Mental retardation in children (the disease is often referred to as mental retardation) is a slow pace of improvement of certain mental functions: thinking, emotional-volitional sphere, attention, memory, which lags behind generally accepted norms for a particular age.
The disease is diagnosed in the preschool or primary school period. It is most often discovered during pre-entry testing before school entry. Expressed in limited ideas, lack of knowledge, inability to intellectual activity, the predominance of playful, purely childish interests, immaturity of thinking. In each individual case, the causes of the disease are different.
In medicine, they are determined different reasons delayed mental development in children:
1. Biological:
- pregnancy pathologies: severe toxicosis, intoxication, infections, injuries;
- prematurity;
- asphyxia during childbirth;
- infectious, toxic, traumatic diseases at an early age;
- genetic predisposition;
- trauma during childbirth;
- lagging behind peers in physical development;
- somatic diseases (disturbances in the functioning of various organs);
- damage to certain areas of the central nervous system.
2. Social:
- restriction of life activity for a long time;
- mental trauma;
- unfavorable living conditions;
- pedagogical neglect.
Depending on the factors that ultimately led to mental retardation, several types of disease are distinguished, on the basis of which a number of classifications have been compiled.
Types of mental retardation
In medicine, there are several classifications (domestic and foreign) of mental retardation in children. The most famous are M. S. Pevzner and T. A. Vlasova, K. S. Lebedinskaya, P. P. Kovalev. Most often in modern domestic psychology use the classification of K. S. Lebedinskaya.
- Constitutional ZPR determined by heredity.
- Somatogenic ZPR acquired as a result of a previous disease that affected the child’s brain functions: allergies, chronic infections, dystrophy, dysentery, persistent asthenia, etc.
- Psychogenic mental retardation determined by socio-psychological factors: such children are brought up in unfavorable conditions: monotonous environment, narrow circle of friends, lack of maternal love, poverty of emotional relationships, deprivation.
- Cerebral-organic mental retardation observed in cases of serious pathological abnormalities in brain development and is most often determined by complications during pregnancy (toxicosis, viral diseases, asphyxia, alcoholism or drug addiction of parents, infections, birth injuries, etc.).
Each of the types according to this classification differs not only in the causes of the disease, but also in symptoms and course of treatment.
Symptoms of mental retardation
A diagnosis of mental retardation can be made with confidence only at the threshold of school, when obvious difficulties arise in preparing for the educational process. However, with careful monitoring of the child, symptoms of the disease can be noticed earlier. These may include:
- skills and abilities lagging behind peers: the child cannot perform the simplest actions characteristic of his age (putting on shoes, dressing, personal hygiene skills, eating independently);
- unsociability and excessive isolation: if he avoids other children and does not participate in common games, this should alert adults;
- indecision;
- aggressiveness;
- anxiety;
- During infancy, such children begin to hold their heads later, take their first steps, and speak.
With mental retardation in children, manifestations are equally possible mental retardation and signs of disturbance in the emotional-volitional sphere, which is very important for the child. Often there is a combination of them. There are cases when a child with mental retardation is practically no different from the same age, but most often the retardation is quite noticeable. The final diagnosis is made by a pediatric neurologist during a targeted or preventive examination.
Differences from mental retardation
If by the end of junior (4th grade) school age signs of mental retardation remain, doctors begin to talk about either mental retardation (MR) or constitutional infantilism. These diseases are different:
- with mental and intellectual underdevelopment, mental and intellectual underdevelopment is irreversible; with mental retardation, everything can be corrected with the proper approach;
- children with mental retardation differ from mentally retarded children in their ability to use the help that is provided to them and independently transfer it to new tasks;
- a child with mental retardation tries to understand what he read, whereas with LD there is no such desire.
There is no need to give up when making a diagnosis. Modern psychology and pedagogy can offer comprehensive assistance to such children and their parents.
Treatment of mental retardation in children
Practice shows that children with mental retardation may well become students of ordinary secondary school, and not a special correctional one. Adults (teachers and parents) must understand that the difficulties of teaching such children at the very beginning school life- is not at all the result of their laziness or negligence: they have objective, sufficient serious reasons, which must be jointly and successfully overcome. Such children should be provided with comprehensive assistance from parents, psychologists, and teachers.
It includes:
- individual approach to each child;
- classes with a psychologist and a teacher of the deaf (who deals with children’s learning problems);
- in some cases - drug therapy.
Many parents find it difficult to accept the fact that their child, due to his developmental characteristics, will learn slower than other children. But this needs to be done to help the little schoolchild. Parental care, attention, patience, coupled with qualified assistance from specialists (teacher-defectologist, psychotherapist) will help provide him with targeted upbringing and create favorable conditions for learning.
The listed characteristics of students with somatogenic mental retardation are a serious obstacle to their learning. Frequent absences due to illness, “switching off” of such a child as fatigue increases from educational process, disinterest in studying put him in the category of persistently underachieving schoolchildren.
Children with somatogenic mental retardation need systematic medical and pedagogical assistance. It is most advisable to place such a child in schools sanatorium type, in their absence - in the class of compensatory training; if there is none, it is necessary to create a protective medication-pedagogical regime in the conditions of an ordinary class.
ZPR of psychogenic origin
Children in this group have normal physical development and are somatically healthy. According to research, most of these children have brain dysfunction. Their mental infantilism is caused by a socio-psychological factor - unfavorable upbringing conditions. A striking example is children raised in an orphanage. Emotional deprivation (deprivation of maternal warmth, emotional richness of relationships), monotony of the social environment and contacts, deprivation, weak individual intellectual stimulation often lead to a slowdown in the rate of mental development of the child; as a result - a decrease in intellectual motivation, superficiality of emotions, lack of independence of behavior, infantilism of attitudes and relationships.
