Delayed mental development is…. Types of mental retardation Zpr types and characteristics

These three ominous letters are nothing but delay mental development ... Doesn't sound very nice, right? Unfortunately, today in medical card a child can often find such a diagnosis.

Over the past few years, there has been an increased interest in the problem of ZPR, there are many disputes around it. All this is due to the fact that in itself such a deviation in mental development is very ambiguous, it can have many different prerequisites, causes and effects. The phenomenon is complex in its structure, requires close and careful analysis, an individual approach to each specific case. Meanwhile, the diagnosis of CRD is so popular among doctors that some of them, based on a minimal amount of information and relying on their professional instincts, unreasonably easily put their autograph under it, often without thinking about the consequences. And this fact is already quite enough to get to know the problem of CRA better.

What is suffering

ZPR refers to the category of mild deviations in mental development and occupies an intermediate place between the norm and pathology. Children with mental retardation do not have such severe deviations in development as mental retardation, primary underdevelopment of speech, hearing, vision, motor system. The main difficulties they experience are primarily related to social (including school) adaptation and learning.

The explanation for this is the slowdown in the rate of maturation of the psyche. It should also be noted that each separately taken child DPR can manifest itself in different ways and differ both in time and in the degree of manifestation. But, despite this, we can try to identify a range of developmental features characteristic of most children with CRD.

Researchers call the most striking sign of CRD immaturity of the emotional-volitional sphere; in other words, it is very difficult for such a child to make a volitional effort on himself, to force himself to do something. And from here inevitably appear attention disorders: his instability, decreased concentration, increased distraction. Attention disorders can be accompanied by increased motor and speech activity. Such a complex of deviations (impaired attention + increased motor and speech activity), not complicated by any other manifestations, is currently denoted by the term "attention deficit hyperactivity disorder" (ADHD).

Perceptual impairment expressed in the difficulty of building a holistic image. For example, it may be difficult for a child to recognize objects they know from an unfamiliar perspective. Such a structured perception is the reason for the insufficiency, limitation, knowledge about the world around. The speed of perception and orientation in space also suffer.

Talking about memory features in children with mental retardation, one regularity was found here: they memorize visual (non-verbal) material much better than verbal material. In addition, it was found that after a course of special training in various memorization techniques, the indicators of children with CRD improved even in comparison with normally developing children.

CRP is often accompanied by speech problemsassociated primarily with the rate of its development. Other features of speech development in this case may depend on the form of severity of CR and the nature of the underlying disorder: for example, in one case it may be only some delay or even compliance with the normal level of development, while in the other case, there is a systemic underdevelopment of speech - a violation of its vocabulary grammatical side.

Children with CRD have lag in the development of all forms of thinking; it is revealed first of all during the solution of problems on verbal-logical thinking. By the beginning of schooling, children with mental retardation do not fully master all the intellectual operations necessary for completing school assignments (analysis, synthesis, generalization, comparison, abstraction).

At the same time, CRA is not an obstacle to the development of general educational programs of study, which, however, require certain adjustments in accordance with the characteristics of the child's development.

Who are these children

The answers of experts to the question of which children should be ranked in the group with CRD are also very ambiguous. Conventionally, they can be divided into two camps.

The first adhere to humanistic views, believing that the main reasons for the developmental deficiencies are primarily socio-pedagogical in nature (unfavorable family situation, lack of communication and cultural development, difficult living conditions). Children with mental retardation are defined as unadapted, difficult to learn, pedagogically neglected. This view of the problem prevails in Western psychology, and recently it has become widespread in our country. Many researchers cite data that mild forms of intellectual underdevelopment tend to be concentrated in certain social strata, where parents have an intellectual level below the average. It is noted that hereditary factors play a significant role in the genesis of intellectual underdevelopment.

Probably, it is most correct to take into account both those and other factors.

So, as the reasons leading to mental retardation, domestic experts M.S. Pevzner and T.A. Vlasov, the following are distinguished.

Unfavorable course of pregnancy:

• mother's illness during pregnancy (rubella, mumps, flu);
• chronic maternal diseases (heart disease, diabetes, thyroid disease);
• toxicosis, especially in the second half of pregnancy;
• toxoplasmosis;
• intoxication of the mother's body due to the use of alcohol, nicotine, drugs, chemicals and drugs, hormones;
• incompatibility of the blood of the mother and the baby for the Rh factor.

Labor pathology:

• injuries due mechanical damage the fetus when using various means of obstetric aid (for example, the application of forceps);
• asphyxia of newborns and its threat.

Social factors:

• pedagogical neglect as a result of limited emotional contact with the child both at the early stages of development (up to three years) and at later age stages.

Types of developmental delay in children

Mental retardation is usually divided into four groups. Each of these types is due to certain reasons, has its own characteristics of emotional immaturity and impaired cognitive activity.

The first type - CRA of constitutional origin... This type is characterized by a pronounced immaturity of the emotional-volitional sphere, which is, as it were, at an earlier stage of development. Here we are talking about the so-called mental infantilism. It must be understood that mental infantilism is not a disease, but rather a certain complex of sharpened character traits and behavioral features, which, however, can significantly affect the child's activity, primarily educational, his adaptive abilities to a new situation.

