How to identify mental retardation in a child and help? The concept of mental retardation What is mental retardation zir

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Mental retardation is not a mental illness. It would be correct to call this a special mental state, which is characterized by a low level of development of the central nervous system.

It is believed that children diagnosed with mental retardation do not have a chance to completely catch up with ordinary children. Babies can develop, but only up to a certain limit of biological capabilities. It is extremely difficult for the relatives of children with such a diagnosis to accept the fact that their child has been diagnosed with mental retardation.

It is very important for them to do everything that is possible in order for the child to become the same as everyone else. In fact, this is the wrong way. You can only help your child adapt to the social environment by accepting him for who he is. Only in this case is there a possibility that he will be accepted in the same way in society.

Signs of mental retardation

In children, mental retardation can be both congenital and acquired before the age of three years. The main sign indicating
a disease is a violation of the intellect. As a rule, these disorders are associated with pathologies of the brain and nervous system.

In addition to violations in the work of intelligence, mental retardation can lead children to social maladjustment. Such children suffer from impaired speech and psychomotor functions, underdevelopment of the emotional-volitional sphere.

Oligophrenia: what you need to know?

It is also customary to call mental retardation in one simple word - "oligophrenia", which translated from ancient Greek means "dementia". So the disease is called in the event that the cause of its occurrence is identified. If the cause is unclear, then the term "mental disability" is considered more appropriate.

This concept is broader, since it accommodates not only the developmental lag caused by organic disorders, but also pedagogical or social neglect. In psychiatry, a person with mental retardation is characterized as a person who is unable to learn to live independently in a social environment.

Congenital mental retardation, or oligophrenia, imposes certain restrictions on the development of a baby who cannot reach the same level as healthy children. When it comes to acquired dementia - dementia, it means a decrease in the level of intelligence in comparison with the indicators of age norms.

The severity of mental retardation

The degree of mental retardation in children can vary. In total, there are several such degrees of mental retardation:

  • easy;
  • moderate;
  • deep.

Each of the degrees is characterized by a certain IQ level. If in children with a mild degree, the IQ indicator ranges from 50-69 points, then in children with the fourth degree, the IQ is no more than 20 points.

The easiest is first stage. Children diagnosed with mental retardation of the first stage have the basic skills of self-care and homework, they can study in specialized institutions according to a special program, and will eventually be able to learn a simple craft for earning money.

The average (moderate) degree of oligophrenia is characterized by the complicated mastering of self-service skills by children, delayed speech development. Such children often cannot cope with mastering even the simplest movements, do not always understand the speech addressed to them, require increased attention to themselves both in childhood and in adulthood.

The last stage is deep delay, or idiocy. Children diagnosed with deep stage mental retardation remain at the child's level
three years. They do not understand the rules, do not follow instructions, are unable to listen and remember, have problems with motor activity, and suffer from fecal and urinary incontinence. Neurological disorders are not excluded. As a rule, they cause such a severe degree of disease of an organic and genetic nature, not so often - brain injuries.

It is believed that it is impossible to completely cure mental retardation in children. Yes, in some cases, stimulating drugs are used, but the effect will be exactly the same as possible within the limits of the biological capabilities of the child.

That is why how successful the child's introduction into society will be depends largely on the system of treatment, education, and upbringing chosen for his case.
Causes of mental retardation

In children, mental retardation can be caused by a number of reasons, both genetic in nature and related to the characteristics of the surrounding social environment. Children of parents whose relatives had a similar diagnosis are at risk. It is at the genetic level that the problem is transmitted in 50 percent of cases. Also, very often it is not possible to identify the cause of mental retardation in a child.

The following are the main reasons for the intellectual retardation of children:

  • diseases of a genetic nature;
  • intrauterine lesions;
  • intoxication;
  • poisoning of the fetus with alcohol;
  • the impact of medications;
  • radiation and chemotherapy;
  • hypoxia;
  • last degree prematurity;
  • birth trauma;
  • infections affecting the central nervous system;
  • social neglect against the background of poor nutrition and pedagogical inattention.

