Emotions are one of the most important mechanisms of mental activity. It is emotions that produce sensually colored total score incoming information from inside and outside. In other words, we evaluate the external situation and our own internal state. Emotions should be assessed along two axes: strong-weak and negative-positive.
Emotion is a feeling, an internally subjective experience that is inaccessible to direct observation. But even this deeply subjective form of manifestation can have disturbances called emotional-volitional disorders.
Emotional-volitional disorders
The peculiarity of these disorders is that they combine two psychological mechanisms: emotions and will.
Emotions have external expression: facial expressions, gestures, intonation, etc. By the external manifestation of emotions, doctors judge a person’s internal state. A long-term emotional state is characterized by the term “mood.” A person’s mood is quite flexible and depends on several factors:
- external: luck, defeat, obstacles, conflicts, etc.;
- internal: health, activity.
Will is a mechanism for regulating behavior that allows you to plan activities, satisfy needs, and overcome difficulties. The needs that contribute to adaptation are usually called “drive.” Attraction is special condition human needs in certain conditions. Conscious attractions are usually called desires. A person always has several pressing and competing needs. If a person does not have the opportunity to fulfill his needs, then an unpleasant condition occurs called frustration.
Emotional disorders are an excessive manifestation of natural emotions:
Disorders of will and desires
In clinical practice, disorders of will and desire are manifested by behavioral disorders:
Emotionally volitional disorders need treatment. Drug therapy combined with psychotherapy is often effective. For effective treatment, the choice of specialist plays a decisive role. Trust only real professionals.
emotional volitional disorders can manifest themselves in different ways:
1. Increased excitability. Children of this type are restless, fussy, irritable, and prone to unmotivated aggression. They are characterized by sudden mood swings: they are either overly cheerful, or suddenly begin to be capricious, seem tired and irritable.
Affective arousal can occur even under the influence of ordinary tactile, visual and auditory stimuli, especially intensifying in an environment that is unusual for the child.
2. Passivity, lack of initiative, excessive shyness. Any situation of choice puts them at a dead end. Their actions are characterized by lethargy and slowness. Such children have great difficulty adapting to new conditions and have difficulty making contact with strangers. This syndrome, as well as a joyful, elated mood with a decrease in criticism (euphoria), is noted with lesions frontal lobes brain
Phobic syndrome, or fear syndrome, is typical for many children with cerebral palsy. Increased impressionability, combined with emotional excitability and affective inertia, creates a favorable background for the emergence of fear neurosis. Fear can arise even under the influence of minor psychogenic factors - an unfamiliar situation, short-term separation from loved ones, the appearance of new faces and even new toys, loud sounds, etc. In some children it manifests itself as motor agitation, screaming, in others - physical inactivity, general lethargy and in both cases it is accompanied by pronounced vegetative-vascular reactions - paleness or redness of the skin, hyperhidrosis, increased heart rate and respiration, sometimes chills, and increased temperature. When fear arises in a child, salivation and movement disorders(spasticity, hyperkinesis, ataxia). Psychogenically caused obsessive phobias in the form of fear of loneliness, heights, and movement are possible; in adolescence - fear of illness and death.
Fears that arise spontaneously, without connection with any psychogenic factors, are called neurosis-like; they are caused by organic brain damage. These include undifferentiated night terrors that appear sporadically during sleep and are accompanied by screaming, crying, general agitation, autonomic disorders. They are typical for children with hypertensive-hydrocephalic syndrome and often occur against the background of hyperthermia. If fears appear suddenly, against the background of somatic well-being, at a certain time of night sleep, at regular intervals, and are accompanied by motor automatisms, they should be distinguished from paroxysms of epileptic origin, which can also be observed in cerebral palsy.
3. But there are a number of qualities characteristic of both types of development. In particular, sleep disorders can often be observed in children suffering from musculoskeletal disorders. They are tormented by nightmares, they sleep anxiously, and have difficulty falling asleep.
4. Increased impressionability. In part, this can be explained by the compensation effect: the child’s motor activity is limited, and against the background of this, the senses, on the contrary, receive high development. Thanks to this, they are sensitive to the behavior of others and are able to detect even minor changes in their mood. However, this impressionability is often painful; Completely neutral situations and innocent statements can cause a negative reaction in them.
5. Increased fatigue– another distinctive feature characteristic of almost all children with cerebral palsy. In the process of correctional and educational work, even with high interest in the task, the child quickly gets tired, becomes whiny, irritable, and refuses to work. Some children become restless as a result of fatigue: the rate of speech accelerates, and it becomes less intelligible; there is an increase in hyperkinesis; Aggressive behavior manifests itself - the child may throw nearby objects and toys.
6. Another area in which parents may encounter serious problems is the child’s volitional activity. Any activity that requires composure, organization and purposefulness causes him difficulties. Mental infantilism, characteristic of most children with cerebral palsy, leaves a significant imprint on the child’s behavior. For example, if the proposed task has lost its attractiveness for him, it is very difficult for him to make an effort and finish the work he started.
Children suffering from cerebral palsy more often experience negative emotions, such as fear, anger, shame, suffering, etc., than children without this disease. The dominance of negative emotions over positive ones leads to frequent experiences of states of sadness, sadness with frequent overstrain of all body systems.
MENTAL DEVELOPMENT DURING ASYNCHRONIES WITH PREMIUM
Among children with disabilities health, i.e. Those who have various deviations in psychophysical and social-personal development and need special help, children are singled out for whom disorders in the emotional-volitional sphere come to the fore. The category of children with disorders of the emotional-volitional sphere is extremely heterogeneous. The main feature of such children is a violation or delay in the development of higher socialized forms of behavior, which involve interaction with another person, taking into account his thoughts, feelings, and behavioral reactions. At the same time, activities that are not mediated by social interaction (play, construction, fantasy, solving intellectual problems alone, etc.) can proceed at a high level.
According to the widespread classification of behavioral disorders in children and adolescents by R. Jenkins, the following types of behavioral disorders are distinguished: hyperkenetic reaction, anxiety, autistic-type withdrawal, escape, unsocialized aggressiveness, group delinquency.
Children with early childhood autism syndrome (ECA) make up the bulk of children who have the most severe disorders in social and personal development that require special psychological, pedagogical, and sometimes medical assistance.
Chapter 1.
PSYCHOLOGY OF CHILDREN WITH EARLY CHILDHOOD AUTISM SYNDROME
SUBJECT AND TASKS OF PSYCHOLOGY OF CHILDREN WITH RDA
The focus of this area is the development of a system of comprehensive psychological support for children and adolescents experiencing difficulties in adaptation and socialization due to disorders in the emotional and personal sphere.
The tasks of primary importance in this section of special psychology include:
1) development of principles and methods for early detection of RDA;
2) questions differential diagnosis, differentiation from similar conditions, development of principles and methods of psychological correction;
3) development of psychological foundations for eliminating the imbalance between the processes of learning and development of children.
Vivid external manifestations of RDA syndrome are: autism as such, i.e. extreme “extreme” loneliness of the child, decreased ability to establish emotional contact, communication and social development. Characterized by difficulties in establishing eye contact, interaction with gaze, facial expressions, gestures, and intonation. There are difficulties in the child expressing his emotional states and understanding the states of other people. Difficulties in establishing emotional connections are manifested even in relationships with loved ones, but to the greatest extent autism disrupts the development of relationships with strangers;
stereotypy in behavior associated with an intense desire to maintain constant, familiar living conditions. The child resists the slightest changes in the environment and order of life. Absorption in monotonous actions is observed: rocking, shaking and waving arms, jumping; addiction to various manipulations of the same object: Shaking, tapping, spinning; being caught up in the same topic of conversation, drawing, etc. and constant return to it (text 1);
“Stereotypes permeate all the mental manifestations of an autistic child in the first years of life, clearly appear when analyzing the formation of his affective, sensory, motor, speech spheres, play activities... this was manifested in the use of rhythmically clear music for stereotypical swaying, twisting, spinning, shaking objects, and by the age of 2 - a special attraction to the rhythm of verse. By the end of the second year of life, there was also a desire for a rhythmic organization of space - laying out monotonous rows of cubes, an ornament of circles, and sticks. Very typical are stereotypical manipulations with a book: fast and rhythmic turning of pages, which often captivates a two-year-old child more than any other toy. Obviously, a number of properties of the book are important here: the convenience of stereotypical rhythmic movements (the leafing itself), the stimulating sensory rhythm (the flickering and rustling of pages), as well as the obvious absence in its appearance of any communicative qualities suggesting interaction.”
