Mental problems. Mental retardation in children. Approximately 3% of children do not have age-appropriate normal cognitive abilities. They are commonly referred to as "mentally retarded" or "developmentally delayed children". This definition refers to all children whose development, according to the standard intelligence index (IQ), is less than 70 (a result of 80 to 130 is normal intelligence, and 100 is average).
Mental retardation in children is defined as "a pronounced decrease in the level of all mental functions", accompanied by a "deficiency in adaptive behavior". In other words, mental retardation is the inability of a child to learn, show independence and social competence in the appropriate age group.
The development of mentally retarded children is much slower than that of their peers in many areas, especially in relation to interest in the world around them and the ability to respond to external events. Such children later develop the ability to smile, stretch their hands towards what they see or hear, grab toys and play with them, with a lag, all kinds of reactions develop in general.
A large number of mentally retarded children suffer from a variety of problems - congenital heart disease, epileptic seizures, hearing loss. Their life expectancy rarely exceeds average age, in part because they do not receive medical treatment.
Although each child develops at a different pace, they always go through the stages listed below. If the child’s developmental indicators do not reach the average values of this stage of development, then this is a signal that the child has difficulties.
0 – 4 months
Shows interest in the environment and particular attention to caregivers and carers.
Reacts to light and sound, especially when communicating with others.
Smiles when spoken to, or reacts to a certain facial expression, hums.
He enjoys being gently and affectionately soothed and stroked.
Follows the eyes of a moving object or person, turns the head towards the sound source.
Can grasp and hold small objects.
Can hold his head when he sits on his knees.
Sleeps more than 4 hours at night.
5 – 8 months
Begins to learn how things work; responds to the request.
Communicates with the person caring for him: smiles, holds out his hands.
Reacts to the simplest games, such as "cuckoo".
Stretches out hands to toys and other items of interest to him.
Shows cautious interest when strangers appear.
Able to focus on toys and strangers for a long time.
Begins to explore and interact with his own environment.
Able to pick up and hold a small object.
Knows how to drink from a cup or glass held by adults.
Pronounces certain sounds and repeats them.
Able to sit without support and play in this position.
Able to crawl or climb.
Able to get up, holding on to the bars of the crib.
9 – 12 months
He begins to interact with the world around him in a complex way: he holds out toys to his parents, he begins to walk with support, roll a ball, use gestures in order to be understood.
Uses a specific pattern of behavior to get close to parents and climb onto their laps.
Reacts to the intonation of the speech of the parents.
Long enough to focus on the game.
Knows how to imitate simple gestures - waving a hand at parting, indicating a sign "yes" or "no" with a nod.
Uses eyesight and hands to explore new objects.
Knows how to toss or throw a ball.
Looks at simple pictures in books with outside help.
Knows how to put a small piece of food in his mouth.
Able to walk holding on to furniture.
understands simple words and directions.
Applies specific sounds to specific objects.
13 – 18 months
Shows conscious intentions and ways of exploring the situation during interactions and games.
Explains his desires and feelings through gestures and words.
Uses one to two word sentences and understands simple phrases.
Establishes a balance between the need for independence and intimacy (for example, going to the other side of the room to play, and returning back to one of the relatives in order to cuddle).
Makes attempts to insist on his own; knows how to express dissatisfaction with his voice without crying, biting and beating with his hands.
Uses representations and roles in games (“cooks in a saucepan”, “rides in a toy car”); plays on his own.
Recognizes familiar objects in pictures, knows how to make a simple mosaic, draw a circle.
Able to run, jump, stand on one leg.
19 months – up to 3 – 3.5 years
Plays complex games of imagination, linking the motives of intimacy, nutrition or care with the need for self-affirmation, exploration and aggression.
Knows what is real and what is not.
Follows the rules.
Understands the relationship between behavior, thoughts, feelings and their consequences.
Interacts with adults and playmates in a socially acceptable manner.
He can draw quite complex drawings, for example, depict a woman with certain facial features.
Able to climb and descend stairs.
Able to purposefully throw a big ball and catch it.
Composes complex sentences containing logically related words.
Begins to ask “why?”, although this is not necessarily accompanied by an interest in answers.
Classification mental retardation
Mental retardation in children is a non-specific disease that is either present or absent in a child and represents a multilevel psychopathological condition that manifests itself in a significant change in behavior and abilities. A large number of classification systems are used to determine the degree of mental retardation. This kind of classification serves as a necessary tool for the selection of special educational and medical institutions. Parents, teachers and physicians must ensure that no classification system interferes with the fullest development of the child's residual potential.
In most cases, four categories of mental retardation are used, ranging from mild to severe. About 85% of mentally retarded children are mild with an intellectual index (IQ) of 50 to 70. Although these children need special education, they are able, even if classes begin in adolescence, to learn to read and count. With appropriate support and assistance, they can eventually achieve independence to a large extent and lead independent life. Children with an average (moderate) degree of mental retardation (intellectual index from 35 to 49) are able to learn how to serve themselves and, to a certain extent, work in protected and facilitated conditions. Children with severe mental retardation (IQ from 20 to 34) are able to master basic hygiene skills through training. However, in the motor and speech areas, they experience great difficulties and, as a rule, cannot acquire any professional skills. Children with severe mental retardation (IQ below 20) cannot express their condition and position in words, they cannot use the toilet. Throughout their lives, they need care and maintenance.
Other classification systems are based on the ability of children to reach a certain educational level. "Learning" children are those whose IQ is typically between 50 and 75. Their school success reaches the level of 3-6 grades. The learning ability of a child with an IQ of 30 to 50 reaches the level of 2nd grade and is usually limited to these results.
Recognition of mental retardation
Developmental delay in most cases is detected immediately after birth or somewhat later. Certain congenital forms of mental retardation, including the so-called Down's syndrome, are identified during prenatal examination. Children with Down syndrome and some other forms of mental retardation differ from the norm in their appearance and show obvious birth defects, which facilitates early diagnosis.
Even if a completely normal child develops slowly, many doctors have questions that require diagnostic efforts to exclude a mild degree of mental retardation. In the second or third year of life and before reaching school age mental retardation is established using psychological and physiological tests. Sometimes the examination reveals other causes of delayed development, such as hearing loss, which makes it difficult to communicate and learn.
It is important to mention that the threshold for mental retardation below 70 IQ is arbitrarily chosen. There are children with an IQ below 70 who are able to lead productive and independent lives. In fact, some studies show that children from poor or other cultural backgrounds whose test scores show IQs below 70 actually show significantly higher IQs when environmental conditions are equalized or improved. Conversely, there are children whose intellectual index is above 70, however, their school success does not correspond to the age level. Therefore, when diagnosing mental retardation, one should take into account not only indicators of behavior and academic performance, but also the cultural environment and socioeconomic data.
Causes of the disease
Hundreds of known causes and risk factors have been identified for mental retardation. These may include chromosomal abnormalities (such as Down's syndrome), genetic disorders, birth trauma, low birth weight and extreme immaturity of the fetus, hormonal disorders, prenatal infection (such as measles in the first third of pregnancy), prenatal malnutrition, and maternal drug use. or alcohol. Postpartum mental retardation can be caused by the child's mental and physical isolation, severe malnutrition, accidental brain damage (such as a fall or nearly drowning), lead poisoning, and infection (meningitis). In most cases real reasons mental retardation remain unknown.
