Mental retardation refers to violations of the pace of mental development. Over time, the child has a lag behind peers in mental development. Mental retardation is heterogeneous in nature, as it has various causes.
According to the etiology, 4 types of ZPR are distinguished:
- constitutional origin;
- psychogenic nature;
- somatogenic character;
- cerebro-organic character.
All types of mental retardation have their own characteristics, which manifest themselves in emotional immaturity and cognitive impairment. Some types of mental retardation are accompanied by complications in the somatic and neurological spheres. But the main difference between the types of delays is in the features of the development of mental functions.
Features of ZPR of constitutional origin
Mental retardation of constitutional origin in medicine is called harmonic psychophysical infantilism. When it is diagnosed, the family conditionality of infantilism is revealed, that is, it occurs in other family members, but does not reach a pathological level.
Harmonic psychophysical infantilism affects not only the mental, but the physical development of the child. Children in height and physical form lag behind their peers by 1.5-2 years.
Such children are characterized by manifestations of lively facial expressions, expressive gestures, sharp expressive movements. Children have a range of interests narrowed down to play activities. At the same time, the game itself is very developed, role-playing, filled with a lot of small plots and additional characters. During the game, the child shows creativity and endurance.
Along with developed play activity, it must be stated that educational and cognitive activity is not very attractive for these children. Study assignments cause fast satiety.
It turns out a paradox: children are tireless in the game, but very quickly get tired in learning activities. It is especially difficult for them to do monotonous tasks that require keeping their attention for a long time: reading, drawing, writing.
Children are emotionally unstable. They may cry over trifles, but quickly switch to play or other enjoyable items or activities. At the same time, there are simply no traces of the previous “hysteria”.
Children with mental retardation of constitutional origin love to fantasize. Moreover, fantasy for them is a means of mental stabilization. They displace unpleasant life situations with fantasies and fictions.
Harmonic psychophysical infantilism affects the emotional-volitional sphere, which leads to insufficiency of arbitrary regulation of activity, as well as mental processes: thinking, attention, memorization.
With the correct organization of the educational process, with the obligatory use of encouragement methods, children with harmonic infantilism demonstrate high results. In the future, the maximum approximation of such children to the level of their peers is possible, thanks to the alignment classes.
Causes of infantilism
The causes of infantilism can be:
- damage to the central nervous system as a result of traumatic brain injury or infection;
- endocrine disorders, chronic diseases, damage to internal organs (kidneys, heart, liver);
- mental metabolism.
Mental metabolism deserves special attention as a situation of revealing the need for certain substances in the process of development.
Correction of mental retardation of constitutional origin
Harmonic infantilism can be corrected quite successfully, provided that the developmental environment is properly organized.
The dynamics of a child's development depends on the depth of disorders, the level of intelligence, the characteristics of mental performance and early correction. The time of the beginning of correctional and developmental work is of paramount importance. The earlier the delay is detected and corrective activity is started, the more likely the child will come closer in his development to the requirements of the norm.
Difficulties in building correctional programs are due to the variety of manifestations of mental retardation. You need to know that every child with harmonic infantilism has a number of features, including immaturity of the emotional-volitional sphere and unformed cognitive activity.
Correctional and pedagogical work with children is conditionally divided into two blocks:
- Educational;
- Developing.
It is necessary to start corrective work at preschool age, so that at the time of the beginning of schooling, the level of development of the child is clearly defined, and together with him a decision is made on the type of class for teaching the child.
Individual correctional programs take into account the following characteristics of the child:
- intelligence level;
- emotional and personal development;
- sensorimotor development of children,
- formation of operational and motivational-required sphere;
- development of perceptual actions;
- formation of the structure of mental activity.
Parents and educators need to know that there are no general programs. Correctional and pedagogical programs can only be individual. For their processing, you need to contact specialists in medical, psychological and psychiatric centers.
The listed features of students with somatogenic mental retardation are a serious obstacle in their education. Frequent absenteeism due to illness, "turning off" such a child from the educational process as fatigue increases, disinterest in learning lead him to the category of persistently underachieving schoolchildren.
Children with somatogenic mental retardation need systematic medical and pedagogical assistance. It is most expedient to place such a child in sanatorium-type schools, in their absence - in a class of compensatory education, if there is none, it is necessary to create a protective medical-pedagogical regime under the conditions of an ordinary class.
ZPR of psychogenic origin
Children of this group have normal physical development and are somatically healthy. According to studies, most of these children have brain dysfunction. Their mental infantilism is due to a socio-psychological factor - unfavorable conditions of education. A vivid example is the children brought up in the Orphanage. Emotional deprivation (deprivation of maternal warmth, emotional richness of relationships), monotony of the social environment and contacts, deprivation, weak individual intellectual stimulation often lead to a slowdown in the pace of the child's mental development; as a result - a decrease in intellectual motivation, superficiality of emotions, lack of independence of behavior, infantilism of attitudes and relationships.