Often the focus of the formation of this childhood anomaly is dysfunctional families: asocial-permissive and authoritarian-conflict. In an asocially permissive family, a child grows up in an atmosphere of complete neglect, emotional rejection combined with permissiveness. Parents, with their lifestyle (drunkenness, promiscuity, disorder, theft) stimulate efficiency (impulsive, explosive reactions), weak-willed adherence to impulses, involuntary behavior, and extinguish intellectual activity. Such conditions of upbringing become a long-term psychotraumatic factor, contributing to the accumulation of traits of mental infantilism in a spectacularly unstable, excitable form. This condition is often fertile ground for the formation of persistent antisocial attitudes, i.e. pedagogical neglect. In an authoritarian-conflict family, the child’s life sphere is saturated with quarrels and conflicts. Between adults. The main form of parental influence - Suppression and punishment - systematically traumatizes the child’s psyche; it accumulates traits of passivity, lack of independence, downtroddenness, and increased anxiety. The child develops mental infantilism of the asthenic inhibitory type.
The problem of underachievement of a certain part of primary secondary school students has long attracted the attention of teachers, psychologists, doctors and sociologists. They identified a certain group of children who could not be classified as mentally retarded, since within the limits of existing knowledge they showed a sufficient ability to generalize, a wide “zone of proximal development.” These children were classified as a special category - children with mental retardation.
M.S. Pevzner and T.A. Vlasova (1968, 1973) drew attention to the role of emotional development in the formation of the personality of a child with mental retardation, as well as to the significance of neurodynamic disorders (asthenic and cerebrasthenic conditions). Accordingly, mental retardation was identified, arising on the basis of mental and psychophysical infantilism associated with harmful effects on the central nervous system during pregnancy, and the delay that occurs in the early stages of a child’s life as a result of various pathogenic factors leading to asthenic and cerebrasthenic conditions of the body.
As a result of further research work by K.S. Lebedinskaya proposed a classification of types of mental retardation according to the etiopathogenetic principle:
Each of these types can be complicated by a number of painful somatic, encephalopathic, neurological symptoms, and has its own clinical and psychological structure, its own characteristics of emotional immaturity and cognitive impairment, and its own etiology.
Mental retardation (MDD)- syndrome of temporary lag in the development of the psyche as a whole or its individual functions, a slowdown in the rate of realization of the body’s potential capabilities, often detected upon entering school and is expressed in an insufficient general stock of knowledge, limited ideas, immaturity of thinking, low intellectual focus, predominance of gaming interests, rapid satiation in intellectual activity
The causes of PPD can be divided into two large groups:
Biological reasons include:
Among the reasons of a socio-psychological nature The following are distinguished:
The basis of ZPR is the interaction of biological and social causes. In the taxonomy of ZPR Vlasova T.A. and Pevzner M.S. There are two main forms:
Infantilism is a violation of the rate of maturation of the most late-forming brain systems. Infantilism can be harmonious (associated with a functional disorder, immaturity of the frontal structures) and disharmonious (due to organic phenomena of the brain);
Asthenia is a sharp weakening of a somatic and neurological nature, caused by functional and dynamic disorders of the central nervous system. Asthenia can be somatic and cerebral-asthenic (increased exhaustion of the nervous system).
Let us describe in more detail each of the types of ZPR.
Mental retardation of constitutional origin – so-called harmonious infantilism (uncomplicated mental and psychophysical infantilism, according to the classification of M.S. Pevzner and T.A. Vlasova), in which the emotional-volitional sphere is, as it were, at an earlier stage of development, in many ways reminiscent normal structure emotional makeup of younger children. Characterized by the predominance of emotional motivation for behavior, heightened background mood, spontaneity and brightness of emotions with their superficiality and instability, easy suggestibility. Difficulties in learning, often observed in these children in the lower grades, are associated with the immaturity of the motivational sphere and the personality as a whole, and the predominance of gaming interests. Harmonic infantilism is, as it were, a nuclear form of mental infantilism, in which the features of emotional-volitional immaturity appear at their most pure form and are often combined with an infantile body type. Such harmony of psychophysical appearance, the presence of family cases, non-pathological mental characteristics suggest a predominantly congenital constitutional etiology of this type of infantilism. However, often the origin of harmonious infantilism can be associated with minor metabolic and trophic disorders in utero or the first years of life. Under favorable conditions, these children show good alignment results.
This group also includes:
Mental retardation of somatogenic origin. This type of developmental anomaly is caused by long-term somatic failure of various origins: chronic infections and allergic conditions, congenital and acquired malformations of the somatic sphere, primarily the heart. In slowing down the rate of mental development of children, a significant role belongs to persistent asthenia* , reducing not only general, but also mental tone. Often there is also a delay in emotional development - somatogenic infantilism, caused by a number of neurotic layers - uncertainty, fearfulness associated with a feeling of physical inferiority, and sometimes caused by a regime of prohibitions and restrictions in which a somatically weakened or sick child is located.
In an asthenic state, a child is not able to cope with the educational load. Often appear following signs fatigue:
Mental retardation of psychogenic origin associated with unfavorable upbringing conditions that prevent the correct formation of the child’s personality. As is known, unfavorable environmental conditions that arise early, have a long-term effect and have a traumatic effect on the child’s psyche can lead to persistent changes in his neuropsychic sphere, disruption first of autonomic functions, and then of mental, primarily emotional development. In such cases we are talking about pathological (abnormal) personality development.
This type of mental retardation should be distinguished from the phenomena of pedagogical neglect, which does not represent a pathological phenomenon, and a deficit of knowledge and skills due to a lack of intellectual information.