Such a child is often not self-sufficient, it is difficult to adapt to new conditions for him, often strongly attached to his mother and in her absence he feels helpless; it is characterized by an increased background of mood, a violent manifestation of emotions, which are very unstable at the same time. By school age, such a child still has playful interests in the foreground, while normally they should be replaced by educational motivation. It is difficult for him to make any decision without outside help, make a choice or make any other volitional effort over himself. Such a kid can behave cheerfully and directly, his developmental lag is not striking, but when compared with his peers, he always seems a little younger.

To the second group - somatogenic origin - weakened, often ill children belong. As a result of long-term illness, chronic infections, allergies, congenital defects developmental delay may form. This is due to the fact that during a long illness, against the background of general weakness of the body mental condition the baby also suffers, and, therefore, cannot fully develop. Low cognitive activity, increased fatigue, dullness of attention - all this creates a favorable situation for slowing down the pace of development of the psyche.

This also includes children from families with overprotection - excessively increased attention to raising a baby. When parents care too much about their beloved child, do not let him go, they do everything for him, fearing that the child may harm himself, that he is still small. In such a situation, relatives, considering their behavior as a model of parental care and guardianship, thereby prevent the child from manifesting independence, and therefore, cognition of the surrounding world, the formation of a full-fledged personality. It should be noted that the situation of overprotection is just very common in families with a sick child, where pity for the baby and constant anxiety for his condition, the desire to supposedly make his life easier in the end turn out to be bad helpers.

The next group is CRA of psychogenic origin.... The main role is assigned to the social situation of the baby's development. Unfavorable situations in the family, problem upbringing, mental trauma become the reason for this type of CRA. If there is aggression and violence in the family towards the child or other family members, this can lead to the predominance in the character of the baby of such traits as indecision, lack of independence, lack of initiative, fearfulness and pathological shyness.

Here, in contrast to the previous type of CRA, there is a phenomenon of hypo-care, or insufficient attention to the upbringing of a child. A child grows up in a situation of neglect, pedagogical neglect. The consequence of this is the lack of ideas about the moral norms of behavior in society, the inability to control their own behavior, irresponsibility and inability to take responsibility for their actions, an insufficient level of knowledge about the world around them.

The fourth and last type of CRA is of cerebral-organic origin... It occurs more often than others, and the prognosis further development for children with this type of CRD, in comparison with the previous three, it is usually the least favorable.

As the name suggests, the basis for the isolation of this group of cerebrovascular accidents are organic disorders, namely, insufficiency nervous system, the causes of which may be: pathology of pregnancy (toxicosis, infections, intoxication and trauma, Rh-conflict, etc.), prematurity, asphyxia, birth trauma, neuroinfections. With this form of CRD, the so-called minimal cerebral dysfunction (MMD) takes place, which is understood as a complex of mild developmental disorders that manifest themselves, depending on the specific case, very diversely in different areas mental activity.

MMD researchers have identified the following risk factors for its occurrence:

• late age of the mother, height and body weight of a woman before pregnancy, beyond the age norm, first birth;
• pathological course of previous labor;
• chronic diseases of the mother, especially diabetes, Rh-conflict, premature birth, infectious diseases during pregnancy;
• psychosocial factors such as unwanted pregnancy, big city risk factors (daily long drive, city noise);
• the presence of mental, neurological and psychosomatic diseases in the family;
• abnormal delivery with forceps, by caesarean section etc.

Children of this type are distinguished by the weakness of the manifestation of emotions, poverty of imagination, disinterest in evaluating themselves by others.

About prevention

The diagnosis of CRD appears in the medical record most often closer to school age, at the age of 5-6, or even when the child is directly faced with learning problems. But with a timely and competently constructed correctional-pedagogical and medical care partial and even complete overcoming of this developmental deviation is possible. The problem is that the diagnosis of CRD in the early stages of development seems to be quite problematic. His methods are based primarily on a comparative analysis of the development of the child with the norms corresponding to his age.

Thus, the first place comes prevention of malnutrition... Recommendations on this matter are no different from those that can be given to any young parents: this is, first of all, the creation of the maximum favorable conditions for the course of pregnancy and childbirth, avoiding the risk factors listed above, and of course, close attention to the development of the baby from the very first days of his life. The latter simultaneously makes it possible to recognize and correct developmental deviations in time.

First of all, it is necessary to show the newborn to a neurologist. Today, as a rule, all children after 1 month are sent for examination to this specialist. Many receive a referral directly from the hospital. Even if both pregnancy and childbirth went perfectly, your baby feels great, and there is not the slightest cause for concern - do not be lazy and visit the doctor.

A specialist, having checked the presence or absence of various reflexes, which, as you know, accompany the child throughout the entire period of newborn and infancy, will be able to objectively assess the development of the baby. The doctor will also check vision and hearing, note the features of interaction with adults. If necessary, he will prescribe neurosonography - ultrasound examination, which will provide valuable information about the development of the brain.

Knowing the age indicators of the norm, you yourself will be able to monitor the psychomotor development of the baby. Today, on the Internet and in various printed publications, you can find many descriptions and tables, which show in detail what a baby should be able to do at a given age, starting from the first days of life. There you can also find a list of behavioral features that should alert young parents. Be sure to read this information, and if you have the slightest suspicion, immediately go to an appointment with a doctor.

If you have already visited the appointment, and the doctor considered it necessary to prescribe medications, you should not neglect his recommendations. And if doubts do not give rest, or the doctor does not inspire confidence, show the child to another, third specialist, ask your questions, try to find the maximum amount of information.

