Features of children with mental retardation (PD): symptoms, prognosis and treatment with corrective education. Symptoms and methods of raising children with mental retardation Zpr in children, symptoms of 8 years

11.03.2020

The mental development of a child is a complex, genetically determined process of the sequential maturation of higher mental functions, which is realized under the influence of various environmental factors. The main mental functions include: gnosis (recognition, perception), praxis (purposeful actions), speech, memory, reading, writing, counting, attention, thinking (analytical and synthetic activity, the ability to compare and classify, generalize), emotions, will, behavior, self-esteem, etc.

V.V. Lebedinsky (2003) identifies six main types of violations mental development in children:

Irreversible mental underdevelopment (mental retardation).
Delayed mental development (reversible - in whole or in part).
Damaged mental development - dementia (the presence of a previous period of normal mental development).
Deficient development (in conditions of visual impairment, hearing impairment, somatic pathology).
Distorted mental development (early childhood autism).
Disharmonious mental development (psychopathy).

Delays in mental development in children and their correction are an urgent problem of pediatric psychoneurology. The term "mental retardation" was proposed by G. Ye. Sukhareva back in 1959. Psychological retardation (PD) is understood as a slowdown in the normal rate of mental maturation in comparison with the accepted age norms. CRD starts early childhood without a previous period of normal development, are characterized by a stable course (without remissions and relapses, in contrast to mental disorders) and a tendency to progressive leveling as the child grows up. It is possible to talk about DPR up to primary school age. The persisting signs of underdevelopment of mental functions at an older age indicate oligophrenia (mental retardation).

Conditions attributable to CRA are an integral part of the broader concept of "borderline intellectual deficiency" (Kovalev V.V., 1973). In the Anglo-American literature, borderline intellectual disability is partially described within the clinically undifferentiated syndrome of "minimal cerebral dysfunction" (MMD).

The prevalence of mental retardation among the child population (as an independent group of conditions) is 1%, 2% and 8-10% in the general structure mental illness (Kuznetsova L.M.). Delays in mental development as a syndrome, of course, are much more common.

The pathogenesis of CR is poorly understood. According to Pevser (1966), the main mechanism of ZPR is maturation disorders and functional insufficiency of younger and complex systems the brain, related mainly to the frontal parts of the cerebral cortex, which provide the implementation of creative acts of human behavior and activity. At present, there are no uniform forms of systematically borderline forms of intellectual disability. The most detailed is the classification of borderline states of intellectual disability presented by V.V.Kovalev (1973).

There is a division of ZPR into primary and secondary. In this case, secondary mental retardation occurs against the background of a primary intact brain in chronic somatic diseases (heart defects, etc.), accompanied by cerebral insufficiency.

In the first years of life due to immaturity nervous system dysfunction of maturation of motor and general mental functions is more often observed in children. Therefore, usually in early childhood, we are talking about a general retardation of psychomotor development with a greater severity of the lag in mental functions.

In children over three years of age, it becomes possible to isolate more outlined neuropsychiatric syndromes. The main clinical sign ZPR (according to M. Sh. Vrono) are: delay in the development of basic psychophysical functions (motor skills, speech, social behavior); emotional immaturity; uneven development of individual mental functions; functional, reversible nature of violations.

If intellectual impairment in preschool age is masked by speech disorders, then at school age it manifests itself clearly and is expressed in a poor supply of information about the environment, slow formation of concepts about the shape and size of objects, difficulties in counting, retelling of what has been read, misunderstanding of the hidden meaning of simple stories. In such children, a concrete-figurative type of thinking prevails. Mental processes are inert. Exhaustion and satiety are expressed. The behavior is immature. The level of visual-figurative thinking is quite high, and the abstract-logical level of thinking, inextricably linked with inner speech, turns out to be insufficient.

In certain forms of intellectual disability V.V.Kovalev distinguishes intellectual disability resulting from defects in analyzers and sense organs, in cerebral palsy and early childhood autism syndrome.