Often, the focus of the formation of this children's anomaly is dysfunctional families: asocial-permissive and authoritarian-conflict. In an asocial-permissive family, a child grows up in an atmosphere of complete neglect, emotional rejection, combined with permissiveness. Parents with their way of life (drunkenness, promiscuity, disorder, theft) stimulate efficiency (impulsive, explosive reactions), limp adherence to inclinations, involuntary behavior, extinguish intellectual activity. Such conditions of upbringing become a long-term psychotraumatic factor contributing to the accumulation of features of mental infantilism in a spectacularly unstable excitable form. This state is often fertile ground for the formation of persistent asocial attitudes, i.e. pedagogical neglect. In an authoritarian-conflict family, the life sphere of a child is saturated with quarrels and conflicts. between adults. The main form of parental influence - Suppression and punishment systematically injures the child's psyche, it accumulates features of passivity, lack of independence, downtroddenness, increased anxiety. The child develops mental infantilism according to the asthenic inhibitory type.
The work of Clara Samoilovna and Viktor Vasilievich Lebedinsky (1969) is based on the etiological principle, which makes it possible to distinguish 4 variants of such development:
1. ZPR of constitutional origin;
2. ZPR of somatogenic origin;
3. ZPR of psychogenic origin;
4.ZPR of cerebro-organic origin.
In the clinical and psychological structure of each of the listed options for mental retardation, there is a specific combination of immaturity of the emotional and intellectual spheres.
1.ZPR constitutional origin
(HARMONIC, MENTAL and PSYCHOPHYSIOLOGICAL INFANTILISM).
This type of mental retardation is characterized by an infantile body type with childish plasticity of facial expressions and motor skills. The emotional sphere of these children is, as it were, at an earlier stage of development, corresponding to the mental makeup of a younger child: the brightness and liveliness of emotions, the predominance of emotional reactions in behavior, play interests, suggestibility and insufficient independence. These children are tireless in the game, in which they show a lot of creativity and invention, and at the same time quickly become fed up with intellectual activity. Therefore, in the first grade of school, they sometimes have difficulties associated both with a small focus on long-term intellectual activity (they prefer to play in the classroom) and an inability to obey the rules of discipline.
This "harmony" of the mental appearance is sometimes violated in school and adulthood, because. immaturity of the emotional sphere makes social adaptation difficult. Unfavorable living conditions can contribute to the pathological formation of an unstable personality.
However, such an "infantile" constitution can also be formed as a result of mild, mostly metabolic-trophic diseases suffered in the first year of life. If at the time of intrauterine development, then this is genetic infantilism. (Lebedinskaya K.S.).
Thus, in this case, there is predominantly a congenital-constitutional etiology of this type of infantilism.
According to G.P. Bertyn (1970), harmonic infantilism is often found in twins, which may indicate the pathogenetic role of hypotrophic phenomena associated with multiple pregnancy.
2. ZPR of somatogenic origin
This type of developmental anomalies is caused by long-term somatic insufficiency (weakness) of various origins: chronic infections and allergic conditions, congenital and acquired malformations of the somatic sphere, primarily the heart, diseases of the digestive system (V.V. Kovalev, 1979).
Prolonged dyspepsia during the first year of life inevitably leads to a developmental delay. Cardiovascular insufficiency, chronic inflammation of the lungs, kidney disease are often found in the anamnesis of children with somatogenic developmental disorders.
It is clear that a poor somatic condition cannot but affect the development of the central nervous system, delaying its maturation. Such children spend months in hospitals, which naturally creates conditions for sensory deprivation and also does not contribute to their development.
Chronic physical and mental asthenia inhibits the development of active forms of activity, contributes to the formation of personality traits such as timidity, timidity, self-doubt. The same properties are largely determined by the creation of a regime of restrictions and prohibitions for a sick or physically weakened child. Thus, to the phenomena caused by the disease, artificial infantilization is added, caused by the conditions of overprotection.
3. ZPR of psychogenic origin
This type is associated with unfavorable upbringing conditions that prevent the correct formation of the child's personality (incomplete or dysfunctional family, mental trauma).
The social genesis of this developmental anomaly does not exclude its pathological nature. As you know, unfavorable environmental conditions that arise early, long-acting and have a traumatic effect on the child's psyche, can lead to persistent shifts in his neuropsychic sphere, disruption of autonomic functions first, and then mental, primarily emotional, development. In such cases, we are talking about the pathological (abnormal) development of the personality. BUT! This type of mental retardation should be distinguished from the phenomena of pedagogical neglect, which are not a pathological phenomenon, but are caused by a lack of knowledge and skills due to a lack of intellectual information. + (Pedagogically neglected children, meaning “pure pedagogical neglect”, in which the lag is due only to social reasons, domestic psychologists do not include in the category of ZPR. Although it is recognized that a prolonged lack of information, the lack of mental stimulation during sensitive periods can lead the child to reduce potential opportunities for mental development).
(It must be said that such cases are recorded very rarely, as well as the developmental disorder of somatogenic origin. There must be very unfavorable conditions, somatic or microsocial, in order for these two forms of developmental disorder to occur. Much more often, we observe a combination of organic CNS insufficiency with somatic weakness or with the influence unfavorable conditions of family education).
ZPR of psychogenic origin is observed, first of all, with abnormal personality development according to the type of mental instability, most often caused by the phenomena of gopuopeky - conditions of neglect, in which the child does not develop a sense of duty and responsibility, forms of behavior, the development of which is associated with active inhibition of affect. The development of cognitive activity, intellectual interests and attitudes is not stimulated. Therefore, the features of pathological immaturity of the emotional-volitional sphere in the form of affective lability, impulsivity, increased suggestibility in these children are often combined with an insufficient level of knowledge and ideas necessary for mastering school subjects.