Down syndrome
A common form of mental retardation is Down syndrome, a chromosomal disorder that occurs in about one in 700 newborns. In most cases, mental development in these children proceeds normally up to 6 months, and then stops or even regresses. Along with a decrease in mental parameters, most children have a pronounced dysplasticity of the face and body, which includes weak muscle tone, a small flat skull, wide cheeks, a protruding tongue and an Asian eye shape (which in the past gave rise to this type of mental retardation). like Mongoloidism). In total, there are about a hundred mental deficiencies associated with Down syndrome, some of which are rare and difficult to distinguish from the rest.
Stages of early child development
You found out that your child is mentally retarded. What to prepare for?
Keep in mind that your child, despite being mentally handicapped, is an individual with their own hopes, dreams, rights and dignity.
If your friends try to avoid meetings or seem insecure or embarrassed, know that most people simply do not know how to react to the news of your child's illness and how to help you. You must understand that some people find it difficult to express their empathy and compassion towards others.
Establish contact with self-help and patient care organizations. Try to get to know other parents of mentally retarded children, find out how they assess the situation and share your experiences with them.
Admit to yourself your feelings of guilt, anger, sadness, and frustration. These feelings are natural. Do not be ashamed of yourself and your child, in order to help him, you must comprehend and process your disappointment.
Even though your child has different requests and needs and requires an individual approach, do not ignore the vital interests of your spouse and other family members. This will make it difficult for them to participate in solving your problems.
You must anticipate that your immediate environment may not only be willing to understand your feelings and problems, but also to resist them. Overcoming this life situation is a difficult problem.
Causes
The cause of this disease may be chromosomal aberrations. Individuals with trisomy 21 have 47 chromosomes in each cell instead of the normal 46 chromosomes. They are born with an extra 21 chromosomes. This form of Down syndrome is the most common (about 95% of all cases) and is not genetically transmitted. Some children with this syndrome, although they have an extra 21 chromosomes, are melted down by other chromosomes, so that 46 chromosomes remain despite this. This is defined as a congenital translocation in a certain form of Down syndrome. Parents of some children with this form of the syndrome can, with a special study, determine which of them is the carrier of the gene for this disease, which can provide information about the possible consequences if they want to have another child. Children whose condition is due to mosaicism (about 1% of cases) have a variety of cells, some of which are normal and some with an extra 21 chromosome. They usually have less pronounced pathology and are more viable. As for other genetic causes, it has not yet been studied what role they play in chromosomal abnormalities. Some studies show that the late age of the mother is important for this syndrome (about 2/3 of all children with Down syndrome were born to mothers over 35), as well as the fact that she was exposed to increased x-ray exposure or lived in an area contaminated with toxic substances. .
Development pace
As with other forms of mental retardation, children with Down syndrome develop with a large delay compared to the age norm. In the first few months of their lives, children with this disorder are more calm and less excitable than their healthy peers. The reason for this is a decrease in muscle tone and underdevelopment of coordination. Most children with Down syndrome do not begin to respond to their environment until the second year of life. They smile at the caregivers, babble and learn to sit without support, while at the same time not being able to crawl and climb. In subsequent years, muscular coordination, speech and other abilities develop, however, the pace of development remains much slower than in other children. By the age of two, many children with Down syndrome are only able to say one or two words. The problem of muscular coordination is also reflected in speech abilities: children with Down syndrome often have great difficulty moving their tongue and coordinating the movements of the lips and jaw necessary for speech. By the age of five, they are usually able to name a few objects and speak short sentences with many articulatory and grammatical errors. Parents can contribute to speech development if they talk to their children regularly and actively help develop their articulation skills by exercising them in certain social situations.
Treatment
Although mentally retarded children rarely reach the level of development of their peers, it is necessary to try to ensure that they reach their maximum potential. The sooner the diagnosis is made, the sooner relatives and children can start a developmental program. At the same time, parents and educators should not express negative feelings. Kindness to the child will accelerate his development.
The treatment is mainly of a promotional nature and its purpose is to help children achieve their maximum possible activity and independence. In the USA, such children are united in groups where they study surrounded by people close and familiar to them. Such institutions combine the tasks of upbringing and education.
Physicians must make a rather difficult prediction of how far a given child may advance. Although mentally retarded children can increase their IQ when properly stimulated, they can never reach the IQ level of normal children. And yet they are able to make progress in their studies, and in some cases they show a clear improvement.
Parents are offered many training and support programs for children. The way in which treatment intervention is needed depends on a qualified expert assessment of the developmental disorder and the needs of each individual child. Teaching speech, neatness, dressing and eating independently is necessary in all cases. Parents are required to be consulted. It is also necessary to coordinate the work of doctors who treat somatic difficulties and disorders, and psychotherapists who are competent in dealing with mental and behavioral problems.
Stages of early childhood development
Love me!
An elementary and essential first step in helping children with developmental delays is the need to give them love and attention. People with mental and somatic retardation are subject to social discrimination, which makes it difficult for them to develop. Their backwardness does not protect them from the painful realization that they are different from others, and then they experience unpleasant feelings. The knowledge that they are loved and desired helps to accelerate the development of children and gives them a positive internal image of themselves, which is necessary for fulfilling the difficult demands that life places on them.
Help with mental and behavioral problems
There is not a single mental and behavioral problem that is unique to children with mental retardation. However, each child with mental retardation has their own personal difficulties and problems. For example, he has behavioral problems, mentally retarded children often become restless and restless due to the inability to concentrate for a long time, their behavior is disturbed, which is especially reflected during classes at home or in educational institution.
Such children have low resistance to stress factors, which is often combined with a lack of control over their urges and desires. It is known that a sick child needs much more time to calm down after excitement and arousal than a child with normal cognitive abilities.
Changes in the routine order, remarks regarding the rules of eating or handling objects in the absence of inhibitory moments in the psyche can easily cause an irritation reaction up to destructive actions or self-harm. Coping with this kind of behavior, even in normal children, is quite difficult. Communication with the moderately retarded is especially difficult due to the fact that they need especially much effort in order to control their behavior. The box on page 338 shows how parents can help. Psychotherapists use the techniques of behavioral psychotherapy for this, with the help of which children can learn new patterns of behavior and control their condition. This is especially important for children with mental retardation.
Already at a very young age, mentally retarded children often suffer from self-esteem. Children with mild developmental disorders often know that they are different from others. They learn about this by comparing themselves to their siblings or by the judgments and comments of those around them—family members, neighborhood children, teachers, and other authority figures. The consequence of this is that mentally retarded children feel unhappy and suffer from depression. It can also lead to social regression or aggressive behavior. Such disorders, even if they are severe, require psychotherapeutic assistance using play techniques, which are also used in the treatment of children with normal development.
Family problems
Those who help children with mental retardation can achieve success and great satisfaction, but this requires a lot of patience and cooperation from all family members. Parents often react to the fact that their child is sick with guilt, sadness and anger. Some of them find it difficult to feel their connection with the child. Other siblings may feel ashamed, guilty, irritated, or annoyed that a mentally retarded child requires special attention and is different from other children. A family with a mentally retarded child may benefit from the advice or support of another family in the same situation.
Psychotherapy of families with mentally retarded children contains a number of explanatory components. Parents are taught how to assess the developmental status of their children and, based on this knowledge, help their children develop and learn.
