The term “cerebral palsy” combines syndromes that arise as a result of brain damage in the early stages of ontogenesis and are manifested by the inability to maintain a normal posture and perform voluntary movements. Movement disorders in children with cerebral palsy (CP) are rarely isolated; as a rule, they are accompanied by impaired development of intellectual-speech, perceptual and communicative functions.
Cerebral palsy is a complex polyetiological neurological disease, arising as a result of early organic damage to the central nervous system. The lesion is mosaic in nature, which determines complex structure violations: combination motor disorders with violations of cortical functions.
It should be emphasized that there is no parallelism between the severity of motor and intellectual functions - severe motor disorders can be combined with mild mental retardation, and vice versa.
Children with CP are characterized by specific deviations in mental development. The mechanism of these disorders is complex and is determined both by time and by the degree and location of brain damage.
In the structure of both motor and mental disorders, a peculiar relationship of symptom complexes is observed, caused both by a delay in the maturation of certain psychomotor functions, primarily those most late in developing in normal ontogenesis, and by manifestations of damage to the central nervous system. nervous system. This causes the formation of a complex dysontogenetic-encephalopathic symptom complex, which determines the uniqueness of psychomotor development in cerebral palsy.
The peculiarity of the formation of motor and mental functions with cerebral palsy, it is not only their slower pace, but also a peculiar disproportionality, asynchrony of maturation with the appearance of secondary compensatory and hypercompensatory, often pathological symptom complexes.
Chronological maturation mental activity children with CP is sharply delayed. Against this background, various forms of mental disorders and, above all, cognitive activity are revealed. Children with CP are characterized by a unique mental development caused by a combination of early organic brain damage with various motor, speech and sensory defects. An important role in the genesis of mental development disorders is played by restrictions on activity, social contacts that arise in connection with the disease, as well as the conditions of upbringing and education.
With cerebral palsy, the formation of not only cognitive activity, but also emotional volitional sphere and personality.
The structure of cognitive impairment in cerebral palsy has a number of specific features that are characteristic of all children:
uneven, disharmonious nature of violations of individual mental functions. This is due to the mosaic nature of brain damage in the early stages of its development in cerebral palsy.
severity of asthenic manifestations - increased fatigue, exhaustion of all mental processes, which is associated with organic damage CNS.
reduced stock of knowledge and ideas about the world around us. This is due to:
forced isolation, restriction of the child’s contacts with peers and adults due to prolonged immobility or difficulties in movement
difficulties in understanding the surrounding world in the process of subject-related practical activity, associated with the manifestation of motor and sensory disorders.
With cerebral palsy, there is a violation of the coordinated activity of various analyzing systems. Pathology of vision, hearing, and muscle-joint senses significantly affects perception as a whole, limits the amount of information, and complicates the intellectual activity of children with CP.
Perceptual disorders in sick children are associated with insufficiency of kinesthetic, visual and auditory perception, as well as their joint activities. Normally, a child’s kinesthetic perception improves gradually. Touching various parts of the body, together with movements and vision, develops the perception of one’s body. This makes it possible to present yourself as a single object. Next, spatial orientation develops. In children with CP, due to motor disorders, the perception of themselves (“self-image”) and the surrounding world is impaired.
The immaturity of higher cortical functions is an important component of cognitive impairment in cerebral palsy. Most often, individual cortical functions are affected, that is, their violations are partial. First of all, there is a lack of spatial and temporal representations. Children have severe body diagram disturbances. It is difficult to differentiate between the right and left sides of the body. Many spatial concepts (front, back, between, above, below) are difficult to grasp. Children have difficulty defining spatial distance: the concepts of far and close are replaced by definitions here and here. Preschoolers with CP have difficulty grasping the concepts of size, do not perceive the shape of objects clearly enough, and do not differentiate similar shapes well - circle and oval, square and rectangle.
A significant proportion of children have difficulty perceiving spatial relationships. Their holistic image of objects is disrupted. Optical-spatial disturbances are often observed. In this case, it is difficult for children to copy geometric shapes, draw, and write. Deficiency is often expressed phonemic awareness, stereognosis, all types of praxis. Many have disturbances in the formation mental activity. Some children develop predominantly visual forms of thinking, while others, on the contrary, especially suffer from visual-effective thinking when better development verbal-logical.
Mental development in cerebral palsy is characterized by the severity of psychoorganic manifestations - slowness, exhaustion of mental processes. There are difficulties in switching to other activities, lack of concentration, slowness of perception, and a decrease in the volume of mechanical memory. A large number of children are characterized by low cognitive activity, which is manifested in decreased interest in tasks, poor concentration, slowness and reduced switchability of mental processes. Low mental performance partly associated with cerebrasthenic syndrome, characterized by rapidly increasing fatigue when performing intellectual tasks.
In terms of intelligence, children with CP represent an extremely heterogeneous group: some have normal intelligence, others have mental retardation, and some children have mental retardation. The main disorder of cognitive activity is mental retardation, which is associated both with early organic brain damage and with living conditions.
Children with CP are characterized by a variety of emotional-volitional disorders. In some children they manifest themselves in the form of increased emotional excitability, irritability, motor disinhibition, in others - in the form of lethargy, shyness, and timidity. The tendency to mood swings is often combined with inertia of emotional reactions. Increased emotional excitability is often combined with tearfulness, irritability, capriciousness, and protest reactions, which intensify in a new environment for the child and when tired. Behavioral disorders are quite common and can manifest themselves in the form of motor disinhibition, aggression, and protest reactions towards others. In some children, one can observe a state of complete indifference, indifference, and indifferent attitude towards others. It should be emphasized that behavioral disorders are not observed in all children with CP; in children with intact intelligence - less often than in mentally retarded children.