Variant of abnormal personality development like "family idol" due, on the contrary, to overprotection - an incorrect, pampering upbringing, in which the child does not instill the traits of independence, initiative, and responsibility. Children with this type of mental retardation, against the background of general somatic weakness, are characterized by a general decrease in cognitive activity, increased fatigue and exhaustion, especially during prolonged physical and intellectual stress. They get tired quickly, they need more time to complete any training tasks. Cognitive and educational activities suffer SECONDARY due to a decrease in the overall tone of the body. This type of psychogenic infantilism, along with a low capacity for volitional effort, is characterized by features of egocentrism and selfishness, dislike for work, and a focus on constant help and guardianship.
Variant of pathological personality development neurotic type It is more often observed in children whose families have rudeness, cruelty, despotism, aggression towards the child and other family members. In such an environment, a timid, timid personality is often formed, whose emotional immaturity is manifested in insufficient independence, indecision, low activity and lack of initiative. Unfavorable conditions of upbringing also lead to a delay in the development of cognitive activity.
4. ZPR of cerebro-organic origin
This type of ZPR occupies the main place in this polymorphic developmental anomaly. It is more common than other types of CRA; often has great persistence and severity of disturbances both in the emotional-volitional sphere and in cognitive activity. It is of the greatest importance for the clinic and special psychology due to the severity of the manifestations and the need (in most cases) for special measures of psychological and pedagogical correction.
The study of the anamnesis of these children in most cases shows the presence of mild organic insufficiency N.S. - RESIDUAL CHARACTER (remaining, preserved).
Abroad, the pathogenesis of this form of delay is associated with "minimal brain damage" (1947), or with "minimal brain dysfunction" (1962) - MMD. → These terms emphasize the NON-EXPRESSION, CERTAIN FUNCTIONALITY OF CEREBRAL DISORDERS.
Pathology of pregnancy and childbirth, infections, intoxication, Rh factor incompatibility between mother and fetus, prematurity, asphyxia, trauma during childbirth, postnatal neuroinfections, toxic-dystrophic diseases and injuries of the NS in the first years of life. - The causes are to some extent similar to the causes of oligophrenia.
COMMON for this form of mental retardation and oligophrenia- is the presence of the so-called EASY BRAIN DYSFUNCTION (LDM). ORGANIC CNS DAMAGE (RETARDATION) AT THE EARLY STAGES OF ONTOGENESIS.
Terms close in meaning: “minimal brain damage”, “mild infantile encephalopathy”, “hyperkinetic chronic brain syndrome”.
Under LDM- refers to a syndrome that reflects the presence of mild developmental disorders that occur mainly in the perinatal period, characterized by a very diverse clinical picture. This term was adopted in 1962 to refer to minimal (dysfunctional) brain disorders in childhood.
FEATURE OF ZPR- is a qualitatively different structure of intellectual insufficiency in comparison with u / o. Mental development is characterized by uneven disturbances of various mental functions; while logical thinking m.b. more preserved compared to memory, attention, mental performance.
In children with LIMITED CNS LESION, a multidimensional picture of cerebral insufficiency is much more often observed, associated with immaturity, immaturity and, therefore, greater vulnerability of various systems, including vascular and cerebrospinal fluid.
The nature of dynamic disorders in them is more severe and more frequent than in children with mental retardation of other subgroups. Along with persistent dynamic difficulties, there is a primary deficiency in a number of higher cortical functions.
Signs of a slowdown in the rate of maturation are often found already in early development and concern almost all spheres, in a significant part of cases up to the somatic. So, according to I.F. Markova (1993), who examined 1000 primary school students of a special school for children with mental retardation, a slowdown in the pace of physical development was observed in 32% of children, a delay in the formation of locomotor functions in 69% of children, a long delay in the formation of skills neatness (enuresis) - in 36% of cases.
In tests for visual gnosis, difficulties arose in the perception of complicated variants of subject images, as well as letters. In praxis tests, perseverations were often observed when switching from one activity to another. In the study of spatial praxis, poor orientation in the "right" and "left", mirroring in writing letters, and difficulties in differentiating similar graphemes were often noted. In the study of speech processes, disorders of speech motor skills and phonemic hearing, auditory memory, difficulties in constructing a detailed phrase, and low speech activity were often found.
Special studies of LDM showed that
RISK FACTORS ARE:
Late age of the mother, height and body weight of a woman before pregnancy, beyond the age norm, first birth;
Pathological course of previous pregnancies;
Chronic diseases of the mother, especially diabetes, Rh conflict, premature birth, infectious diseases during pregnancy;
Psychosocial factors such as unwanted pregnancy, big city risk factors (daily long commute, city noises, etc.)
The presence of mental, neurological and psychosomatic diseases in the family;
Low or, conversely, excessive (more than 4000 kg.) Weight of the child during childbirth;
Pathological childbirth with forceps, caesarean section, etc.
DIFFERENCE FROM U/O:
1. The massiveness of the lesion;
2. Time of defeat. - ZPR is much more often associated with later ones,
exogenous brain damage affecting the period,
when the differentiation of the main brain systems is already in
largely advanced and there is no danger of their rude
underdevelopment. However, some researchers suggest
and the possibility of genetic etiology.
3. Delay in the formation of functions is qualitatively different than with
oligophrenia. In cases with ZPR - you can observe the presence
temporary regression of acquired skills and their subsequent
instability.