Diagnosis is not a sentence!

As mentioned above, mental retardation in children is not treated. However, we are not talking about all children with this diagnosis. Only those who do not respond to treatment
guys whose backwardness is caused by severe genetic inheritance or social reasons. And there are actually only about 30% of them. All the rest, and this is the overwhelming majority, received such a diagnosis as a result of somatic reasons, so they can and should be treated.

Unfortunately, most often doctors diagnose "mental retardation" and, along with it, give up on the little patient, believing that the best solution to the problem for him will be training in a special school for underdeveloped children. This approach is fundamentally wrong and has already managed to cripple the lives of many families.

In fact, for the majority of children suffering from mental underdevelopment, this problem is temporary. It will be enough to identify the reason for the delay in order to understand how effective the treatment and the introduction of a correction program can be.
If the reason is heredity, when the baby cannot develop above the measured mark, this is one thing. In this case, he really will require special care and training.

But if mental retardation is a consequence of chronic infection, allergies, heart disease, and so on, then the matter is fixable. The child's organism, weakened by diseases, really reduces the activity of the process of its development. The result is mental retardation, a diagnosis that denies the right to a normal life. If we provide such children with the right approach, first of all, strengthening the immune system, creating comfortable conditions in the family, at school, in kindergarten, then it will be possible to achieve positive dynamics.

Mental retardation can also be a consequence of unfavorable social conditions, as a result of which the psyche of children is traumatized. For example, they may be deprived of adult control and attention.

Approximately the same effect, often without realizing it, is achieved by parents whose upbringing method is excessive care and guardianship of the baby. Infantile children grow up unadapted, selfish and dependent on others. In such cases, it will be possible to change the situation only by changing the conditions of upbringing.

Children who have suffered from brain disease, birth trauma, or have been poisoned in the womb by toxins, have suffered from infections or suffocation are less likely to affect the mental development process.

Timely diagnosis is the key to success

Regardless of the type of mental retardation in children, it is extremely important to carry out a timely diagnosis to identify its root cause. Treatment must necessarily be carried out in a complex, with the involvement of parents, teachers, the use of drugs and modern techniques.

It is not recommended to apply to children not fully proven methods, for example, fetal therapy, manual therapy, as well as electrical procedures.

As for the task of parents, their main mission is to monitor the development of babies and, in case of suspicion of developmental delay, immediately consult an experienced doctor. And, of course, if the diagnosis is confirmed, do not give up hope and do everything to help children cope with the problem as much as possible.

Impaired mental function(ZPR) is a temporal lag in the development of mental processes and the immaturity of the emotional-volitional sphere in children, which can potentially be overcome with the help of specially organized training and upbringing. Delayed mental development is characterized by an insufficient level of development of motor skills, speech, attention, memory, thinking, regulation and self-regulation of behavior, primitiveness and instability of emotions, poor school performance. Diagnosis of cerebrovascular accidents is carried out collectively by a commission consisting of medical specialists, teachers and psychologists. Children with mental retardation need specially organized correctional and developmental education and medical support.

General information

Mental retardation (PDD) is a reversible violation of the intellectual and emotional-volitional sphere, accompanied by specific learning difficulties. The number of persons with mental retardation reaches 15-16% in the child population. DPD is more of a psychological and pedagogical category, however, it may be based on organic disorders, therefore, this condition is also considered by medical disciplines - primarily pediatrics and pediatric neurology.

Since the development of various mental functions in children is uneven, usually the conclusion "mental retardation" is established for preschool children not earlier than 4-5 years old, but in practice - more often in the process of schooling.

Reasons for DPR

The etiological basis of CRA is made up of biological and socio-psychological factors that lead to a temporal delay in the intellectual and emotional development of the child.