Children with CP have disturbances in personal development. Disturbances in personality formation in cerebral palsy are associated with the action of many factors (biological, psychological and social). In addition to the reaction to the awareness of one’s own inferiority, there is social deprivation and improper upbringing. A physical disability significantly affects the social position of a child or adolescent, his attitude towards the world around him, which results in a distortion of leading activities and communication with others. Sufficient intellectual development in these patients it is often combined with a lack of self-confidence, independence, and increased suggestibility. Personal immaturity is manifested in naivety of judgment, poor orientation in everyday and practical issues of life. Children and adolescents develop a reluctance and inability to engage in independent practical activities. Expressed difficulties social adaptation contribute to the formation of personality traits such as timidity, shyness, and inability to stand up for one’s interests. This is combined with increased sensitivity, touchiness, impressionability, and isolation.
Among the variants of abnormal personality development in cerebral palsy, delayed development of the type of mental infantilism is most often noted. It is based on disharmony in the maturation of the intellectual and emotional-volitional spheres with the prevailing immaturity of the latter. The main sign of infantilism is the underdevelopment of voluntary regulation of behavior and other forms of voluntary activity. In their actions, children are guided mainly by the emotion of pleasure and momentary desires. They are self-centered, unable to combine their interests with the interests of others and obey the demands of the team.
The basis for the formation of personality according to the type of mental infantilism is a violation of the maturation of the frontal parts of the cerebral cortex. In complicated forms of infantilism, which is most typical for children with CP, along with the main manifestations, increased mental exhaustion and motor disinhibition are observed.
In addition, children with CP are characterized by a neuropathic variant of mental infantilism. The main characteristics of these children include: lack of independence, increased suggestibility, fearfulness, lack of self-confidence, excessive dependence on the mother, and adaptation difficulties.
In such children at an early age, various somatovegetative disorders (sleep disorders, appetite disorders, hypersensitivity to irritants) are usually persistently expressed. In a new environment, these children show increased fearfulness, lethargy, lack of initiative, low level motivation. At school age, these features are often combined with increased self-esteem and egocentrism, which often results in situational conflict experiences. Not finding recognition from their peers, some children show a tendency to retreat into the world of fantasy, and gradually a feeling of loneliness develops and becomes entrenched. All this leads to even greater disharmony in personality development. With long-term adverse effects environment inhibition of behavioral reactions is consolidated, and the characterological characteristics of the inhibitory type are formed.
With the neuropathic variant of mental infantilism, the so-called affect of inadequacy often occurs, which manifests itself in various forms. One of them is protest reactions, which are transient behavioral disorders based on affective experiences. Protest reactions are characterized by a certain selectivity and focus. Reactions of passive protest usually predominate: refusing to eat, leaving home; sometimes they manifest themselves in the form of separate somatovegetative disorders: vomiting, enuresis, encopresis. Passive protest in children with CP most often manifests itself as refusal to comply with the demands of a parent or teacher.
So, the mental development of a child with CP is characterized by a violation of the formation of cognitive activity, emotional-volitional sphere and personality.
Thus, personal characteristics children with cerebral palsy include a number of signs:
Changes in the self-esteem component of personality, which manifest themselves in a decrease in current self-esteem, negative attitude sick children to themselves in general.
Changes in the emotional component of the personality, which manifests itself in emotional instability, a tendency to neurotic reactions.
Changes in the communicative component of the personality, which manifests itself in a tendency towards pseudoautization: isolation, isolation from the world, difficulties in establishing social contacts.
Changes in the intellectual component of the personality, which manifests itself in decreased productivity intellectual activity.
The personal characteristics of children with cerebral palsy have a number of special features:
reduced ideal self-esteem (claims)
changes in the volitional component of the personality, which manifests itself in a decrease in initiative, activity, conformist, dependent behavior, and the desire to fulfill social rules and requirements, which allows the sick child to maintain the required level of activity through compensatory conformal and socially approved behavior.
The identified general personality deviations reflect General characteristics psychogenesis of the personality of children with motor disorders and are associated with factors of social deprivation, lack of communication, and psychogenic influence, which is based on physical disability.
Specific Features The personalities of children with cerebral palsy are associated with the presence of an organically changed “soil” and represent secondary changes that determine the way the child’s personality adapts to the existing cerebral-organic insufficiency and to the motor defect.
Table of contents
1. Causes of personality development disorders in children with cerebral palsy 1
2. Specifics of personal development and formation of communicative functions 1
3. Characteristics of the formation of the image of “I” 4
4. Features of the development of the emotional-volitional sphere of children with cerebral palsy 5
5. Relationships with peers and family members as a factor in the personality development of children with musculoskeletal disorders 5
4. Features of the development of the emotional-volitional sphere of children with cerebral palsy
They manifest themselves in increased excitability, excessive sensitivity to all external stimuli. Typically, these children are restless, prone to outbursts of irritability, and stubbornness. Their larger group, on the contrary, is characterized by lethargy, passivity, lack of initiative, indecision, and lethargy. Many children are characterized by increased impressionability, they react painfully to the tone of voice and neutral questions and proposals, and note the slightest change in the mood of loved ones. Children with cerebral palsy often have sleep disorders: they sleep restlessly, with terrible dreams. Increased fatigue is typical for almost all children with cerebral palsy. It is important that the child begins to recognize himself as such........
Psychological mechanisms personality formation is uniform and normal developing child, and for a child with developmental disabilities, but different conditions This formation leads to the emergence of specific patterns of personality development in a child with developmental anomalies.
Among the types of abnormal development of children with cerebral palsy, the most common are developmental delays of the type of mental infantilism (see text at the end of the section). The basis of mental infantilism is the disharmony of maturation of the intellectual and emotional-volitional spheres with the immaturity of the latter. Mental development in infantilism is characterized by uneven maturation of individual mental functions. However, as M.S. Pevzner notes, “in all forms of infantilism, personality underdevelopment is the leading and defining symptom.” Mental infantilism in Russian literature is highlighted as a special type of developmental disorder, which is based on the immaturity of late-forming children. brain systems(T.A. Vlasova, M.S. Pevzner). Simple (uncomplicated) mental infantilism is distinguished; it also includes harmonious infantilism. In this form, mental immaturity manifests itself in all areas of the child’s activity, but mainly in the emotional-volitional one. Along with the uncomplicated form of mental infantilism, there are complicated forms - the so-called organic infantilism.