Mental retardation of psychogenic origin is observed primarily with abnormal personality development according to the type of mental instability, most often caused by the phenomenon hypoprotection – conditions of neglect, under which the child does not develop a sense of duty and responsibility, forms of behavior associated with the active inhibition of affect. The development of cognitive activity, intellectual interests and attitudes is not stimulated. Therefore, the features of pathological immaturity of the emotional-volitional sphere in the form of affective lability, impulsiveness, and increased suggestibility in these children are often combined with an insufficient level of knowledge and ideas necessary for mastering school subjects.
Option abnormal development personality type "family idol" caused, on the contrary, overprotective-pampering education. In which the child is not instilled with the traits of independence, initiative, and responsibility. This psychogenic infantilism, along with a low capacity for volitional effort, is characterized by features of egocentrism and selfishness, dislike of work, and an attitude towards constant help and guardianship.
A variant of pathological personality development of the neurotic type is more often observed in children whose parents show rudeness, cruelty, despoticism, and aggression towards the child and other family members. The so-called type "Cinderella". In such an environment, a timid, fearful personality is often formed, whose emotional immaturity manifests itself in insufficient independence, indecision, little activity and initiative, and subsequently leads to maladjustment.
Child development in conditions contradictory upbringing. Children are forced to adapt to adults, which leads to a lack of core attitudes and the formation of an unstable personality.
Mental retardation of cerebral-organic origin occurs more often than other described stages and often has great persistence and severity of disturbances both in the emotional-volitional sphere and in cognitive activity and occupies the main place in this developmental anomaly. A study of the anamnesis shows the presence of mild organic insufficiency of the nervous system, often of a residual nature due to the pathology of pregnancy (severe toxicosis, infections, intoxication and trauma, incompatibility of the blood of mother and fetus according to the Rh factor), prematurity, asphyxia and trauma during childbirth, postnatal neuroinfections , toxic-dystrophic diseases of the first years of life.
Anamnestic data often indicate a slowdown in the change of age-related phases of development: a delay in the formation of static functions, walking, speech, neatness skills, and stages of play activity.
In a somatic state along with common symptoms delays physical development(underdevelopment of muscles, insufficiency of muscle and vascular tone, growth retardation) general malnutrition is often observed, which does not allow us to exclude the pathogenetic role of disorders of autonomic regulation; may be observed and different kinds body dysplasticity. In the neurological condition, hydrocephalic and sometimes hypertensive stigmas (local areas with increased intracranial pressure), and the phenomenon of vegetative-vascular dystonia are often encountered.
Cerebral-organic insufficiency primarily leaves a typical imprint on the structure of the mental retardation itself - both on the characteristics of emotional-volitional immaturity, and on the nature of cognitive impairment. Emotional-volitional immaturity is represented organic infantilism. Children lack the liveliness and brightness of emotions typical of a healthy child; characterized by weak interest in evaluation, low level claims. Suggestibility has a rough connotation and is often accompanied by a lack of criticism. Gaming activity is characterized by poverty of imagination and creativity, monotony and monotony. The very desire to play often looks like a way to avoid difficulties in classes. Often, activities that require targeted intellectual activity, such as preparing homework, turn into a game.
Depending on the predominance of one or another emotional background, two main types of organic infantilism can be distinguished: unstable – with psychomotor disinhibition, euphoric mood and impulsiveness and braked – with a predominance of low mood, indecision, timidity.
This type of mental retardation is characterized by disturbances in cognitive activity caused by insufficient attention, memory, inertia of mental processes, their slowness and reduced switchability, as well as insufficiency of individual cortical functions.
Psychological and pedagogical research conducted at the Research Institute of Defectology of the Academy of Pedagogical Sciences of the USSR under the leadership of V.I. Lubovsky, state that these children have instability of attention, insufficient development of phonemic hearing, visual and tactile perception, optical-spatial synthesis, motor and sensory aspects of speech, long-term and short-term memory, hand-eye coordination, automation of movements and actions. Often there is poor orientation in “right-left”, phenomena of mirroring in writing, and difficulties in distinguishing similar graphemes.
General psychological and pedagogical characteristics of children with delaysmental development
Depending on the origin (cerebral, constitutional, somatogenic, psychogenic), as well as on the time of exposure of the child’s body to harmful factors, mental retardation gives rise to different types of deviations in the emotional-volitional sphere and cognitive activity. As a result of studying the mental processes and learning opportunities of children with mental retardation, a number of specific features were identified in their cognitive, emotional-volitional sphere, behavior and personality in general. The following common features for mental retardation of various etiologies were identified:
Memory: Insufficient formation cognitive processes is often the main reason for the difficulties that children with mental retardation experience when learning at school. As numerous clinical and psychological-pedagogical studies show, memory impairments play a significant role in the structure of mental activity defects in this developmental anomaly.
Observations of teachers and parents of children with mental retardation, as well as special psychological studies indicate shortcomings in the development of their involuntary memory. Much of what normally developing children remember easily, as if by itself, causes significant effort among their lagging peers and requires specially organized work with them.
One of the main reasons for the insufficient productivity of involuntary memory in children with mental retardation is decrease in their cognitive activity. In a study by T.V. Egorova (1969), this problem was subjected to special study. One of the experimental methods used in the work involved the use of a task, the purpose of which was to arrange pictures with images of objects into groups in accordance with the initial letter of the name of these objects. It was found that children with developmental delays not only reproduced verbal material worse, but also spent significantly more time recalling it than their typically developing peers. The main difference was not so much in the extraordinary productivity of the answers, but in the different attitude towards the goal. Children with mental retardation made almost no attempts on their own to achieve more complete recall and rarely used auxiliary techniques for this. In cases where this did happen, a substitution of the purpose of the action was often observed. The auxiliary method was not used for recall the right words, starting with a specific letter, and for inventing new (extraneous) words starting with the same letter.