“Perhaps the most common type of motor patterns seen in autism are: symmetrical swinging of both arms, elbows at maximum speed, light finger strikes, body rocking, head shaking, or spinning and clapping of various types... many autistic people live their lives with strict adherence to routine and unchanging rituals. They may enter and leave the bathroom 10 times before entering it to perform routine procedures or, for example, spin around themselves before agreeing to get dressed.” characteristic delay and disturbance speech development, namely its communicative function. In at least one third of cases, this can manifest itself in the form of mutism (lack of purposeful use of speech for communication, while maintaining the possibility of accidentally pronouncing individual words and even phrases). A child with RDA may also have formally well-developed speech with a large vocabulary and extensive “adult” phrases. However, such speech has the character of cliched, “parrot-like”, “photographic”. The child does not ask questions and may not respond to speech addressed to him; he may enthusiastically recite the same poems, but not use speech even in the most necessary cases, i.e. there is an avoidance of verbal interaction as such. A child with RDA is characterized by speech echolalia (stereotypical meaningless repetition of heard words, phrases, questions), a long lag in the correct use of personal pronouns in speech, in particular, the child continues to call himself “you”, “he” for a long time, and indicates his needs with impersonal orders: “give me something to drink”, “cover”, etc. The unusual tempo, rhythm, and melody of the child’s speech is noteworthy;
early manifestation the above disorders (up to 2.5 years of age).
The greatest severity of behavioral problems (self-isolation, excessive stereotypical behavior, fears, aggression and self-injury) is observed in preschool age, from 3 to 5-6 years (an example of the development of a child with RDA is given in the appendix).
HISTORICAL EXCURSION
The term “autism” (from the Greek autos - itself) was introduced by E. Bleuler to designate a special type of thinking characterized by “separation of associations from given experience, ignoring actual relationships.” Defining the autistic type of thinking, E. Bleuler emphasized its independence from reality, freedom from logical laws, and being captured by one’s own experiences.
The syndrome of early childhood autism was first described in 1943 by the American clinician L. Kanner in his work “Autistic disorders of affective contact,” written on the basis of a generalization of 11 cases. He concluded that there was a special clinical syndrome of “extreme loneliness,” which he called early childhood autism syndrome and which later became known as Kanner syndrome after the scientist who discovered it.
G. Asperger (1944) described children of a slightly different category, he called it “autistic psychopathy.” The psychological picture of this disorder is different from Kanner’s. The first difference is that signs of autistic psychopathy, unlike RDA, appear after the age of three. Autistic psychopaths clearly exhibit behavioral disorders, they are devoid of childishness, there is something senile in their entire appearance, they are original in their opinions and original in their behavior. Games with peers do not attract them; their play gives the impression of being mechanical. Asperger talks about the impression of floating in a dream world, poor facial expressions, monotonous “booming” speech, disrespect for adults, rejection of affection, and the lack of necessary connection with reality. There is a lack of intuition and insufficient ability to empathize. On the other hand, Asperger noted a desperate commitment to home and love for animals.
S. S. Mnukhin described similar conditions in 1947.
Autism occurs in all countries of the world, on average in 4-5 cases per 10 thousand children. However, this figure only covers so-called classic autism, or Kanner syndrome, and will be significantly higher if other types of behavior disorders with autistic-like manifestations are taken into account. Moreover, early autism occurs in boys 3-4 times more often than in girls.
In Russia, issues of psychological and pedagogical assistance to children with RDA began to be developed most intensively from the late 70s. Subsequently, the result of research was an original psychological classification (K.S. Lebedinskaya, V.V. Lebedinsky, O.S. Nikolskaya, 1985, 1987).
REASONS AND MECHANISMS OF RDA.
PSYCHOLOGICAL ESSENCE OF RDA. CLASSIFICATION OF CONDITIONS BY DEGREE OF SEVERITY
According to the concept being developed, according to the level of emotional regulation, autism can manifest itself in different forms:
1) as complete detachment from what is happening;
2) as active rejection;
3) as being caught up in autistic interests;
4) as an extreme difficulty in organizing communication and interaction with other people.
Thus, four groups of children with RDA are distinguished, which represent different stages of interaction with the environment and people.
With successful correctional work, the child climbs these kind of steps of socialized interaction. In the same way, if educational conditions deteriorate or do not correspond to the child’s condition, a transition to more unsocialized forms of life will occur.
Children of the 1st group are characterized by manifestations of a state of severe discomfort and a lack of social activity at an early age. It is impossible even for loved ones to get a return smile from the child, to catch his gaze, to receive a response to the call. The main thing for such a child is not to have any points of contact with the world.
The establishment and development of emotional connections with such a child helps to increase his selective activity, to develop certain stable forms of behavior and activity, i.e. make a transition to a higher level of relations with the world.
Children of the 2nd group are initially more active and slightly less vulnerable in contacts with the environment, and their autism itself is more “active”. It manifests itself not as detachment, but as increased selectivity in relations with the world. Parents usually point to a delay in the mental development of such children, primarily speech; They note increased selectivity in food and clothing, fixed walking routes, and special rituals in various aspects of life, the failure of which leads to violent affective reactions. Compared to children of other groups, they are most burdened with fears and display a lot of speech and motor stereotypies. They may experience unexpected violent manifestations of aggression and self-injury. However, despite the severity various manifestations, these children are much more adapted to life than the children of the first group.
Children of the 3rd group are distinguished by a slightly different way of autistic defense from the world - this is not a desperate rejection of the world around them, but an over-preoccupation with their own persistent interests, manifested in a stereotypical form. Parents, as a rule, complain not about developmental delays, but about increased conflict in children and lack of consideration for the interests of others. For years, a child can talk on the same topic, draw or act out the same story. Often the themes of his interests and fantasies are frightening, mystical, and aggressive in nature. The main problem of such a child is that the behavior program he has created cannot be adapted to flexibly changing circumstances.
In children of the 4th group, autism manifests itself in its mildest form. The increased vulnerability of such children and inhibition in contacts (interaction stops when the child senses the slightest obstacle or opposition) comes to the fore. This child is too dependent on emotional support from adults, so the main direction of helping these children should be to develop in them other ways of obtaining pleasure, in particular from the experience of realizing their own interests and preferences. To do this, the main thing is to provide the child with an atmosphere of safety and acceptance. It is important to create a clear, calm rhythm of classes, periodically including emotional impressions.
The pathogenetic mechanisms of childhood autism remain unclear. At different times in the development of this issue, much attention was paid to various reasons and the mechanisms of occurrence of this disorder.
L. Kanner, who identified “extreme loneliness” with a desire for ritual forms of behavior, disturbances or absence of speech, mannerisms of movements and inadequate reactions to sensory stimuli as the main symptom of autism, considered it an independent developmental anomaly of constitutional genesis.
Regarding the nature of RDA, B. Bittelheim’s (1967) hypothesis about its psychogenic nature dominated for a long time. It consisted in the fact that such conditions of the child’s development as suppression of his mental activity and affective sphere an “authoritarian” mother lead to pathological personality formation.
Statistically, RDA is most often described in the pathology of the schizophrenic circle (L. Bender, G. Faretra, 1979; M.Sh. Vrono, V.M. Bashina, 1975; V.M. Bashina, 1980, 1986; K.S. Lebedinskaya, I.D. Lukashova, S.V. Nemirovskaya, 1981), less often - with organic pathology of the brain (congenital toxoplasmosis, syphilis, rubeolar encephalopathy, other residual failure of the nervous system, lead intoxication, etc. (S.S. Mnukhin, D.N.Isaev, 1969).
When analyzing the early symptoms of RDA, an assumption arises about special damage to the ethological mechanisms of development, which is manifested in a polar attitude towards the mother, in great difficulties in the formation of the most basic communicative signals (smile, eye contact, emotional syntony1), weakness of the self-preservation instinct and affective defense mechanisms.
At the same time, children exhibit inadequate, atavistic2 forms of cognition of the surrounding world, such as licking and sniffing an object. In connection with the latter, assumptions are made about the breakdown of the biological mechanisms of affectivity, the primary weakness of instincts, information blockade associated with a disorder of perception, the underdevelopment of internal speech, the central disturbance of auditory impressions, which leads to a blockade of the needs for contacts, the disruption of the activating influences of the reticular formation, and many others. . etc. (V. M. Bashina, 1993).
V.V. Lebedinsky and O.N. Nikolskaya (1981, 1985) when addressing the issue of the pathogenesis of RDA, proceed from the position of L.S. Vygotsky about primary and secondary developmental disorders.
Primary disorders in RDA include increased sensory and emotional sensitivity (hypersthesia) and weakness of energy potential; to the secondary ones - autism itself, as a withdrawal from the surrounding world, which hurts with the intensity of its stimuli, as well as stereotypies, overvalued interests, fantasies, disinhibition of drives - as pseudo-compensatory autostimulatory formations that arise in conditions of self-isolation, replenishing the deficit of sensations and impressions from the outside and thereby perpetuating the autistic barrier. They have a weakened emotional reaction to loved ones, up to a complete absence of external reaction, the so-called “affective blockade”; insufficient response to visual and auditory stimuli, which gives such children a resemblance to the blind and deaf.