“Among the types of abnormal development of children with cerebral palsy, the most common are children with mental development delays of the type of mental infantilism.
The basis of mental infantilism is the disharmony of maturation of the intellectual and emotional-volitional spheres with the immaturity of the latter. Mental development in infantilism is characterized by uneven maturation of individual mental functions. Mental infantilism in Russian literature is highlighted as a special type of developmental disorder, which is based on the immaturity of late-forming brain systems (T.A. Vlasova, M.S. Pevzner, 1973).
There is simple (uncomplicated) mental infantilism (V.V. Kovalev, 1973), and it also includes harmonious infantilism (G. E. Sukhareva, 1959). In this form, mental immaturity manifests itself in all areas of the child’s activity, but mainly in the emotional-volitional one (M.S. Pevzner, 1982).
Along with the uncomplicated form of mental infantilism, complicated forms are distinguished. Several variants of the manifestation of complicated infantilism have been described (M.S. Pevzner, 1982; V.V. Kovalev, 1973). However, as M. S. Pevzner notes, “in all forms of infantilism, underdevelopment of the personality is the leading and defining symptom.”
The main sign of mental infantilism is considered to be underdevelopment of higher forms of volitional activity. In their actions, children are guided mainly by the emotion of pleasure, the desire for the present moment. They are self-centered, unable to combine their interests with the interests of others and obey the demands of the team. In intellectual activity, the predominance of emotions of pleasure is also expressed; intellectual interests themselves are poorly developed: these children are characterized by violations of purposeful activity. All these features, according to V.V. Kovalev (1973), together constitute the phenomenon of “school immaturity,” which emerges at the first stage of schooling.
Damage to the immature brain in cerebral palsy leads to the fact that cortical brain structures, especially those that form late frontal regions, mature unevenly and at a slow pace, which is the cause of personality changes such as mental infantilism. However, a specific condition for the development of this type of personality disorder is improper upbringing, restriction of activity associated with motor and speech insufficiency.
The immaturity of sick children, mainly in their emotional-volitional sphere, often persists into high school age and impedes their school, work and social adaptation. This immaturity is disharmonious. There are cases of a combination of mental immaturity with traits of egocentrism, sometimes with a tendency to reasoning; In children, emotional-volitional immaturity is combined with early manifestations of sexuality. Signs of immaturity of the emotional-volitional sphere in older children school age, manifested in behavior, increased interest in play activities, weakness of volitional effort, unfocused intellectual activity, increased suggestibility, have, however, a different coloring than in young children. Instead of true liveliness and gaiety, motor disinhibition predominates here, emotional instability, there is poverty and monotony of gaming activities, easy exhaustion, and inertia. There is a lack of childlike liveliness and spontaneity in the expression of emotions.
The peculiarity of mental infantilism in the schoolchildren with cerebral palsy we observed was that it was complicated. Three variants of complicated mental infantilism in schoolchildren with cerebral palsy have been identified. The first neuropathic variant of complicated infantilism is a combination of mental infantilism with manifestations of neuropathy (V.V. Kovalev, 1973).
Neuropathy, or congenital childhood nervousness, is characterized by increased excitability and significant instability. vegetative functions nervous system. Children with neuropathy are characterized by increased sensitivity to various stimuli, emotional excitability, exhaustion, and often inhibition of behavior, manifested in the form of timidity and fear of everything new.
With the neuropathic variant of mental infantilism, children with cerebral palsy are characterized by a combination of lack of independence, increased suggestibility with inhibition, timidity, and lack of self-confidence. They are usually overly attached to their mother, have difficulty adapting to new conditions, and take a long time to get used to school. At school, many of them show cases of increased timidity, shyness, cowardice, lack of initiative, low level of motivation, sometimes with increased self-esteem. All these features can cause disturbances in adaptation to school, and to the social environment in general. Children often have situational conflict experiences due to dissatisfaction of their desire for leadership, egocentrism and lack of self-confidence, increased inhibition and fearfulness.
With the neurotic variant of mental infantilism in children with cerebral palsy, passive protest reactions predominate. They manifest themselves in refusal to eat, from oral communication with certain persons (selective mutism), in leaving home or school; sometimes they manifest themselves in the form of disorders of individual somatovegetative functions: vomiting, enuresis (urinary incontinence), encopresis (fecal incontinence)
Much less often, suicidal behavior may arise as a result of passive protest, which manifests itself only in thoughts and ideas, or in a suicide attempt.
The most common manifestation of passive protest in students with cerebral palsy may be refusal to comply with certain demands of a teacher or educator. In case of improper upbringing in the family - refusal to fulfill the requirements of the parents.
The second variant of complicated mental infantilism in schoolchildren with cerebral palsy is a combination of mental infantilism with symptoms of irritable weakness. This type is described in the literature as a cerebroasthenic variant of complicated infantilism (V. Kovalev, 1973). Manifestations of emotional-volitional immaturity in these children are combined with increased emotional excitability, impaired attention, often memory, and low performance. The behavior of these schoolchildren is characterized by irritability and lack of restraint; Characteristic of these schoolchildren is a tendency to conflicts with others, combined with excessive mental fatigue and intolerance to mental stress. Difficulties in teaching these children are associated not only with underdevelopment of the emotional-volitional sphere, but also with their increased fatigue and rapid depletion of active attention. Their mood is extremely unstable, with a tinge of discontent and irritation. These children require constant attention and approval of their actions; otherwise, outbursts of discontent and anger arise, which usually end in tears. They most often exhibit affectively excitable forms of behavior, however, in a new environment for them, on the contrary, increased inhibition may appear.
Children in this group often have incorrect relationships with their peers, which has an adverse effect on their further development their personalities. A feature of school age is the emergence of a new social need to find one’s place in a group of peers. If this need is not fulfilled, various affective reactions may arise, manifested in the form of resentment and anger, isolation, and sometimes aggressive behavior.
The third variant of complicated mental infantilism in schoolchildren with cerebral palsy refers to the so-called organic infantilism, described by domestic psychiatrists (G.E. Sukhareva, 1965; S.S. Mnukhin, 1968; etc.).