Features of a child and adolescent with mental retardation ( manifestations, symptoms, signs)
For children with mental retardation ( mental retardation) characterized by similar manifestations and signs ( violations of attention, memory, thinking, behavior and so on). At the same time, the severity of these disorders directly depends on the degree of oligophrenia.Mentally retarded children are characterized by:
- impaired thinking;
- impaired concentration;
- violations of cognitive activity;
- speech disorders;
- communication problems;
- violations vision ;
- hearing impairment;
- sensory development disorders;
- memory impairment;
- movement disorders ( motor disorders);
- violations of mental functions;
- behavioral disorders;
- violations of the emotional-volitional sphere.
Disorders of mental development and thinking, intellectual disorders ( basic violation)
Impairment of mental development is the main symptom of oligophrenia. This manifests itself in the inability to think normally, make the right decisions, draw conclusions from the information received, and so on.Disorders of mental development and thinking in oligophrenia are characterized by:
- Violation of perception of information. With a mild degree of the disease, the perception of information ( visual, written or verbal) is much slower than normal. Also, the child needs more time to “comprehend” the data received. With moderate oligophrenia, this phenomenon is even more pronounced. Even if a child can perceive any information, he cannot analyze it, as a result of which his ability for independent activity is limited. In severe oligophrenia, damage to sensitive organs is often observed ( eye, ear). Such children cannot perceive certain information at all. If these sense organs work, the data perceived by the child is not analyzed by him. He may not distinguish colors, not recognize objects by their outlines, not distinguish between the voices of relatives and strangers, and so on.
- Inability to generalize. Children cannot make connections between similar items, draw conclusions from data, or pick out small details in any general flow of information. With a mild form of the disease, this is not pronounced, while with moderate oligophrenia, children have difficulty learning to arrange clothes in groups, distinguish animals from a set of pictures, and so on. In a severe form of the disease, the ability to somehow connect objects or associate them with each other may be completely absent.
- Violation of abstract thinking. Everything they hear or see is taken literally. They do not have a sense of humor, they cannot understand the meaning of "winged" expressions, proverbs or sarcasm.
- Violation of the sequence of thinking. This is most pronounced when trying to complete a task consisting of several stages ( for example, take a cup out of the cupboard, put it on the table and pour water from a jug into it). For a child with a severe form of oligophrenia, this task will be impossible ( he can take the cup, put it in its place, go up to the jug several times and take it in his hands, but he will not be able to connect these objects). At the same time, in moderate and mild forms of the disease, intensive and regular training sessions can help develop sequential thinking, which will allow children to perform simple and even more complex tasks.
- Slow thinking. To answer a simple question e.g. how old is he), a child with a mild form of the disease can think of an answer for several tens of seconds, but in the end usually gives the correct answer. With moderate oligophrenia, the child will also think about the question for a very long time, but the answer may be meaningless, unrelated to the question. In a severe form of the disease, the answer from the child may not be received at all.
- Inability to think critically. Children are not aware of their actions, they cannot assess the importance of their actions and their possible consequences.
Cognitive Disorders
Children with a mild degree of oligophrenia are characterized by a decrease in interest in the objects, things and events around them. They do not seek to learn something new, and when learning, they quickly forget what they have received ( read, heard) information. At the same time, properly conducted classes and special training programs allow them to learn simple professions. With moderate and severe mental retardation, children can solve simple problems, but they remember new information extremely hard and only if they are engaged with them for a long time. They themselves do not show any initiative to learn something new.Concentration disorder
All children with oligophrenia have a decrease in the ability to concentrate, which is due to impaired activity. brain.With a mild degree of mental retardation, it is difficult for a child to sit still, for a long time to do the same thing ( for example, they cannot read a book for several minutes in a row, and after reading they cannot retell what was said in the book). At the same time, an absolutely opposite phenomenon can be observed - when studying a subject ( situations) the child overly focuses on its smallest details, while not evaluating the subject ( situation) generally.
With moderately severe oligophrenia, it is extremely difficult to attract the attention of a child. If this can be done, after a few seconds the child is again distracted, switching to another activity. In a severe form of the disease, it is not possible to attract the attention of the patient at all ( only in exceptional cases can the child react to any bright objects or loud, unusual sounds).
Violation / underdevelopment of speech and problems in communication
Speech disorders may be associated with functional underdevelopment of the brain ( what is typical for a mild form of the disease). At the same time, with moderately severe and deep oligophrenia, an organic lesion of the speech apparatus can be observed, which will also create certain problems in communication.Speech impairment in children with mental retardation is characterized by:
- Silence. With a mild form of the disease, complete dumbness is relatively rare, usually in the absence of the necessary corrective programs and classes. With imbecility ( moderately severe oligophrenia) dumbness may be associated with damage to the speech apparatus or hearing impairment ( if the child is deaf, he will also not be able to memorize words and pronounce them). With severe mental retardation, children usually cannot talk. Instead of words, they utter incomprehensible sounds. Even if they manage to learn a few words, they are not able to use them correctly.
- Dyslalia. It is characterized by a speech disorder, consisting in the incorrect pronunciation of sounds. At the same time, children may not pronounce some sounds at all.
- Stuttering. It is typical for oligophrenia of mild and moderate severity.
- Lack of expressiveness of speech. With a mild form of the disease, this deficiency can be eliminated with the help of classes, while in more severe forms this cannot be done.
- Impaired speech volume control. This can be seen in hearing loss. Normally, when a person speaks and hears his speech, he automatically controls its volume. If the oligophrenic does not hear the words he utters, his speech will be too loud.
- Difficulties in building long phrases. Starting to say one thing, the child can immediately switch to another phenomenon or object, as a result of which his speech will be meaningless and incomprehensible to others.
visual impairment
With a mild and moderate form of the disease, the visual analyzer is usually developed normally. At the same time, due to a violation of thought processes, the child may not distinguish certain colors ( for example, if he is asked to choose yellow pictures among pictures of other colors, he will distinguish yellow from the rest, but it will be difficult for him to complete the task.).Severe visual impairment can be observed with deep oligophrenia, which is often combined with defects in the development of the visual analyzer. In this case, the child may not distinguish colors, see objects distorted, or even be blind.
It should also be noted that visual impairment strabismus , blindness and so on) may be associated with an underlying disease that causes mental retardation ( for example, with hereditary Bardet-Biedl syndrome, in which children can be born already blind).
Are there hallucinations in oligophrenia?
hallucinations- these are non-existent images, images, sounds or sensations that the patient sees, hears or feels. For him, they seem realistic and plausible, although in reality they are not.For the classical course of mental retardation, the development of hallucinations is not typical. At the same time, when oligophrenia is combined with schizophrenia symptoms characteristic of the latter disease may appear, including hallucinations. Also, this symptom can be observed when psychoses, with severe mental or physical overwork and the use of any toxic substances ( alcoholic drinks, drugs ) even in small quantities. The latter phenomenon is due to the inferior development of the central nervous system and the brain in particular, as a result of which even a negligible amount of alcohol can cause visual hallucinations and other mental disorders in the patient.
hearing loss ( deaf children with mental retardation)
Hearing disorders can be observed with any degree of oligophrenia. The reason for this may be organic lesions of the hearing aid ( for example, with congenital developmental anomalies, which is typical for children with severe mental retardation). Also, damage to the auditory analyzer can be observed when hemolytic disease of the newborn, with some genetic syndromes and so on.The development and education of a deaf mentally retarded child proceeds even more slowly, since he cannot perceive the speech of the people around him. With complete deafness, children, as a rule, cannot speak ( without hearing the speech, they cannot repeat it), as a result of which, even with a mild form of the disease, they express their emotions and feelings only with a kind of lowing and screaming. With partial deafness or deafness in one ear, children can learn to speak, but during a conversation they may mispronounce words or speak too loudly, which is also associated with the inferiority of the auditory analyzer.