Clinical differentiation of RDA is of great importance for determining the specifics of treatment and pedagogical work, as well as for school and social prognosis.
To date, there has been an understanding of two types of autism: classical Kanner autism (KKA) and variants of autism, which include autistic conditions of different genesis, which can be seen in various types of classifications. The Asperger's variant is usually milder, and the “core personality” is not affected. Many authors refer to this variant as autistic psychopathy. The literature contains descriptions of various clinical
1 Syntony is the ability to respond emotionally to the emotional state of another person.
2 Atavisms are outdated signs or forms of behavior that are biologically inappropriate at the present stage of development of the organism.
manifestations in these two variants of abnormal mental development.
If Kanner's RDA is usually detected early - in the first months of life or during the first year, then with Asperger's syndrome, developmental features and strange behavior, as a rule, begin to appear in the 2nd -3rd years and more clearly - by primary school age. With Kanner's syndrome, the child begins to walk before speaking; with Asperger's syndrome, speech appears before walking. Kanner's syndrome occurs in both boys and girls, and Asperger's syndrome is considered "an extreme expression of masculine character" With Kanner syndrome, there is a cognitive defect and a more severe social prognosis; speech, as a rule, does not have a communicative function. With Asperger's syndrome, intelligence is more preserved, social prognosis is much better, and the child usually uses speech as a means of communication. Eye contact is also better with Asperger's syndrome, although the child avoids other people's gaze; general and special abilities are also better in this syndrome.
Autism can arise as a unique developmental anomaly of genetic origin, and can also be observed as a complicating syndrome in various neurological diseases, including metabolic defects.
Currently, ICD-10 has been adopted (see appendix to section I), in which autism is considered in the group “general disorders of psychological development” (F 84):
F84.0 Childhood autism
F84.01 Childhood autism caused by organic brain disease
F84.02 Childhood autism due to other causes
F84.1 Atypical autism
F84.ll Atypical autism with mental retardation
F84.12 Atypical autism without mental retardation
F84.2 Rett syndrome
F84.3 Other disintegrative disorder of childhood
F84.4 Hyperactive disorder associated with mental retardation and stereotypic movements
F84.5 Asperger's syndrome
F84.8 Other pervasive developmental disorders
F84.9 Pervasive developmental disorder, unspecified
Conditions associated with psychosis, in particular schizophrenia-like, are not classified as RDA.
All classifications are based on etiological or pathogenic principles. But the picture of autistic manifestations is characterized by great polymorphism, which determines the presence of variants with different clinical and psychological pictures, different social adaptation and different social prognosis. These options require a different correctional approach, both therapeutic and psychological-pedagogical.
For milder manifestations of autism, the term parautism is often used. Thus, parautism syndrome can often be observed in Down syndrome. In addition, it can occur in diseases of the central nervous system such as mucopolysaccharidosis, or gargoilism. This disease involves a complex of disorders, including pathology of the connective tissue, central nervous system, visual organs, musculoskeletal system and internal organs. The name “Gargoilism” was given to the disease due to the external resemblance of patients to sculptural images of chimeras. The disease predominates in males. The first signs of the disease appear soon after birth: Trits’s rough features, a large skull, a forehead hanging over the face, a wide nose with a sunken bridge, deformed ears, high palate, large tongue. Characterized by a short neck, torso and limbs, a deformed chest, changes in internal organs: heart defects, enlargement of the abdomen and internal organs - liver and spleen, umbilical and inguinal hernias. Mental retardation of varying severity is combined with defects in vision, hearing and communication disorders such as early childhood autism. Signs of RDA appear selectively and inconsistently and do not determine the main specifics of abnormal development;
Lesch-Nyhan syndrome is a hereditary disease that includes mental retardation, motor disorders in the form of violent movements - choreoathetosis, auto-aggression, spastic cerebral palsy. Characteristic signs of the disease are pronounced violations behavior - auto-aggression, when a child can cause serious harm to himself, as well as disruption of communication with others;
Ullrich-Noonan syndrome. The syndrome is hereditary and is transmitted as a Mendelian autosomal dominant trait. Manifests itself in the form of a characteristic appearance: anti-Mongoloid eye shape, narrow upper jaw, small lower jaw, low-set ears, drooping upper eyelids(ptosis). A characteristic feature is the cervical pterygoid fold, short neck, and low stature. The incidence of congenital heart defects and visual defects is characteristic. Changes in the limbs, skeleton, dystrophic, flat nails, pigment spots on the skin are also observed. Intellectual disabilities do not appear in all cases. Despite the fact that children at first glance seem sociable, their behavior can be quite disordered, many of them experience obsessive fears and persistent difficulties social adaptation;
Rett syndrome is a neuropsychiatric disease that occurs exclusively in girls with a frequency of 1:12500. The disease manifests itself from 12-18 months, when the girl, who had previously developed normally, begins to lose her newly formed speech, motor and object-manipulative skills. A characteristic sign of this condition is the appearance of stereotypical (monotonous) hand movements in the form of rubbing, wringing, and “washing” against the background of loss of purposeful manual skills. The girl’s appearance gradually changes: a peculiar “lifeless” facial expression (“unhappy” face) appears, her gaze is often motionless, directed at one point in front of her. Against the background of general lethargy, attacks of violent laughter are observed, sometimes occurring at night and combined with attacks of impulsive behavior. Seizures may also occur. All these behavioral features of girls resemble behavior with RDA. Most of them have difficulty engaging in verbal communication; their answers are monosyllabic and echolalic. At times, they may experience periods of partial or total loss of verbal communication (mutism). They are also characterized by extremely low mental tone, the responses are impulsive and inadequate, which also resembles children with RDA;
early childhood schizophrenia. In early childhood schizophrenia, the type of continuous course of the disease predominates. However, it is often difficult to determine its onset, since schizophrenia usually occurs against the background of autism. As the disease progresses, the child’s psyche becomes increasingly disordered, and the dissociation of all mental processes, and above all thinking, personality changes such as autism and emotional decline and disturbances in mental activity are increasing. Stereotypic behavior increases, peculiar delusional depersonalizations arise when the child transforms into images of his overvalued fantasies and hobbies, pathological fantasizing arises;
autism in children with cerebral palsy, visually impaired and blind, with a complex defect - deaf-blindness and other developmental disabilities. Manifestations of autism in children with organic damage to the central nervous system are less pronounced and unstable. They retain the need to communicate with others, they do not avoid eye contact, in all cases the most late-forming neuropsychic functions are more insufficient.
With RDA, there is an asynchronous variant of mental development: a child, without mastering basic everyday skills, can demonstrate a sufficient level of psychomotor development in activities that are significant to him.
It is necessary to note the main differences between RDA as a special form of mental dysontogenesis and autism syndrome in the psychoneurological diseases described above and childhood schizophrenia. In the first case, there is a peculiar asynchronous type of mental development, the clinical symptoms of which vary depending on age. In the second case, the characteristics of the child’s mental development are determined by the nature of the underlying disorder; autistic manifestations are often temporary and vary depending on the underlying disease.
FEATURES OF COGNITIVE SPHERE DEVELOPMENT
In general, mental development in RDA is characterized by unevenness. Thus, increased abilities in certain limited areas, such as music, mathematics, painting, can be combined with a profound violation of ordinary life skills. One of the main pathogenic factors determining the development of personality according to the autistic type is a decrease in general vitality. This manifests itself primarily in situations requiring active, selective behavior.
Attention
Lack of general, including mental, tone, combined with increased sensory and emotional sensitivity, causes an extremely low level of active attention. From a very early age, there is a negative reaction or no reaction at all when trying to attract the child’s attention to objects in the surrounding reality. Children suffering from RDA experience gross violations purposefulness and arbitrariness of attention, which prevents the normal formation of higher mental functions. However, individual bright visual or auditory impressions coming from objects in the surrounding reality can literally fascinate children, which can be used to concentrate the child’s attention. This could be some sound or melody, a shiny object, etc.
A characteristic feature is severe mental satiety. The attention of a child with RDA is stable for literally several minutes, and sometimes even seconds. In some cases, satiation can be so strong that the child does not simply
disconnects from the situation, but shows pronounced aggression and tries to destroy what he was just doing with pleasure.
Sensations and perception
Children with RDA are characterized by unique responses to sensory stimuli. This is expressed in increased sensory vulnerability, and at the same time, as a consequence of increased vulnerability, they are characterized by ignoring influences, as well as a significant discrepancy in the nature of reactions caused by social and physical stimuli.
If normally the human face is the most powerful and attractive stimulus, then children with RDA give preference to a variety of objects, while the human face almost instantly causes satiety and a desire to avoid contact.