The basis of organic infantilism is a combination of immaturity of the emotional-volitional sphere with disturbances of intellectual activity, manifested in the form of inertia, slow mobility of thinking, with a low level in the development of the generalization operation. These children are often motorically disinhibited, complacent, their goal-directed activity is grossly impaired, and the level of critical analysis of their actions and deeds is reduced.
Their increased suggestibility is combined with manifestations of stubbornness and poor attention span. In these children, more pronounced cases of impaired attention, memory, and a decrease in the level of performance are observed than in the previously considered variants.
The manifestation of organic infantilism was more often observed in the atonic-astatic form of cerebral palsy, when there is damage or underdevelopment of the fronto-cerebellar structures. This is due to the role played by the frontal cortex in the development of goal-directed activity, motivation, i.e. that level of mental development that is necessary for the formation of the so-called core of personality. Emotional-volitional disorders in organic infantilism are characterized by great disharmony. Along with the traits of “childishness,” increased suggestibility, lack of independence, and naivety of judgment, these children are characterized by a tendency to “disinhibit” drives and insufficiently developed criticality; They combine elements of impulsiveness with manifestations of inertia. During clinical and psychological examination, these children initially show a low level of personal readiness for learning. Their self-esteem and level of aspirations were inadequately inflated; There was also no adequate reaction to success. When exposed to additional unfavorable environmental factors, these children were observed to develop a tendency to develop characterological deviations of the excitable type. Children became restless, irritable, impulsive, unable to adequately take into account the situation, and were uncritical of themselves and their behavior. Such forms of behavior tended to become entrenched.” Mastyukova E.M. Personality features of students with cerebral palsy: Features psychophysical development students of special schools for children with musculoskeletal disorders / Ed. T.A. Vlasova. - M., 1985.)
Specific features in the development and formation of the emotional-volitional sphere of children with cerebral palsy can be associated with both biological factors (nature of the disease) and social conditions (upbringing and education of the child in the family and institution). The degree of impairment of motor functions does not determine the degree of impairment of emotional-volitional and other areas of personality in children with cerebral palsy.
Emotional-volitional disorders and behavioral disorders in children with cerebral palsy in one case manifest themselves in increased excitability, excessive sensitivity to all external stimuli. Typically, these children are restless, fussy, disinhibited, prone to outbursts of irritability, and stubbornness. These children are characterized by rapid mood swings: sometimes they are overly cheerful and noisy, sometimes they suddenly become lethargic, irritable, and whiny.
A larger group of children, on the contrary, is characterized by lethargy, passivity, lack of initiative, indecisiveness, and lethargy. Such children have difficulty getting used to a new environment and cannot adapt to rapidly changing conditions. external conditions, have great difficulty establishing interactions with new people, are afraid of heights, darkness, and loneliness. At the moment of fear, they experience increased heart rate and breathing, increased muscle tone, sweat, increased salivation and hyperkinesis. Some children are characterized by excessive worry about their health and the health of their loved ones. More often, this phenomenon is observed in children who are raised in a family where all attention is focused on the child’s illness and the slightest change in the child’s condition causes parents to worry.
Many children are highly impressionable: they react painfully to the tone of voice, notice the slightest change in the mood of loved ones, and react painfully to seemingly neutral questions and suggestions.
Children with cerebral palsy often have sleep disorders: they have difficulty falling asleep, sleep restlessly, and have terrible dreams. In the morning the child wakes up lethargic, capricious, and refuses to study. When raising such children, it is important to maintain a daily routine, it should be in a calm environment, before bedtime, avoid noisy games, exposure to various sharp irritants, and limit watching television.
Increased fatigue is typical for almost all children with cerebral palsy. They quickly become lethargic or irritable and whiny, and have difficulty concentrating on a task. If they fail, they quickly lose interest in it and refuse to carry it out. Some children experience motor restlessness as a result of fatigue. The child begins to fuss, gesticulate and grimace intensely, his hyperkinesis intensifies, and drooling appears. The pace of speech accelerates, it becomes slurred and incomprehensible to others. In the game, the child tries to grab all the toys and immediately scatters them. The development of organization and purposefulness of all types of activities in such a child occurs with great difficulty and requires the active participation of volitional processes.
The volitional activity of children suffering from musculoskeletal disorders has its own characteristics. Research by N.M. Saraeva included observations, experiment and other methods that made it possible to study the volitional activity of 120 adolescents with cerebral palsy. The data obtained made it possible to subdivide the factors that determine the characteristics of the volitional sphere of children with cerebral palsy into objective ones, which include the conditions of the disease, long-term stay in medical institution, artificial restriction of activity, special treatment to the sick child of those around him, and subjective ones, such as the teenager’s attitude towards his illness and self-esteem.
According to the level of volitional development, three main groups were found among the subjects.
The first group is characterized by a general decrease in emotional-volitional tone, asthenization of behavior, and volitional infantilism. This manifests itself in the inability, and sometimes even unwillingness, of a teenager to regulate his behavior, in general lethargy, reaching the point of apathy in some, and in extreme incontinence in others, in the lack of sufficient persistence in achieving both a correctional and restorative effect and good results in educational work. Getting used to the role of patients, adolescents weaken their independence and display dependent attitudes. Such teenagers accounted for 37% of general composition studied.
The second group consists of teenagers whose level of volitional development is quite high. Possessing adequate self-esteem and correctly determining their capabilities, adolescents of this group are able to mobilize the compensatory forces of the body and personality on the basis of long-term volitional efforts. They are actively fighting the disease and its consequences, persistent in achieving therapeutic effect, are temperate and patient, show perseverance in their studies, develop their independence, and engage in self-education. There were 20% of such children out of the total number of those examined.
The level of volitional development of adolescents included in the third group can be defined as average. Depending on their state of health, well-being, and many other circumstances, adolescents occasionally demonstrate sufficient volitional activity. In academic work, this is associated with interest, current grades, medical events- with a therapeutic perspective, etc. Periods of volitional growth are replaced by a decrease in the level of volitional activity. This group included 43% of the total number of adolescents studied.