RPD syndrome is polyetiologic, the main reasons are:

The most important clinical characteristic of Encephabol is its safety, which is especially important, given the specificity of the population - the main consumers of this drug - pediatric, where safety problems are not inferior in importance to the assessment of effectiveness. Adverse reactions when taking Encephabol, they occur rarely and, as a rule, are associated with its general stimulating effect (insomnia, increased excitability, mild forms of dizziness) or, in extremely rare cases, with individual intolerance ( allergic reactions, dyspeptic manifestations). All of the above symptoms are almost always transient and do not always require discontinuation of the drug.

On the Russian pharmaceutical market, Encephabol is presented in the form of a suspension for oral administration 200 ml in a bottle and coated tablets 100 mg.

The dosage of Encephabol is usually, depending on the stage of the pathological process and the individual reaction:

for adults - 1-2 tablets or 1-2 teaspoons of the suspension 3 times a day (300-600 mg);
for newborns - from the 3rd day of life, 1 ml of suspension per day in the morning for a month;
from the 2nd month of life, the dose should be increased by 1 ml every week to 5 ml (1 teaspoon) per day;
for children from 1 to 7 years old - 1 / 2-1 teaspoon of the suspension 1-3 times a day;
for children over 7 years old - 1 / 2-1 teaspoon of the suspension 1-3 times a day or 1-2 tablets 1-3 times a day.

Although the first results of the clinical action of Encephabol may appear after 2-4 weeks of taking the drug, optimal results are usually achieved with a course duration of 6-12 weeks.

Literature

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N. A. Notkina et al. Assessment of the physical and neuropsychic development of children of early and preschool age... SPb: Childhood-Press, 2008.32 p.
Petelin L.S., Shtok V.N., Pigarov V.A. Encephabol in a neurological clinic // Encephabol: aspects of clinical application. M., 2001, p. 7-11.
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A. P. Skoromets 1, 2, 3, doctor of Medical Sciences, Professor
I. L. Semichova 4
I. A. Kryukova 1, 2, 3, candidate of Medical Sciences
T.V. Fomina 6
M.V.Shumilina 3, 5

1 SPbMAPO, 2 SPbSPMA, 3 Children's hospital No. 1, 4 SPbGC "Children's Psychiatry",
5 SPbGMU,St. Petersburg
6 MSCh 71 FMBA RF,Chelyabinsk

Today we will try to figure out one acronym that scares many parents. ZPR - what is it? Can this state be corrected?

In medicine, this is referred to as hyperactivity: the child is spinning, unable to stand still, unable to wait for a turn in the game, answers without hearing the question to the end, he cannot speak or play quietly.

Violations with CRA

What it is is now clear. ZPR is often expressed in the rate of speech development. As a rule, a child with this problem in communication pays more attention to gestures and intonation, having limited vocabulary... At the same time, violations are reversible and can be corrected. Every year the child is catching up more and more with his peers, overcoming speech impairment.

Lagging in all forms of thinking (analysis, generalization, synthesis, comparison) is also observed in such children. They cannot distinguish, for example, the main features when generalizing. Answering the question: "How can you call a dress, trousers, socks, sweater in one word?" - such a child will say: "This is everything a person needs" or "This is all in our closet." At the same time, children with CRD can supplement the proposed group of objects without any difficulty. When comparing objects, this process is carried out according to random signs. "How do people differ from animals?" "People wear coats, but animals don't."

Problems of communicative adaptation of children with mental retardation, what is it

A distinctive feature of children with mental retardation is the problematic nature of interpersonal relationships for them, both with peers and with adults. The need for communication in such children is reduced. For the adults on whom they depend, many have increased anxiety. Such children are attracted by new people much less than new objects. When problems arise, the child is more likely to stop his activities than turn to someone for help.

As a rule, children with DPD are not ready for “warm” relationships with their peers, reducing them to purely “businesslike” ones. Moreover, the games take into account the interest of only one side, and the rules are always rigid in nature, excluding any variations.

How to react to parents if the record "mental retardation" appeared in the medical card of the baby. Of course, they are scared enough, but do not give up. In the case of CRA, the main thing is to find out the cause of the problem and understand how to deal with it. More details - in our old material.

How to recognize?

Impaired mental function - violation of the established terms of maturation of the emotional-volitional and intellectual spheres of the child, slowing down the pace of development of the psyche.

Can parents themselves suspect the problem? If the baby is three months old absent " " , that is, he does not begin to walk and smile in response to the voice and smile of his parents - it is necessary to go to an appointment with a pediatric neurologist.