4. Unlike oligophrenia, children with mental retardation lack inertia
mental processes. They are capable of not only accepting
to use help, but also to transfer the learned skills to the mental
activities in other situations. With the help of an adult, they can
carry out the intellectual tasks offered to them at close to
normal level.
5. The predominance of later terms of the defeat causes along with
with phenomena of IMMUNITY almost constant PRESENCE
DAMAGE N.S. → Therefore, unlike oligophrenia, which
often occurs in the form of uncomplicated forms, in the structure of the ZPR
OF CEREBRAL-ORGANIC GENESIS- almost always present
a set of encephalopathic disorders (cerebroasthenic,
neurosis-like, psychopathic), testifying to
damage to N.S..
CEREBRAL-ORGANIC INSUFFICIENCY first of all, it leaves a typical imprint on the structure of the mental retardation itself - both on the features of emotional-volitional immaturity, and on the nature of cognitive impairment
Data from neuropsychological studies have revealed a certain THE HIERARCHY OF COGNITIVE DISORDERS IN CHILDREN WITH CEREBRAL-ORGANIC GENESIS. Yes, in more mild cases it is based on neurodynamic insufficiency, associated primarily with the EXHAUSTIBILITY of MENTAL FUNCTIONS.
With a greater severity of organic brain damage, more severe neurodynamic disorders, expressed in the inertness of mental processes, are joined by PRIMARY DEFICIENCY OF INDIVIDUAL CORTIC-SUBCORTICAL FUNCTIONS: praxis, visual gnosis, memory, speech sensorimotor. + At the same time, a certain PARTIALITY, MOSAICITY OF THEIR VIOLATIONS is noted. (Therefore, some of these children experience difficulties mainly in mastering reading, others in writing, others in counting, etc.). PARTIAL INSUFFICIENCY OF CORTICAL FUNCTIONS, in turn, leads to underdevelopment of the most complex mental neoplasms, including voluntary regulation. Thus, the hierarchy of disorders of mental functions in mental retardation of cerebral-organic genesis is the reverse of that which exists in oligophrenia, where the intellect suffers primarily, and not its prerequisites.
1. EMOTIONAL-volitional immaturity is represented by organic infantilism. With this infantilism, children lack the liveliness and brightness of emotions typical of a healthy child. Children are characterized by a weak interest in evaluation, a low level of claims. There is a high suggestibility and rejection of criticism in his address. Game activity is characterized by the poverty of imagination and creativity, certain monotony and originality, the predominance of the component of motor disinhibition. The desire to play itself often looks more like a way of avoiding difficulties in tasks than a primary need: the desire to play arises precisely in situations where purposeful intellectual activity and lesson preparation are necessary.
Depending on the prevailing emotional background, one can distinguish II MAIN TYPES OF ORGANIC INFANTILISM:
1) UNSTABLE - with psychomotor disinhibition, a euphoric shade of mood and impulsiveness, imitating childish cheerfulness and spontaneity. Characterized by a low ability for volitional effort and systematic activity, the absence of persistent attachments with increased suggestibility, poverty of the imagination.
2) BRAKE - with a predominance of a low mood background, indecision, lack of initiative, often timidity, which may be a reflection of congenital or acquired functional insufficiency of autonomic N.S. type of neuropathy. In this case, there may be a violation of sleep, appetite, dyspepsia, vascular lability. In children with organic infantilism of this type, asthenic and neurosis-like features are accompanied by a feeling of physical weakness, timidity, inability to stand up for themselves, lack of independence, and excessive dependence on loved ones.
2. COGNITIVE DISORDERS.
They are caused by insufficient development of the processes of memory, attention, the inertia of mental processes, their slowness and reduced switchability, as well as the deficiency of individual cortical functions. There is instability of attention, insufficient development of phonemic hearing, visual and tactile perception, optical-spatial synthesis, motor and sensory aspects of speech, long-term and short-term memory, hand-eye coordination, automation of movements and actions. Often there is a poor orientation in the spatial concepts of "right - left", the phenomenon of mirroring in writing, difficulties in differentiating similar graphemes.
Depending on the predominance of phenomena in the clinical picture, either emotional-volitional immaturity, or cognitive impairment ZPR of CEREBRAL GENESIS can be subdivided
on the II MAIN OPTION:
1. organic infantilism
Its various types represent a milder form of mental retardation of cerebral-organic origin, in which functional disorders of cognitive activity are caused by emotional-volitional immaturity and mild cerebrosthenic disorders. Violations of cortical functions are dynamic in nature, due to their insufficient formation and increased exhaustibility. Regulatory functions are especially weak in the control link.
2. ZPR with a predominance of functional disorders of cognitive activity - with this variant of ZPR, symptoms of damage dominate: pronounced cerebrosthenic, neurosis-like, psychopathic-like syndromes.
In essence, this form often expresses a state that is borderline with u / o (of course, the variability of the state in terms of its severity is also possible here).
Neurological data reflect the severity of organic disorders and a significant frequency of focal disorders. There are also severe neurodynamic disorders, deficiency of cortical functions, including local disorders. Dysfunction of regulatory structures is manifested in the links of both control and programming. This variant of ZPR is a more complex and severe form of this developmental anomaly.
CONCLUSION: The presented clinical types of the most persistent forms of mental retardation basically differ from each other precisely in the peculiarity of the structure and the nature of the ratio of the two main components of this developmental anomaly: the structure of infantilism and the peculiarities of the development of mental functions.