The above groups include adolescents with musculoskeletal system lesions of varying severity.
Corrective and restorative work with adolescents suffering from diseases of the musculoskeletal system requires taking into account the noted volitional differences. The first group of children, whose weak will only aggravates their well-being and illness, needs special attention. Building prospects for each such child, the focused work of a psychologist, educator, speech therapist and other specialists on the development of the strong-willed side of the personality, imitation of strong-willed teenagers (second group) can significantly strengthen the will of children and contribute to their socio-psychological rehabilitation.
It is important that the child begins to recognize himself as he is, so that he gradually develops the right attitude towards his illness and his capabilities. The leading role in this belongs to parents and educators: from them the child borrows an assessment and idea of himself and his illness. Depending on the reaction and behavior of adults, he will view himself either as a disabled person who has no chance of taking an active place in life, or as a person who is quite capable of achieving success.
Pathocharacterological formation of personality (psychogenically determined development of personality due to the long-term effect of a psychotraumatic factor and improper upbringing) is observed in the majority of children with cerebral palsy. Negative character traits are formed and consolidated in children with cerebral palsy to a large extent due to the type of overprotective upbringing that is typical for many (families where children with pathologies of the motor sphere are brought up. Such upbringing leads to the suppression of natural activity that is feasible for the child. Parents, fearing that the child will fall, will drop dishes, dress incorrectly, deprive him of independence, prefer to do everything for him. This leads to the fact that the child grows up passive and indifferent, does not strive for independence, he develops dependent moods, egocentrism, a feeling of constant dependence on adults, lack of self-confidence, timidity, vulnerability, shyness, isolation, and inhibitory forms of behavior. Some children exhibit a desire for demonstrative behavior and a tendency to manipulate others.
In some cases, in children with severe motor and speech disorders and intact intelligence, inhibitory forms of behavior are compensatory in nature. Children are characterized by slow reactions, lack of activity and initiative. They consciously choose this form of behavior and thereby try to hide their motor and speech disorders. Having proficient speech, children, masking pronunciation defects, answer questions in monosyllables, never ask questions themselves, and refuse to perform motor tasks available to them.
Deviations in the development of the personality of a child with cerebral palsy can also arise with a different style of upbringing in the family. Many parents take an unreasonably harsh position in raising a child with cerebral palsy. These parents demand that the child fulfill all requirements and tasks, but do not take into account the specifics of the child’s motor development. Often, such parents, if the child does not comply with their demands, resort to punishment. All this leads to negative consequences in the development of the child and the worsening of his physical and mental condition.
In conditions of hyper-custody or hypo-custody of a child, the most unfavorable situation arises for the formation of an adequate assessment of his motor and other capabilities.
Studying a child’s reaction to his physical defect is a necessary condition for studying personality, self-awareness, self-esteem, as well as a condition for carrying out proper work on educating the personality of children with musculoskeletal disorders.
E. S. Kalizhnyuk found that awareness of the defect in children with cerebral palsy occurs more often at the age of 7-8 years and is associated with their worries about the unkind attitude of their peers, as well as with social deprivation. She divided the psychogenic reactions that occur in such children into two options:
neurotic reactions combined with passive-defensive ones - hyposthenic variant (excessive vulnerability, shyness, timidity, tendency to solitude, etc.);
aggressive-defensive forms of behavior - hypersthenic variant (affective incontinence, readiness for conflicts and aggression).
Psychogenic reactions occurring at the neurotic level can be divided into three groups, according to their clinical severity: 1) asthenophobic, 2) asthenodepressive and 3) polymorphic syndromes with the inclusion of a hysterical component.
Children with asthenophobic manifestations are timid, shy, embarrassed and inhibited in a new environment. Increased fearfulness and sensitivity are noted in them early period development. The first age crisis (at 2-4 years) is somewhat delayed due to a general retardation of development. The age of mastery of motor and speech functions (3 - 5 years) is often characterized by neurotic manifestations, disorders of the somatovegetative sphere, a tendency to habitual vomiting, enuresis, tearfulness, and moodiness. The second age crisis (11 - 12 years), characterized by an increase in asthenoneurotic manifestations, often in combination with a syndrome of motor disinhibition, is an affective stage of personality development. And although the true experience of the defect is not yet observed at this age, children are faced with such a psycho-traumatic situation as the unkind attitude of healthy peers towards them. Due to the impossibility of completely eliminating this situation, increased emotional excitability occurs, which, in combination with organic cerebral insufficiency, is a favorable background for the manifestation various types phobic reactions. A unique feature of the affective response of children with cerebral palsy is the tendency to develop an affect of fear under the influence of insignificant external influences.
In children with asthenodepressive form of reactions, awareness of their physical inferiority comes to the fore. They have increased vulnerability and fear of being funny in society strangers, and hence the desire to protect oneself as much as possible from visiting crowded places - a kind of isolation, in some cases reaching the level of pronounced asthenodepressive syndrome with suicidal thoughts.
Children with hypersthenic reactions have polymorphic symptoms. During the period of the first age crisis, along with neurotic manifestations, more pronounced deviations in behavior are often found - motor disinhibition, stubbornness, negativism, hysterical reactions, etc.
The experience of physical insufficiency is observed among children of different ages. They are most acute during adolescence and youth. These periods are characterized by multilateral processes affecting the intellectual, emotional and volitional spheres. IN adolescence The features of an adult are actively being formed. The teenager himself begins to realize that he is approaching adulthood and strives for independence. For children with movement disorders, age-related difficulties are complemented by acute mental trauma associated with physical disability.
A study conducted by T.V. Esipova for three years gave grounds to distinguish three main groups among children with motor impairments in terms of their attitude towards their physical defect.
Children of the first group, the most prosperous, fully understand the consequences of the disease, soberly assess their strengths and capabilities, and are ready to overcome difficulties. As a rule, thanks to their determination and strong-willed qualities, they achieve success in their studies and become established in the team healthy people, in life.