In the study by N.G. Poddubnaya studied the dependence of the productivity of involuntary memorization on the nature of the material and the characteristics of activities with it in primary schoolchildren with mental retardation. The subjects had to establish semantic connections between units of the main and additional sets of words and pictures (in different combinations). Children with mental retardation showed difficulties in assimilating instructions for series that required independent selection of nouns that matched the meaning of the pictures or words presented by the experimenter. Many children did not understand the task, but were eager to quickly receive the experimental material and begin to act. At the same time, they, unlike normally developing preschoolers, could not adequately assess their capabilities and were confident that they knew how to complete the task. Clear differences were revealed both in productivity and in the accuracy and stability of involuntary memorization. The amount of correctly reproduced material was normally 1.2 times higher.
N.G. Poddubnaya notes that visual material is remembered better than verbal material and in the process of reproduction is a more effective support. The author points out that involuntary memory in children with mental retardation does not suffer to the same extent as voluntary memory, therefore it is advisable to teach it widely.4
TA. Vlasova, M.S. Pevzner point to a decrease in voluntary memory in students with mental retardation as one of the main reasons for their difficulties in school learning. These children do not remember texts well: the multiplication tables; they do not keep the goal and conditions of the task in mind. They are characterized by fluctuations in memory productivity and rapid forgetting of what they have learned.
Specific features of the memory of children with mental retardation:
Reduced memory capacity and memorization speed,
Involuntary memorization is less productive than normal,
The memory mechanism is characterized by a decrease in the productivity of the first attempts at memorization, but the time required for complete memorization is close to normal,
The predominance of visual memory over verbal memory,
Reduced random memory.
Mechanical memory impairment.
Attention: Causes of impaired attention:
The asthenic phenomena present in the child have an influence.
Immaturity of the mechanism of voluntariness in children.
Lack of motivation, the child shows good concentration of attention when it is interesting, and when it is necessary to show a different level of motivation - a violation of interest.
Researcher of children with mental retardation L.M. Zharenkova notes the following features of attention characteristic of this disorder:
Low concentration: the child’s inability to concentrate on a task, on any activity, rapid distractibility. In the study by N.G. Poddubnaya clearly demonstrated the peculiarities of attention in children with ZPR: During the entire experimental task, cases of fluctuations in attention, a large number of distractions, rapid exhaustion and fatigue were observed.
Low level of attention stability. Children cannot engage in the same activity for a long time.
Voluntary attention is more severely impaired. IN correctional work With these children, it is necessary to attach great importance to the development of voluntary attention. To do this, use special games and exercises (“Who is more attentive?”, “What’s missing on the table?” and so on). In progress individual work apply techniques such as drawing flags, houses, working according to a model, etc.
Perception. Causes of impaired perception : with ZPR impaired integrative activities cerebral cortex, cerebral hemispheres and, as a result, the coordinated work of various analyzer systems is disrupted: hearing, vision, motor system, which leads to disruption of systemic mechanisms of perception.
Disadvantages of perception:
The teacher’s task is to help a child with mental retardation organize the processes of perception and teach him to reproduce the subject purposefully. On the first academic year In teaching, an adult guides the child’s perception during the lesson; at an older age, children are offered a plan for their actions. To develop perception, children are offered material in the form of diagrams and colored chips.
Features of mental activity of children with mental retardation
This problem was studied by U.V. Ulienkova, T.V. Egorova, T.A. Strekalova and others. The thinking of children with mental retardation is more intact than that of mentally retarded children; the ability to generalize, abstract, accept help, and transfer skills to other situations is more preserved.
The development of thinking is influenced by all mental processes:
In children with mental retardation, all these prerequisites for the development of thinking are impaired to one degree or another. Children have difficulty concentrating on a task. These children have impaired perception, they have a rather meager experience in their arsenal - all this determines the thinking characteristics of a child with mental retardation.
That aspect of cognitive processes that is disrupted in a child is associated with a violation of one of the components of thinking.
Children with mental retardation suffer from coherent speech and the ability to plan their activities using speech is impaired; inner speech is impaired - active agent child's logical thinking.
General deficiencies in the mental activity of children with mental retardation:
Lack of formation of cognitive, search motivation (a peculiar attitude towards any intellectual tasks). Children tend to avoid any intellectual effort. For them, the moment of overcoming difficulties is unattractive (refusal to perform a difficult task, replacement of an intellectual task with a closer, playful task.). Such a child does not complete the task completely, but only a simpler part of it. Children are not interested in the outcome of the task. This feature of thinking manifests itself at school, when children very quickly lose interest in new subjects.
Lack of a pronounced orientation stage when solving mental problems. Children with mental retardation begin to act immediately, on the fly. This position was confirmed in the experiment of N.G. Poddubny. When presented with instructions for the task, many children did not understand the task, but sought to quickly obtain the experimental material and begin to act. It should be noted that children with mental retardation are more interested in finishing their work as quickly as possible, rather than in the quality of the task. The child does not know how to analyze conditions and does not understand the significance of the orientation stage, which leads to many errors. When a child begins to learn, it is very important to create conditions for him to initially think and analyze the task.
3. Low mental activity, “mindless” style of work (children, due to haste and disorganization, act at random, without fully taking into account the given conditions; there is no directed search for a solution or overcoming difficulties). Children solve a problem on an intuitive level, that is, the child seems to give the answer correctly, but cannot explain it.
4. Stereotypic thinking, its stereotyped nature.
Visual-figurative thinking.
Children with mental retardation find it difficult to act according to a visual model due to violations of analysis operations, violation of integrity, focus, activity of perception - all this leads to the fact that the child finds it difficult to analyze the model, identify the main parts, establish the relationship between parts and reproduce this structure in the process of his own activities.