Sensory Development Disorders
Sensory development is the child's ability to perceive the world around him with the help of various senses ( first of all, sight and touch). It has been scientifically proven that the majority of mentally retarded children are characterized by violations of these functions of varying degrees of severity.Sensory development disorders can manifest as:
- Slow visual perception. To evaluate an object seen ( understand what it is, why it is needed, and so on), a mentally retarded child needs several times more time than a normal person.
- Narrowness of visual perception. Normally, older children can simultaneously perceive ( notice) up to 12 items. At the same time, patients with oligophrenia can perceive no more than 4-6 objects at the same time.
- Violation of color perception. Children may not be able to distinguish between colors or shades of the same color.
- Violation of touch. If you close your child's eyes and give him a familiar object ( like his personal cup), he can easily recognize her. At the same time, if you give the same cup, but made of wood or other material, the child will not always be able to accurately answer what is in his hands.
Memory disorders
In a healthy person, after several repetitions of the same material, certain connections are formed between the nerve cells of the brain ( synapses), which allows him to remember the information received for a long time. With mild mental retardation, the rate of formation of these synapses is impaired ( slows down), as a result of which the child must repeat certain information much longer ( more times) to remember. At the same time, when the lessons are stopped, the memorized data is quickly forgotten or may be distorted ( the child incorrectly retells the information read or heard).With moderate oligophrenia, the listed violations are more pronounced. The child hardly remembers the information received, and when it is reproduced, it may get confused in dates and other data. At the same time, with deep oligophrenia, the patient's memory is extremely poorly developed. He can recognize the faces of the closest people, can respond to his name or ( rarely) memorize a few words, although he does not understand their meaning.
movement disorders ( motor disorders)
Motility and voluntary movement disorders are observed in almost 100% of children with oligophrenia. At the same time, the severity of movement disorders also depends on the degree of the disease.Movement disorders in mentally retarded children can manifest themselves as:
- Slow and clumsy movements. When trying to take an object from the table, the child can bring his hand to it very slowly, clumsily. Such children also move very slowly, they can often stumble, their legs can tangle, and so on.
- Motor restlessness. This is another type of movement disorder, in which the child does not sit still, constantly moves, performs simple movements with his arms and legs. At the same time, his movements are uncoordinated and senseless, sharp and sweeping. During a conversation, such children may accompany their speech with excessively pronounced gestures and facial expressions.
- Violation of coordination of movements. Children with a mild and moderate form of the disease take a long time to learn to walk, to take objects in their hands, to maintain balance in a standing position ( some of them may develop these skills only by adolescence).
- Inability to perform complex movements. Children with mental retardation experience significant difficulty if they need to perform two consecutive, but different movements ( for example, toss the ball up and hit it with your hand). The transition from one movement to another is slowed down, as a result of which the ball thrown up will fall, and the child will not “have time” to hit it.
- Violation of fine motor skills. Precise movements that require increased concentration of attention are extremely difficult for oligophrenics. For a child with mild disease, tying their shoelaces can be a difficult and sometimes impossible task ( he will take the shoelaces, twist them in his hands, try to do something with them, but the ultimate goal will not be achieved).
Violations of mental functions and behavior
Mental disorders can manifest themselves in children with any degree of the disease, which is due to a violation of the functioning of the cerebral cortex and a disturbed, incorrect perception of oneself and the world around.Children with mental retardation may experience:
- Psychomotor agitation. In this case, the child is mobile, can pronounce various incomprehensible sounds and words ( if he knows them), move from side to side, and so on. At the same time, all his movements and actions are devoid of any meaning, disorderly, chaotic.
- impulsive actions. Being in a state of relative rest ( e.g. lying on the couch), the child may suddenly stand up, go to the window, walk around the room, or perform some similar aimless action, and then return to the previous activity ( lie back on the couch).
- stereotypical movement. During training, the child memorizes certain movements ( e.g. waving a hand in greeting), after which it repeats them constantly, even without any obvious need ( for example, when he is himself indoors, when he sees an animal, bird or any inanimate object).
- Repetition of the actions of others. At an older age, children with mild mental retardation may begin to repeat the movements and actions they have just seen ( provided that they are trained in these actions). So, for example, seeing a person who pours water into a cup, the patient can immediately take the cup and also start pouring water for himself. At the same time, due to the inferiority of thinking, he can simply imitate these movements ( while not having a jug of water in hand) or even take a jug and start pouring water on the floor.
- The repetition of the words of others. If the child has a certain vocabulary, he, having heard a word familiar to him, can immediately repeat it. At the same time, children do not repeat unfamiliar or too long words ( instead, they can make incoherent sounds).
- Complete immobility. Sometimes a child can lie absolutely still for several hours, after which it can also suddenly begin to perform any actions.
Violations of the emotional-volitional sphere
All children with oligophrenia are characterized by a violation of motivation of one degree or another, as well as a violation of the psycho-emotional state. This greatly complicates their stay in society, and with moderately severe, severe and deep oligophrenia, it makes it impossible for them to be independent ( without the supervision of another person) accommodation.Children with mental retardation may experience:
- Decreased motivation. The child does not show initiative for any actions, does not seek to learn new things, to learn the world and yourself. They do not have any "their" goals or aspirations. Everything they do, they do only according to what they are told by those close to them or those around them. At the same time, they can do absolutely everything that they will be told, since they are not aware of their actions ( cannot critically evaluate them).
- Easy suggestibility. Absolutely all people with oligophrenia are easily influenced by others ( because they cannot distinguish between lies, jokes or sarcasm). If such a child goes to school, classmates may mock him, forcing him to do abnormal things. This can significantly traumatize the child's psyche, leading to the development of deeper mental disorders.
- Slow development emotional sphere. Children begin to feel something only by 3 - 4 years or even later.
- Limitation of feelings and emotions. Children with severe illness may experience only primitive feelings ( fear, sadness, joy), while with a deep form of oligophrenia, they may also be absent. At the same time, patients with mild or moderate mental retardation may experience much more feelings and emotions ( can empathize, feel sorry for someone, and so on).
- Chaotic emergence of emotions. Feelings and emotions of oligophrenics can arise and change suddenly, without any apparent reason ( the child has just laughed, after 10 seconds he is already crying or behaving aggressively, and in another minute he is laughing again).
- "Surface" feelings. Some children very quickly experience any life joys, hardships and hardships, forgetting about them within a few hours or days.
- "Intense" feelings. The other extreme in mentally retarded children is the over-expressed experience of even the most minor problems ( for example, dropping a mug on the floor, a child may cry because of this for several hours or even days).
Is aggression characteristic of mental retardation?
Aggression and inappropriate, hostile behavior is most often observed in patients with severe mental retardation. Most of the time they can behave aggressively towards others, as well as towards themselves ( can beat, scratch, bite, and even inflict severe bodily harm on themselves). In this regard, their separate residence ( without constant control) impossible.Children with a severe form of the disease also often show outbursts of anger. They can be aggressive towards others, but harm themselves relatively rarely. Often their aggressive mood can change to the exact opposite ( they become calm, quiet, friendly), but any word, sound or image can again provoke an outbreak of aggression or even rage in them.