For children of the second group, a depressed mood and loss of faith in the improvement of their condition are typical. This has an impact on all areas of the lives and activities of these children and complicates therapeutic, psychological and pedagogical work with them.
The third group includes teenagers who are relatively calm about their illness. For some, this is explained by compensation for physical deficiency by other developing qualities and certain achievements (success in certain types sports, good academic performance, social work, etc.), for others - spoilage in the family, dependency, for others - insufficient development of the personality as a whole. Teenagers in this group do not have an objective assessment of their capabilities or a critical attitude towards them.
As you can see, the experiences of physical insufficiency mobilize some to fight the disease, to take a full-fledged place in social life, while for others these experiences begin to occupy a central place and take the teenager away from active life.
The difference in the reactions of adolescents with musculoskeletal disorders to a physical defect, as shown by this study, is determined by the orientation of the child’s personality: for some, experiences are associated with increased attention to their appearance, i.e. to the cosmetic side of the defect, others have an interest in the internal content, in the intellectual and moral sides of the personality. In order to properly develop the personality, it is very important to overcome experiences aimed only at the cosmetic side of the defect. This is achieved not so much by treating a physical illness, but by competent psychological work with baby.
According to E. Heisserman, some intellectually gifted children with severe cerebral palsy suffer less from their defect than other children with physical damage of the same severity. Due to their natural talent, these children provide the highest level of compensation.
Other studies show that those who acquired musculoskeletal disorders in adolescence (sports injury, transport accident, etc.) experience their physical defect most acutely.
One of the aspects of studying the characteristics of the personality development of children with cerebral palsy - the accentuation of the character of adolescents - was considered by I.Yu. Levchenko. Among those examined, it was possible to identify only a part of those types of accentuation that are detected during examination of healthy adolescents: asthenoneurotic (20%), sensitive (19%), unstable (22%), psychoasthenic (21%). Noteworthy was the relatively high frequency of patients with cerebral palsy of asthenoneurotic, psychoasthenic and sensitive types of accentuation, which were observed extremely rarely in healthy adolescents.
An unstable type of character accentuation, which is just as common in the norm, was identified with high frequency in the group of those examined. According to the analysis, features of mental development, lack of criticality in assessing the severity of one’s illness - all this allowed us to assume the leading role of organic brain damage in the formation of features of an unstable type of accentuation in these children.
During the study, I.Yu. Levchenko did not identify children with hyperthymic, labile and cycloid types of character accentuation. She suggested that the constitutionally determined traits of these types in children of this category are leveled out under the influence of an immobile or sedentary lifestyle, experience of a defect and other factors.
Another study by I. Yu. Levchenko, conducted on adolescents, gave the following results:
An analysis of relationships with their mother showed that almost 90% of children assessed their relationship with her highly positively, but there was some ambivalence in the assessment - the same children noted increased irritability of the mother and frequent quarrels with her. When processing the questions asked of the children, the following data were obtained: 30% of the children said that their mother loved them: 60% described her positive qualities (“My mother is very kind”). 10% of children refused frank answers, a strong aggressive reaction was observed (“Many mothers are unworthy of motherhood”; “If mom wanted, she would fly into space”);
an analysis of attitudes towards their father showed: 19% of children talked about love between father and child; 64% believed that their father pays little attention to their upbringing (“Father works a lot,” “Father rarely works with me,” “Father rarely plays with me”), the main reason for which the child considered his own I defect;
More than half of the children have a sharply negative attitude towards the future (“The future seems cruel to me,” “difficult,” “heavy,” “not very happy,” etc.), and yet some of them admitted the possibility of positive development of their own future (“I hope for the best”, “I hope that I will meet my love”, that “I will get married”, “I will finish school”, etc.), 17% of the subjects expressed confidence in their abilities, showed a desire to build their own future, to use everything your mental and physical potential (“I rely on myself”, “I am confident in my abilities”, “I will try not to be decrepit”, etc.). 11% of the group showed pronounced egocentrism and an inadequate attitude towards opportunities in the future, 2% hoped for a miracle;
in relation to the fears and concerns of children can be divided as follows: for 50% of children, the most terrible thing seemed to be the possibility of a serious conflict situation in their own microsociety; 30% experience object-related fears (“I’m afraid of elevators,” “I’m afraid of losing the key to the classroom,” “I’m afraid of wild animals,” etc.); 14% - expressed fears about the possibility of others realizing their inferiority, 6% - feared for own health;
The attitude of children towards themselves can be represented as follows: 80% of the subjects considered themselves capable of taking more serious responsibility for themselves than their parents and teachers allow them. These children are aware of the fact of overprotection on the part of significant adults, considering it unnecessary. Only 15% take parental care for granted, expressing concerns about being deprived of it. It was revealed that 5% of children grew up in conditions of hypoprotection, communicated outside of school mainly with older disadvantaged teenagers, had a tendency to “fake growing up,” and imitated negative, asocial examples.
According to the results of this study, 90% of children were fully aware of their own defect, considered themselves disabled, deliberately limited their own capabilities, and did not recognize communication with healthy peers as necessary for themselves. They had certain goals and forecasts for their future, and linked their own unrealized potential directly with the existing defect. 8% of children, realizing their own defect, did not deprive themselves of the opportunity to communicate with normally developing children, but some aggressiveness was observed towards people with the same developmental anomaly; There was a lack of clear goals, a tendency towards antisocial behavior, and insufficient awareness of actions. 2% of the subjects did not have a clear awareness of their own defect, were overly self-confident, and set themselves “enchanting” tasks and goals.
Thus, the development of personality in children with cerebral palsy in most cases occurs in a very unique way, although according to the same laws as the personality development of normally developing children. The specifics of personality development of children with cerebral palsy are determined by both biological and social factors. The development of a child in conditions of illness, as well as unfavorable social conditions, negatively affect the formation of all aspects of the personality of a child suffering from cerebral palsy.
1.Primary personality traits.
2.Secondary personality traits.
3.Personality traits manifested in children with cerebral palsy.