Logical thinking.
Children with mental retardation have impairments in the most important mental operations, which serve as components of logical thinking:
In all children with mental retardation, the level of logical thinking lags significantly behind the level of a normal schoolchild. By the age of 6-7 years, children with normal mental development begin to reason, draw independent conclusions, and try to explain everything. Children independently master two types of inferences:
Children with mental retardation experience great difficulty in forming the simplest conclusions. The stage in the development of logical thinking - drawing a conclusion from two premises - is still little accessible to children with mental retardation. In order for children to be able to draw a conclusion, they are given great help by an adult who indicates the direction of thought, highlighting those dependencies between which relationships should be established.7 According to Ulienkova U.V., “children with mental retardation do not know how to reason or draw conclusions; try to avoid such situations. These children, due to their undeveloped logical thinking, give random, thoughtless answers and show an inability to analyze the conditions of the problem. When working with these children, it is necessary to pay attention Special attention to develop all forms of thinking in them.”
Considering all of the above, these children need a special approach.
Training requirements that take into account the characteristics of children with mental retardation:
Questions for self-control:
Azbukina E.Yu., Mikhailova E.N. Fundamentals of special pedagogy and psychology: Textbook. - Tomsk: Tomsk State Publishing House pedagogical university, 2006.- 335 p.
The works of Klara Samoilovna and Viktor Vasilyevich Lebedinsky (1969) are based on etiological principle, allowing us to distinguish 4 options for this development:
1. ZPR of constitutional origin;
2. ZPR of somatogenic origin;
3. Mental retardation of psychogenic origin;
4. ZPR of cerebral-organic origin.
In the clinical and psychological structure of each of the listed variants of mental retardation there is a specific combination of immaturity in the emotional and intellectual spheres.
1.ZPR constitutional origin
(HARMONIC, MENTAL and PSYCHOPHYSIOLOGICAL INFANTILISM).
This type of mental retardation is characterized by an infantile body type with childlike plasticity of facial expressions and motor skills. The emotional sphere of these children is, as it were, at an earlier stage of development, corresponding to the mental makeup of a child of a younger age: brightness and liveliness of emotions, the predominance of emotional reactions in behavior, play interests, suggestibility and lack of independence. These children are tireless in play, in which they show a lot of creativity and invention, and at the same time quickly get fed up with intellectual activity. Therefore, in the first grade of school, they sometimes have difficulties associated with both a lack of focus on long-term intellectual activity (they prefer to play in class) and an inability to obey the rules of discipline.
This “harmony” of mental appearance is sometimes disrupted at school and adulthood, because immaturity of the emotional sphere makes social adaptation difficult. Unfavorable living conditions can contribute to the pathological formation of an unstable personality.
However, such an “infantile” constitution can also be formed as a result of mild, mostly metabolic and trophic diseases suffered in the first year of life. If at the time of intrauterine development, then this is genetic infantilism. (Lebedinskaya K.S.).
Thus, in this case there is a predominantly congenital constitutional etiology of this type of infantilism.
According to G.P. Bertyn (1970), harmonic infantilism is often found in twins, which may indicate the pathogenetic role of hypotrophic phenomena associated with multiple births.
2. ZPR of somatogenic origin
This type of developmental anomalies is caused by long-term somatic insufficiency (weakness) of various origins: chronic infections and allergic conditions, congenital and acquired malformations of the somatic sphere, primarily the heart, diseases digestive system(V.V. Kovalev, 1979).
Long-term dyspepsia during the first year of life inevitably leads to developmental delays. Cardiovascular failure, chronic pneumonia, and kidney disease are often found in the history of children with mental retardation of somatogenic origin.
It is clear that a poor somatic condition cannot but affect the development of the central nervous system and delays its maturation. Such children spend months in hospitals, which naturally creates conditions of sensory deprivation and also does not contribute to their development.
Chronic physical and mental asthenia inhibits the development of active forms of activity and contributes to the formation of personality traits such as timidity, timidity, and lack of self-confidence. These same properties are largely determined by the creation of a regime of restrictions and prohibitions for a sick or physically weakened child. Thus, artificial infantilization caused by conditions of overprotection is added to the phenomena caused by the disease.
3. Mental retardation of psychogenic origin
This type is associated with unfavorable upbringing conditions that prevent the correct formation of the child’s personality (incomplete or dysfunctional family, mental trauma).
The social genesis of this developmental anomaly does not exclude its pathological nature. As is known, unfavorable environmental conditions that arise early, have a long-term effect and have a traumatic effect on the child’s psyche can lead to persistent changes in his neuropsychic sphere, disruption first of autonomic functions, and then of mental, primarily emotional, development. In such cases, we are talking about pathological (abnormal) personality development. BUT! This type of mental retardation should be distinguished from the phenomena of pedagogical neglect, which do not represent a pathological phenomenon, but are caused by a deficit of knowledge and skills due to a lack of intellectual information. + (Domestic psychologists do not classify pedagogically neglected children, meaning “pure pedagogical neglect”, in which the lag is caused only by reasons of a social nature. Although it is recognized that a long-term lack of information, the lack of mental stimulation during sensitive periods can lead a child to a decrease in potential opportunities for mental development).
(It must be said that such cases are recorded very rarely, as well as mental retardation of somatogenic origin. There must be very unfavorable somatic or microsocial conditions for mental retardation of these two forms to occur. Much more often we observe a combination of organic failure of the central nervous system with somatic weakness or with the influence unfavorable conditions of family upbringing).