What will the doctor pay attention to? There are certain normative terms according to which at 1-2 months the baby must follow the rattle with his eyes, at 6-7 - sit, at 7-8 - crawl, at 9-10 - stand, and by the age of one year old take the first steps. If the development of the child does not correspond to the norms, the neurologist may assume problems. Another factor of concern is if the child suddenly regresses, that is, he stops doing what he already knew or does it much worse than before.

The kid grew up and his parents noticed that he behaving wrong , as his peers, has difficulties with communication, problems with mastering speech, it is difficult for him to concentrate, is he closed or uncoordinated? With all such manifestations, the doctor can state a mental retardation, which means it is time to figure out what led to it and find a way to deal with the disease.

You will have to work in a close team: a pediatrician, a neurologist, parents, sometimes a speech therapist and a child psychiatrist are included. It is important to understand what caused the developmental delay and to find ways in which the child will catch up with his peers.

Voinovskaya Irina Vladimirovna, pediatric neurologist of the Dobrobut Children's Clinic on the Left Bank says: “The reasons for the delay in psychological development can be both biological - pathologies of pregnancy, prematurity, trauma and asphyxiation during childbirth, mother's illness in the early stages of fetal development, genetic conditioning, and social - long-term limitation of the child's life, unfavorable conditions of upbringing, psycho-traumatic situations in life child. If the parents notice unstable emotions in the child, a decrease in cognitive activity, problems in the formation of speech activity with the child, you should contact a child neurologist, speech therapist, psychologist or psychiatrist. Experts will develop an individual scheme of pedagogical and medical correction, which, together with the close attention of parents to the development of the baby, will help to partially or even completely overcome the mental retardation. "

How does it manifest

Doctors call the most striking sign of CRD immaturity of the emotional-volitional sphere ... It is quite difficult for a child with such a disease to force himself to do something.

Consequently - attention deficit and decreased concentration ... The kid is often distracted, it is difficult to interest him in any process.

Due to problems with a limited amount of knowledge about the world around them, children diagnosed with IAD may experience difficulties with orientation in space , they find it difficult to recognize even familiar objects from a new perspective.

A feature of children with mental retardation is that they better remember what they see than what they hear, and they also often have problems with the development of speech at different levels.

Lagging is also observed in thinking, for example, children with mental retardation have serious difficulties while solving problems based on synthesis, analysis, comparison and generalization.

Reasons and not only

What is the reason for the violation of normal development in a child?

These are genetic factors, and mild organic brain damage due to an illness (for example, a severe form of flu or), a number of factors associated with the development of a child in infancy (irrational use of large doses of antibiotics), an unfavorable course of pregnancy and childbirth (illness, intoxication, asphyxia during childbirth).

Vaccination of a baby with neurological problems or can also provoke CRA. For example, mental retardation is noted in almost all orphanage children, and those who did not get there directly from the hospital, but were with their mother for a while, regression of previously acquired skills is observed.

Many experts believe that social and pedagogical factors are the cause of the developmental deficiencies: an unfavorable situation in the family, lack of development, difficult living conditions.

Our mom- Anutik tells: “At the age of 3 we had OHR, ZRR, pseudobulbar dysarthria. The EEG showed organic brain damage, without intellectual disruption ... His coordination and setting of the legs when walking was slightly impaired. He spoke 5 words at that time, without verbs. Somewhere 3.5 years of intensive training, the child had other words, then simple sentences, then a story. At 5.5 years old, we began to slowly master reading, and by the age of 6 my child began thorough preparation for entering the 1st grade ... Now we are first graders, in the most ordinary kindergarten school, near the house, studies are good, even Ukrainian we master it, although before school I grew up in a Russian-speaking family ... English is bad so far, but I don't really want to load it with the third language, in fact, for him. The memory is good, we learn poems well ... The child likes the team, they like it when they take everyone out for a walk, play all sorts of games on the street with a crowd, like to stay at the extended day and all drink tea and eat sandwiches together at the table, like to do lessons in an organized way ... There remained blurred speech, of course, mild dysarthria, some neurological moments. But while they are small, 1st grade, classmates do not really understand what the matter is, they do not distinguish him on this basis, besides, there are still a lot of ordinary children in the class who still don’t speak “p”, hissing. But in 2 years (from 3.5 to 5.5), I can tell you, the child made a HUGE breakthrough in the development of speech ... We underwent treatment at a speech center in Kiev. And there, each course of classes with a speech therapist, massage therapist and other specialists is always supported with medication. How everything will develop further, she herself is in the dark .... Let's see ... "

What to do?