With moderate mental retardation, children can also be aggressive towards others. The child may scream at the “offender”, cry, gesticulate menacingly with his hands, but this aggression rarely becomes open ( when a child seeks to harm someone physically). Outbursts of anger can be replaced by other emotions after a few minutes or hours, but in some cases the child may be in bad mood During a long time ( days, weeks or even months).
With a mild form of oligophrenia, aggressive behavior is extremely rare and is usually associated with some kind of negative emotions, experiences or events. Wherein close person can quickly calm the child ( to do this, you can distract him with something fun, interesting), as a result of which his anger is replaced by joy or another feeling.
Is physical development impaired in children with mental retardation?
mental retardation itself especially light form) does not lead to a lag in physical development. The child may be relatively tall, his musculature may be quite developed, and his musculoskeletal system may be no less strong than in normal children ( however, only if there is regular physical activity and training). At the same time, with severe and deep mental retardation, it is rather difficult to force a child to do physical exercises, and therefore such children can lag behind their peers not only in mental, but also in physical development ( even if they were born physically healthy). Also, physical underdevelopment can be observed in cases where the cause of oligophrenia affected the child after his birth ( for example, heavy injury heads during the first 3 years of life).At the same time, it is worth noting that physical underdevelopment and developmental anomalies may be associated with the cause of mental retardation itself. For example, in oligophrenia caused by alcoholism or drug addiction of the mother, a child can be born with various congenital anomalies, physical deformities, underdevelopment of certain parts of the body, and so on. The same is characteristic of oligophrenia caused by various intoxications, some genetic syndromes, trauma and fetal exposure to radiation for early dates intrauterine development, diabetes mothers and so on.
As a result of long-term observations, it was noticed that the more severe the degree of oligophrenia, the higher the likelihood that the child has certain physical anomalies in the development of the skull, chest, spine, oral cavity, vulva and so on.
Signs of mental retardation in newborns
Detect mental retardation newborn happens to be extremely difficult. The fact is that this disease is characterized by a slow mental development of the child ( compared to other children). However, this development does not begin until a certain time after birth, as a result of which the child must live at least a few months to make a diagnosis. When, during routine examinations, the doctor reveals any developmental delays, then it will be possible to talk about one degree or another of mental retardation.At the same time, it is worth noting that the identification of certain predisposing factors and symptoms may prompt the doctor to think about the possible mental retardation of the child at the first examination ( immediately after birth).
An increased likelihood of oligophrenia may indicate:
- Maternal predisposing factors- alcoholism, drug use, the presence of chromosomal syndromes in close relatives ( like other children), diabetes and so on.
- The presence of signs of mental retardation in the mother or father- people with a mild form of the disease can start families and have children, but the risk of having ( their children) oligophrenia increased.
- Newborn skull deformities- with microcephaly ( reduction in the size of the skull) or with congenital hydrocephalus (an increase in the size of the skull as a result of the accumulation of a large amount of fluid in it) the probability of having mental retardation in a child is close to 100%.
- Congenital developmental anomalies- defects in the limbs, face, oral cavity, chest or other parts of the body can also be accompanied by a severe or deep form of mental retardation.
Diagnosis of mental retardation
Diagnosis of mental retardation, determination of its degree and clinical form is a complex and lengthy process that requires a comprehensive examination of the child and the implementation of various diagnostic studies. Which doctor diagnoses and treats mental retardation?
Since mental retardation is characterized by a predominant violation of the mental processes and psycho-emotional state of the patient, the diagnosis of this pathology and the treatment of children with oligophrenia should be dealt with psychiatrist ( enroll ) . It is he who can assess the degree of the disease, prescribe treatment and monitor its effectiveness, as well as determine whether a person poses a danger to others, select optimal correction programs, and so on.At the same time, it is worth noting that in almost 100% of cases, oligophrenics have not only mental, but also other disorders ( neurological, sensory organ damage, and so on). In this regard, the physician psychiatrist never treats a sick child on his own, but constantly refers him to consultations with specialists from other fields of medicine, who help him choose the most appropriate treatment suitable for each specific case.
When diagnosing and treating a mentally retarded child, a psychiatrist may prescribe a consultation:
- neurologist ( enroll ) ;
- defectologist-speech therapist ( enroll ) ;
- psychologist ( enroll ) ;
- psychotherapist ( enroll ) ;
- ophthalmologist ( ophthalmologist) (enroll ) ;
- otorhinolaryngologist ( ENT doctor) (enroll ) ;
- dermatologist ( enroll ) ;
- pediatric surgeon ( enroll ) ;
- neurosurgeon ( enroll ) ;
- endocrinologist ( enroll ) ;
- infectiologist ( enroll ) ;
- manual therapist ( enroll ) and other specialists.
Methods of examination of a child with mental retardation
Data are used to make a diagnosis. history (the doctor asks the parents of the child about everything that may be related to the existing disease). After that, he examines the patient, trying to identify certain disorders characteristic of mentally retarded people.When interviewing parents, the doctor may ask:
- Were there mentally retarded children in the family? If among the next of kin there were oligophrenics, the risk of having this disease in a child is increased.
- Did any of the next of kin suffer from chromosomal diseases (down syndrome, Bardet-Biedl, Klinefelter and so on)?
- Did the mother take any toxins while carrying the baby? If the mother smoked, drank alcohol, or took psychotropic/narcotic drugs, she was at increased risk of having a child with mental retardation.
- Was the mother exposed to radiation during pregnancy? This could also contribute to the development of oligophrenia in a child.
- Does the child's memory suffer? The doctor can ask the baby what he ate for breakfast, what book was read to him at night, or something like that. normal child ( able to speak) will easily answer these questions, while it will be difficult for an oligophrenic.
- Does the child have outbursts of aggression? Aggressive, impulsive behavior during which the child can hit other people, including parents) is characteristic of a severe or deep degree of oligophrenia.
- Is the child characterized by frequent and causeless mood swings? This may also indicate the presence of oligophrenia, although it is also observed in a number of other mental disorders.
- Does the child have congenital malformations? If yes, which ones and how many?
The examination of the child includes:
- Speech assessment. By the age of 1 year, children should speak at least a few words, and by the age of two they should be able to communicate more or less. Speech impairment is one of the main signs of oligophrenia. To assess speech, the doctor can ask the baby simple questions - how old is he, what grade of school he is in, what are the names of his parents, and so on.
- Hearing assessment. The doctor can whisper the child's name, assessing his reaction to this.
- Vision assessment. To do this, the doctor can place a bright object in front of the child's eyes and move it from side to side. Normally, the child should follow a moving object.
- Thinking speed assessment. To test this, the doctor may ask the child a simple question ( for example, what are the names of his parents). A mentally retarded child may be late in answering this question ( after a few tens of seconds).
- Assessment of the ability to concentrate. The doctor can give the child some bright object or picture, call him by name or ask some question that requires a complex answer ( For example, what would the child like to eat for dinner?). For an oligophrenic, answer this question it will be extremely difficult, since his emotional-volitional sphere is violated.
- Assessment of fine motor skills. To assess this indicator, the doctor can give the baby a felt-tip pen and ask him to draw something ( for example the sun). Healthy child will do it easily if you have reached the appropriate age). At the same time, with mental retardation, the child will not be able to complete the task assigned to him ( he can drive a felt-tip pen over paper, draw some lines, but the sun will never draw).
