the fluency and rhythm of speech. Communication limitations were evident, including potential deficits or difficulties in speaking, listening, engaging in conversations and interpersonal interactions. Environmental factors such as family support, peer attitudes, professional services and the accessibility of assistive communication technologies significantly impacted the development of speech function and communication activity in these children. This study proposed a systematic assessment methodology for children's speech function and communication activity based on the ICF framework, emphasizing a holistic understanding of impairments of speech functions and activity limitation of communication in children with intellectual disabilities, and highlighting the impact of communication activity on children's learning and daily life. In speech rehabilitation therapy and educational rehabilitation settings, individualized intervention strategies should be designed according to the specific characteristics of impairments of speech functions and activity limitation of communication in children with intellectual disabilities, focusing on fostering functional communication skills and integrating them into daily life and educational activities. Augmentative and alternative communication technologies, natural context language interventions, visual supports, and peer-mediated interventions might be effective.
Conclusion This study has utilized the ICF framework to systematically analyze impairments of speech functions and activity limitation of communication in children with intellectual disabilities, interms of body functions and structures, activities and participation, and environmental factors. A systematic approach to promoting the development of speech function and communication activity in children with intellectual disabilities has been proposed within speech rehabilitation therapy and educational rehabilitation settings, including individualized intervention strategies, the application of assistive technologies, the use of visual support, and the implementation of peer-mediated interventions.

Key words: intellectual disability, children, impairments of speech function, activity limitation of communication, International Classification of Functioning, Disability and Health

CLC Number:

R748

YI Ling, ZHOU Jing, CHEN Xuefen, CHEN Chuanfan, CHEN Keyi, DONG Huifan. Characteristics and intervention of speech function impairments and communication limitation in children with intellectual disabilities based on ICF[J]. Chinese Journal of Rehabilitation Theory and Practice, 2025, 31(4): 398-405.