Peculiarities of perception are observed in 71% of children diagnosed as having RDA (according to K.S. Lebedinskaya, 1992). The first signs of “unusual” behavior in children with RDA that are noticed by parents include paradoxical reactions to sensory stimuli that appear already in the first year of life. Great polarity is found in reactions to objects. Some children have an unusually strong reaction to “novelty,” such as a change in lighting. It is expressed in an extremely sharp form and continues for a long time after the cessation of the stimulus. Many children, on the contrary, were weakly interested in bright objects, they also did not have a reaction of fear or crying to sudden and strong sound stimuli, and at the same time they noted increased sensitivity to weak stimuli: children woke up from a barely audible rustling, fear reactions easily occurred , fear of indifferent and habitual stimuli, for example, working household appliances in the house.
In the perception of a child with RDA, there is also a violation of orientation in space, a distortion of the holistic picture of the real objective world. For them, it is not the object as a whole that is important, but its individual sensory qualities: sounds, shape and texture of objects, their color. Most children have an increased love for music. They are hypersensitive to odors; they examine surrounding objects by sniffing and licking.
Tactile and muscle sensations coming from their own body are of great importance for children. Thus, against the background of constant sensory discomfort, children strive to receive certain activating impressions (swinging their whole body, making monotonous jumps or spinning, enjoying tearing paper or fabric, pouring water or pouring sand, watching fire). With often reduced pain sensitivity, they have a tendency to inflict various injuries on themselves.
Memory and Imagination
From a very early age, children with RDA have good mechanical memory, which creates conditions for preserving traces of emotional experiences. It is emotional memory that stereotypes the perception of the environment: information enters the consciousness of children in whole blocks, is stored without being processed, and is applied in a stereotyped manner, in the context in which it was perceived. Children may repeat the same sounds, words, or ask the same question over and over again. They easily memorize poems, while strictly ensuring that the person reading the poem does not miss a single word or line; the rhythm of the verse, children can begin to sway or compose their own text. Children in this category memorize well and then repeat monotonously various movements, game actions, sounds, entire stories, strive to obtain familiar sensations coming through all sensory channels: vision, hearing, taste, smell, skin.
Regarding imagination, there are two opposing points of view: according to one of them, defended by L. Kanner, children with RDA have a rich imagination, according to the other, the imagination of these children, if not reduced, is bizarre, has the character of pathological fantasy. The content of autistic fantasies intertwines fairy tales, stories, films and radio programs accidentally heard by the child, fictional and real events. Pathological fantasies of children are characterized by increased brightness and imagery. Often the content of fantasies can have an aggressive connotation. Children can spend hours, every day, for several months, and sometimes several years, telling stories about the dead, skeletons, murders, arson, call themselves a “bandit,” and attribute various vices to themselves.
Pathological fantasy serves as a good basis for the emergence and consolidation of various inadequate fears. This could be, for example, fears of fur hats, certain objects and toys, stairs, withered flowers, strangers. Many children are afraid to walk the streets, fearing, for example, that a car will run into them, they experience a hostile feeling if they happen to get their hands dirty, and they get irritated if water gets on their clothes. They exhibit more pronounced than normal fears of the dark and fear of being left alone in the apartment.
Some children are overly sentimental and often cry when watching certain cartoons.
Speech
Children with RDA have a peculiar attitude towards speech reality and, at the same time, a peculiarity in the development of the expressive side of speech.
When perceiving speech, there is a noticeably reduced (or completely absent) reaction to the speaker. By “ignoring” simple instructions addressed to him, the child may interfere in a conversation that is not addressed to him. The child responds better to quiet, whispered speech.
The first active speech reactions, which manifest themselves in the form of humming in normally developing children, may be delayed, absent, or impoverished in children with RDA, lacking intonation. The same applies to babbling: according to the study, in 11% the babbling phase was absent, in 24% it was weakly expressed, and in 31% there was no babbling reaction to an adult.
Children usually develop their first words early. In 63% of observations these are ordinary words: “mom”, “dad”, “grandfather”, but in 51% of cases they were used without correlation with an adult (K.S. Lebedinskaya, O.S. Nikolskaya). Most children develop phrasal speech from the age of two, usually with clear pronunciation. But children practically do not use it to contact people. They rarely ask questions; if they appear, they are of a recurring nature. At the same time, when alone with themselves, children discover rich speech production: they tell something, read poetry, sing songs. Some demonstrate pronounced verbosity, but despite this, it is very difficult to get an answer to a specific question from such children, their speech does not fit the situation and is not addressed to anyone. Children of the most severe, group 1, according to the classification of K.S. Lebedinskaya and O.S. Nikolskaya, may never master spoken language. Children of the 2nd group are characterized by “telegraphic” speech patterns, echolalia, and the absence of the pronoun “I” (referring to oneself by name or in the third person - “he”, “she”).
The desire to avoid communication, especially using speech, has a negative impact on the prospects for the speech development of children in this category.
Thinking
The level of intellectual development is associated, first of all, with the uniqueness of the affective sphere. They focus on perceptually bright rather than functional features of objects. The emotional component of perception retains its leading importance in RDA even throughout school age. As a result, only part of the signs of the surrounding reality is assimilated, and objective actions are poorly developed.
The development of thinking in such children is associated with overcoming the enormous difficulties of voluntary learning and purposeful resolution of real-life problems. Many experts point to difficulties in symbolization and transfer of skills from one situation to another. It is difficult for such a child to understand the development of a situation over time and to establish cause-and-effect relationships. This is very clearly manifested in the retelling of educational material, when performing tasks related to plot pictures. Within a stereotypical situation, many autistic children can generalize, use game symbols, and build a program of action. However, they are not able to actively process information, actively use their capabilities in order to adapt to the changing environment, environment, and situation.
At the same time, intellectual disability is not necessary for early childhood autism. Children may show giftedness in certain areas, although the autistic orientation of thinking remains.
When performing intellectual tests, such as the Wechsler test, there is a pronounced disproportion between the level of verbal and non-verbal intelligence in favor of the latter. However, low levels of performance on tasks related to speech mediation mostly indicate the child’s reluctance to use speech interaction, and not a truly low level of development of verbal intelligence.
FEATURES OF PERSONALITY AND EMOTIONAL-VOLITIONAL SPHERE
Violation of the emotional-volitional sphere is the leading symptom of RDA syndrome and can appear soon after birth. Thus, in 100% of observations (K.S. Lebedinskaya) in autism, the earliest system of social interaction with surrounding people, the revitalization complex, sharply lags behind in its formation. This is manifested in the absence of fixation of gaze on a person’s face, a smile and emotional responses in the form of laughter, speech and motor activity to manifestations of attention from an adult. As you grow
The child's weakness of emotional contacts with close adults continues to increase. Children do not ask to be held when in their mother’s arms, do not take an appropriate position, do not cuddle, and remain lethargic and passive. Usually the child distinguishes his parents from other adults, but does not express much affection. They may even experience fear of one of the parents, they may hit or bite, they do everything out of spite. These children lack the characteristic desire for this age to please adults, to earn praise and approval. The words “mom” and “dad” appear later than others and may not correspond to parents. All of the above symptoms are manifestations of one of the primary pathogenic factors of autism, namely a decrease in the threshold of emotional discomfort in contacts with the world. A child with RDA has extremely low endurance in communicating with the world. He quickly gets tired even from pleasant communication, and is prone to fixating on unpleasant impressions and developing fears. K. S. Lebedinskaya and O. S. Nikolskaya identify three groups of fears:
1) typical for childhood in general (fear of losing a mother, as well as situationally determined fears after experiencing a fright);
2) caused by increased sensory and emotional sensitivity of children (fear of household and natural noises, strangers, unfamiliar places);
Fears occupy one of the leading places in the formation of autistic behavior in these children. When establishing contact, it is discovered that many ordinary objects and phenomena (certain toys, household items, the sound of water, wind, etc.), as well as some people, cause a constant feeling of fear in the child. The feeling of fear, which sometimes persists for years, determines the desire of children to preserve their familiar environment and produce various defensive movements and actions that are in the nature of rituals. The slightest changes in the form of rearranging furniture or daily routine cause violent emotional reactions. This phenomenon is called the “identity phenomenon.”
Speaking about the characteristics of behavior with RDA of varying degrees of severity, O. S. Nikolskaya characterizes children of group I as not allowing themselves to experience fear, reacting with care to any impact of great intensity. In contrast, children of the 2nd group are almost constantly in a state of fear. This is reflected in their appearance and behavior: their movements are tense, frozen facial expressions, a sudden cry. Some local fears can be provoked by individual signs of a situation or object that are too intense for the child in terms of their sensory characteristics. Also, local fears can be caused by some kind of danger. The peculiarity of these fears is their rigid fixation - they remain relevant for many years and the specific cause of fears is not always determined. In children of the 3rd group, the causes of fears are determined quite easily; they seem to lie on the surface. Such a child constantly talks about them and includes them in his verbal fantasies. The tendency to master a dangerous situation often manifests itself in such children in the recording of negative experiences from their own experience, the books they read, especially fairy tales. At the same time, the child gets stuck not only on some scary images, but also on individual affective details that slip through the text. Children of the 4th group are fearful, inhibited, and unsure of themselves. They are characterized by generalized anxiety, especially increasing in new situations, when it is necessary to go beyond the usual stereotypical forms of contact, when the level of demands of others in relation to them increases. The most characteristic are fears that grow out of the fear of a negative emotional assessment by others, especially loved ones. Such a child is afraid of doing something wrong, of being “bad,” of not living up to his mother’s expectations.