- Assessment of abstract thinking. Older children may be asked by the doctor to describe what the child would do in a fictional situation ( like if he could fly). A healthy child can easily “fantasize” a lot of interesting things, while an oligophrenic child will not be able to cope with the task due to the complete absence of abstract thinking.
- Examination of the child. During the examination, the doctor tries to identify any defects or developmental anomalies, deformations of various parts of the body and other abnormalities that can be observed in severe forms of mental retardation.
What tests may be needed to diagnose mental retardation?
As mentioned earlier, to make a diagnosis, it is not enough just to identify mental retardation in a child, but you also need to determine its degree. For this, various diagnostic tests, as well as instrumental studies, are used.For mental retardation, the doctor may prescribe:
- tests to determine the level of intelligence ( e.g. Wechsler test);
- psychological age tests;
- EEG ( electroencephalogram) (enroll );
- MRI ( magnetic resonance imaging) (enroll ).
Tests to determine iq and psychological age in mental retardation ( Wechsler test)
I.Q. ( intelligence quotient) - an indicator that allows you to numerically evaluate the mental abilities of a person. When diagnosing mental retardation, it is iq that is used to determine the degree of the disease.The degree of mental retardation depending on iq
It is worth noting that healthy people should have an iq of at least 70 ( ideally over 90).
To determine the iq level, many methods have been proposed, the best of which is the test ( scale) Wexler. The essence of this test is that the subject is asked to solve several tasks ( build a series of numbers or letters, count something, find an extra or missing number / letter, perform certain actions with images, and so on). The more tasks the patient completes correctly, the higher his iq level will be.
In addition to determining iq, the doctor can also determine the psychological age of the patient ( There are also many different tests for this.). Psychological age does not always correspond to biological ( that is, the number of years that have passed since the birth of a person) and allows you to assess the degree of development of the child. The fact is that the psychological maturation of a person occurs as he learns, introduces him into society, and so on. If the child does not learn the basic skills, concepts and rules of behavior in society ( what is typical for mentally retarded children), his psychological age will be below the norm.
The psychological age of the patient depending on the degree of oligophrenia
Consequently, the thinking and behavior of a patient with severe mental retardation corresponds to those of a three-year-old child.
Basic diagnostic criteria for mental retardation
In order to confirm the diagnosis of mental retardation, you need to undergo a series of examinations from various specialists and pass a series of tests. At the same time, there are certain diagnostic criteria, in the presence of which it is possible to say with a high degree of probability that the child suffers from oligophrenia.The diagnostic criteria for oligophrenia include:
- Delayed psycho-emotional development and thought processes.
- Decreased iq level.
- Mismatch of biological age with psychological age ( the latter is significantly below the norm).
- Violation of the patient's adaptation in society.
- Behavioral disorders.
- The presence of a cause that led to the development of mental retardation ( not necessary).
Does an EEG show mental retardation?
EEG ( electroencephalography)- a special study that allows you to evaluate the activity of various parts of the patient's brain. In some cases, this allows us to assess the severity of mental disorders in mental retardation.The essence of the method is as follows. The patient comes to the doctor's office and after a short conversation lies down on the couch. Special electrodes are attached to his head, which will register electrical impulses emitted by brain cells. After installing the sensors, the doctor starts the recording device and leaves the room, leaving the patient alone. In this case, the patient is forbidden to stand up or speak during the entire procedure ( unless the doctor asks for it).
During the study, the doctor can contact the patient using radio communication, ask him to perform certain actions ( raise your arm or leg, touch your finger to the tip of your nose, and so on). Also, in the room in which the patient is located, the light may periodically turn on and off or certain sounds and melodies can be heard. This is necessary in order to evaluate the reaction of individual sections of the cerebral cortex to external stimuli.
The whole procedure usually lasts no more than an hour, after which the doctor removes the electrodes, and the patient can go home. Received data ( written on special paper) the doctor carefully studies, trying to identify any deviations characteristic of mentally retarded children.
Can an MRI detect mental retardation?
MRI ( Magnetic resonance imaging) head does not allow to determine mental retardation or assess the degree of its severity. At the same time, this study can be used to identify the cause of oligophrenia.The study is carried out using a special apparatus ( magnetic resonance imaging). The essence of the procedure is as follows. At the appointed time, the patient comes to the clinic where the examination will be carried out. First, he lies down on a special retractable table of the tomograph in such a way that his head is located in a strictly defined place. Next, the table moves to a special compartment of the apparatus, where the study will be carried out. During the entire procedure which can last up to half an hour) the patient must lie absolutely still ( don't move your head, don't cough, don't sneeze). Any movement can distort the quality of the received data. After the procedure is over, the patient can go home immediately.
The essence of the MRI method lies in the fact that during the patient's stay in a special compartment of the apparatus, a strong electromagnetic field is created around his head. As a result, the tissues of various organs begin to radiate a certain energy, which is recorded by special sensors. After processing the received data, the information is presented on the doctor's monitor in the form of a detailed layered image of the brain and all its structures, the bones of the skull, blood vessels and so on. After examining the data obtained, the doctor can identify certain disorders that could cause mental retardation ( for example, lesions of the brain after an injury, a decrease in the mass of the brain, a decrease in the size of certain lobes of the brain, and so on.).
Despite its safety, MRI has a number of contraindications. The main one is the presence of any metal objects in the patient's body ( splinters, dentures, dental crowns and so on). The fact is that magnetic resonance imaging is a strong electromagnet. If a patient is placed in it, in whose body there are metal objects, this can lead to very disastrous consequences ( up to damage to the internal organs and tissues of the patient).
Differential Diagnosis ( differences) mental retardation and autism, dementia, mental retardation ( mental retardation, borderline mental retardation in preschoolers)
The symptoms of mental retardation can be similar to those of a number of other mental illnesses. In order to correctly diagnose and prescribe adequate treatment, the doctor needs to know how these pathologies differ from each other. Mental retardation should be differentiated ( differ):
- From autism. Autism- a disease resulting from the underdevelopment of certain structures of the brain. People with autism are withdrawn, do not like to communicate with others and may outwardly resemble mentally retarded patients. At the same time, unlike oligophrenia, autism does not show any pronounced disturbances in thought processes. Moreover, people with autism may have very extensive knowledge in various fields of science. Another distinguishing feature is the ability to concentrate. With oligophrenia, children cannot do the same thing for a long time ( they have increased distractibility), while autistic people can sit in the same place for hours, repeating the same action.
- From dementia. dementia It is also characterized by a violation of thought processes and the loss of all skills and abilities acquired during life. Unlike mental retardation, dementia does not develop in early childhood. Main hallmark is that with mental retardation, a child cannot acquire new knowledge and skills due to brain damage. In dementia, previously healthy ( mentally and psycho-emotionally) a person begins to lose the skills he already had and forget the information that he once knew.
- From ZPR ( delays mental development, borderline mental retardation). ZPR is characterized insufficiently advanced thinking, attention and emotional-volitional sphere in children preschool age (up to 6 years old). The reasons for this may be unfavorable circumstances in the family, lack of attention from parents, social isolation ( lack of communication with peers), psycho-emotional trauma and experiences in early childhood, less often - minor organic lesions of the naked brain. At the same time, the child retains the ability to learn and receive new information, but his mental functions are less developed than those of his peers. An important diagnostic criterion is the fact that the ZPR must be fully completed by the time of admission to the first grade of the school. If, after 7-8 years of life, the child has signs of impaired thinking, they are not talking about mental retardation, but about oligophrenia ( mental retardation).