Figures/Tables 3

Table 1

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Table 3

References 47

[1]	KACKA M, KIKA B, MORINA E, et al. Speech sound disorders of children with mental delays[J]. J Human Res Rehabil, 2024, 14(1): 66-73.
[2]	National Joint Committee for the Communicative Needs of Persons with Severe Disabilities. Guidelines for meeting the communication needs of persons with severe disabilities[J]. ASHA Suppl, 1992(7): 1-8.
[3]	MCCORMACK J, BAKER E, CROWE K. The human right to communicate and our need to listen: learning from people with a history of childhood communication disorder[J]. Int J Speech Lang Pathol, 2018, 20(1): 142-151. doi: 10.1080/17549507.2018.1397747 pmid: 29160112
[4]	MEMISEVIC H, HADZIC S. Speech and language disorders in children with intellectual disability in Bosnia and Herzegovina[J]. Asia Pacific Disabil Rehabil J, 2013, 24(2): 92-99.
[5]	ZABLOTSKY B, BLACK L I, MAENNER M J, et al. Prevalence and trends of developmental disabilities among children in the United States: 2009-2017 [J]. Pediatrics, 2019, 144(4): e20190811.
[6]	MOSCA R, KRITZINGER A, VAN DER LINDE J. Language and communication development in preschool children with visual impairment: a systematic review[J]. S Afr J Commun Disord, 2015, 62(1): e1-e10.
[7]	JACOB U, OLISAEMEKA N, EDOZIE I. Developmental and communication disorders in children with intellectual disability: the place early intervention for effective inclusion[J]. J Educ Pract, 2015, 6(3): 42-46.
[8]	HOFMANN V, MÜLLER C. Challenging behaviour in students with intellectual disabilities: the role of individual and classmates' communication skills[J]. J Intellect Dis Res, 2022, 66(4): 353-367.
[9]	邱卓英, 陈迪. 基于ICF的残疾和康复信息标准体系及其应用研究[J]. 中国康复理论与实践, 2014, 20(6): 501-507.
	QIU Z Y, CHEN D. ICF based disability and rehabilitation information standard and its applications[J]. Chin J Rehabil Theory Pract, 2014, 20(6): 501-507.
[10]	世界卫生组织. 国际功能、残疾和健康分类(国际中文增补版)[M]. 邱卓英,译. 日内瓦: 世界卫生组织, 2015.
[11]	邱卓英, 李安巧, 黄珂, 等. 基于ICF和联合国«残疾人权利公约»对国际组织有关残疾定义及其测量的内容研究[J]. 中国康复理论与实践, 2018, 24(10): 1117-1121. doi: 10.3969/j.issn.1006-9771.2018.10.001
	QIU Z Y, LI A Q, HUANG K, et al. Content analysis of definition and measurement of disability: based on ICF and UN Convention on the Rights of Persons with Disabilities[J]. Chin J Rehabil Theory Pract, 2018, 24(10): 1117-1121.
[12]	邱卓英, 李沁燚, 陈迪, 等. ICF-CY理论架构、方法、分类体系及其应用[J]. 中国康复理论与实践, 2014, 20(1): 1-5.
	QIU Z Y, LI Q Y, CHEN D, et al. ICF-CY: framework, approach, classification and implementation[J]. Chin J Rehabil Theory Pract, 2014, 20(1): 1-5.
[13]	杨亚茹, 邱卓英, 陈迪, 等. 运用ICF构建残疾标准的理论架构与方法体系[J]. 中国康复理论与实践, 2025, 31(2): 125-135. doi: 10.3969/j.issn.1006-9771.2025.02.001
	YANG Y R, QIU Z Y, CHEN D, et al. Constructing disability eligibility standards using ICF: conceptual framework, approaches and methodological systems[J]. Chin J Rehabil Theory Pract, 2025, 31(2): 125-135.
[14]	STUCKI G, POLLOCK A, ENGKASAN J P, et al. How to use the International Classification of Functioning, Disability and Health as a reference system for comparative evaluation and standardized reporting of rehabilitation interventions[J]. Eur J Phys Rehabil Med, 2019, 55(3): 384-394.
[15]	邱卓英, 黎东晓, 李欣, 等. 当代智力残疾测量与统计方法和社会支持与服务体系研究[J]. 中国康复理论与实践, 2016, 22(4): 383-388.
	QIU Z Y, LI D X, LI X, et al. Research on measurement and statistics, and social support and services for intellectual disability[J]. Chin J Rehabil Theory Pract, 2016, 22(4): 383-388.
[16]	邱卓英, 李欣, 刘冯铂, 等. 基于ICF的智力残疾模式、测量方法及社会支持系统研究[J]. 中国康复理论与实践, 2016, 22(4): 373-377.
	QIU Z Y, LI X, LIU F B, et al. Framework, measurement, and social support of intellectual. disability based on ICF[J]. Chin J Rehabil Theory Pract, 2016, 22(4): 373-377.
[17]	PANEL A R C P G D, BASURA G, CIENKOWSKI K, et al. American Speech-Language-Hearing Association Clinical Practice Guideline on Aural Rehabilitation for Adults with Hearing Loss[J]. Am J Audiol, 2023, 32(1): 1-51.
[18]	MCNEILLY L G. Using the International Classification of Functioning, Disability and Health framework to achieve interprofessional functional outcomes for young children: a speech-language pathology perspective[J]. Pediatr Clin North Am, 2018, 65(1): 125-134.
[19]	MARRUS N, HALL L. Intellectual disability and language disorder[J]. Child Adolesc Psychiatr Clin N Am, 2017, 26(3): 539-554.
[20]	NÆSS K B, NYGAARD E, HOFSLUNDSENGEN H, et al. The association between difficulties with speech fluency and language skills in a national age cohort of children with down syndrome[J]. Brain Sci, 2021, 11(6): 704.
[21]	KENT R D, VORPERIAN H K. Speech impairment in Down syndrome: a review[J]. J Speech Lang Hear Res, 2013, 56(1): 178-210.
[22]	SEAGER E, SAMPSON S, SIN J, et al. A systematic review of speech, language and communication interventions for children with Down syndrome from 0 to 6 years[J]. Int J Lang Commun Disord, 2022, 57(2): 441-463. doi: 10.1111/1460-6984.12699 pmid: 35191587
[23]	VAN DER SCHUIT M, SEGERS E, VAN BALKOM H, et al. How cognitive factors affect language development in children with intellectual disabilities[J]. Res Dev Disabil, 2011, 32(5): 1884-1894. doi: 10.1016/j.ridd.2011.03.015 pmid: 21498046