If you are confused by a medicine prescribed by a doctor, do not hesitate to ask about it in more detail, let the doctor tell you how it works, what substances it contains, why your child needs it. After all, under an hour, under the menacing-sounding names, relatively "harmless" drugs are hidden, acting as a kind of vitamins for the brain.

Of course, many doctors are reluctant to share such information, believing, not without reason, that there is no need to initiate people who are not related to medicine into purely professional matters. But trying is not torture. If you were not able to talk with a specialist, try to find people who have encountered similar problems. Here again, the Internet and the corresponding literature will come to the rescue. But, of course, you should not take on faith all the statements of parents from Internet forums, because most of them do not have medical education, but only share their personal experience and observations. It will be more effective to use the services of an online consultant who can give qualified recommendations.

In addition to visiting doctors' offices, there are several points regarding the interaction of parents with children, which are also necessary for the normal and full development of the child. The components of communication with the baby are familiar to every caring mother and are so simple that we do not even think about their colossal effect on the growing body. it body-emotional contact with the baby. Skin contact means any touch to the child, hugs, kiss, stroking the head. Since in the first months after birth, the baby has a very developed tactile sensitivity, bodily contact helps him to navigate in a new environment for him, to feel more confident and calm. The baby must be taken in your arms, caressing him, stroking not only on the head, but all over the body. The touch of tender parental hands to the baby's skin will allow him to form the correct image of his body, to adequately perceive the space around him.

A special place is given to eye contact, which is the main and most effective way transfer of feelings. In particular, of course, this applies to infants, who are not yet available other means of communication and expression of emotions. A kind look reduces anxiety in the baby, has a calming effect on him, and gives him a sense of security. And, of course, it is very important to pay all your attention to the baby. Some believe that by indulging a baby's whims, you are spoiling him. This is certainly not the case. After all, the little man feels so insecure in a completely unfamiliar environment that he constantly needs confirmation that he is not alone, he is needed by someone. If the child received less attention in early childhood, this will certainly affect later.

Needless to say, a baby with certain developmental disabilities needs the warmth of mother's hands, her gentle voice, kindness, love, attention and understanding a thousand times more than his healthy peers.

What is CRP?

These three ominous letters are nothing butdelay mental development... Doesn't sound very nice, right? Unfortunately, today in a child's medical record one can often find such a diagnosis.

Over the past few years, there has been an increased interest in the problem of ZPR, there are many disputes around it. All this is due to the fact that in itself such a deviation in mental development is very ambiguous, it can have many different prerequisites, causes and effects. The phenomenon is complex in its structure, requires close and careful analysis, an individual approach to each specific case. Meanwhile, the diagnosis of CRD is so popular among doctors that some of them, based on a minimal amount of information and relying on their professional instincts, unreasonably easily put their autograph under it, often without thinking about the consequences. And this fact is already quite enough to get to know the problem of CRA better.

What is suffering

ZPR refers to the category of mild deviations in mental development and occupies an intermediate place between the norm and pathology. Children with mental retardation do not have such severe deviations in development as mental retardation, primary underdevelopment of speech, hearing, vision, motor system. The main difficulties they experience are primarily related to social (including school) adaptation and learning.

The explanation for this is the slowdown in the rate of maturation of the psyche. It should also be noted that for each individual child, CRD can manifest itself in different ways and differ both in time and in the degree of manifestation. But, despite this, we can try to identify a range of developmental features characteristic of most children with CRD.

Researchers call the most striking sign of CRDimmaturity of the emotional-volitional sphere; in other words, it is very difficult for such a child to make a volitional effort on himself, to force himself to do something. And from here inevitably appearattention disorders: his instability, decreased concentration, increased distraction. Attention disorders can be accompanied by increased motor and speech activity. Such a complex of deviations (impaired attention + increased motor and speech activity), not complicated by any other manifestations, is currently denoted by the term "attention deficit hyperactivity disorder" (ADHD).

Perceptual impairment expressed in the difficulty of building a holistic image. For example, it may be difficult for a child to recognize objects they know from an unfamiliar perspective. Such a structured perception is the reason for the insufficiency, limitation, knowledge about the world around. The speed of perception and orientation in space also suffer.

Talking aboutmemory features in children with mental retardation, one regularity was found here: they memorize visual (non-verbal) material much better than verbal material. In addition, it was found that after a course of special training in various memorization techniques, the indicators of children with CRD improved even in comparison with normally developing children.

CRP is often accompanied byspeech problems associated primarily with the rate of its development. Other features of speech development in this case may depend on the form of severity of CR and the nature of the underlying disorder: for example, in one case it may be only some delay or even compliance with the normal level of development, while in the other case, there is a systemic underdevelopment of speech - a violation of its vocabulary grammatical side.

Children with CRD havelag in the development of all forms of thinking; it is revealed first of all during the solution of problems on verbal-logical thinking. By the beginning of schooling, children with mental retardation do not fully master all the intellectual operations necessary for completing school assignments (analysis, synthesis, generalization, comparison, abstraction).

At the same time, CRA is not an obstacle to the development of general educational programs of study, which, however, require certain adjustments in accordance with the characteristics of the child's development.

Who are these children

The answers of experts to the question of which children should be ranked in the group with CRD are also very ambiguous. Conventionally, they can be divided into two camps.