Mental retardation of psychogenic origin is observed, first of all, with abnormal personality development by type of mental instability, most often caused by the phenomena of foster care - conditions of neglect, under which the child does not develop a sense of duty and responsibility, forms of behavior, the development of which is associated with the active inhibition of affect. The development of cognitive activity, intellectual interests and attitudes is not stimulated. Therefore, the features of pathological immaturity of the emotional-volitional sphere in the form of affective lability, impulsiveness, and increased suggestibility in these children are often combined with an insufficient level of knowledge and ideas necessary for mastering school subjects.
Variant of abnormal personality development like a “family idol” caused, on the contrary, by overprotection - incorrect, pampering upbringing, in which the child is not instilled with the traits of independence, initiative, and responsibility. Children with this type of mental retardation, against the background of general somatic weakness, are characterized by a general decrease in cognitive activity, increased fatigue and exhaustion, especially during prolonged physical and intellectual stress. They get tired quickly and take longer to complete any educational tasks. Cognitive and educational activities suffer SECONDARYLY due to a decrease in the general tone of the body. This type of psychogenic infantilism, along with a low capacity for volitional effort, is characterized by features of egocentrism and selfishness, dislike of work, and an attitude towards constant help and guardianship.
Variant of pathological personality development neurotic type It is more often observed in children in whose families there is rudeness, cruelty, despotism, and aggression towards the child and other family members. In such an environment, a timid, fearful personality is often formed, whose emotional immaturity is manifested in insufficient independence, indecisiveness, low activity and lack of initiative. Unfavorable upbringing conditions also lead to a delay in the development of cognitive activity.
4. ZPR of cerebral-organic origin
This type of developmental disorder occupies the main place in this polymorphic developmental anomaly. It is more common than other types of mental retardation; often has great persistence and severity of disturbances both in the emotional-volitional sphere and in cognitive activity. It is of the greatest importance for the clinic and special psychology due to the severity of the manifestations and the need (in most cases) for special measures of psychological and pedagogical correction.
A study of the anamnesis of these children in most cases shows the presence of mild organic failure of N.S. - RESIDUAL CHARACTER (remaining, preserved).
Abroad, the pathogenesis of this form of delay is associated with “minimal brain damage” (1947), or with “minimal brain dysfunction” (1962) - MMD. → These terms emphasize the UNEXPRESSIVENESS, CERTAIN FUNCTIONALITY OF CEREBRAL DISORDERS.
Pathology of pregnancy and childbirth, infections, intoxication, incompatibility of the blood of mother and fetus according to the Rh factor, prematurity, asphyxia, injuries during childbirth, postnatal neuroinfections, toxic-dystrophic diseases and injuries of the nervous system in the first years of life. - The reasons are to a certain extent similar to the reasons for mental retardation.
COMMON for this form of mental retardation and oligophrenia- is the presence of so-called MILD BRAIN DYSFUNCTION (LMD). ORGANIC DAMAGE TO THE CNS (RETARDATION) AT THE EARLY STAGES OF ONTOGENESIS.
Similar terms: “minimal brain damage”, “mild childhood encephalopathy”, “hyperkinetic chronic brain syndrome”.
Under LDM- is understood as a syndrome reflecting the presence of mild developmental disorders that occur mainly in the perinatal period, characterized by a very varied clinical picture. This term was adopted in 1962 to designate minimal (dysfunctional) brain disorders in childhood.
FEATURE OF ZPR- there is a qualitatively different structure of intellectual disability compared to u/o. Mental development is characterized by UNEVENITY of disturbances of various mental functions; wherein logical thinking M.B. more preserved compared to memory, attention, mental performance.
In children with LIMITED CNS LESION, a multidimensional picture of cerebral insufficiency is much more often observed, associated with immaturity, immaturity and therefore greater vulnerability of various systems, including the vascular and cerebrospinal fluid.
The nature of dynamic disorders in them is more severe and more frequent than in children with mental retardation of other subgroups. Along with persistent dynamic difficulties, there is a primary deficiency of a number of higher cortical functions.
Signs of a slowdown in the rate of maturation are often detected already in early development and concern almost all areas, in a significant part of cases even the somatic one. Thus, according to I.F. Markova (1993), who examined 1000 students junior classes special school for children with mental retardation, a slowdown in the rate of physical development was observed in 32% of children, a delay in the formation of locomotor functions - in 69% of children, a long delay in the formation of neatness skills (enuresis) - in 36% of observations.
In tests for visual gnosis, difficulties arose in perceiving complicated versions of object images, as well as letters. In praxis tests, perseverations were often observed when switching from one action to another. When studying spatial praxis, poor orientation in “right” and “left”, specularity in writing letters, and difficulties in differentiating similar graphemes were often noted. When studying speech processes, disorders of speech motor skills and phonemic hearing, auditory-verbal memory, difficulties in constructing an extended phrase, and low speech activity were often discovered.
Special LDM studies have shown that
RISK FACTORS ARE:
Late age mothers, height and weight of a woman before pregnancy, beyond the age norm, first birth;
Pathological course of previous pregnancies;
Chronic diseases of the mother, especially diabetes, Rhesus conflict, premature birth, infectious diseases during pregnancy;
Psychosocial factors such as unwanted pregnancy, risk factors big city(long daily commute, city noises, etc.)
Presence of mental, neurological and psychosomatic diseases in the family;
Low or, conversely, excessive (more than 4000 kg) weight of the child at birth;
Pathological birth with forceps, caesarean section and so on.
DIFFERENCE FROM U/O:
1. Massiveness of the lesion;
2. Time of defeat. - ZPR is much more often associated with later ones,
exogenous brain damage affecting the period,
when differentiation of the main brain systems is already in
significantly advanced and there is no danger of their rough
underdevelopment. However, some researchers suggest
and the possibility of a genetic etiology.