4. The mechanism of pathological personality formation.
5.Comprehensive psychological, medical and pedagogical analysis for diagnosing personality traits.
6. Neuropathic variant of mental infantilism.
7. Forms of “affect of inadequacy”.
8. Formation of a personality of the inhibitory type.
Vygotsky G.S. distinguished primary and secondary personality characteristics. Myasishchev V.N. Primary features included properties determined by the properties of the nervous system and the characteristics of the disease. Secondary features are manifested by characterological shifts from the interaction of external and internal factors. Secondary characteristics of a child are caused by a number of reasons, which include experiences of a physical defect, conditions of upbringing, and relationships in the child’s family.
The leading role in the mechanism of pathological formation of personality belongs to the personality's reaction to awareness of a defect, physical inferiority. Early social deprivation (isolation from peers due to physical underdevelopment) and the peculiar attitude of others towards a child with disabilities have a negative impact. disabilities. All this leads to immaturity of the emotional-volitional sphere, egocentrism, and increased suggestibility.
Normal intellectual development in cerebral palsy is often combined with a lack of self-confidence and independence. Personal immaturity is manifested in naivety of judgment, poor orientation in everyday and practical issues. Patients easily develop dependent attitudes, inability and unwillingness to act independently. Difficulties in social adaptation contribute to the development of timidity, shyness, and inability to stand up for one’s interests. This is combined with increased sensitivity, touchiness, impressionability, and isolation. Most often, with cerebral palsy, asthenoneurotic, psychasthenic, and less often, unstable and excitable types of personality accentuation develop.
The negative impact of organic damage to the central nervous system determines the characteristics of the response to a physical defect as passive-defensive or aggressive-defensive. At an early age, inadequacy of self-esteem and violations of ideas about one’s body are revealed. Frequent hospitalization leads to early mental and social deprivation. The main style of family education becomes hyperprotection, which reduces the level of social adequacy of behavior. The underdevelopment of parental feelings and instability of upbringing lead to a decrease in independence, sensitivity, and frustration.
In cases of intellectual impairment, personality traits are combined with insufficient criticality and low cognition. There is indifference, weakness of willpower and motivation.
To identify deviations it is necessary comprehensive psychological, medical and pedagogical analysis. You should pay attention to pronounced signs of behavior that disrupt adaptation; you need to take into account subtle manifestations of character, temperament, drives, thinking, direction of interests, development of activity and communication. It is important for a psychologist to note not only negative traits, and primarily positive ones, which can be relied upon in correctional work.
Personality disorders in cerebral palsy are more often manifested by variants of mental infantilism. Three variants of complicated mental infantilism in schoolchildren have been identified.
1. The neuropathic variant is manifested by a combination of lack of independence, increased suggestibility with inhibition, timidity, and lack of self-confidence. Children can be overly attached to their mother, have difficulty adapting to new conditions, and take a long time to get used to school. At school there is increased timidity, cowardice, shyness, lack of initiative, low level of motivation, sometimes with increased self-esteem. Children often have situational conflict experiences due to dissatisfaction of their desire for leadership, egocentrism and uncertainty, increased inhibition and fearfulness.
Not finding recognition from their peers, some are inclined to leave for their own inner world fantasies, they develop a feeling of loneliness. All this leads to even greater disharmony in personality development.
The “affect of inadequacy” manifests itself in various forms. One of them is the reaction of protest, arising on the basis of affective experiences (resentment, injured pride). Reactions predominate passive protest. They manifest themselves in refusal to eat, from oral communication, in leaving home or school; sometimes they are manifested by disorders of somatovegetative functions: vomiting, enuresis, encopresis. Suicidal behavior may occur much less frequently, manifesting itself in thoughts and ideas or in making an attempt. Suicidal attempts as reactions of passive protest arise in prepubertal and pubertal age as a result of acute experiences. The reason for suicidal behavior may be undeserved punishment, receiving a bad grade, unrequited first feelings of love, etc. This behavior is not thought out in advance, it occurs suddenly, impulsively; may be unexpected for others. The most common protest is refusal to comply with the teacher’s demands, and if there is improper upbringing in the family, refusal to fulfill the parents’ demands.
A form of “affect of inadequacy” can be reactions of refusal. They manifest themselves in passivity, in the refusal of his usual desires and aspirations, often in the thoughtless nature of his answers, and the lack of contacts. The child acutely experiences the loss of perspective and seems to give up his claims. Similar reactions occur in situations of frustration. From the psychological side, this is a frustration of plans, a collapse of hopes, manifested in confusion, anxiety, and a feeling of helplessness. A manifestation of this can be general passivity, refusal of aspirations, and refusal of communication. The consolidation of such behavior contributes to the pathocharacterological formation of a personality of the inhibitory type.
With the inhibitory variant, a combination of such character traits as uncertainty, inhibition, touchiness, and a tendency to fear occurs. Education in the form of hyperprotection leads to the suppression of natural activity, his desire for independence; as a result, a feeling of dependence on adults, uncertainty, passivity, and timidity are consolidated as stable personality traits.
Literature:
1. Danilova L.A. Methods for correcting speech and mental development of children with cerebral palsy. – M., 1977.
2.Kalizhnyuk E.S. Mental disorders for children with cerebral palsy. – M., 1990.
3. Kovalev V.V. Semiotics and diagnostics mental illness in children and adolescents. – M., 1985.
4. Mastyukova E.M. Personality features of students with cerebral palsy//Psychology of children with disabilities and disorders of psychological development: Reader. – St. Petersburg, 2001.
Topic No. 19. Complicated variants of mental infantilism as a disorder of the personality development of children with cerebral palsy
Plan:
1. Mental infantilism with irritable weakness
2. Changes with increasing demands at school
3. Organic infantilism.
A variant of mental infantilism with irritable weakness is described in the literature as a cerebrasthenic variant of complicated infantilism. Manifestations of emotional-volitional immaturity are combined with increased emotional excitability, impaired attention, often memory, and low performance. Behavior is characterized by increased irritability and lack of restraint; characterized by a tendency to conflict, combined with excessive mental fatigue and intolerance to mental stress. Difficulties in learning are associated not only with underdevelopment of the emotional-volitional sphere, but also with increased mental fatigue and rapid depletion of active attention. The mood is extremely unstable, sometimes with a tinge of discontent and irritation. These children require constant attention and approval of their actions; otherwise, outbursts of discontent and anger occur, ending in tears. Affectively excitable behavior is often observed, and increased inhibition may occur in a new environment.