P.S. It should also be noted that within each of the listed groups of children with mental retardation there are variants that differ both in severity and in the characteristics of individual manifestations of mental activity.
CLASSIFICATION OF ZPR L.I. PERESLENI and E.M. Mastyukova
II TYPE ZPR:
1) Type BENIGN (NON-SPECIFIC) DELAY- is not associated with brain damage and is compensated with age under favorable environmental conditions, even without any special therapeutic measures. This type of mental retardation is due to a slow maturation of brain structures and their functions in the absence of organic changes in the central nervous system.
Benign (non-specific) developmental delay manifests itself in a certain delay in the formation of motor and (or) psychomotor functions, which can be detected at any age stage, is relatively quickly compensated and is not combined with pathological neurological and (or) psychopathological symptoms.
This type of mental retardation is easily corrected by early stimulation of psychomotor development.
It can manifest itself both in the form of a general, total retardation in development, and in the form of partial (partial) delays in the formation of certain neuropsychic functions, especially often this applies to a lag in the development of speech.
Benign nonspecific retention may be a familial trait and is often seen in physically debilitated and preterm infants. It can also take place with insufficient early pedagogical influence.
2) Type SPECIFIC (or CEREBRAL-ORGANIC) DEVELOPMENT REST- associated with damage to brain structures and functions.
Specific or cerebro-organic developmental delay is associated with changes in the structural or functional activity of the brain. Its cause may be disorders of intrauterine brain development, fetal hypoxia and asphyxia of the newborn, intrauterine and postnatal infectious and toxic effects, trauma, metabolic disorders and other factors.
Along with severe N.S. diseases that cause developmental delay, most children have mild neurological disorders that are detected only during a special neurological examination. These are the so-called signs of MMD, which usually occur in children with cerebral-organic mental retardation.
Many children with this form of mental retardation already in the first years of life show motor disinhibition - hyperactive behavior. They are extremely restless, constantly on the move, all their activities are not purposeful, they cannot complete any work they have begun. The appearance of such a child always brings anxiety, he runs, fusses, breaks toys. Many of them are also characterized by increased emotional excitability, pugnacity, aggressiveness, and impulsive behavior. Most children are not capable of playing activities, they do not know how to limit their desires, they react violently to all prohibitions, and are stubborn.
Many children are characterized by motor clumsiness, they have poorly developed fine differentiated movements of the fingers. Therefore, they hardly master the skills of self-service, for a long time they cannot learn how to fasten buttons, lace up their shoes.
From a practical point of view, the differentiation of specific and non-specific developmental delay, i.e. essentially, pathological and non-pathological delay, is extremely important in terms of determining the intensity and methods of stimulating age-related development, predicting the effectiveness of treatment, learning and social adaptation.
Delay in the development of certain psychomotor functions SPECIFIC FOR EACH AGE STAGE OF DEVELOPMENT.
Yes, during the period NEWBORN - such a child does not form a clear conditioned reflex to time for a long time. Such a baby does not wake up when he is hungry or wet, and does not fall asleep when he is full and dry; all unconditioned reflexes are weakened and are called after a long latent period. One of the main sensory reactions of this age is weakened or does not appear at all - visual fixation or auditory concentration. At the same time, unlike children with CNS lesions, he does not show signs of dysembryogenesis, malformations, including those that are minimally expressed. He also has no violations of crying, sucking, assimilation of muscle tone.
Aged 1-3 MONTHS such children may show some delay in the pace of age development, the absence or a weakly expressed tendency to lengthen the period of active wakefulness, the smile when communicating with an adult is absent or manifests itself inconsistently; visual and auditory concentrations are short-lived, humming is absent or only a few rare sounds are observed. Progress in its development begins to be clearly outlined by 3 months of life. By this age, he begins to smile and follow a moving object. However, all these functions can manifest themselves inconsistently and are characterized by rapid exhaustion.
At all subsequent stages of development, benign developmental delay is manifested in the fact that the child in his development goes through stages that are more characteristic of the previous stage. However, ZPR can manifest itself at each age stage for the first time. For example, a 6-month-old child with this form of developmental delay does not give a differentiated reaction to acquaintances and strangers, the development of babbling may also be delayed, and a 9-month-old child may be insufficiently active in communicating with adults, he does not imitate gestures, he has weak game contact is developed, babble is absent or weakly expressed, intonation-melodic imitation of a phrase is not manifested, it can hardly capture or not capture small objects with two fingers at all, or it does not respond clearly enough to verbal instructions. The slow rate of motor development is manifested in the fact that the child can sit, but does not sit down on his own, and if he sits, he does not make attempts to stand up.
benign developmental delay 11-12 MONTHS It manifests itself most often in the absence of the first babble words, weak intonational expressiveness of voice reactions, indistinct correlation of words with an object or action. A delay in motor development is manifested in the fact that the child stands with support, but does not walk. The lag in mental development is characterized by weakness of repeated actions and imitative games, the child does not confidently manipulate with two hands, does not grasp objects with two fingers sufficiently.