Mental retardation in children with cerebral palsy
In 10-50% of children with cerebral palsy ( cerebral palsy) there may be signs of mental retardation, and the frequency of occurrence of oligophrenia depends on the specific form of cerebral palsy.The essence of cerebral palsy is a violation of the patient's motor functions associated with damage to his brain in the prenatal period, during childbirth or immediately after birth. There can also be many reasons for the development of cerebral palsy ( injury, poisoning, oxygen starvation fetus, irradiation and so on), but all of them contribute to developmental disorders or damage ( destruction) certain parts of the brain.
It is worth noting that the same causal factors can lead to the development of oligophrenia. That is why the identification of signs of mental retardation in patients with cerebral palsy is one of the physician's primary tasks.
With a combination of these two pathologies, violations of mental, cognitive and psycho-emotional functions in a child are more pronounced than with isolated oligophrenia. Most often, severe or profound mental retardation occurs, but even with a moderate and mild degree of the disease, patients cannot serve themselves ( due to impaired motor function). That is why any child with cerebral palsy and mental retardation needs constant care from the moment of birth and throughout life. Such children are extremely difficult to learn, and the information they receive is quickly forgotten. Their emotions may be weakly expressed, however, in severe forms of oligophrenia, unreasonable aggression towards others may appear.
Differential diagnosis of alalia and oligophrenia ( mental retardation)
Alalia is a pathological condition in which a child has a speech disorder ( pronunciation of sounds, words, sentences). The cause of the disease is usually a lesion ( with birth trauma, as a result of intoxication, oxygen starvation, and so on) structures of the brain responsible for the formation of speech.In medical practice, it is customary to distinguish two forms of alalia - motor ( when a person understands the speech of others, but cannot reproduce it) and sensory ( when a person does not understand what they hear). An important feature is the fact that with alalia, the child's hearing organ is not damaged ( that is, he normally hears the speech of others) and there are no mental disabilities ( that is, he is not mentally retarded). At the same time, speech impairment in oligophrenia is associated with underdevelopment of the hearing organ ( deafness ) or with the inability of the child to memorize and reproduce the sounds, words he heard.
The difference between mental retardation and schizophrenia
Schizophrenia is mental illness, characterized by impaired thinking and severe psycho-emotional disorders. If the disease manifests itself in childhood, they speak of childhood schizophrenia.Childhood schizophrenia is characterized by a severe course accompanied by delirium ( the child says incoherent words or sentences) and hallucinations ( the child sees or hears something that is not really there, and therefore he may panic, scream in fear, or be in an unreasonably good mood). Also, the child may have problems communicating with peers ( children with schizophrenia are closed, have poor contact with others), problems with sleep, with concentration, and so on.
Many of these symptoms also occur in children with mental retardation ( especially in the atonic form of the disease), which greatly complicates differential diagnosis. In this case, signs such as delusions, hallucinations, perversion, or a complete lack of emotions can indicate schizophrenia.
It is worth noting that the onset of schizophrenia in early childhood disrupts the development of the central nervous system and the brain in particular, which can cause mental retardation. At the same time, mental retardation may be present in a child from birth ( however, has not yet been diagnosed), and against its background ( at the age of 2 - 3 years) may develop schizophrenia.
IN Lately more and more often in kindergartens and schools there are children who lag behind their peers in development.
They quickly get tired in the classroom, they need much more time to complete a task, and sometimes they do not understand the task at all and refuse to complete it.
These guys have a bad memory, speech and attention are not sufficiently developed.
They do not know how to organize the game alone, and when they start playing with other children, they stop following the rules, and this often ends badly for them.
These children, without existing reasons, are whiny, touchy or, conversely, aggressive if something is not as they would like. The guys have no interest in the world around them, they are not interested in anything and do not ask questions to adults.
All this is a manifestation of mental retardation. This concept combines various pathologies associated with a violation of the cognitive sphere, mental processes.
Mental retardation: what is it?
Such a deviation in development as mental retardation is characterized by limited intelligence and behavioral disorders.
If the average person has an IQ in the range of 100 points, then in people with this disorder, IQ does not exceed 75 points.
In medicine, it is customary to subdivide mental retardation into degrees and types. It is possible to determine the degree of SV at an early age of the child.
The basic criteria for making a diagnosis will be the severity of defects, the alleged causes of the disorder, and the nature of its course.
The level of SV in the doctor's report will be determined by the symbols F70-F79. The diagnosis can be deciphered as follows:
1 F70 - a mild form of mental retardation. Children suffering from this type of disorder have the ability to socialize, independently orient themselves in space, and without much difficulty master everyday self-care skills.
They serve themselves almost on a par with healthy children: dress, put on shoes, wash, eat.
The main indicator of the disease is failure in education. It is more difficult for such children to perceive the program of preschool preparation, they are distinguished by poor performance at school. Also, children may suffer from memory disorders.
2 F71 - moderate degree of mental retardation. Children with such a diagnosis should be constantly under the supervision of specialists. Doctors do not welcome the practice of teaching children with MR with an F71 coefficient in ordinary educational institutions.
3
F72 - severe degree of mental retardation.
The clinical picture may coincide with the previous degree of the disease, but speech disorders and motor disorders are noted. This indicates defects in the development of the central nervous system.
4 F73-F77 - a deep degree of mental retardation.
It is practically impossible for patients with a diagnosis with the indicated coefficients to adapt in society.
Unfortunately, such children from birth are very limited in their ability to comprehend what is happening around and perform even the simplest actions.
5 F78-F79 - especially complex forms of the disease. This category is used to indicate the diagnosis only when the assessment of mental activity is significantly difficult due to concomitant disorders. These include heavy behavioral disorders, blindness, deafness.
The main manifestations of mental retardation in children
Symptoms of mild VR may not be noticeable until school age. In the presence of more complex forms of the disease, the manifestations become noticeable much earlier.
The main symptom of the disorder is the limited mental abilities and skills appropriate for the age of the child.
Often, mental retardation occurs in conjunction with motor disorders, such as cerebral palsy.
Most often, the reason for the inpatient diagnosis of a child is the parent's complaints about his behavior.
It could be uncontrolled aggression in relation to peers, refusal to fulfill the requirements of elders, a tendency to tantrums and whims. Sometimes there is also hyperactivity.
It is important for parents of "special" children to understand that the behavioral aspects caused by this disease should in no case be treated superficially, let alone encouraged.
Your baby has all the data to learn new skills, including in communication, on an equal basis with other children.
Often, children who received such a diagnosis became even more sociable and pleasant interlocutors in the future, largely thanks to the efforts of their parents.
Causes of mental retardation
Causes of mental retardation can be congenital and acquired factors.
to congenital causes Pathogenic factors include:
Mother's illness during
chronic diseases parents,
long and fast childbirth,
mental and physical trauma;
influence and chemical substances that were taken by the mother during pregnancy - these are antibiotics, hormonal drugs, etc .;
occupational hazard - vibration;
as well as hereditary genetic diseases characterized by various metabolic abnormalities (for example, a violation in the set of chromosomes leads to).
The intellectual abilities of a child are most often determined by genetics, to a lesser extent - by the conditions of his environment.
If there is a tendency in the family for the transmission of diseases associated with mental retardation, the fetus is also at great risk of getting the disorder.
Mental retardation can be a manifestation (squeezing the neck with the umbilical cord).