So, what should parents do if doctors have found and confirmed the diagnosis of mental retardation in the baby?

If a diagnosis is made, then specialists should determine the cause , due to which there was a developmental delay. It is also important to understand if the child has any related problems, for example, if the child has difficulty developing speech, it is important to understand that he does not have hearing problems.

If the doctor prescribes the child medicines that will have a direct impact on his psyche, try to be sure to get an appointment with another specialist in order to listen to not one, but two to three or five opinions. Most often, experts are of the opinion that in case of CRA, the correct rehabilitation of competent specialists is sufficient.

Find a child working with children diagnosed with CRD in your city. Working in adaptation groups, mini-kindergartens or independently, the child will be able to cope with the disease faster, and parents will receive qualified consultations and will be able to participate in trainings.

Specialists of the center for helping children with mental retardation will develop individual program rehabilitation baby, which will be aimed directly at stimulating the affected mental processes.

Work with your child according to the developed rehabilitation program under the supervision of the center's specialists, and most importantly - do not lose contact with the child, believe in his development.

Our mother - JuliaL tells: “In my opinion, the most important thing is not to lose contact with the child, not to let HIM move away ... You see, I have two more ordinary children, and for a long time I could not understand what was wrong with my son ... I was already thinking Maybe I really have some kind of coldness, or something ... And then I realized that he was trying to distance himself, withdraw into himself, but you can't let go. Such contact helps us a lot to keep the family in general, sisters, pets - although there are a lot of problems and inconsistencies. It was a great happiness when, after 3 years, he first began to settle down next to me, then he said "mommy", at 5 he suddenly began to hug ... Now sometimes he just has bouts of tenderness, and tells how glad he is that with lives by us, etc. IMHO - medical specialists-teachers advise what they know, but everything must be applied with an eye to how the mother feels. It is very important that we, our children and they feel good with us, do not break this. Honestly, we have trips, some good, warm events have always made some progress. And when "building" the son does not give progress at all ... This is the simplest and most difficult for me, sorry for the unnecessary emotions ... "

We are sure that if you start working with your baby in a timely manner, you will be able to solve many problems, and over time the child will recover and will be no different from his peers!

In medicine and pedagogy, there is no clear differential diagnosis problems of ZPR, ZRR and ZPRR. Parents are offered average recommendations that should be suitable for correcting the diagnoses of RRD, RRR and RRP in all children. But in practice, this is far from the case, and treatment does not always help. In what cause of CRA, ZRR and ZPRR in a child and how it is possible to remove the diagnosis, read this article.

ZPR, ZRR, ZPRR: what are these diagnoses

ZPR. Impaired mental function. It is given to children who have impaired normal development of mental functions - thinking, memory, attention, the ability to learn and acquire new skills.
ZRR. Delayed speech development. It is given to children who, by 3-4 years old, have a small vocabulary or no phrasal speech, at a normal pace of development of the psyche.
ZPRR. Delayed mental and speech development. It combines both a lag in the formation of the psyche and a delay in the development of speech.

Kindergarten teachers may report that the child is behaving "strange", aggressive, shouting, and prefers to be alone. Does not perform tasks together with everyone due to restlessness. He may need additional time, new knowledge is not retained in his memory, and he has to repeat everything, like the first time. The lag in early childhood, when children are most actively developing, can be irreparable. In the first grades of school, a child diagnosed with CRD, CRD, and CRD often has reading, writing and counting disorders. If the situation is not corrected, then the baby becomes a candidate for training in a correctional program. How to avoid this, read on.

Diagnosis of ZPR, ZRR and ZPRR in children

Diagnostics of children with RPD, ZRD and ZPRD includes several stages:

Study of anamnesis and living conditions;
Examination of the child by a pediatrician, neurologist and ENT doctor;
Examination of the child by a speech therapist, psychologist and psychiatrist.