1. Biological factors(non-gross organic damage to the central nervous system of a local nature and their residual phenomena) cause a violation of the maturation of various parts of the brain, which is accompanied by partial disorders of the child's mental development and activity. Among the causes of a biological nature, acting in the perinatal period and causing mental retardation, the most important are:

  • pathology of pregnancy (severe toxicosis, Rh-conflict, fetal hypoxia, etc.), intrauterine infections, intracranial birth trauma, prematurity, nuclear jaundice of newborns, FAS, etc., leading to the so-called perinatal encephalopathy.
  • severe somatic diseases of the child (malnutrition, flu, neuroinfections, rickets), craniocerebral trauma, epilepsy and epileptic encephalopathy, etc., arising in the postnatal period and early childhood.
  • CRD is sometimes hereditary and is diagnosed from generation to generation in some families.

2. Social factors. A delay in mental development can occur under the influence of environmental (social) factors, which, however, does not exclude the presence of an initial organic basis for the disorder. Most often, children with mental retardation grow up in conditions of hypo-care (neglect) or over-care, an authoritarian upbringing, social deprivation, and a lack of communication with peers and adults.

A delay in mental development of a secondary nature can develop with early hearing and vision impairments, speech defects due to a pronounced deficit of sensory information and communication.

Classification

The group of children with mental retardation is heterogeneous. In special psychology, many classifications of mental retardation have been proposed. Let us consider the etiopathogenetic classification proposed by K. S. Lebedinskaya, which identifies 4 clinical types of CRA.

  1. CRA of constitutional genesis due to a slowdown in the maturation of the central nervous system. It is characterized by harmonious mental and psychophysical infantilism. With mental infantilism, the child behaves like a younger child; with psycho-physical infantilism, the emotional-volitional sphere and physical development suffer. The anthropometric data and behavior of such children do not correspond to the chronological age. They are emotionally labile, spontaneous, and lack attention and memory. Even at school age, their interests in play prevail.
  2. CRD of somatogenic genesis due to severe and prolonged somatic diseases of the child at an early age, inevitably delaying the maturation and development of the central nervous system. The history of children with somatogenic mental retardation often includes bronchial asthma, chronic dyspepsia, cardiovascular and renal failure, pneumonia, etc. Usually, such children are treated for a long time in hospitals, which in addition also causes sensory deprivation. CRD of somatogenic genesis is manifested by asthenic syndrome, low performance of the child, less memory, superficial attention, poor formation of skills of activity, hyperactivity or lethargy with overwork.
  3. CRD of psychogenic genesis due to the unfavorable social conditions in which the child lives (neglect, overprotection, cruel treatment). Deficit of attention to the child forms mental instability, impulsivity, and lag in intellectual development. Increased care fosters in a child lack of initiative, egocentrism, lack of will, lack of purposefulness.
  4. CRA of cerebral-organic genesis occurs most often. It is caused by a primary non-gross organic brain damage. In this case, violations can affect individual areas of the psyche or manifest themselves in a mosaic manner in various mental areas. The delay in the mental development of cerebral-organic genesis is characterized by the lack of formation of the emotional-volitional sphere and cognitive activity: lack of vividness and brightness of emotions, low level of claims, pronounced suggestibility, poverty of imagination, motor disinhibition, etc.

Characteristics of children with CRD

Intellectual sphere

Emotional sphere

The personal sphere in children with mental retardation is characterized by emotional lability, easy mood swings, suggestibility, lack of initiative, lack of will, immaturity of the personality as a whole. There may be affective reactions, aggressiveness, conflict, increased anxiety. Children with mental retardation are often withdrawn, prefer to play alone, do not seek to contact their peers. The play activity of children with DPD is characterized by monotony and stereotype, lack of a detailed plot, poverty of imagination, non-observance of game rules. Motility features include motor awkwardness, lack of coordination, and often hyperkinesis and tics.

A feature of mental retardation is that compensation and reversibility of violations are possible only in the context of special education and upbringing.