[24]	VASILEIADIS I, DOIKOU-AVLIDOU M. Enhancing social interaction of pupils with intellectual disabilities with their general education peers: the outcomes of an intervention programme[J]. J Res Special Educ Needs, 2018, 18(2): 1-11.
[25]	SCHUCHARDT K, MAEHLER C, HASSELHORN M. Functional deficits in phonological working memory in children with intellectual disabilities[J]. Res Dev Disabil, 2011, 32(5): 1934-1940. doi: 10.1016/j.ridd.2011.03.022 pmid: 21570810
[26]	NÆSS K A, LYSTER S A, HULME C, et al. Language and verbal short-term memory skills in children with Down syndrome: a meta-analytic review[J]. Res Dev Disabil, 2011, 32(6): 2225-2234.
[27]	KASARI C, STERLING L. Loneliness and social isolation in children with autism spectrum disorders[M]// KASARIC, STERLINGL. The Handbook of Solitude. Hoboken: Wiley, 2013: 409-426.
[28]	MACHALICEK W, LANG R, RAULSTON T J. Training parents of children with intellectual disabilities: trends, issues, and future directions[J]. Curr Develop Disordes Rep, 2015, 2(2): 110-118.
[29]	CARTER E W, GUSTAFSON J R, SRECKOVIC M A, et al. Efficacy of peer support interventions in general education classrooms for high school students with autism spectrum disorder[J]. Remedial Special Educ, 2017, 38(4): 207-221.
[30]	周静, 张晓晓, 丁忠冰, 等. 智力与发展性残疾儿童言语与语言障碍康复的系统综述[J]. 中国康复理论与实践, 2024, 30(8): 894-902. doi: 10.3969/j.issn.1006-9771.2024.08.004
	ZHOU J, ZHANG X X, DING Z B, et al. Effect of speech and language. rehabilitation on children with intellectual and developmental disabilities: a systematic review[J]. Chin J Rehabil Theory Pract, 2024, 30(8): 894-902.
[31]	王勇丽, 余新春, 金昕玥, 等. 言语表象疗法改善脑瘫患儿构音障碍的效果[J]. 中国康复理论与实践, 2023, 29(5): 601-607. doi: 10.3969/j.issn.1006-9771.2023.05.017
	WANG Y L, YU X C, JIN X Y, et al. Effect of speech imagery therapy on dysarthria in children with cerebral palsy[J]. Chin J Rehabil Theory Pract, 2023, 29(5): 601-607.
[32]	VAGHELA M, BODLA D. Challenges faced by parents of intellectually disabled children of rural and urban areas[J]. Educ Admin Theory Pract, 2024, 30(2): 33-50.
[33]	KOSTANJSEK N. Use of The International Classification of Functioning, Disability and Health (ICF) as a conceptual framework and common language for disability statistics and health information systems[J]. BMC Public Health, 2011, 11(Suppl 4): S3.
[34]	World Health Organization. ICF browser [EB/OL]. (2024-12-27) [2025-02-10]. https://apps.who.int/classifications/icfbrowser/.
[35]	ZERBETO A B, ZANOLLI M L, SHON R Y. ICF and perception of functioning according to children/adolescents in follow-up with speech/language disorders[J]. Codas, 2023, 35(5): e20210167.
[36]	MCLEOD S. Speech pathologists' application of the ICF to children with speech impairment[J]. Int J Speech Lang Pathol, 2009, 6(3): 12-30.
[37]	TSAI M J. Development of ICF core set to profile communicative competence in dyadic communication among adults who use communication devices in Taiwan[J]. Disabil Rehabil Assist Technol, 2024, 19(3): 658-670.
[38]	American Psychiatric Association. Diagnostic and statistical manual of mental disorders: DSM-5™, 5th ed[M]. ArlingtonVA, US: American Psychiatric Publishing, Inc., 2013.
[39]	BELL J, CONDREN M. Communication strategies for empowering and protecting children[J]. J Pediatr Pharmacol Ther, 2016, 21(2): 176-184. doi: 10.5863/1551-6776-21.2.176 pmid: 27199626
[40]	BANU L, SAAD T, HOSSAIN M, et al. Speech language disorder in children: an overview[J]. J Comilla Med College Teachers Assoc, 2024, 27(3): 75-82.
[41]	AGUSTINA P, MANIPUSPIKA Y. Phonological development in child language acquisition: a study of a child with speech delay[J]. J Eng Lang Teach Linguistics, 2022, 7(3): 545.
[42]	LIGHT J, MCNAUGHTON D. Designing AAC research and intervention to improve outcomes for individuals with complex communication needs[J]. Augment Altern Commun, 2015, 31(2): 85-96. doi: 10.3109/07434618.2015.1036458 pmid: 25904008
[43]	SYRIOPOULOU-DELLI C, GKIOLNTA E. Effectiveness of different types of augmentative and alternative communication (AAC) in improving communication skills and in enhancing the vocabulary of children with ASD: a review[J]. Rev J Autism Dev Disord, 2021, 9(2): 493-506.
[44]	STERRETT K, KASARI C. Interventions for individuals with autism spectrum disorder and complex communication needs[M]. Baltimore, MD, US: Brookes Publishing Co., 2019: 251-278.
[45]	HOLYFIELD C, DRAGER K D R, KREMKOW J M D, et al. Systematic review of AAC intervention research for adolescents and adults with autism spectrum disorder[J]. Augment Altern Commun, 2017, 33(4): 201-212. doi: 10.1080/07434618.2017.1370495 pmid: 28884601
[46]	DONATO C, SPENCER E, ARTHUR-KELLY M. A critical synthesis of barriers and facilitators to the use of AAC by children with autism spectrum disorder and their communication partners[J]. Augment Altern Commun, 2018, 34(3): 242-253. doi: 10.1080/07434618.2018.1493141 pmid: 30231643
[47]	O'TOOLE C, LEE A S, GIBBON F E, et al. Parent-mediated interventions for promoting communication and language development in young children with Down syndrome[J]. Cochrane Database Syst Rev, 2018, 10(10): Cd012089.