In this case, irreversible processes occur that lead to disruption of the central nervous system, caused by insufficient supply of oxygen to the brain.
And drug addiction leads to poisoning of the fetus and causes irreversible changes in the body of an unborn child.
The consequences are microcephaly - a decrease in the size of the brain, hydrocephalus - the accumulation of fluid in the brain, paresis and paralysis, hyperkinesis - the presence of obsessive movements, brain disorders, etc. The earlier the fetal brain is damaged, the more pronounced the impact on further development.
Acquired Factors caused by birth and postpartum lesions - these are prolonged labor with stimulation, and rapid labor and asphyxia - oxygen deficiency. At the time of childbirth, intracranial injuries can also occur, when blood circulation is disturbed and leads to a change in the structure of the nervous system.
Most often, obstetric pathology contributes to this - the wrong technique of childbirth, a narrow pelvis.
Often the cause of mental retardation is transferred to early childhood diseases of neuroinfections, when damage to the membranes of the brain occurs (meningitis, encephalitis, poliomyelitis).
This leads to the onset of deafness, hydrocephalus, cessation of movement, mental retardation.
Inflammatory processes in the brain leave persistent irreversible changes, which is the cause of impaired cognitive activity.
Especially dangerous is the fact that sometimes mental retardation is detected in a child at the age of 3 years, and then it becomes difficult to correct his development.
In the future, such children will be taught in special correctional schools, and those who are included in the group of the uneducated will be brought up in special boarding schools for the mentally retarded.
Prevention of mental retardation in children
If the diagnosis is carried out and assistance is provided in time, then it is possible to prevent the complete degradation of the child's personality.
Of course, most of them will never be able to socialize in society and become a worthy citizen of the country.
Therefore, prevention, that is, the elimination of the causes and early diagnosis of mental insufficiency, is very important.
This means that future parents should take care of their health, and real parents should be extremely attentive to their children and, having noticed any deviations in the cognitive sphere - indifference to toys, indifference to what is happening, lack of interest in the world around them, immediately contact specialists - psychologists, defectologists.
How to raise mentally retarded children?
The work of the parents of "special" children is indeed priceless. It is much more difficult than it seems at first glance - sacrificing one's own strength, means and time to patiently make another attempt to treat a child.
Parents and close relatives of children with the most dangerous, deep degree of mental retardation find themselves in the most difficult situation.
Such children, alas, throughout their lives remain completely helpless and unadapted to external conditions.
Effective methods of influencing the perception of a mentally retarded child will be repeated repetitions of sounds, letters, words, and even whole sentences.
For children who have not been able to adapt to society due to their illness, communication within the family is very important.
The perception of the child as a full-fledged member of society, friendly conversations with him are of no small importance in his development.
In general, children suffering from a degree of mental retardation below the deep should, in any case, have the opportunity to communicate with their peers. Loneliness for such kids is simply dangerous.
Both teachers and doctors are of the opinion that mental retardation is not a valid reason for isolating a child from society. No specialist can put the final verdict on the rich and active life of your baby.
Even such a serious illness as mental retardation can be overcome by regular activities with the child and, of course, by the boundless love of his parents.
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Mental retardation is a condition caused by congenital or early acquired underdevelopment of the psyche with a pronounced lack of intelligence, which makes it difficult or completely impossible for the adequate social functioning of the individual.
The term "mental retardation" has become generally accepted in world psychiatry over the past two decades, replacing the term "mental retardation", which has been common in our and some other countries for a long time.
The term "oligophrenia" is narrower, it is used to refer to a condition that meets a number of clear criteria.
- The totality of mental underdevelopment with a predominance of the weakness of abstract thinking. The severity of violations of the prerequisites of intelligence (attention, memory, performance) is less, the underdevelopment of the emotional sphere is less severe.
- Non-progression of intellectual insufficiency and irreversibility of the pathological process that caused underdevelopment.
The concept of "mental retardation" is broader and more correct, as it includes diseases with congenital or early acquired underdevelopment of mental functions, in which the progressive nature of brain damage is noted. Clinically, this is only detected during long-term observation.
Mental retardation is characterized by a marked decrease in intellectual ability compared to average (often expressed as an IQ below 70-75) in combination with a limitation in more than 2 of the following functions: communication, independence, social skills, self-care, use of community resources, maintaining personal safety. Treatment includes education, family work, social support.
It is incorrect to assess the severity of mental retardation on the basis of intelligence quotient (IQ) alone (for example, mild 52-70 or 75; moderate 36-51; severe 20-35 and profound less than 20). The classification should also take into account the level of assistance and care required by the patient, ranging from occasional support to a high degree of constant assistance in all activities. This approach focuses on the strengths and weaknesses of the individual and how they relate to the needs of the patient's environment, as well as the expectations and attitudes of the family and society.
Approximately 3% of the population lives with an IQ less than 70, which is at least 2 standard deviations below the average IQ in the general population (IQ less than 100); when care is taken into account, only 1% of the population has severe mental retardation (SMR). Severe mental retardation is observed in children in families of all socioeconomic groups and levels of education. Less severe mental retardation (in which the patient requires intermittent or limited assistance) is more common in groups of lower socioeconomic status, similar to the observation that IQ correlates more with school achievement and socioeconomic status than with specific organic factors. However, recent studies have suggested a role for genetic factors in the development of mild cognitive impairment.
ICD-10 codes
In the ICD-10, mental retardation is coded under F70, depending on the severity of intellectual disability. As the first diagnostic guideline, a general intellectual indicator is used, determined using the Wexler technique. The following IQ scores are accepted for assessing mental retardation:
- an indicator in the range of 50-69 - mild mental retardation (F70);
- an indicator in the range of 35-49 - moderate mental retardation (F71);
- an indicator in the range of 20-34 - severe mental retardation (F72);
- a score below 20 - profound mental retardation (F73).
The fourth character is used to determine the severity of behavioral disorders, if they are not due to a concomitant mental disorder:
- 0 - the minimum value of violations or their absence;
- 1 - significant behavioral disorders requiring therapeutic measures;
- 8 - other behavioral disorders;
- 9 - behavioral disorders are not defined.
If the etiology of mental retardation is known, an additional code from ICD-10 should be used.
Lysosomal defects:
Gaucher disease
Hurler syndrome (mucopolysaccharidosis)
Niemann-Pick disease
Tay-Sachs disease X-linked recessive diseases:
Lesch-Nyhan syndrome (hyperuricemia)
Hunter syndrome (a variant of mucopolysaccharidosis)
Lowe's oculocerebrorenal syndrome
Postnatal factors
Malnutrition and psycho-emotional deprivation (lack of physical, emotional and cognitive support necessary for growth, development and social adaptation) in children in their first years of life may be the most common causes of mental retardation worldwide. Mental retardation may result from viral and bacterial encephalitis (including AIDS-associated neuroencephalopathy) and meningitis, poisoning (eg, lead, mercury), severe malnutrition, and accidents that result in head trauma or asphyxia.
References
- Pediatrics with childhood infections - Zaprudnov A.M., Grigoriev K.I. - Textbook. 2011
- Children's diseases - Shabalov N.P. - 6th edition. 2009
- Pediatrics - under the leadership of Baranov A.A. - Quick guide. 2014
- Emergency conditions in children - V.P. Dairy, M.F. Rzyankina, N.G. Zhila - Directory. 2010
- Propaedeutics of childhood diseases - Vorontsov I.M., Mazurin A.V. 2009