Along with the above, children with RDA experience a violation of the sense of self-preservation with elements of self-aggression. They can unexpectedly run out onto the roadway, they lack a “sense of edges”, and the experience of dangerous contact with sharp and hot things is poorly consolidated.
All children, without exception, lack a craving for peers and the children's group. When contacting children, they usually experience passive ignoring or active rejection of communication, and lack of response to the name. The child is extremely selective in his social interactions. The constant immersion in internal experiences and the isolation of an autistic child from the outside world hinder the development of his personality. Such a child has extremely limited experience of emotional interaction with other people, he does not know how to empathize, or become infected by the mood of the people around him. All this does not contribute to the formation of adequate moral guidelines in children, in particular the concepts of “good” and “bad” in relation to a communication situation.
FEATURES OF ACTIVITY
Active forms of cognition begin to clearly manifest themselves in normally developing children from the second half of the first year of life. It is from this time that the characteristics of children with RDA become most noticeable, while some of them show general lethargy and inactivity, while others show increased activity: they are attracted by the sensory perceived properties of objects (sound, color, movement), manipulations with them have a stereotypically repetitive nature. Children, grasping objects they come across, do not try to study them by feeling, looking, etc. Actions aimed at mastering specific socially developed ways of using objects do not attract them. In this regard, self-service actions are formed in them slowly and, even when formed, can cause protest in children when trying to stimulate their use.
A game
Children with RDA from an early age are characterized by ignoring toys. Children examine new toys without any desire to manipulate them, or they manipulate selectively, with only one. The greatest pleasure is obtained when manipulating with non-game objects that provide a sensory effect (tactile, visual, olfactory). The play of such children is non-communicative; children play alone, in a separate place. The presence of other children is ignored; in rare cases, the child can demonstrate the results of his play. Role play is unstable and can be interrupted by erratic actions, impulsive role changes, which also do not receive their development (V.V. Lebedinsky, A.S. Spivakovskaya, O.L. Ramenskaya). The game is full of auto-dialogues (talking to oneself). There may be fantasy games when the child transforms into other people, animals, or objects. In spontaneous play, a child with RDA, despite being stuck on the same plots and a large number of simply manipulative actions with objects, is able to act purposefully and interestedly. Manipulative games in children of this category persist into older age.
Educational activities
Any voluntary activity in accordance with a set goal poorly regulates the behavior of children. It is difficult for them to distract themselves from immediate impressions, from the positive and negative “valence” of objects, i.e. on what makes them attractive to the child or makes them unpleasant. In addition, autistic attitudes and fears of a child with RDA are the second reason preventing the formation of educational activities
in all its integral components. Depending on the severity of the disorder, a child with RDA can be educated either in an individual education program or in a mass school program. At school there is still isolation from the community; these children do not know how to communicate and have no friends. They are characterized by mood swings and the presence of new fears already associated with school. School activities cause great difficulties; teachers note passivity and inattention in lessons. At home, children perform tasks only under the supervision of their parents, satiety quickly sets in, and interest in the subject is lost. At school age, these children are characterized by an increased desire for “creativity.” They write poems, stories, compose stories in which they are the heroes. A selective attachment appears to those adults who listen to them and do not interfere with their fantasies. Often these are random, unfamiliar people. But there is still no need for active life together with adults, for productive communication with them. Studying at school does not develop into a leading educational activity. In any case, special correctional work is required to shape the educational behavior of an autistic child, to develop a kind of “learning stereotype.”
PSYCHOLOGICAL DIAGNOSTICS AND CORRECTION FOR EARLY CHILDHOOD AUTISM
In 1978, M. Rutter formulated diagnostic criteria RDA is:
special deep disturbances in social development, manifesting itself outside of connection with the intellectual level;
delay and disturbances in the development of speech not related to the intellectual level;
the desire for constancy, manifested as stereotypical activities with objects, over-predilection for objects of the surrounding reality, or as resistance to changes in the environment; manifestation of pathology up to 48 months of age. Since children in this category are very selective in communication, the possibilities of using experimental psychological techniques are limited. The main emphasis should be placed on the analysis of anamnestic data on the characteristics of the child’s development, obtained through a survey of parents and other representatives of the immediate social environment, as well as on monitoring the child in different situations communication and activity.
Observations of a child according to certain parameters can provide information about his capabilities both in spontaneous behavior and in created interaction situations.
These parameters are:
a more acceptable communication distance for the child;
favorite activities when he is left to his own devices;
methods of examining surrounding objects;
the presence of any stereotypes of everyday skills;
whether speech is used and for what purposes;
behavior in situations of discomfort, fear;
the child’s attitude towards the inclusion of an adult in his activities.
Without determining the level of interaction with the environment that is accessible to a child with RDA, it is impossible to correctly construct the methodology and content of a comprehensive correctional and developmental intervention (Text 2).
An approach to solving the problems of restoring affective connections for such children can be expressed by the following rules.
"!. Initially, in contacts with the child there should be not only pressure, pressure, but even just direct treatment. A child who has a negative experience in contacts should not understand that he is again being drawn into a situation that is habitually unpleasant for him.
2. The first contacts are organized at a level adequate for the child within the framework of the activities in which he is engaged himself.
3. It is necessary, if possible, to include elements of contact in the usual moments of autostimulation of the child with pleasant impressions and thereby create and maintain one’s own positive valence.
4. It is necessary to gradually diversify the child’s usual pleasures, strengthen them with affective contamination of one’s own joy - to prove to the child that it is better to be with a person than without him.
5. The work to restore the child’s need for affective contact can be very long, but it cannot be forced.
6. Only after the child’s need for contact has been consolidated, when an adult becomes for him the positive affective center of the situation, when the child’s spontaneous, explicit appeal to another appears, can one begin to try to complicate the forms of contact.
7. The complication of forms of contact should occur gradually, based on the existing stereotype of interaction. The child must be sure that the forms he has learned will not be destroyed and he will not remain “unarmed” in communication.
8. The complication of contact forms follows the path not so much of offering new variants of it, but of carefully introducing new details into the structure of existing forms.
9. It is necessary to strictly dose affective contacts with the child. Continuing interaction in conditions of mental satiety, when even a pleasant situation becomes uncomfortable for the child, can again extinguish his affective attention to the adult and destroy what has already been achieved.
10. It must be remembered that when an affective connection is achieved with a child, his autistic attitudes are softened, he becomes more vulnerable in contacts and must be especially protected from situations of conflict with loved ones.
11. When establishing affective contact, it is necessary to take into account that this is not the end in itself of the entire correctional work. The task is to establish affective interaction for joint mastery of the surrounding world. Therefore, as contact with the child is established, his affective attention begins to gradually be directed to the process and result of joint contact with the environment.”
Since most autistic children are characterized by fears, the system of correctional work, as a rule, includes special work to overcome fears. For this purpose, play therapy is used, in particular in the “desensitization” version, i.e. gradual “getting used to” the frightening object (text 3).
“...Establishing contact. Despite the individuality of each child, in the behavior of all children who have undergone play therapy, something common stands out in the first sessions. Children are united by a lack of directed interest in toys, refusal to contact the experimenter, weakening of orientation activity, and fear of a new environment. In this regard, in order to establish contact, it was first of all necessary to create conditions for weakening or removing anxiety, fear, instill a sense of security, and produce stable spontaneous activity accessible to the child level. It is necessary to establish contact with the child only in accessible activities.
Methodological techniques used at the first stage of play therapy. Primary importance was attached to the fact that sick children, being unable to communicate at a level normal for their age, showed the preservation of early forms of influence. Therefore, at the first stage of correctional work, these preserved forms of contact were identified, and communication with the child was built on their basis.
Methodological techniques used at the second stage of play therapy. Solving the problems of play therapy at the second stage required the use of different tactics. Now the experimenter, remaining attentive and friendly to the child, was actively involved in his activities, making it clear in every possible way that best form behavior in game room- This is a joint game with an adult. The experimenter’s efforts at this point in therapy are aimed at trying to reduce disordered active activity, eliminate obsessions, limit egocentric speech production or, conversely, stimulate speech activity. It is especially important to emphasize that the formation of sustainable joint activity was carried out not in a neutral, but in a motivated (even pathological) game. In some cases, the simultaneous use of unstructured material and a personally meaningful toy was effective in creating collaborative and purposeful play with the experimenter. In this case, sand or water stabilized the child's erratic activity, and the plot of the game was built around the child's favorite object. Subsequently, new objects were added to play with attractive toys, and the experimenter encouraged the child to act with them. Thus, the range of objects with which children consistently played expanded. At the same time, a transition was made to more advanced methods of interaction, and verbal contacts were formed.