身体功能和结构	ICF编码	ICF类别	智力残疾儿童的常见障碍描述
身体功能-精神功能(b1)	b167	语言精神功能	语言习得延迟、词汇量不足、词语使用不当、理解和表达困难
身体功能-嗓音和言语功能(b3)	b320	清晰度功能	发音不清、音素替代、遗漏或扭曲、语音异常
	b330	言语的流畅度和节奏功能	口吃、语速过快或过慢、不流畅、重复音节或词语
	b310	嗓音功能	声音嘶哑、音调异常、音量控制困难、鼻音过重或过轻
身体功能-感觉功能和疼痛(b2)	b230	听觉功能	听力损失可能进一步加剧沟通困难
身体结构	s320-s340	参与发声和言语的结构	腭裂等物理异常可能影响言语产生

活动和参与	ICF编码	ICF 类别	智力残疾儿童的常见特征描述
交流(d3)	d330	说	表达性词汇量有限、难以形成复杂句子、言语可理解性低
	d310	交流-接收-口头讯息	理解指令困难、难以理解复杂的口语信息、对语境线索理解不足
	d350	交谈	难以发起和维持对话、轮流说话困难、偏离主题、语用技能不足
人际交往和联系(d7)	d710	基本的人际交往	难以建立和维持友谊、理解社会线索困难、情感表达不当
基本学习(d1)	d131	通过与物体和人的行动进行学习	语言发展里程碑延迟、学习新词汇和语法规则困难
	d133	掌握其他的语言	发展用词语、符号、短语和句子来表达人物、物体、事件、感觉的能力受限
	d140	学习阅读	流利且准确阅读书面材料(包括盲文和其他符号)的能力受限
	d163	思考	理解抽象概念和隐喻性语言困难，推理能力受限

环境因素	ICF编码	ICF类别	智力残疾儿童言语和沟通功能的影响描述
支持和相互关系(e3)	e310	直系亲属	家庭支持、鼓励沟通、使用清晰简单的语言、提供沟通机会对儿童的语言发展至关重要
	e320	朋友	同伴互动提供语言练习和社交学习的机会
	e325	熟人、同龄人、同事、邻居和社区成员	包容和积极的态度能够促进儿童的社会参与和沟通
	e355	卫生健康专业人员	言语治疗师、教师等专业人员提供的早期干预和持续支持对改善沟通能力至关重要
服务、体制和政策(e5)	e580	卫生健康的服务、体制和政策	获得早期干预服务、特殊教育资源和辅助沟通技术的机会对儿童的沟通发展至关重要
用品和技术(e1)	e120	用于个人室内外移动和交通的产品和技术	辅助和替代沟通(augmentative and alternative communication, AAC)可以显著提高非言语儿童的沟通能力
态度(e4)	e410	直系亲属家庭成员的个人态度	对智力残疾的负面态度和污名化会阻碍儿童的社会融合和沟通

Characteristics and intervention of speech function impairments and communication limitation in children with intellectual disabilities based on ICF

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