Such children often have abnormal relationships with peers, which adversely affects the further development of the individual. If the need for one’s place in the team is not realized, affective reactions may arise in the form of resentment, anger, isolation, and sometimes aggression.
In the family and in a special kindergarten, different requirements are placed on children than in school. At school, the demands increase, the cerebrasthenic state of children deepens and they cannot adapt to new conditions. The teacher's reproaches regarding slowness, lack of skills, and dirty writing traumatize children and cause a negative attitude towards school. A conflict arises between self-esteem and the assessment of others. As a result, children become stubborn, irritable, whiny, and aggressive. Affective behavior is associated with the fact that the demands of others begin to exceed the capabilities of children. All this gives rise to teachers’ dissatisfaction with the child and leads to a feeling of inferiority in the child.
The third option refers to organic infantilism. This option is based on a combination of immaturity of the emotional-volitional sphere with intellectual impairments. This manifests itself in the form of inertia, rigidity of thinking, with a low level in the development of generalization operations. Children are often motorically disinhibited, complacent, their goal-directed activity is grossly impaired, and their level of critical analysis of actions and behavior is reduced.
Organic infantilism more often occurs in the atonic form of cerebral palsy, when there is damage or underdevelopment of the fronto-cerebellar structures. It is the frontal cortex that plays the most important role in purposeful activity and motivation, which are necessary for the formation of the core of personality.
Emotional-volitional disorders are characterized by great disharmony. Along with the traits of childishness, increased suggestibility, lack of independence, and naivety of judgment, a tendency to disinhibition of drives, insufficient criticality, and impulsiveness are combined with a manifestation of inertia.
During a psychological examination at the beginning of their education, these children show a low level of personal readiness for learning. Self-esteem and level of aspirations are inadequately inflated; there is no adequate reaction to failure. When exposed to additional unfavorable factors, such children develop a tendency to develop characterological deviations of the excitable type. Children become restless, irritable, impulsive, and unable to adequately take into account the situation.
Thus, the formation of the personality of children with cerebral palsy is associated with early organic brain damage and with errors in their upbringing and environment. There is a connection between personality development and severity and movement disorders. In more severe forms of the disease, complicated mental infantilism manifests itself in a more pronounced form. Involvement in pathological process various brain structures have a certain impact on the personality development features of children with cerebral palsy.
Literature:
1. Danilova L.A. Methods for correcting speech and mental development of children with cerebral palsy. – M., 1977.
2. Kalizhnyuk E.S. Mental disorders in cerebral palsy. – M., 1990.
3. Kovalev V.V. Semiotics and diagnosis of mental illness in children and adolescents. – M., 1985.
4. Mastyukova E.M. Personality features of students with cerebral palsy//Psychology of children with disabilities and disorders of psychological development: Reader. – St. Petersburg, 2001.
Features of personality formation and the emotional-volitional sphere in children diagnosed with cerebral palsy can be determined by two factors:
· biological features related to the nature of the disease;
· social conditions - the impact of family and teachers on the child.
In other words, the development and formation of a child’s personality, on the one hand, is significantly influenced by his exceptional position associated with the restriction of movement and speech; on the other hand, the family’s attitude towards the child’s illness and the atmosphere surrounding him. Therefore, you should always remember that the personal characteristics of children suffering from cerebral palsy are the result of the close interaction of these two factors. It should be noted that parents, if desired, can mitigate the social impact factor.
The personality characteristics of a child with developmental anomalies, including cerebral palsy, are associated, first of all, with the conditions of its formation, which differ significantly from the conditions of development of a normal child.
Most children with cerebral palsy are characterized by delayed mental development of the type of so-called mental infantilism. Mental infantilism is understood as the immaturity of the emotional-volitional sphere of the child’s personality. This is explained by the delayed formation of higher brain structures (frontal parts of the brain) associated with volitional activity. The child's intelligence may correspond to age standards, while emotional sphere remains unformed.11
Behavior. In the psychophysiological aspect, the behavior of animals and humans is an optimal program of muscle contractions, responses to an external stimulus with minimal energy expenditure. For example, with hyperkinesis and spastic paralysis in children with cerebral palsy, inadequate energy expenditure is observed muscle contractions. A distorted amplified continuous signal from the periphery is registered in various parts of the brain as a stagnant focus of excitation and gives incorrect information about the surrounding reality. Such distorted information leads to improper development of the cerebral cortex, as an intermediate link in the cyclical process of perception, analysis and implementation of the information received. Distorted information from the periphery leads to inadequate
child's reactions. In addition to motor disorders, children with cerebral palsy experience various inappropriate emotional outbursts: tearfulness, hysteria, or, conversely, inhibition. Genetically determined programs of a child’s behavioral reactions manifest themselves in the form without conditioned reflexes and instincts. The appearance of conditioned reflexes (behavior) in ontogenesis is due to changes in factors external environment: education and imprinting. Imprinting (imitation of the people around the child) is normally expressed in children up to 5-7 years of age and decreases with the development of consciousness, the accumulation of personal experience and critical perception of the surrounding reality. The majority of children with cerebral palsy lag behind in their development and their imprinting time is increased due to a delay in motor-psychic development. They are raised in an environment specially created for them (specialized kindergartens and schools), among the same children with cerebral palsy, so they often have behavioral deviations not only of a primary, but also of a secondary nature. They copy each other's behavior because there is no one else to copy. These factors should be taken into account when creating rehabilitation pedagogical programs. By achieving restoration of adequate sensitivity, forming correct movements in children with cerebral palsy, teaching the child the rules of behavior among ordinary healthy children, you can quickly achieve the desired results.
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