As a result of play activities, in a number of cases it was possible to significantly change the behavior of children. First of all, this was expressed in the absence of any fear or fear. The children felt natural and free, became active and emotional.”
A specific method that has proven itself to be an effective technique for overcoming the main emotional problems in autism is the so-called “holding therapy” method (from English, hold), developed by the American doctor M. Welsh. The essence of the method is that the mother attracts the child to her, hugs him and holds him tightly, being face to face with him, until the child stops resisting, relaxes and looks into her eyes. The procedure can take up to 1 hour. This method is a kind of impetus to begin interaction with the outside world, reduce anxiety, strengthen the emotional connection between the child and the mother, which is why a psychologist (psychotherapist) should not carry out the holding procedure.
With RDA, to a greater extent than with other deviations, the circle of communication is limited to the family, the influence of which can be both positive and negative. In this regard, one of the central tasks of the psychologist is to assist the family in accepting and understanding the child’s problems, developing approaches to “home correction” as an integral component general plan implementation of the correctional and educational program. At the same time, parents of autistic children themselves often need psychotherapeutic help. Thus, the child’s lack of a pronounced desire to communicate, avoidance of eye, tactile and speech contacts can create in the mother a feeling of guilt and uncertainty about the ability to fulfill her maternal role. At the same time, the mother usually acts as the only person through whom the interaction of an autistic child with the outside world is organized. This leads to the formation of increased dependence of the child on the mother, which causes the latter to worry about the possibility of the child’s inclusion in the wider society. Hence the need for special work with parents to develop an adequate, future-oriented strategy for interacting with their own child, taking into account the problems he has at the moment.
An autistic child has to be taught almost everything. The content of classes may include teaching communication and everyday adaptation, school skills, expanding knowledge about the world around us and other people. In elementary school it is reading, natural history, history, then subjects in the humanities and natural sciences. Particularly important for such a child is the study of literature, first children’s, and then classical. What is needed is a slow, careful, emotionally rich mastery of the artistic images of people, circumstances, and logic of their lives contained in these books, awareness of their internal complexity, the ambiguity of internal and external manifestations, and relationships between people. This helps to improve understanding of oneself and others, and reduces the one-dimensionality of autistic children’s perception of the world. The more such a child masters various skills, the more adequate and structurally developed his social role becomes, including school behavior. Despite the importance of all school subjects, educational material delivery programs must be individualized. This is due to the individual and often unusual interests of such children, in some cases their selective talent.
Physical exercise can increase the child’s activity and relieve pathological tension. This child needs a special individual program physical development, combining working techniques in a free, playful and clearly structured form. Labor, drawing, and singing lessons at a young age can also do a lot to adapt such a child to school. First of all, it is in these lessons that an autistic child can get the first impressions that he is working together with everyone, and understand that his actions have a real result.
American and Belgian specialists have developed a special program for “forming a stereotype of independent activity.” As part of this program, the child learns to organize his activities by receiving hints: using a specially structured educational environment - cards with symbols of a particular type of activity, a schedule of activities in visual and symbolic execution. Experience using similar programs
V different types educational institutions show their effectiveness for the development of purposeful activity and independence not only of children with RDA, but also those with other types of dysontogenesis.
Lebedinskaya K. S., Nikolskaya O. S. Diagnosis of early childhood autism. - M., 1991. - P. 39 - 40.
Gilberg K., Peters T. Autism: medical and pedagogical aspects. - St. Petersburg, 1998. - P. 31.
Ethological mechanisms of development are innate, genetically fixed forms of species behavior that provide the necessary basis for survival.
As noted by O.S. Nikolskaya, E.R. Baenskaya, M.M. Liebling, one should not talk about the absence of certain abilities in RDA, for example, the ability to generalize and plan.
For more details, see: Liblipg M.M. Preparation for teaching children with early childhood autism // Defectology. - 1997. - No. 4.
The section uses the experience of GOU No. 1831 in Moscow for children suffering from early childhood autism.
Lebedinsky V.V. Nikolskaya O.V. et al. Emotional disorders in childhood and their correction. - M., 1990. - P. 89-90.
Spivakovskaya A. S. Violations of gaming activity. - M., 1980. - P. 87 - 99.
Few adults think about the role of emotions in life. But when a married couple has children and suddenly it turns out that the baby cannot control his feelings, the parents begin to panic. In fact, a violation of the emotional-volitional sphere is not so serious problem, if detected immediately. You can cure such a disorder either independently or with the help of a qualified doctor.
Causes
What influences the formation of a person’s will and emotions? There are two main reasons that can cause a violation. One of them is heredity, and the other is social circle. The causes of disturbances in the emotional-volitional sphere are discussed in more detail below.
- Impression. If the child does not receive enough impressions and most his life sits at home, his development occurs very slowly. In order for the psyche to develop normally, parents should walk with the child in the yard, show him other children, study trees, and give him the opportunity to play with sand. Impressions form a normal nervous system and help the child learn to experience and then control his emotions.
- Another reason for the disturbance of the emotional volitional sphere is the lack of movement. A child whose parents do not bother themselves much with their child’s development may begin to walk late. Such inhibition of normal physical development leads to inhibited emotional reactions. And some parents tend to realize over time that their child is not walking, but the neighbor’s children are already running. Parents begin to catch up, and the child suffers not only physically, but also psychologically.
- The child may suffer greatly due to the absence mother's love. If a woman does not take her child in her arms, stroke the baby, rock him and sing lullabies to him, the baby will quickly lose contact with his mother. Such a child will grow up inferior, as people say - unloved.
Volitional act
Sphering occurs at an early age. To understand where the failure occurred, you need to find out how the will functions in a normal person. The sequence of decision-making for all people is as follows:
- Emergence of an impulse. A person has an urge to do something.
- Motivation. The person considers what he will receive when the action is completed. Most often, a person receives emotional satisfaction from his action.
- Instrument of activity. It’s not always possible to do an imagined action without additional equipment. Before starting work you have to find everything necessary equipment.
- Decision-making. The person once again thinks about whether he should carry out his plan or not.
- Performing an action. The person carries out his idea.
This process occurs in the head of every person before he takes any action. You should not think that children, due to their undeveloped intelligence, do not carry out such work in their heads. Even our primitive ancestors - monkeys, make volitional efforts in order to perform this or that act.
How is emotional-volitional disorder diagnosed? The spheres of application of human will are varied. A person must move to take something or to eat. If a child is apathetic and doesn’t want anything, it means he has some kind of deviation. The same goes for overly active children who take actions without having time to think about the consequences of their decisions.
Main problems
Depending on the degree of disturbance of the emotional-volitional sphere, the child becomes irritable, lethargic or generative. Parents should notice their child's problems as soon as they appear. Any disease, before settling in the body, manifests itself in symptoms. At this stage, it is necessary to determine the extent of the child’s problems and prescribe treatment. What is the classification of persons with disorders of the emotional-volitional sphere?
- Aggressiveness. Persons behave inappropriately, bully others and take pleasure in tears and humiliation of a weaker opponent. Even children who behave aggressively will never bully someone who is stronger than them. They will logically reason that a harmless creature will not be able to fight back, and therefore can be humiliated.
- Slow reaction. Children cannot immediately understand what the problem is. For example, they may feel hungry, but will not make any effort to ask for food or to get food themselves.
- Disinhibited reaction. The second point in the classification of persons with disorders of the emotional-volitional sphere are people who cannot control their emotions. If they cry, they cry too loudly; if they laugh, they do so for an unnaturally long time.
- Excessive anxiety. Downtrodden children of overactive parents become quiet. They are afraid to talk about their desires and problems. They fail to attract attention due to their weakness of character.
Groups of violations
Classification of disorders of the emotional-volitional sphere is necessary in order to correctly prescribe therapeutic measures. All children are different, and their problems may not be the same. Even children who grow up in the same family can suffer from various ailments. The main groups of disorders of the emotional-volitional sphere:
- Mood disorder. Violation of the emotional-volitional sphere in children often manifests itself in uncontrollable emotions. The child cannot control himself, and therefore his feelings are always on edge. If a baby is happy about something, then soon his state reaches euphoria. If a child is sad, he can easily become depressed. And often one state after an hour turns into another, polar to the original one.
- Unusual behavior. When considering children, one cannot fail to mention deviations from the norm of behavior. Guys can be either too calm or overly active. The first case is dangerous due to the fact that the child is lacking initiative, and the second situation threatens because the child has problems with attention.
- Psychomotor problems. The child suffers from strange surges of feelings that overwhelm him for no reason. For example, a child may complain that he is too scared, although in reality the child is not in danger. Anxiety, impressionability and imaginary behavior are well known to children with a violation of the emotional-volitional sphere and behavior that differs from the generally accepted norm.