First, it turns out the presence of injuries, infections and other factors that could lead to a violation of the development of the baby's nervous system. Information about the child's behavior and treatment in the family and in kindergarten is also important. Specialist doctors help to determine concomitant diseases and the condition of the body as a whole. The diagnosis of ZPR, ZRR or ZPRR is carried out by the medical and pedagogical commission on the basis of the conclusions of a speech therapist, psychologist, psychiatrist and teacher-defectologist.

Delayed speech and mental development is also detected during preventive medical examinations of children of established ages, as well as during a medical examination of a child for admission to kindergarten... Methods for diagnosing ZPR, ZRR and ZPRR are based on determining the compliance of the child's developmental level with age norms.

If a child has been diagnosed with RRD, RRR or RRR, this means that special attention should be paid to the development of the baby.

Causes of ZPR, ZRR and ZPRR in children

The causes of ZPR, ZRR and ZPRR in children are:

Organic damage to the central nervous system

Physical damage to the brain can occur during birth trauma, severe hypoxia, infectious diseases central nervous system, head injuries and repeated operations under anesthesia.

Chromosomal, genetic and somatic diseases

Diseases such as Down syndrome, cerebral palsy, congenital sensorineural hearing loss, and others, carry a secondary delay in the development of speech and psyche.

In this article, we will talk about those children who do not have obvious signs of brain damage. When the pregnancy and childbirth proceeded normally, and the child lags behind in development due to the inconsistency of the conditions of the environment with his individual mental characteristics... These conditions include the choice of the wrong methods of education and training.

ZPR, ZRR and ZPRR in children: symptoms and signs

Symptoms of ZPR, ZRR and ZPRR include:

Poverty or lack of independent speech from the age of 3;
The child does not understand well and does not perform simple tasks;
Slowly acquires new skills;
Restlessness, attention deficit hyperactivity disorder;
Neurotic reactions (nocturnal enuresis, tearfulness, fears);
Closedness, isolation, absence or weak reaction to addressing a child with preserved hearing;
Auto-like behavior;

A child with RRD, RRD, or RRD may have individual symptoms or all of the above.

The problem of classifications of symptoms of CRP, CRP and CRP is that they do not take into account the individual characteristics of the baby, equalize different children and adjust them to generally accepted norms. What is the reason for the delay in mental and speech development in a particular child? We will understand this with the help of the system-vector psychology of Yuri Burlan.

Mental characteristics of children with diagnoses of CRP, CRP and CRP

According to the system-vector psychology of Yuri Burlan, a person is born with certain vectors. Each vector has its own properties, unlike others, and its own psychophysical characteristics.

Knowledge of the child's vectors allows him to develop him correctly. After all, what is the norm for one can be a pathology for another. In children with diagnoses of PDA, PDA and PDA, the causes of their appearance lie in developmental disorders in one or more of the following vectors.

A child with a sound vector has a special sensitivity to sounds and words of other people. They are children who are silent for a long time, and then immediately begin to speak in sentences. When a child does not turn to adults, does not strive for communication, does not speak, but understands everything and does what he is told - it can be a kid with a sound vector. If the sounds outside are unpleasant to his sensitive ear, then the psyche is protected. The child “withdraws into himself”, his interaction with the environment is disrupted. This can happen when there are quarrels, scandals, noises in the family, household appliances and the like are working loudly. The harsh voice of the mother and even unwanted words in a quiet voice, which she speaks casually, can cause a delay in psycho-speech development in children with a sound vector. When the environment is too traumatic, the child may be diagnosed with autosimilar behavior and childhood autism.

This is a severe disorder of communication and behavior with partial or complete loss of the ability to distinguish the meaning of the speech of others, while retaining hearing. The child cannot develop further, because his psyche curls up into a ball inside himself. He needs to be helped to "get out." For this, the rules of sound ecology at home must be observed. Close people, especially a mother, need to know the characteristics of such children. A child with a sound vector is not like everyone else. And the more complex the psyche, the more fragile it is, the easier it is to break it without even wanting to.

Children with an anal vector are slow and detailed. It is vital for them to complete the work they have begun to the end, whether it is sitting on a potty or buttoning up the buttons. It is psychologically important for such a child to put an end to any business.