Nonspecific developmental delay in the first THREE YEARS OF LIFE most often manifests itself in the form of a lag in the development of speech, insufficiency of play activity, a lag in the development of the function of active attention that regulates the function of speech (the child's behavior is poorly controlled by the instruction of an adult), insufficient differentiation of emotional manifestations, and also in the form general psychomotor disinhibition. It can also be manifested by a lag in the development of motor functions. At the same time, in the FIRST MONTHS OF LIFE, the pace of normalization of muscle tone, the extinction of unconditioned reflexes, the formation of rectifying reactions and balance reactions, sensory-motor coordination, voluntary motor activity and especially fine differentiated movements of the fingers lag behind.
B 4. PSYCHOLOGICAL PARAMETERS OF ZPR
Lebedinskaya's classification, which is based on the main etiological factors and pathogenetic mechanisms that cause developmental delay and lead to a certain structure of the defect. Based on this criterion, 4 main forms of ZPR.
ZPR of constitutional origin (congenital). But often its origin is associated with mild metabolic and trophic disorders in the prenatal period and in the first years of life.
The child is distinguished by a special, infantile (childish) body type, he has a childish face and childish facial expressions, an infantile psyche (mental infantilism). A characteristic feature of this form of mental retardation is the combination immaturity of the emotional and intellectual spheres. At the same time, the emotional-volitional sphere is, as it were, at an earlier stage of development, in many respects resembling the structure of the emotional make-up of younger children. In children, emotional motivation of behavior predominates, there is an increased background of mood, spontaneity and brightness of emotions with their superficiality and instability, and easy suggestibility. Their learning difficulties are connected not so much with their intellectual incompetence, but with the immaturity of the motivational sphere and the personality as a whole, with the persistent predominance of gaming interests. The prognosis for the development of such children is favorable, they eventually level off in their development and reach the level of their peers under favorable conditions for training and education. ZPR of somatogenic origin. It is observed in those children who for a long time and often suffer from severe somatic diseases (diabetes mellitus, bronchial asthma, cancer, diseases of the circulatory system, etc.). Before the main disease, the development of the child proceeded without any features, his nervous system also functioned normally, since initially there was no organic damage to it. 1. Nervous system and brain suffer, since somatic ill health has a harmful effect on all body systems, including the nervous system and brain (intoxication, hypoxia). 2. Decreased amount of time the child is active when he can play, study, communicate with other people, as this time is spent on the examination and treatment of the child. 3. Decreased mental tone due to general painful weakness (asthenia), increased exhaustion and fatigue, therefore, the child's developmental opportunities are sharply limited. In independent activity, less manipulations with objects are performed compared to healthy children. General activity decreases, and especially cognitive activity. Attention fluctuates, concentration decreases. In the most severe cases, cerebrasthenic phenomena are also observed in children. Cerebrosthenia Syndrome manifests itself in a child not only in increased fatigue, but also in an increase in mental slowness, in a deterioration in concentration, memory, in unmotivated mood disorders, tearfulness, lethargy, drowsiness. The child has an increased sensitivity to bright light, strong noise, stuffiness, headaches. All this has a negative impact on academic achievement. Pathogenic influence on the development of the child also has a long, painful and difficult process of treatment for the child, long and frequent hospitalizations. Children are prescribed numerous prohibitions and restrictions in nutrition, pastime, communication, related to the nature of the disease and treatment. Gradually, the content of basic needs also changes in children, the range of their interests is built around the main disease, he is less interested in everything that healthy peers live with. The child cares and worries about his condition, the possibility of recovery. The main principle in relations between adults and children is hyperprotection, that is, excessive care. Hyperprotection by itself leads to a decrease in the activity of the child, he expects adults to do everything for him. Parents underestimate the level of requirements for the child, forming in him a consumer position, self-doubt, low self-esteem. Egocentrism is encouraged, the child's attention is fixed on his illness, it is given special significance. Often in children there is also a delay in emotional and volitional development associated with insecurity, timidity, fears, general anxiety, as the child is aware and feels his physical inferiority. Thus, in children with severe somatic diseases, a developmental delay begins to gradually accumulate with initially normal development. Asthenization (weakness, lethargy) in combination with unfavorable socio-psychological conditions leads to a distortion in the formation of the child's personality. The prognosis of development in children with a somatogenic form directly depends on the severity, course and outcome of the underlying disease. ZPR of psychogenic origin associated with unfavorable conditions of life and upbringing of the child, both in the family and outside the family. ZPR of psychogenic origin often occurs in those children who from an early age were subjected to mental (deprivation of emotions, impressions) and social (deprivation of communication) deprivation, which is especially typical for children who are brought up in closed institutions (orphanages, boarding schools), in social dysfunctional families. Deprivation has long-term negative consequences, which manifest themselves in distortions in the development of the emotional-volitional, and later on, the intellectual sphere. This form of mental retardation has a social origin, it is not associated with immaturity or brain damage. But with early onset and prolonged action, traumatic factors can lead to permanent changes in the neuropsychic sphere of the child. In infancy, such children have a sharply reduced need for communication, they do not form attachment relationships with close adults, at an early age they have apathy and inactivity, lack of initiative, a decrease in general and cognitive motivation, and lag in speech development. At preschool age, depression, reduced emotionality, passivity are noted, empathic abilities are not formed. At primary school age, children do not develop voluntariness, there is an insufficiency of the intellectual sphere, these children are prone to conflict and aggressive behavior. At the same time, they feel a great need for benevolent attention from others, their need for communication is not satisfied. In adolescence, children have a variety of problems in the formation of personality, its self-awareness, a fuzzy orientation to the future develops, and all these features persist into adulthood. This type of ZPR is considered quite favorable from the point