External manifestation
Violations can be determined by the baby's behavior.
- Strong dependence on parents. A child who, at five years old, cannot trust the people around him causes a strange reaction. The baby hides behind his mother’s skirt all the time and tries to close himself off from the world. Normal childhood embarrassment is one thing. And something completely different - distrust, unsociability and intractability.
- A child who is neglected in the family will feel lonely. The child will not be able to form relationships normally, since the parents will convince the child that he is stupid, crooked and unworthy of love. The loneliness that such a child will exude will be strongly felt.
- Aggression. Children who lack attention or who want to relieve tension may not withdraw into themselves, but, on the contrary, behave too relaxed. Such children will not restrain their emotions and will try with all their might to attract attention to their person.
Methods
Emotional-volitional disturbances in the personality sphere can be subject to correction. What methods do specialists resort to to correct what parents have wrongly instilled in their child?
- Game therapy. With the help of the game, the rules of adequate behavior in the group are explained to the child. The child develops new neural connections that help transform what he sees in the game and transfer examples to life situations.
- Art therapy. With the help of a drawing you can learn a lot about a child’s personality. A creative work will show the specialist how the baby feels in the garden, in the family and in this world. Drawing helps you relax and feel confident. Other types of art work the same way: modeling, embroidery, design.
- Psychoanalysis. An experienced psychotherapist can help a child reconsider his views on familiar things. The doctor will tell the baby what is good and what is bad. The specialist will act in two ways: suggestion and persuasion.
- Trainings. This method of influence involves working with a group of children who have a common problem. The guys will jointly review their habits and form new ones based on old ones.
Psychoanalytic therapy
Correction of disturbances in the emotional-volitional sphere occurs using various methods. One of them is psychoanalytic therapy. Such therapy can be carried out either individually or in a group. If the child studies alone, the psychotherapist talks to the child about feelings in the form of a game. He asks to portray anger, joy, love, etc. in turn. This is done so that the baby learns to distinguish between his feelings and understand at what moment and what exactly he should feel. Also, individual consultations help the child understand his significance and importance, and what is very necessary in most cases is to feel loved and welcome in the doctor’s office.
In group therapy, the specialist does not have time to play with each child. Therefore, the procedure for restoring the emotional-volitional sphere goes through drawing. Children express their emotions, and then tell why they feel anger, joy, etc. By telling themselves and listening to others, the children begin to realize in what cases what they need to feel and how to correctly express their emotions.
Behavioral therapy
This type of therapy takes place in the form of a game. The child is offered a simulated situation, and he must show how he will behave in it. The game is aimed at developing in the baby those feelings that any normal individual should experience in a given situation. After conducting a game situation to reinforce the material, the presenter must once again explain what exactly was being modeled and how the patient should behave in such a situation. You should definitely get feedback from your child. The child must explain the material he has learned. Moreover, you need to get the child not only to tell you how to behave in a situation, but also to explain why such behavior will be considered acceptable.
Such therapies should be carried out once a week. And for the remaining 7 days, the child must consolidate the material received in class. Since the child will have little interest in his own development, parents should monitor the child’s behavior. And if the child does something differently from the training, mom or dad must repeat the recently completed lesson with their child.
Cognitive behavioral psychotherapy
Persons with emotional-volitional disorders who have reached adulthood also need help, just like children. But it will be difficult to change a teenager with the help of a game. Therefore, you should use What is its essence?
A person is given a situation and several ways to develop it. The teenager must tell what awaits the person who has gone through each of the fictional paths. In this way, the person will better master the situation and understand the essence of the consequences of this or that behavior. In a similar way, you can instill responsibility in teenagers and explain the price with your promise. The formation of new behavioral habits will not happen immediately. It’s one thing to theoretically lose a situation, and quite another to change your character.
The older a person is, the less chance he has of making internal changes. Therefore, the specialist who conducts classes with a teenager must positively reinforce the patient’s successes and focus on any positive changes. People who suffer from a disorder of the emotional-volitional sphere are subject to self-criticism and it is very important for them to hear approving words from adults and respected people.
Gestalt therapy
Such therapy allows the child to expand his feelings, or rather develop them. The specialist’s task is to transform the child’s inadequate reactions into ones that will be acceptable to society. How does the transformation process work? The specialist identifies a problem, such as excessive aggression, which the child expresses by beating his opponent. The doctor should tell the child that his way of solving the problem is ineffective, and in return offer more civilized methods of expressing emotions. For example, a verbal form of expressing your dissatisfaction. Then you need to play out the situation with the child. After your child loses his temper, you should remind him of the recent conversation and ask him to express his feelings in words.
The child's anger should decrease over time as the task will seem too difficult at first. Over time, the baby should get used to the new strategy for expressing aggression. And in order for the learned material to be better understood, the child needs to be constantly reminded of the lesson completed. And it is advisable for the child to see similar methods in adults. For example, when mom and dad quarrel, they should not shout at each other, but calmly and measuredly express dissatisfaction with one or another offense of their spouse.
– these are symptoms of a violation of the purposefulness of activity, represented by weakening, absence, intensification and distortion of voluntary activity. Hyperbulia is manifested by extraordinary determination and hasty actions. Hypobulia is a pathological decrease in volitional abilities, accompanied by lethargy, passivity, and inability to carry out plans. With abulia, a complete loss of desires and motivations is determined. Variants of parabulia are stupor, stereotypies, negativism, echopraxia, echolalia, catalepsy. Diagnosis is made through conversation and observation. Treatment is medicinal and psychotherapeutic.
ICD-10
F60.7 Dependent personality disorder
General information
Will is a mental function that ensures a person’s ability to consciously control his emotions, thoughts and actions. The basis of purposeful activity is motivation - a set of needs, motivations, desires. An act of will unfolds in stages: a motivation and a goal are formed, ways to achieve a result are realized, a struggle of motives unfolds, a decision is made, an action is carried out. If the volitional component is violated, the stages decrease, intensify or distort. The prevalence of volitional disorders is unknown due to the fact that mild deviations do not come to the attention of doctors, and more pronounced ones are found in a wide range of diseases - neurological, mental, general somatic.
Causes
Mild volitional disorders are considered as features of the emotional-personal sphere, determined by the type of higher nervous activity, conditions of upbringing, the nature of interpersonal relationships. For example, children who are often ill find themselves in a situation of overprotection from parents, teachers, and peers, and as a result, their strong-willed qualities are weakened. The reasons for pronounced changes in will are:
- Depressive disorders. A decrease in willpower up to the complete absence of impulses is observed with endogenous depression. In neurotic and symptomatic forms, the intention is preserved, but the implementation of the action is inhibited.
- Schizophrenia. Weakening of volitional operations – characteristic feature schizophrenic defect. Patients with schizophrenia are suggestible, fall into a catatonic stupor, and are prone to stereotypies and echolalia.
- Psychopathic disorders. Disorders of the will can be the result of improper upbringing or sharpened character traits. Dependence on others, uncertainty and subordination are determined in persons with anxious, suspicious, hysterical traits, prone to alcoholism and drug addiction.
- Manic states. An increased desire for activity, a high speed of decision-making and their implementation are diagnosed in people with bipolar affective disorder in the manic phase. Also severe symptoms develop during hysterical attacks.
- Organic pathologies of the brain. Damage to the central nervous system is accompanied by a decrease in all components of volitional activity. Hypobulia and abulia are found in encephalitis, consequences of head injury and intoxication.
Pathogenesis
The neurophysiological basis of volitional disorders is a change in the complex interactions of various brain structures. In case of damage or underdevelopment frontal regions There is a violation of focus, a decrease in the ability to plan and control complex actions. An example is teenagers who have many desires, needs, and energy to satisfy them, but do not have sufficient persistence and perseverance. The pathology of the pyramidal tract is manifested by the inability to perform voluntary actions - paralysis, paresis, and tremors occur. This is a physiological (not mental) level of change in voluntariness.
The pathophysiological basis of willpower disorders may be dysfunction or damage to the reticular formation, which provides energy supply to cortical structures. In such cases, the first stage of the volitional act is disrupted - the formation of motives and motivation. In patients with depression and organic lesions The central nervous system has a reduced energy component, they do not want to act, they do not have goals and needs that motivate them to be active. Manic patients, on the contrary, are overly excited, ideas quickly replace each other, and planning and control of activities are insufficient. In schizophrenia, the hierarchy of motives is distorted; changes in perception and thinking make it difficult to plan, evaluate and control actions. Energy processes are reduced or increased.
Classification
Violations of volitional acts refer to the pathology of the effector link - the system that transmits information from the central nervous system to the executive systems. In clinical practice, it is customary to classify these disorders according to the nature of the symptoms: hypobulia (weakening), abulia (absence), hyperbulia (intensification) and parabulia (distortion). According to the stages of a voluntary act, seven groups of volitional pathologies are distinguished:
- Disorder of voluntary acts. A person cannot perform actions whose results are not obvious or distant in time. In particular, he cannot learn complex skills, save money for large purchases in the future, or perform altruistic acts.