If he is rushed or interrupted, then he begins to be stubborn and offended. As a reaction to stress, a stupor may appear - the baby stops and cannot continue what he started. With chronic stress in the anal vector, thinking becomes excessively slow, and becomes stuck on irrelevant details. Attention is switched with difficulty, the baby cannot assimilate knowledge, does not acquire new skills. The developmental lag in a child with an anal vector appears due to the discrepancy between the pace of his mental activity and the requirements of the environment. Stuttering may occur. The anal vector should be distinguished from others and the child should be provided with optimal conditions for development.

The skin vector is opposite in properties to the anal vector. A child with a skin vector is nimble, flexible, able to quickly switch from one to another. Grabbing a few things and not finishing them is about him. With the wrong upbringing of such a child, he may experience mental retardation with attention deficit hyperactivity disorder.

Then it is difficult for him to learn and acquire skills due to distraction and restlessness. Such a baby needs discipline and an adequate system of prohibitions more than others, because in the skin vector self-restraint has a special meaning. Parents, annoyed at the child's behavior, begin to abruptly grab him, spank him, scold him. This cannot be done - humiliation, infliction of pain, beating a baby with a skin vector inhibits his development.

Children with visual vectors are the most emotional and prone to mood swings. To educate their sensuality is the task of parents. If a child with a visual vector is not taught to empathize with other people, then he may experience fears, throw tantrums, cry and blow an elephant out of a fly for any reason. When a child develops a habit of receiving emotions in this way, it disrupts his interaction with other people. There is a fear of communication, and then the talkative at home baby is silent and afraid strangers, stuttering may appear.

The role of a child's sense of security and safety in the development of ZPR, ZRR and ZPRR

Mom is the most close person for a child, and most important. She gives him a sense of security and safety. This is a prerequisite for the development of the baby's psyche. Mom keeps his life and psychological comfort. Then the child is able to develop the properties in his vectors to the maximum.

The loss of a sense of security and safety is fraught with a stop in development for him. Then, the still immature properties of vectors begin to appear in the child, some of which are recognized as symptoms and signs of DPR, ЗРР and ЗПРР.

Up to 6-7 years, the child's unconscious connection with his mother is absolute - he takes over her internal state without words. If the mother is annoyed, depressed, upset, and herself subject to frequent stress, then the child will not feel protected either. When a mother puts her psyche in order, the baby's condition improves. A calm, well-balanced mother is able not to make mistakes in upbringing, to react correctly to any child's behavior and not to break down on him.

When the mother finds out that the child has been diagnosed with CRP, CRP and CRP, she is covered with a wave of fear for his future. Internal tension, a sense of guilt increases. She strives to give him the best, and if there is no result, despair ensues. Such an anxious state of the mother affects the child negatively. Mom needs to know what to do, gain confidence in her actions, and increase stress resistance.

Getting knowledge at the training "System-vector psychology" is the best advice that can be given in this situation.

Pedagogical and social neglect is a consequence of ignorance of the rules of education

When ZPR, ZRR or ZPRR in a child appears due to improper methods of education and the impact of not favorable conditionssuch as humiliation, physical and psychological violence, overprotection or homelessness in the family, lack of upbringing of the emotional sphere, labor, hygiene skills and the inability to overcome laziness - they speak of a pedagogically neglected child.

Often these are socially dysfunctional families, but even in exemplary families there are pedagogically neglected children.

When a person is subjected to something that is contrary to his nature, when they do not know the peculiarities of his psyche, this is a matter of the psychological literacy of the parents.

Everyone is born with certain inclinations that can both be developed and destroyed. It is easy to involve any baby in the activities that nature intended for him, if you know what he is inclined to.

Diagnoses of RRD, RRR and RRR include many conditions, each of which has its own vector-based cause. If a child has been diagnosed with RRD, RRR or RRP, this is not a sentence. How to remove the diagnosis of RPRD - you need to know what kind of child is diagnosed with RPRD. Having understood the peculiarities of the child's psyche, it will turn out to develop it correctly.

If you are a mother of a small son or daughter diagnosed with CRP, CRP or CRP, come to the free online lectures of the training "System Vector Psychology" by Yuri Burlan. Watch and read