Diagnostics

Delayed mental development can be diagnosed only as a result of a comprehensive examination of the child by the psychological, medical and pedagogical commission (PMPK) consisting of a child psychologist, speech therapist, defectologist, pediatrician, child neurologist, psychiatrist, etc. This is done:

  • collection and study of anamnesis, analysis of living conditions;
  • examination of the child's medical records;
  • a conversation with a child, a study of intellectual processes and emotional-volitional qualities.

Based on information about the development of the child, the members of the PMPK make a conclusion about the presence of a mental retardation, give recommendations on the organization of the upbringing and education of the child in the conditions of special educational institutions.

In order to identify the organic substrate of mental retardation, the child needs examination by medical specialists, first of all, a pediatrician and a pediatric neurologist. Instrumental diagnostics may include EEG, CT and MRI of the child's brain, etc. Differential diagnosis of mental retardation should be carried out with oligophrenia and autism.

Correction of mental retardation

Working with children with mental retardation requires a multidisciplinary approach and the active participation of pediatricians, child neurologists, child psychologists, psychiatrists, speech therapists, and defectologists. Correction of mental retardation should begin from preschool age and be carried out for a long time.

Children with mental retardation must attend specialized preschool educational institutions (or groups), type VII schools or correctional classes of general education schools. The peculiarities of teaching children with mental retardation include the dosage of educational material, reliance on visualization, repeated repetition, frequent changes in activities, and the use of health-saving technologies.

When working with such children, special attention is paid to the development of:

  • cognitive processes (perception, attention, memory, thinking);
  • emotional, sensory and motor spheres with the help of fairy tale therapy,.
  • correction of speech disorders in the framework of individual and group speech therapy classes.

Together with teachers, correctional work on teaching students with mental retardation is carried out by teachers-defectologists, psychologists, and social teachers. Medical care for children with mental retardation includes drug therapy in accordance with the identified somatic and cerebral-organic disorders, physiotherapy, exercise therapy, massage, hydrotherapy.

Forecast and prevention

The lag in the rate of the child's mental development from the age norms can and must be overcome. Children with mental retardation are learnable, and with properly organized correctional work, positive dynamics are observed in their development. With the help of teachers, they are able to assimilate knowledge, skills and abilities that their normally developing peers master on their own. After leaving school, they can continue their studies at vocational schools, colleges and even universities.

Prevention of mental retardation in a child involves careful planning of pregnancy, avoiding adverse effects on the fetus, preventing infectious and somatic diseases in young children, providing favorable conditions for education and development. If the child lags behind in psychomotor development, an immediate examination by specialists and the organization of correctional work is necessary.

Also, the causes of this disease are: malnutrition of the fetus, which is caused by defects in the placenta, prematurity and its complications, intracerebral bleeding, which is caused by the difficulty in releasing or not supplying oxygen to the brain, congenital dysfunction of the thyroid gland. In childhood, mental retardation is sometimes caused by trauma to the brain, which is the result of an accident or child abuse. Parents should understand that they must use a special seat and seat belts while driving. Children who are involved in contact sports are required to wear special protective helmets.

Signs

Some syndromes include mental retardation and can be identified at birth by a specific set of physical symptoms. Explicit and subtle physical symptoms indicate a specific defect and its severity. Babies with a congenital defect are more likely to be born with low weight and short stature, with small or large heads. Often, babies are born with a heart defect, have difficulty breathing, and develop respiratory infections in infancy. If there are difficulties in feeding and digestion, this is due to the presence of malformations of the gastrointestinal tract.

Often, parents realize that a baby is developing differently from everyone else. Often, parents are concerned about two main problems: the slow acquisition of the skill to sit and walk and the delay in speech development by 2-3 years. Many children have mild developmental delays in certain directions. Mentally retarded children lag even more behind in development in all directions, but even in them it manifests itself more strongly in one direction and weaker in others. Like some normal children, newborns with moderate or severe mental retardation have a weak sucking and grasping reflex. Their screams can be weak or shrill. Over time, such babies, unlike healthy peers, may not communicate with loved ones. Children with congenital malformations often retain weight inappropriate for their age, they do not acquire the appropriate physical and social skills, such as the first steps, the ability to gurgle, smile, laugh, and their facial expressions are not developed.