The first adhere to humanistic views, believing that the main reasons for the developmental deficiencies are primarily socio-pedagogical in nature (unfavorable family situation, lack of communication and cultural development, difficult living conditions). Children with mental retardation are defined as unadapted, difficult to learn, pedagogically neglected. This view of the problem prevails in Western psychology, and recently it has become widespread in our country. Many researchers cite data that mild forms of intellectual underdevelopment tend to be concentrated in certain social strata, where parents have an intellectual level below the average. It is noted that hereditary factors play a significant role in the genesis of intellectual underdevelopment.

Probably, it is most correct to take into account both those and other factors.

So, as the reasons leading to mental retardation, domestic experts M.S. Pevzner and T.A. Vlasov, the following are distinguished.

Unfavorable course of pregnancy:

• mother's illness during pregnancy (rubella, mumps, flu);
• chronic diseases of the mother (heart disease, diabetes, thyroid disease);
• toxicosis, especially in the second half of pregnancy;
• toxoplasmosis;
• intoxication of the mother's body due to the use of alcohol, nicotine, drugs, chemicals and drugs, hormones;
• incompatibility of the blood of the mother and the baby for the Rh factor.

Labor pathology:

• trauma due to mechanical damage to the fetus when using various means of obstetric aid (for example, the imposition of forceps);
• asphyxia of newborns and its threat.

Social factors:

• pedagogical neglect as a result of limited emotional contact with the child both at the early stages of development (up to three years old) and at later age stages.

Delay types

Mental retardation is usually divided into four groups. Each of these types is due to certain reasons, has its own characteristics of emotional immaturity and impaired cognitive activity.

The first type - CRA of constitutional origin... This type is characterized by a pronounced immaturity of the emotional-volitional sphere, which is, as it were, at an earlier stage of development. Here we are talking about the so-called mental infantilism. It is necessary to understand that mental infantilism is not a disease, but rather a certain complex of sharpened character traits and behavioral features, which, however, can significantly affect the child's activity, first of all, educational, his adaptive abilities to a new situation.

Such a child is often not self-sufficient, it is difficult to adapt to new conditions for him, is often strongly attached to his mother and in her absence he feels helpless; it is characterized by an increased background of mood, a violent manifestation of emotions, which are very unstable at the same time. By school age, such a child still has playful interests in the foreground, while normally they should be replaced by educational motivation. It is difficult for him to make any decision without outside help, make a choice or make any other volitional effort over himself. Such a baby can behave cheerfully and directly, his developmental lag is not striking, but when compared with his peers, he always seems a little younger.

To the second group - somatogenic origin - weakened, often ill children belong. As a result of long-term illness, chronic infections, allergies, congenital malformations, mental retardation may form. This is due to the fact that during a long illness, against the background of a general weakness of the body, the mental state of the baby also suffers, and, therefore, cannot fully develop. Low cognitive activity, increased fatigue, dullness of attention - all this creates a favorable situation for slowing down the pace of development of the psyche.

This also includes children from families with overprotection - excessively increased attention to raising a baby. When parents take too much care of their beloved child, do not let him go, they do everything for him, fearing that the child may harm himself, that he is still small. In such a situation, relatives, considering their behavior as a model of parental care and guardianship, thereby prevent the child from manifesting independence, and therefore, cognition of the surrounding world, the formation of a full-fledged personality. It should be noted that the situation of overprotection is just very common in families with a sick child, where pity for the baby and constant anxiety for his condition, the desire to supposedly make his life easier, ultimately turn out to be bad helpers.

The next group is CRA of psychogenic origin.... The main role is assigned to the social situation of the baby's development. Unfavorable situations in the family, problem upbringing, mental trauma become the reason for this type of CRA. If there is aggression and violence in the family towards the child or other family members, this can lead to the predominance in the character of the baby of such traits as indecision, lack of independence, lack of initiative, fearfulness and pathological shyness.

Here, in contrast to the previous type of DP, there is a phenomenon of hypo-care, or insufficient attention to the upbringing of a child. A child grows up in a situation of neglect, pedagogical neglect. The consequence of this is the lack of ideas about the moral norms of behavior in society, the inability to control their own behavior, irresponsibility and inability to take responsibility for their actions, an insufficient level of knowledge about the world around them.

The fourth and last type of CRA is of cerebral-organic origin... It occurs more often than others, and the prognosis of further development for children with this type of CRD is usually the least favorable in comparison with the previous three.

As the name suggests, the basis for the isolation of this group of cerebrovascular accidents are organic disorders, namely, the failure of the nervous system, the causes of which can be: pathology of pregnancy (toxicosis, infections, intoxication and trauma, Rh-conflict, etc.), prematurity, asphyxia, birth trauma, neuroinfection. With this form of CRD, the so-called minimal cerebral dysfunction (MMD) takes place, which is understood as a complex of mild developmental disorders that manifest themselves, depending on the specific case, very diversely in various areas of mental activity.

MMD researchers have identified the followingrisk factors for its occurrence:

• late age of the mother, height and body weight of a woman before pregnancy, beyond the age norm, first birth;
• pathological course of previous labor;
• chronic diseases of the mother, especially diabetes, Rh-conflict, premature birth, infectious diseases during pregnancy;
• psychosocial factors such as unwanted pregnancy, big city risk factors (daily long drive, city noise);
• the presence of mental, neurological and psychosomatic diseases in the family;
• pathological childbirth with the imposition of forceps, cesarean section, etc.

Children of this type are distinguished by the weakness of the manifestation of emotions, poverty of imagination, disinterest in evaluating themselves by others.