3. The delay in the formation of functions is qualitatively different than with
oligophrenia. In cases with ZPR, one can observe the presence
temporary regression of acquired skills and their subsequent
instability.
4. Unlike oligophrenia, children with mental retardation do not have inertia
mental processes. They are able not only to accept and
use help, but also transfer learned mental skills
activities in other situations. With the help of an adult they can
carry out the intellectual tasks offered to him at close
normal level.
5. The predominance of later stages of damage determines along with
with symptoms of almost immaturity constant AVAILABILITY
DAMAGE N.S. → Therefore, unlike oligophrenia, which
often occurs in uncomplicated forms, in the structure of the ZPR
CEREBRAL-ORGANIC GENESIS- almost always available
a set of encephalopathic disorders (cerebroasthenic,
neurosis-like, psychopath-like), indicating
damage to N.S..
CEREBRAL-ORGANIC INSUFFICIENCY first of all, it leaves a typical imprint on the structure of the mental retardation itself - both on the characteristics of emotional-volitional immaturity, and on the nature of cognitive impairment
Data from neuropsychological studies have revealed certain HIERARCHY OF COGNITIVE ACTIVITY DISORDERS in children with mental retardation of CEREBRAL-ORGANIC GENESIS. Yes, in more mild cases it is based on neurodynamic insufficiency, associated primarily with EXHAUSTIBILITY OF MENTAL FUNCTIONS.
With greater severity of organic brain damage, more severe neurodynamic disorders, expressed in the inertia of mental processes, are joined by PRIMARY DEFICITIES OF INDIVIDUAL CORTICO-SUBCORTAL FUNCTIONS: praxis, visual gnosis, memory, speech sensorimotor. + At the same time, a certain PARTIALITY, MOSAICALITY OF THEIR VIOLATIONS is noted. (Therefore, some of these children experience difficulties primarily in mastering reading, others in writing, others in counting, etc.). PARTIAL INSUFFICIENCY OF CORTICAL FUNCTIONS, in turn, leads to underdevelopment of the most complex mental formations, including ARBITRARY REGULATION. Thus, the hierarchy of mental function disorders in mental retardation of cerebral-organic origin is the opposite of that found in oligophrenia, where the intellect, and not its prerequisites, is primarily affected.
1. EMOTIONAL-VOLITIONAL IMMATURITY is represented by organic infantilism. With this infantilism, children lack the typical healthy child liveliness and brightness of emotions. Children are characterized by a weak interest in evaluation and a low level of aspirations. There is high suggestibility and non-acceptance of criticism addressed to oneself. Gaming activity is characterized by a lack of imagination and creativity, a certain monotony and originality, and a predominance of the component of motor disinhibition. The very desire to play often looks more like a way of avoiding difficulties in tasks than a primary need: the desire to play arises precisely in situations of the need for purposeful intellectual activity and preparation of lessons.
Depending on the prevailing emotional background, one can distinguish II MAIN TYPES OF ORGANIC INFANTILISM:
1) UNSTABLE - with psychomotor disinhibition, a euphoric tint of mood and impulsiveness, imitating childish cheerfulness and spontaneity. Characterized by a low capacity for volitional effort and systematic activity, a lack of stable attachments with increased suggestibility, and poverty of imagination.
2) INHIBITED - with a predominance of low mood, indecision, lack of initiative, often timidity, which may be a reflection of congenital or acquired functional failure of the autonomic N.S. according to the type of neuropathy. In this case, sleep disturbances, appetite disturbances, dyspeptic symptoms, and vascular lability may be observed. In children with organic infantilism of this type, asthenic and neurosis-like features are accompanied by a feeling of physical weakness, timidity, inability to stand up for themselves, lack of independence, and excessive dependence on loved ones.
2. COGNITIVE DISORDERS.
They are caused by insufficient development of memory processes, attention, inertia of mental processes, their slowness and reduced switchability, as well as deficiency of certain cortical functions. There is instability of attention, insufficient development of phonemic hearing, visual and tactile perception, optical-spatial synthesis, motor and sensory aspects of speech, long-term and short-term memory, hand-eye coordination, automation of movements and actions. Often there is poor orientation in the spatial concepts of “right - left”, the phenomenon of mirroring in writing, and difficulties in differentiating similar graphemes.
Depending on the predominance in clinical picture phenomena of either emotional-volitional immaturity or cognitive impairment ZPR OF CEREBRAL GENESIS can be roughly divided
on II MAIN OPTIONS:
1. organic infantilism
Its various types represent a milder form of mental retardation of cerebral-organic origin, in which functional impairments of cognitive activity are caused by emotional-volitional immaturity and mild cerebrasthenic disorders. Violations of cortical functions are dynamic in nature, due to their insufficient formation and increased exhaustion. Regulatory functions are especially weak at the control level.
2. ZPR with predominance functional disorders cognitive activity - with this variant of mental retardation, symptoms of damage dominate: pronounced cerebrasthenic, neurosis-like, psychopath-like syndromes.
In essence, this form often expresses a state bordering on u/o (of course, the variability of the state in terms of its severity is also possible here).
Neurological data reflect the severity of organic disorders and a significant frequency of focal disorders. Severe neurodynamic disorders and deficits in cortical functions, including local disorders, are also observed. Dysfunction of regulatory structures is manifested in the links of both control and programming. This variant of ZPR is a more complex and severe form of this developmental anomaly.
CONCLUSION: The clinical types presented are the most persistent forms ZPD mainly differ from each other precisely in the peculiarities of the structure and the nature of the relationship between the two main components of this developmental anomaly: the structure of infantilism and the characteristics of the development of mental functions.
P.S. It should also be noted that within each of the listed groups of children with mental retardation there are variants that differ both in the degree of severity and in the characteristics of individual manifestations of mental activity.