This general lag remains during the entire period of development of such children. When a child in school is unable to act in the same way as other children, it is immediately obvious to an experienced teacher. A toddler with an unrecognized developmental delay will not be able to participate in group activities, he will play alone. The child is able to maintain limited connections, has limited self-care skills, sometimes he does not know how to concentrate on the activities that are taking place.

Diagnosis

Diagnosing mental retardation is very difficult and requires the participation of health professionals who can assess the physical growth of the child, the stage of development of skills that require rough and precise movements, speech development and cognitive skills, and the development of social character. If this reveals brain damage, then you need to consult a neurologist in order to more clearly assess the state of the nervous system.

To make a diagnosis, you will need a physical examination, a thorough study of prenatal and postnatal history, a study of the development of the baby, and familiarity with the history of the parents. Laboratory analysis will allow you to study the chromosomes. If the child has seizures (which can also be the result of brain damage), an EEG (electroencephalogram) may be prescribed to study the electrical waves in the child's brain. It is also necessary to investigate the state of vision and hearing. The physical therapist will measure the baby's muscle strength, find out if he is able to maintain balance, the level of dexterity, thereby determining the level of development of the skills of fine and rough movements. A speech therapist will examine the level of development of language skills, and an audiologist will determine the ability to hear. The psychologist uses a set of tests to measure a child's mental and emotional development. A pedagogical specialist will determine the ability to learn, evaluate academic achievement.

Treatment

Mental retardation is not treatable. But the degree of child's backwardness can sometimes be significantly reduced if a diagnosis is made early and the implementation of an appropriate pedagogical program is started as early as possible.

Babies with birth defects sometimes require intense, constant and challenging medical care. If there is a sharp lag in physical development or when the child's backwardness is very severe, parents have to find people to care for their baby in order to be able to rest. Brothers and sisters of a mentally retarded child find it difficult to adapt to him, because he is very "different" from them and takes too much time and effort from the parents. Other children in the family need to be taught how to treat people who are unable to develop.

Treatment and care for a child with developmental delay differs depending on age, health and developmental level. Sometimes intensive medical measures may be necessary only in the first months of life, then the need for them decreases, since pedagogical and professional measures are required. A child who is incapable of normal development needs social support all his life. It is a difficult task for parents of underdeveloped children to take care of their future.

Developmental delay is a symptom of a pathological process that leads to physiological or psychological disorders. It should be noted that the delay in psychoverbal development may have a hereditary etiology. In some cases, depending on the etiological factor and the general health of the child, this is an irreversible pathological process. Early, and accordingly timely, diagnosis of the violation is rather difficult. Definitely, at the first manifestations of the clinical picture in a child, you should urgently seek medical help, and not ignore the symptom or make attempts to eliminate it yourself.

Etiology

As for this pathological process, there are no uniform etiological factors, since each type of developmental delay has its own provoking factors. However, it should be noted that for almost all cases there is one common cause - intrauterine growth retardation (IUGR).

Delayed speech development (RAD) can be caused by the following etiological factors:

  • head trauma or neoplasms in the brain;
  • pathology of the nervous system;
  • infectious ailments that the mother suffered during pregnancy;
  • impaired hearing or complete deafness;
  • social maladjustment;
  • if adults do not stimulate the development of speech in a child - by sounds or incorrectly pronounced words, they understand the meaning of what is said and react to it. In such cases, the child simply will not try to speak correctly, since he achieves the desired result immediately.

As a rule, the delay in speech development in children is determined up to three years. If, before this age, the baby has not learned to pronounce correctly, does not have a certain vocabulary that is optimal for his age, then consultation of a psychologist, neurologist and speech therapist is required.