About prevention

The diagnosis of CRD appears in the medical record most often closer to school age, at the age of 5-6, or even when the child is directly faced with learning problems. But with timely and competently constructed correctional-pedagogical and medical assistance, partial and even complete overcoming of this deviation in development is possible. The problem is that the diagnosis of CRD in the early stages of development seems to be quite problematic. His methods are based primarily on a comparative analysis of the development of the child with the norms corresponding to his age.

Thus, the first place comesprevention of malnutrition... Recommendations on this matter are no different from those that can be given to any young parents: this is, first of all, creating the most favorable conditions for pregnancy and childbirth, avoiding the risk factors listed above, and of course, close attention to the development of the baby from the very first days of his life. The latter simultaneously makes it possible to recognize and correct developmental deviations in time.

First of all, it is necessary to show the newborn to a neurologist. Today, as a rule, all children after 1 month are sent for examination to this specialist. Many receive a referral directly from the hospital. Even if both pregnancy and childbirth went perfectly, your baby feels great, and there is not the slightest cause for concern - do not be lazy and visit the doctor.

A specialist, having checked the presence or absence of various reflexes, which, as you know, accompany the child throughout the entire period of neonatal and infancy, will be able to objectively assess the development of the baby. The doctor will also check vision and hearing, note the features of interaction with adults. If necessary, he will prescribe a neurosonography - an ultrasound examination, which will provide valuable information about the development of the brain.

Knowing the age indicators of the norm, you yourself will be able to monitor the psychomotor development of the baby. Today, on the Internet and in various printed publications, you can find many descriptions and tables, which show in detail what a baby should be able to do at a given age, starting from the first days of life. There you can also find a list of behavioral features that should alert young parents. Be sure to read this information, and if you have even the slightest suspicion - immediately go to an appointment with a doctor.

If you have already visited the appointment, and the doctor considered it necessary to prescribe medications, you should not neglect his recommendations. And if doubts do not give rest, or the doctor does not inspire confidence, show the child to another, third specialist, ask questions that concern you, try to find the maximum amount of information.

If you are confused by the medicine prescribed by the doctor, do not hesitate to ask about it in more detail, let the doctor tell you how it works, what substances are in its composition, why your child needs it. After all, under an hour, under the menacing-sounding names, relatively "harmless" drugs are hidden, acting as a kind of vitamins for the brain.

Of course, many doctors are reluctant to share such information, believing, not without reason, that there is no need to initiate people who are not related to medicine into purely professional matters. But trying is not torture. If you were not able to talk with a specialist, try to find people who have encountered similar problems. Here again, the Internet and the corresponding literature will come to the rescue. But, of course, you should not take on faith all the statements of parents from Internet forums, because most of them do not have medical education, but only share their personal experiences and observations. It will be more effective to use the services of an online consultant who can give qualified recommendations.

In addition to visiting doctors' offices, there are several points regarding the interaction of parents with children, which are also necessary for the normal and full development of the child. The components of communication with the baby are familiar to every caring mother and are so simple that we do not even think about their colossal effect on the growing body. itbody-emotional contact with the baby. Skin contact means any touch to the child, hugs, kiss, stroking the head. Since in the first months after birth, the baby has a very developed tactile sensitivity, bodily contact helps him to navigate in a new environment for him, to feel more confident and calm. The baby must be taken in your arms, caressing him, stroking not only on the head, but all over the body. The touch of tender parental hands to the baby's skin will allow him to form the correct image of his body, to adequately perceive the space around him.

A special place is given to eye contact, which is the main and most effective way of transmitting feelings. In particular, of course, this applies to infants, who are not yet available other means of communication and expression of emotions. A kind look reduces anxiety in the baby, has a calming effect on him, and gives him a sense of security. And, of course, it is very important to pay all your attention to the baby. Some believe that by indulging a baby's whims, you are spoiling him. This is certainly not the case. After all, the little man feels so insecure in a completely unfamiliar environment that he constantly needs confirmation that he is not alone, he is needed by someone. If the child received less attention in early childhood, this will certainly affect later.

Needless to say, a baby with certain developmental disabilities needs the warmth of her mother's hands, her gentle voice, kindness, love, attention and understanding a thousand times more than her healthy peers.

Topic: ZPR. Definition, main reasons, their brief description.

Plan:

Introduction.

1. Determination of ZPR

2. Reasons for ZPR and their characteristics.

3.Classification of children with mental retardation.

List of references.

Introduction.

A significant number of children study in the mass school, who already in the elementary grades cannot cope with the curriculum and have difficulties in communication. This problem is especially acute for children with mental retardation. The problem of learning difficulties for these children is one of the most pressing psychological and pedagogical problems.

Children with mental retardation entering school have a number of specific features. In general, they have not formed the skills, skills and knowledge necessary for mastering the program material, which normally developing children usually master in the preschool period. In this regard, children are unable (without special help) to master counting, reading and writing. It is difficult for them to comply with the accepted norms of behavior at school. They experience difficulties in the arbitrary organization of activity: they do not know how to consistently follow the teacher's instructions, switch from one task to another at his direction. The difficulties they experience are aggravated by the weakening of their nervous system: students quickly get tired, their performance decreases, and sometimes they simply stop performing the activity they started.

The task of the psychologist is to establish the level of development of the child, to determine whether it corresponds or does not correspond to age norms, as well as to identify pathological features of development. A psychologist, on the one hand, can give useful diagnostic material to the attending physician, and on the other hand, he can choose methods of correction, give recommendations regarding the child.