of view of overcoming the temporary lag in development. With corrective work begun in a timely manner (as early as possible) and competently carried out corrective work, while creating adequate favorable conditions for upbringing for the child, developmental delay can be overcome or significantly reduced. However, upbringing outside the conditions of the family at a very early age cannot be completely overcome, because the state of emotional distress of the child that arises at this age persists in various forms throughout a person’s life. Children with a psychogenic form of mental retardation do not have gross violations of intelligence or its prerequisites (memory, attention, performance) - these functions remain relatively intact. The main factor that leads to a decrease in intellectual productivity, to school failure, is a decrease in motivation and distortion in the formation of the emotional-volitional sphere. This form of ZPR must be distinguished from the phenomena of pedagogical neglect. With pedagogical neglect, there is a lack of knowledge and skills of the child, a reduced range of ideas due to insufficient information and the poor environment surrounding the child. When filling in information, the child quickly learns and acquires knowledge and skills, accumulates impressions. ZPR of psychogenic origin is a consequence of long-term pathological conditions that act systemically, and it cannot be overcome only through the transfer of information and the creation of favorable environmental conditions. ZPR of cerebro-organic origin. The child has an organic lesion of the central nervous system. Brain damage in a child mainly occurs in the late stages of intrauterine development, during childbirth and in the first days after birth. In most cases, developmental delay in such children cannot be completely overcome, it can only be partially compensated. A more favorable variant is when a child's attention disorder and motor disinhibition come to the fore, and memory and thinking suffer to a lesser extent. Markovskaya describes two variants of mental retardation of cerebral-organic origin.1st option - with a predominance of the phenomena of organic infantilism: in children, there is a lesser severity of brain lesions, the prognosis for development and overcoming developmental delay is more favorable. In children, the features of immaturity of the emotional sphere according to the type of organic infantilism predominate, violations of higher mental functions are of a mosaic and mostly dynamic nature, due to low mental tone and increased exhaustion, underdevelopment of the regulatory mechanisms of the psyche. There are no primary intellectual impairments: verbal and non-verbal intelligence are on average within the age norm. Decreased mental performance and attention. This variant is also observed in children with attention deficit hyperactivity disorder. For 2nd option characterized by a greater severity of brain lesions, their localization in the parietal and temporal regions of the brain, for them the prognosis is less favorable. In this variant, violations of cognitive activity predominate, that is, memory, thinking and imagination. Observed primary deficiency higher mental functions: difficulties in perceiving complicated objects, impaired visual-motor coordination, spatial orientation, phonemic hearing, auditory memory, active speech, insufficiency of verbal and logical thinking. Indicators of the intelligence quotient (general, verbal and non-verbal), measured using the Wechsler test, are in the border zone between the norm and mental retardation.
Children with mental retardation (mental retardation) are included in a special group of persons mixed in terms of the degree of psychophysiological development. Psychiatrists refer to mental retardation as a class of mild mental developmental disorders. ZPR today is considered a common type of mental pathology at an early age. The presence of inhibition in the development of mental processes should be spoken of only on the condition that the individual has not yet gone beyond the boundaries of the primary school period. In cases where the symptoms of ZPR are observed in the phase of the senior school period, one should already speak of or infantilism. The deviation, expressed in the delay in mental formation, occupies a position between abnormal development and the norm.
Toddlers with slow development are inherently afraid of new, unexpected experiences that inevitably appear in their lives due to changes in learning conditions. They feel an increased need for approval and attention. Some children may show when changing their usual conditions, some show a peculiar reaction to punishment (they may begin to sway or sing). Such a reaction can be regarded as excessive compensation in a traumatic situation. Such children are characterized by increased sensitivity to rhythmic influences, the need for such actions and a love of music. The kids love to attend music lessons. They are able to quickly master various dance moves. Due to the influence of the rhythm, such children quickly calm down, their mood becomes even.
Children with mental retardation have pronounced difficulties with adaptive behavior, which can manifest itself in various forms. Limited opportunities for self-care and learning social skills, along with severe behavioral deficiencies, are characteristic features of children with mental retardation. Pain in response to criticism, limited self-control, inappropriate behavior, aggressiveness, often self-mutilation can all be observed. Behavior problems are determined by the degree of developmental delay - the deeper the level of developmental delay, the more pronounced the violation of behavioral responses.
Thus, a pathological condition, expressed in a delay in the formation of mental processes, can be considered as a polysymptomatic type of changes in the intensity and nature of the development of children, which covers diverse combinations of disorders and their symptoms. Despite this, in the mental status of children with mental retardation, a number of key features should be highlighted, presented below.
The sensory-perceptual sphere is represented by the immaturity of various analyzer systems and the inferiority of visual-spatial orientation. Disorder of the psychomotor sphere includes an imbalance in motor activity, impulsivity, difficulty in mastering motor skills, and various disorders of motor coordination. Mental activity is represented by the predominance of the simplest mental operations, a decrease in the degree of logic and abstractness of thinking, difficulties in the transition to abstract-analytical configurations of mental activity. In the mnemonic sphere, there is a dominance of mechanical memorization over abstract-logical memory, a predominance of direct memory over indirect memorization, a decrease in memory volume, and a significant decrease in involuntary memorization. Speech development is represented by a limited vocabulary, a slowdown in the assimilation of the grammatical structure, difficulties in mastering written speech, and deficiencies in pronunciation. The emotional-volitional sphere is represented by general immaturity, infantilism. The predominance of gaming motivation, the desire for pleasure, the inability of motives and interests are observed in the motivational sphere. In the characterological sphere, there is a noticeable increase in the likelihood of various accentuations of characterological qualities and psychopathic manifestations.