Mental retardation (PDD) can be caused by both pathological and social factors. The first should include:

  • lesions of the central nervous system of the child during the period of formation. In this case, fetal growth retardation (FGR) is observed with all the ensuing consequences;
  • bad habits of the mother - smoking, alcohol and drug use, frequent stress and severe nervous tension;
  • infectious diseases (most often it leads to such a symptom);
  • diseases with hereditary etiology;
  • autoimmune pathological processes;
  • impaired functioning of sensory perception of information (vision and hearing).

Social provoking factors include the following:

  • frequent psychological trauma;
  • pedagogical neglect of the child;
  • restriction of the child's activity, which leads to social maladjustment.

As a rule, children with mental retardation are withdrawn, do not like to let strangers near them, including their own age. Such a diagnosis is made in early preschool and school age, when the child begins to communicate with other children.

The delay in psychomotor development has the following etiology:

  • congenital and acquired endocrine pathologies;
  • household or chemical (typical for children in the first year of life);
  • IUGR, which have a chromosomal nature -,;
  • infectious diseases;
  • consequences of perinatal and postnatal pathology (fetal growth retardation);
  • ailments of a genetic nature.

Social reasons are no exception in this case - lack of care and nutrition, frequent and pedagogical neglect of the child.

We can talk about delayed puberty when there are no age-related changes in boys by the age of 14 and in girls by the age of 13. The following factors precede the onset of a symptom:

  • chromosomal abnormalities;
  • oncological processes that lead to improper production of hormones;
  • suffered severe infectious diseases;
  • dysfunction of the thyroid gland;
  • malnutrition.

In some cases, delayed sexual development can be observed in girls who go in for sports from an early age - constant physical activity changes natural physiological processes.

Symptoms

Each form of developmental delay has its own clinical picture. Delayed speech development is characterized by the following features:

  • in the first months of life, the baby does not walk;
  • children aged one year do not respond to their name;
  • the child does not recognize pictures in books, cannot fulfill the simplest instructions of adults;
  • at the age of 2-3 years, the child does not pronounce simple sentences and meaningful phrases;
  • the child asks questions less often than other children.

Disorders in psychomotor development are manifested as follows:

  • lack of concentration on bright objects or sounds (children from two months of age);
  • there is no emotional interest in new subjects, no physical activity;
  • the formation of babbling speech is sharply behind;
  • by the age of 12 months, the child does not understand the speech addressed to him;
  • aimless activity is observed after 15 months;
  • no vocabulary after two years.

Pathological processes in mental development have the following clinical picture:

  • slow, often inaccurate perception;
  • superficial, unstable attention;
  • violation of figurative and abstract thinking - the child cannot express his thoughts;
  • limitation of vocabulary, speech impairment.

Violations in the development of puberty appear only by the age of 13-15 and have the following symptoms:

  • girls by the age of 14 do not have menstruation and there is no enlargement of the mammary glands;
  • in boys by the age of 14, the genitals are not developed;
  • by the age of 15, there is no pubic hair.

The manifestation of any type of developmental delay requires consultation with a specialized medical specialist.

Diagnostics

The diagnostic program may include the following methods:

  • standard laboratory tests (blood and urine sampling);
  • determination of the level of blood hormones;
  • immunological studies;
  • CT and MRI of the brain;
  • psychological tests;
  • consultations with related specialists (depending on the type of developmental delay and the current clinical picture).

Treatment should be prescribed only by a doctor; you should not do anything on your own in such cases, since you can only aggravate the condition.

Treatment

As for drug therapy, it will be purely individual, since it will depend on the underlying factor. Treatment almost always involves the work of the child and the parents with or. If we are talking about a violation of speech development, then consultations and classes are required. In more difficult cases, doctors recommend continuous education of the child in specialized educational institutions, where the program is adapted for them.

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