Deviations in the mental development of primary school children are usually associated with the concept of "school failure". To determine deviations in the mental development of unsuccessful schoolchildren who do not have mental retardation, profound disorders sensory systems, lesions of the nervous system, but at the same time lag behind in learning from their peers, most often we use the term "mental retardation"

1. Determination of ZPR

Retardation of mental development (PD) is a concept that does not speak of persistent and irreversible mental underdevelopment, but of a slowdown in its pace, which is more often found when entering school and is expressed in a lack of general stock of knowledge, limited ideas, immaturity of thinking, low intellectual purposefulness, predominance of gaming interests, rapid supersaturation in intellectual activity. In contrast to children suffering from oligophrenia, these children are quite quick-witted within the limits of available knowledge, and are much more productive in using help. Moreover, in some cases, the delay in the development of the emotional sphere will come to the fore ( different kinds infantilism), and violations in the intellectual sphere will not be expressed sharply. In other cases, on the contrary, a slowdown in the development of the intellectual sphere will prevail.

Delayed mental development (abbr. ZPR) is a violation of the normal pace of mental development, when individual mental functions (memory, attention, thinking, emotional-volitional sphere) lag behind the accepted psychological norms for a given age in their development. PDA as a psychological and pedagogical diagnosis is made only in preschool and primary school age, if by the end of this period there are signs of underdevelopment of mental functions, then we are talking about constitutional infantilism or mental retardation.

These children had the potential for learning and development, but for various reasons it was not realized, and this led to the emergence of new problems in learning, behavior, health. Range definitions of RR quite broad: from “specific learning disabilities”, “learning disabilities” to “borderline intellectual disabilities”. In this regard, one of the tasks of a psychological examination is to distinguish between CRA and pedagogical neglect and intellectual disability ( mental retardation).

Pedagogical neglect - This is a state in the development of a child, which is characterized by a lack of knowledge and skills due to a lack of intellectual information. Pedagogical neglect is not a pathological phenomenon. It is not associated with a failure of the nervous system, but with defects in upbringing.

Mental retardation - These are qualitative changes in the entire psyche, the entire personality as a whole, resulting from the suffered organic damage to the central nervous system. Not only intelligence suffers, but also emotions, will, behavior, physical development.

Developmental anomaly, defined as PD, occurs much more often than other, more severe disorders of mental development. According to various sources, up to 30% of children in the population have MRI to one degree or another, and their number is increasing. There is also reason to believe that this percentage is higher, especially recently.

With PD, the child's mental development is characterized by uneven disorders of various mental functions. At the same time, logical thinking can be more preserved in comparison with memory, attention, and mental performance. In addition, in contrast to mental retardation, children with mental retardation do not have the inertia of mental processes that is observed with mental retardation. Children with CRD are able not only to accept and use help, but also to transfer the learned skills of mental activity to other situations. With the help of an adult, they can perform the intellectual tasks offered to them at a level close to the norm.

2. Reasons for ZPR and their characteristics.

The reasons for mental retardation can be severe infectious diseases of the mother during pregnancy, toxicosis of pregnancy, chronic fetal hypoxia due to placental insufficiency, trauma during pregnancy and during childbirth, genetic factors, asphyxia, neuroinfections, severe diseases, especially in early age nutritional deficiencies and chronic somatic diseases, as well as brain injury in early period the child's life, the initial low level of functional capabilities as an individual feature of the child's development ("cerebrasthenic infantilism" - according to VV Kovalev), severe emotional disorders of a neurotic nature, associated, as a rule, with extremely unfavorable conditions of early development. As a result of the adverse effect of these factors on the central nervous system of the child, there is a kind of suspension or distorted development of certain structures of the cerebral cortex. The disadvantages of the social environment in which the baby is brought up are very important and sometimes decisive. Here, in the first place are the lack of maternal affection, human attention, lack of care for the baby. It is for these reasons that mental retardation is so common in children who are brought up in orphanages, round-the-clock nurseries. Children who are left to themselves, who are brought up in families where parents abuse alcohol and lead a hectic lifestyle, find themselves in the same difficult situation.

According to the American Association for the Study of Brain Injury, up to 50% of children with learning disabilities are children who sustain a head injury between birth and 3-4 years of age.

It is known how often young children fall; this often happens when there are no adults nearby, and sometimes the adults present do not attach much importance to such falls. But recent studies by the American Association for the Study of Brain Damage have shown that this seemingly small traumatic brain injury in early childhood can even lead to irreversible consequences. This happens in cases where the brainstem is compressed or stretched nerve fibers, which can manifest itself in more pronounced cases throughout life.

3.Classification of children with mental retardation.

Let us dwell on the classification of children with mental retardation. Our clinicians distinguish four groups among them (classification by K.S. Lebedinskaya).

The first group is a mental retardation of constitutional origin. This is a harmonious mental and psychophysical infantilism. Such children are already outwardly different. They are more slender, often their height is less than average and their face retains the features of an earlier age, even when they are already schoolchildren. In these children, the lag in the development of the emotional sphere is especially pronounced. They are, as it were, more early stage development versus chronological age. They have a great severity of emotional manifestations, the brightness of emotions and at the same time their instability and lability, they are very characteristic of easy transitions from laughter to tears and vice versa. The children of this group have very pronounced play interests, which prevail even at school age.