Working with children with mental retardation
Methods of influence and corrective work with children with mental retardation should strictly correspond to the key positions of formation in a particular age period, based on the features and achievements characteristic of this age period.
In the first place should be corrective work with children with mental retardation, aimed at correcting and further development, compensation for such processes of the psyche and its neoplasms that began to form in the previous age interval and which represent the foundation for development in the subsequent age interval.
Correctional and developmental work with children with mental retardation should create conditions and organize them in order to develop the most effective mental functions, especially intensively developed in the current period.
The program for children with mental retardation, ideally, should be focused on creating the prerequisites for further successful development at the next age interval, on harmonizing the development of the baby's personality at the current age stage.
When building a strategy for corrective work aimed at development, it will be no less important, as L. Vygostsky believed, to take into account the zone of the nearest formation. Under such a zone of development, one can understand the difference between the degree of complexity of the tasks set, accessible to the baby with its independent resolution, and that which he can achieve with the help of adults or comrades in a group.
Correctional work with children with mental retardation should be built taking into account periods of development that are the most optimal for the formation of a certain quality or mental function (sensitive periods). Here you need to understand that with the inhibition of the formation of mental processes, sensitive periods can also shift in time.
There are several important areas of correctional work with sick children. The first direction has a health character. After all, the full formation of children is possible only under the condition of his physical development and health. This area also includes the tasks of streamlining the lives of babies, i.e. creation of normal conditions for their further optimal life, the introduction of a reasonable daily routine, the creation of the best motor schedule, etc.
The next direction can be considered a corrective-compensatory effect using neuropsychological techniques. The current level of development of children's neuropsychology makes it possible to achieve significant results in the work of a corrective nature with the cognitive activity of children. With the help of neuropsychological techniques, school skills such as reading, writing and counting are successfully aligned, various behavioral disorders, such as focus or control, can be corrected.
The next area of work includes the formation of a sensory-motor sphere. This direction is of particular importance when working with students who have deviations in sensory processes and defects in the musculoskeletal system. To develop the creative abilities of children with delayed formation of mental processes, stimulation of sensory development is very important.
The fourth direction is the stimulation of cognitive processes. The system of psychological influence and pedagogical assistance in the full formation, alignment and compensation of defects in the development of all mental processes can be considered the most developed today.
The fifth direction is work with emotional processes. Increasing emotional awareness, which implies the ability to understand the feelings of other individuals, expressed in the adequate manifestation and control of their own emotions, is important for absolutely all babies, regardless of the severity of the pathology.
The last direction will be the development of activities that are characteristic of a certain age category, for example, gaming or productive activities, educational activities and communication.
Teaching children with mental retardation
By the time they start learning, children with a slow development of mental processes, as a rule, have not fully formed core mental operations, such as analysis and synthesis, generalization and comparison.
Children with mental retardation are not able to navigate the tasks set, they do not know how to plan their own activities. If we compare them with mentally retarded kids, then their learning ability will be an order of magnitude higher than that of oligophrenics.
Students with CPD are much better at using help, they are able to transfer the demonstrated way of doing things to similar tasks. Provided that teachers comply with the special requirements for teaching such children, they are able to study educational information of considerable complexity, designed for students with normal development corresponding to their age category.
The peculiarities of teaching children with mental retardation are largely determined by the extent to which students acquire the skills of educational activities at the preparatory stage. In the preparatory class, the core tasks of education are corrective work in relation to specific defects in the development of students' cognitive activity, their thought processes, compensation for shortcomings in elementary knowledge, preparation for mastering key subjects, and the formation of mental activity in the course of comprehending educational material.
In teaching children suffering from retardation of the development of mental processes, one should be based on the tasks set by the requirements of the curriculum of a general education school, as well as take into account a number of specific tasks and a corrective orientation arising from the peculiarities of the psychophysiological characteristics of schoolchildren of this category.
Practice shows that it is more expedient to start preventing possible difficulties in teaching and school adaptation of children even in preschool centers. For this purpose, a specific model of a preschool institution (DOE) of an educational orientation of a compensatory type for children characterized by a retardation of the development of mental processes has been developed. In such institutions, correctional work is represented by: diagnostic and advisory direction, medical and recreational and correctional and developmental direction. Defectologists or speech therapists conduct correctional and developmental work with preschool children with the participation of a family of kids.
Classes for children with mental retardation take into account the state and degree of development of children, as a result of which they involve training in various areas: familiarization with the environment, development of speech functions, development of correct sound pronunciation, acquaintance with fiction, training in gaming activities, preparation for further learning to read and write, formation of primitive mathematical concepts, labor education, physical development and aesthetic education.
With the productive assimilation of curricula in specialized classes, as a result of the decision of the school medical-psychological-pedagogical council, the child is transferred to a general education school in a class corresponding to his level.
The information provided in this article is for informational purposes only and cannot replace professional advice and qualified medical assistance. At the slightest suspicion that the child has this disease, be sure to consult a doctor!
Loading...