- Coping disorder. The accomplishment of the plan may be hindered by physical barriers, social conditions, novelty of the situation, or the need for search. Patients cannot make efforts to overcome even minor difficulties and quickly give up on their plans: if they fail in exams, graduates do not try to re-enter universities, depressed patients are left without lunch, since the need to prepare food becomes an obstacle.
- Conflict coping disorder. It is based on the incompatibility of actions, the need to choose one of the goals. Clinically, the disorder is manifested by the inability to make a choice, avoidance of decision-making, shifting this function to surrounding people or chance (fate). In order to begin to act at least somehow, patients perform “rituals” - tossing a coin, using nursery rhymes, connecting a random event with a certain decision option (if a red car passes, I’ll go to the store).
- Premeditation disorder. The strength, speed or pace of action changes pathologically, the inhibition of inadequate motor and emotional reactions is impaired, the organization of mental activity and the ability to resist reflex acts are weakened. Examples: autonomous limb syndrome with loss of motor control of the hand, affective explosiveness in psychopathy, preventing the achievement of goals.
- Disorder with automatisms, obsessions. Automated actions are pathologically easily developed and control over them is lost. Obsessions are perceived as one's own or alien. In practice, this manifests itself as difficulty in changing habits: the same route to work, the same breakfasts. At the same time, adaptive abilities decrease, and in changing conditions people experience severe stress. Intrusive thoughts and actions cannot be changed by willpower. Patients with schizophrenia lose control not only over behavior, but also over their own personality (alienation of the self).
- Disorder of motives and drives. The feeling of primary attraction, natural urge at the level of instinct and purposeful act is distorted. The idea of the means and consequences of achieving a goal, the awareness of voluntariness as a natural human ability changes. This group includes psychopathological phenomena in eating disorders and sexual disorders.
- Disorder of prognostic functions. Patients have difficulty anticipating the outcome and secondary effects of their own activities. Symptoms are caused by a decrease in the function of predicting and assessing objective conditions. This variant of the disorder partially explains the hyperactivity and determination of adolescent manic patients.
Symptoms of volitional disorders
The clinical picture is varied, represented by strengthening, distortion, weakening and absence of voluntary functions. Hypobulia – decreased volitional activity. The strength of motives and motivations is weakened, setting a goal and maintaining it is difficult. The disorder is typical for depression and long-term somatic illnesses. Patients are passive, lethargic, not interested in anything, sit or lie for a long time without changing posture, and are unable to begin and continue purposeful action. They need treatment control and constant stimulation to perform simple everyday tasks. Lack of will is called abulia. Urges and desires are completely absent, patients are absolutely indifferent to what is happening, inactive, do not talk to anyone, do not make any effort to eat or go to the toilet. Abulia develops with severe depression, schizophrenia (apatoabulic syndrome), senile psychoses, and damage to the frontal lobes of the brain.
With hyperbulia, patients are overly active, full of ideas, desires, and aspirations. They have a pathologically relieved determination, a readiness to act without thinking through the plan and taking into account the consequences. Patients are easily involved in any ideas, begin to act under the influence of emotions, and do not coordinate their activities with objective conditions, tasks, and the opinions of other people. When mistakes are made, they do not analyze them and do not take them into account in subsequent activities. Hyperbulia is a symptom of manic and delusional syndrome, some somatic diseases, and can be provoked by taking medications.
Perversion of the will is represented by parabulia. They manifest themselves in strange, absurd behaviors: eating sand, paper, chalk, glue (parorexia), sexual perversions, a desire for arson (pyromania), a pathological attraction to theft (kleptomania) or vagrancy (dromomania). A significant portion of parabulia are motor control disorders. They are part of syndromes characterized by disturbances of movement and will. A common variant is catatonia. With catatonic excitement, sudden attacks of rapid, inexplicable frenzy or nothing motivated actions with inadequacy of affect. The enthusiastic exaltation of patients is quickly replaced by anxiety, confusion, and fragmented thinking and speech. The main symptom of catatonic stupor is absolute immobility. More often, patients freeze while sitting or lying in the fetal position, less often - standing. There are no reactions to surrounding events and people, contact is impossible.
Another form of motor-volitional disorders is catalepsy (waxy flexibility). The arbitrariness of active movements is lost, but pathological subordination to passive ones is observed - any posture given to the patient is maintained for a long time. With mutism, patients are silent and do not establish verbal contact while the physiological component of speech is preserved. Negativism is manifested by meaningless opposition, unmotivated refusal to perform expedient actions. Sometimes it is accompanied by the opposite activity. Characteristic of children during periods of age-related crises. Stereotypes are monotonous monotonous repetitions of movements or rhythmic repetition of words, phrases, syllables. Patients with passive obedience always follow the orders of others, regardless of their content. With echopraxia, there is a complete repetition of all the actions of another person, with echolalia - a complete or partial repetition of phrases.
Complications
If prolonged and untreated, volitional disorders can become dangerous to the health and life of the patient. Hypobulic symptoms interfere with professional activities and become grounds for dismissal. Abulia leads to weight loss, exhaustion of the body, infectious diseases. Hyperbulia is sometimes the cause of illegal actions, as a result of which patients are brought to administrative and criminal liability. Among parabulia, the most dangerous is the perversion of the instinct of self-preservation. It appears when severe course anorexia, the development of suicidal behavior and is accompanied by a risk of death.
Diagnostics
The main method of examining patients with volitional disorders remains clinical and anamnestic analysis. The psychiatrist needs to find out whether neurological diseases(study of outpatient records, neurologist notes), mental disorders and hereditary burden. The collection of information is carried out in the presence of relatives, because the patients themselves are not always able to maintain productive contact. During the diagnosis, the doctor differentiates disorders of volition with the characterological traits of the psychasthenic and excitable/hyperthymic type. In these cases, deviations in emotional-volitional reactions are the result of upbringing and are built into the structure of the personality. Methods for studying the volitional sphere include:
- Clinical conversation. In direct communication with the patient, the psychiatrist determines the preservation of a critical attitude towards the disease, the ability to establish contact, and maintain the topic of conversation. Hypobulia is characterized by poor speech, long pauses; for hyperbulia – asking again, quickly changing the direction of the conversation, an optimistic view of problems. Patients with parabulia provide information distorted, the motive of their communication differs from the motives of the doctor.
- Observation and experiment. To obtain more varied information, the doctor asks the patient to perform simple and complex tasks - take a pencil and a piece of paper, stand up and close the door, fill out a form. Disorders of the will are evidenced by changes in expressiveness, accuracy and speed of movements, the degree of activity and motivation. With hypobulic disorders, task performance is difficult, motor skills are slow; with hyperbulic - speed is high, but focus is reduced; with parabulia, the patient’s answers and reactions are unusual and inadequate.
- Specific questionnaires. In medical practice, the use of standardized methods for studying volitional deviations is not widespread. In the context of a forensic psychiatric examination, questionnaires are used that make it possible to objectify the data obtained to a certain extent. An example of such a technique is the Normative Scale for the Diagnostics of Volitional Disorders. Its results indicate the characteristics of volitional and affective deviations and the degree of their severity.
Treatment of volitional disorders
Violations of volitional functions are treated in combination with the underlying disease that caused them. Selection and appointment therapeutic activities a psychiatrist and a neurologist are involved. As a rule, treatment is carried out conservatively with the use of medications, and in some cases, psychotherapy. Rarely, for example, with a brain tumor, the patient needs surgery. The general treatment regimen includes the following procedures:
- Drug treatment. With a decrease in willpower, a positive effect can be achieved by using antidepressants and psychostimulants. Hyperbulia and some types of parabulia are corrected with the help of antipsychotics, tranquilizers, and sedatives. Patients with organic pathology are prescribed vascular drugs and nootropics.
- Psychotherapy. Individual and group sessions are effective for pathologies of the volitional and affective sphere due to psychopathic and neurotic personality disorders. Patients with hypobulia are shown cognitive and cognitive-behavioral directions, psychoanalysis. Hyperbulic manifestations require mastering relaxation, self-regulation (auto-training), improving communication skills, and the ability to cooperate.
- Physiotherapy. Depending on the prevailing symptoms, procedures are used that stimulate or reduce the activity of the nervous system. Low-frequency current therapy and massages are used.
Prognosis and prevention
If you consult a doctor in a timely manner and strictly follow his prescriptions, the prognosis for volitional disorders is favorable - patients return to their usual lifestyle, and the ability to regulate their own actions is partially or completely restored. It is quite difficult to prevent disorders; prevention is based on preventing the causes - mental illness, damage to the central nervous system. Maintaining a healthy lifestyle, drawing up correct mode day. Another way to prevent disorders is regular examinations for early detection of the disease and preventive medication.
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