Harmonious infantilism is a uniform manifestation of infantilism in all spheres. Emotions lag behind in development, speech development is delayed, and the development of the intellectual and volitional sphere. In some cases, the physical lag may not be expressed - only mental lag is observed, and sometimes there is also a psychophysical lag in general. All these forms are combined into one group. Psychophysical infantilism sometimes has a hereditary nature. In some families, it is noted that parents in childhood had the corresponding traits.

The second group is mental retardation of somatogenic origin, which is associated with long-term severe somatic diseases at an early age. These can be severe allergic diseases ( bronchial asthma, for example), diseases digestive system... Prolonged dyspepsia during the first year of life inevitably leads to developmental delays. Cardiovascular failure, chronic pneumonia, kidney disease are often found in the history of children with mental retardation of somatogenic origin.

Deviation from the age norm, i.e. developmental delay children are most often observed by educators and teachers in preschool and elementary school age.

During developmental classes or lessons, they discover a child's lack of knowledge about the world around him, as well as an underdevelopment of ideas about him, a narrowing of thinking, his limited play interests, difficulty in mastering new, practical skills, a small vocabulary, etc.

ICD-10 code

Medical science classifies CRD as a developmental disorder (F80-F89).

These pathologies have a number general characteristics:

• appear from childhood;
• flow smoothly, without exacerbations;
• suffer: nervous system, speech, general constitution of the body.

A child's developmental delay affects more than just quality of educationbut also on relationship with adults and children. Often, patients with CRD are unable to build interpersonal relationships with the people around them, and suffer from behavioral and emotional disorders.

Classification

Violations child development can proceed in different ways, they are divided into the following types:

1. CRA of a constitutional nature

This disorder is based on heredity, which leads to the simultaneous immaturity of the physical and psychological development of the child. Even outwardly, these children lag behind their peers in height, weight gain, and during games they are inferior to them in strength and dexterity.

At school age, they disregard generally accepted rules (they are late for classes, talk loudly or laugh during class, do not understand the advantages of good grades over bad ones, do not take disciplinary actions, and are dismissive of keeping notebooks or diaries.

2. CRD of somatogenic nature

Deviations in this type of development of the disease appear after severe infections, allergic shock, astheno-neurotic disorders.

In infancy, it is difficult to detect a slowdown in the pace of child development, only from the age of 3, when the kids begin to draw and are actively involved in the game, parents may notice:

- Concentration disorders in a child (severe distraction, lethargy);
- the occurrence of heart, head, abdominal pain during overwork;
- a narrow outlook of the child.

3. CRD of psychogenic nature

The normal development of children in this case is suspended due to psychological trauma, sensory deprivation (parental coldness), verbal and physical aggression on the part of adults.

In this case, the disease is characterized by:

- immaturity of emotions;
- lack of elementary independence;
- behavioral infantilism;
– high level anxiety.

4. CRA of cerebral organic nature

Here, the slowdown in mental development is based on organic lesions of the brain. Pathological changes in the brain tissue appear under the influence of prolonged fetal hypoxia or severe toxicosis during pregnancy, severe poisoning, alcoholism and / or drug addiction of the parents. You can observe a pronounced picture of the disease after 4 years, with the beginning of regular preparatory classes in kindergarten.

Educators and methodologists immediately notice:

- poor assimilation of the proper amount of knowledge (fragmentary);
- lack of motivation to learn;
- memory loss;
– speech disorders;
- inadequate emotional reactions (anger, aggression, lethargy, indifference to the outside world).

Causes of occurrence

The factors that provoke the appearance of CRA include:

– genetic predisposition (combination of lag in the development of the body and psyche);
- persistent illness, disability, long courses treatment measures;
- traumatic emotional experiences;
- brain dysfunction.

CRD symptoms are best diagnosed in children 3 years and older, at an earlier age, it is difficult to recognize the disease, since it clinical manifestations are subjective and associated with the assimilation of knowledge.

IN school age, the presence of the disease can be assumed based on the results of training, diagnostic tests. The psychological pedagogical characteristics of children with developmental delays can indicate the degree of development of the disease, and a defectologist or child psychologist should identify the reasons. Only then can we develop a treatment program for this deviation and achieve positive results in teaching such children.

CRA: symptoms and signs

It is possible to identify a developmental lag only with the use of comprehensive examinationi am children. In some cases, the line between CRA and mental retardation is very thin, and clinical picture very similar. Therefore, only a specialist should diagnose ZPR in children whose symptoms are similar to mental, autonomic or somatic disorders.

FROM it is very difficult to recognize it independently, and without the necessary knowledge it is practically impossible. Taking into account the nature of the manifestations of cerebrovascular accidents, sometimes erased or copying diseases of the nervous system, special commissions are created at educational institutions.

For instance, characteristics for a child with Zpr for PMPK includes a number of parameters examined by observation methods, questionnaires, testing. The document describes the physical and psychological development pupil (student), the level of his knowledge, skills, abilities, ability to concentrate, behavioral reactions and much more.

Such commissions make a general decision on the child's education system and his psychological support. A collegial approach is necessary because the clinical manifestations of the disease are varied, in each individual case, ZPR occurs individually ... For many children, inappropriate emotional reactions, fears and anxiety, immaturity of self-control, combined with normal intellectual development... It is difficult even for a professional to distinguish such a course of CR from neurosis.

Some guys only experience difficulties with the assimilation of knowledge, building good relationships with others, having adequate behavior. Others simply withdraw into themselves, are afraid of any contacts, stress, but at the same time they can study well. Needed here differential diagnosis with autism.

Treatment

Despite the fact that CRD has multifaceted symptoms, in children this disease lends itself well to correction. It is important to start dealing with them systematically, combining methods medicinal therapy and psychology .
An adapted educational program is required only for children with an organic nature of the disease.

In other cases, individual and group correctional lessons ... Special exercises help fight the main manifestations of cerebrovascular accidents.

Gradually, children return to their normal ability to assimilate knowledge and the diagnosis is removed.

For effective treatment of CRD, it is necessary to combine the efforts of teachers, educators and parents.

Video:

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 mental development disorders in children:

1. Irreversible mental underdevelopment (mental retardation).
2. Delayed mental development (reversible - in whole or in part).
3. Damaged mental development - dementia (the presence of a previous period of normal mental development).
4. Deficient development (in conditions of visual impairment, hearing impairment, somatic pathology).
5. Distorted mental development (early childhood autism).
6. 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 in the framework of 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 of 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 the immaturity of the nervous system in children, maturation dysfunction of motor and general mental functions is more often observed. 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 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 rarely occur 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 as early as 2-4 weeks of taking the drug, optimal results are usually achieved with a course duration of 6-12 weeks.

Literature

1. Amasyants R.A., Amasyants E.A. Clinic of Intellectual Disabilities. Textbook. Moscow: Pedagogical Society of Russia, 2009.320 p.
2. Actual problems of diagnostics of mental retardation in children / Ed. K. S. Lebedinskaya. M., 1982.
3. Bazhenova O. V. Diagnostics of the mental development of children in the first year of life. M., 1987.
4. Bruner J., Olver R., Greenfield P. Research on the development of cognitive activity. M., 1971.
5. Burchinsky S.G. Modern nootropic drugs // Journal of a practical doctor. 1996, No. 5, p. 42-45.
6. Burchinskiy S.G. Old brain and pathology: from pharmacology to pharmacotherapy // Bulletin of Pharmacology and Pharmacy. 2002, No. 1, p. 12-17.
7. Voronina T.A., Seredenin S. B. Nootropic drugs, achievements and prospects // Experimental and Clinical Pharmacology. 1998, No. 4, p. 3-9.
8. Voronina T.A. The role of synaptic transmission in memory processes, neurodegeneration and the mechanism of action of neurotropic drugs // Experimental and Clinical Pharmacology. 2003, No. 2, p. 10-14.
9. Dolce A. Review of experimental studies on Encephabol (pyritinol). In the book: Encephabol: aspects of clinical use. M., 2001, p. 43-48.
10. Zavadenko N. N.Nootropic drugs in the practice of a pediatrician and pediatric neurologist. M., 2003, 23 p.
11. Zozulya T.V., Gracheva T.V. Dynamics and prognosis of the incidence of mental disorders in older persons // Journal of Neuropathology and Psychiatry. 2001, vol. 101, no. 3, p. 37-41.
12. Kovalev G.V. Nootropic drugs. Volgograd, Nizhne-Volzhskoe pr. ed., 1990, 368 p.
13. G. N. Kryzhanovsky Dysregulatory pathology // Dysregulatory pathology. 2002, p. 18-78.
14. Lebedeva N.V. Encephabol and its analogues in treatment neurological diseases... In the book: Encephabol: aspects of clinical use. M., 2001, p. 27-31.
15. Lebedeva N.V., Kistenev V.A., Kozlova E.N. etcephabol in complex treatment patients with cerebrovascular diseases. In the book: Encephabol: aspects of clinical use. M., 2001, p. 14-18.
16. Lebedinsky V.V. Mental developmental disorders in children. M., 1985.
17. Lebedinsky V.V. Mental developmental disorders in childhood: Textbook. manual for stud. psychol. fac. higher. study. institutions. M .: Publishing Center "Academy", 2003. 144 p.
18. Markova E.D., Insarov N.G., Gurskaya N.Z. et al. Role of Encephabol in the treatment of extrapyramidal and cerebellar syndromes of hereditary etiology. In the book: Encephabol: aspects of clinical use. M., 2001., p. 23-26.
19. Maslova O. I. Rehabilitation tactics for children with delays in neuropsychic development. Russian medical journal... 2000, vol. 8, no. 18, p. 746-748.
20. Maslova O.I., Studenikin V.M., Balkanskaya S.V. et al. Cognitive neurology // Russian pediatric journal. 2000, No. 5, p. 40-41.
21. Mnukhin S.S. On time delays, slow pace of mental development and mental infantilism in children. L., 1968.
22. 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.
23. Petelin L.S., Shtok V.N., Pigarov V.A. Encephabol in a neurological clinic // Encephabol: aspects of clinical application. M., 2001, p. 7-11.
24. Pshennikova M.G. Stress: regulatory systems and resistance to stress damage // Disregulation pathology. 2002, p. 307-328.
25. Aging of the brain / Ed. V.V. Frolkis. L., Nauka, 1991, 277 p.
26. Amaducci L., Angst J., Bech O. et al. Consensus conference on the methodology of clinical trial of "Nootropics" // Pharmacopsychiatry. 1990, v. 23, p. 171-175.
27. Almquist & Wiksell. Sientific studies in mild mental retardation: Epidemiology; a. prevention: Proc. of the 2 nd Europ. symp. on scientific studies in Mental Retardation, U Sweden, June 24-26, 1999 .-- 240 p.
28. Bartus R., Deen O., Beer T.Cholinergic hypotheses of memory dysfunction // Science. 1982, v. 217, p. 408-417.

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