CLASSIFICATION OF ZPR L.I.PERESLENI and E.M. MASTYUKOVA
II TYPE ZPR:
1) Type BENIGN (NON-SPECIFIC) DELAY- is not associated with brain damage and is compensated with age under favorable conditions external environment even without any special therapeutic measures. This type of mental retardation is caused by a slow rate of maturation of brain structures and their functions in the absence of organic changes in the central nervous system.
Benign (nonspecific) developmental delay manifests itself in some delay in the development of motor and (or) psychomotor functions, which can be detected at any age stage, is relatively quickly compensated and is not combined with pathological neurological and (or) psychopathological symptoms.
This type of mental retardation can be easily corrected through early stimulation of psychomotor development.
It can manifest itself both in the form of a general, total lag in development, and in the form of partial (partial) delays in the formation of certain neuropsychic functions, this especially often applies to a lag in the development of speech.
Benign nonspecific delay can be a familial symptom; it is often observed in somatically weakened and premature children. It can also occur when there is insufficient early pedagogical influence.
2) Type SPECIFIC (or CEREBRAL-ORGANIC) DEVELOPMENTAL DELAY- associated with damage to brain structures and functions.
Specific or cerebral-organic developmental delay is associated with changes in the structural or functional activity of the brain. Its cause may be disturbances in intrauterine brain development, fetal hypoxia and asphyxia of the newborn, intrauterine and postnatal infectious and toxic effects, trauma, metabolic disorders and other factors.
Along with severe diseases of N.S., which cause developmental delays, most children have mild neurological disorders, which are detected only during a special neurological examination. These are the so-called signs of MMD, which usually occur in children with cerebral-organic mental retardation.
Many children with this form of mental retardation exhibit motor disinhibition—hyperactive behavior—already in the first years of life. They are extremely restless, constantly on the move, all their activities are unfocused, and they cannot complete a single task they start. The appearance of such a child always brings anxiety, he runs around, fusses, breaks toys. Many of them are also characterized by increased emotional excitability, pugnacity, aggressiveness, impulsive behavior. Most children are not capable of playful activities, they do not know how to limit their desires, they react violently to all prohibitions, and they are stubborn.
For many children it is typical motor awkwardness, they have poorly developed subtle differentiated movements of the fingers. Therefore, they have difficulty mastering self-care skills, and for a long time they cannot learn to fasten buttons or lace shoes.
From a practical point of view, differentiating specific and nonspecific developmental delay, i.e. essentially pathological and non-pathological delay, is extremely important in terms of determining the intensity and methods of stimulating age-related development, predicting the effectiveness of treatment, learning and social adaptation.
Delay in the development of certain psychomotor functions SPECIFIC FOR EACH AGE STAGE OF DEVELOPMENT.
So, during the period NEWBORN - such a child long time no clear image is formed conditioned reflex for a while. Such a baby does not wake up when he is hungry or wet, and does not fall asleep when he is full and dry; all unconditioned reflexes are weakened and evoked after a long latent period. One of the main sensory reactions of this age - visual fixation or auditory concentration - is weakened or does not appear at all. At the same time, unlike children with damage to the central nervous system, he does not show signs of dysembryogenesis and developmental defects, including those expressed to a minimal extent. He also does not have any disturbances in screaming, sucking, or assymmetry. muscle tone.
Aged 1-3 MONTHS in such children, there may be a slight lag in the rate of age-related development, the absence or a weakly expressed tendency to lengthen the period of active wakefulness, a smile when communicating with an adult is absent or appears inconsistently; visual and auditory concentrations are short-term, humming is absent or only isolated rare sounds are observed. Progress in its development begins to be clearly visible by 3 months of life. By this age, he begins to smile and follow a moving object. However, all these functions may not manifest themselves constantly and are characterized by rapid depletion.
At all subsequent stages of development, benign developmental delay manifests itself in the fact that the child in his development goes through stages that are more characteristic of the previous stage. However, mental retardation can appear for the first time at each age stage. For example, a 6-month-old child with this form of developmental delay does not give a differentiated reaction to familiar and unfamiliar people, he may also have delayed development of babbling, and a 9-month-old child may show insufficient activity in communicating with adults, he does not imitate gestures, he has poor play contact is developed, babbling is absent or weakly expressed, intonation-melodic imitation of a phrase does not appear, he may have difficulty grasping or not grasping small objects with two fingers at all, or he may not respond clearly enough to verbal instructions. The slow pace of motor development is manifested in the fact that the child can sit, but does not sit down on his own, and if he sits, he makes no attempt to stand up.
Benign developmental delay in age 11-12 MONTHS most often manifests itself in the absence of the first babbling words, weak intonation expressiveness of vocal reactions, and unclear correlation of words with an object or action. Delayed motor development results in the child standing with support but not walking. Retardation in mental development is characterized by weakness in repeated actions and imitative games; the child does not manipulate with both hands confidently enough and does not sufficiently grasp objects with two fingers.
Nonspecific developmental delay in the first THREE YEARS OF LIFE most often manifests itself in the form of a lag in the development of speech, insufficient play activity, a lag in the development of the function of active attention, the regulating function of speech (the child’s behavior is poorly controlled by the instructions of an adult), insufficient differentiation emotional manifestations, as well as in the form of general psychomotor disinhibition. It can also manifest itself as a delay in the development of motor functions. At the same time, IN THE FIRST MONTHS OF LIFE, the rate of normalization of muscle tone and decline lags behind. unconditioned reflexes, the formation of straightening reactions and balance reactions, sensory-motor coordination, voluntary motor activity and especially fine differentiated movements of the fingers.
B 4. PSYCHOLOGICAL PARAMETERS OF DPR
Modern school programs require the child to be sufficiently prepared for school. However, not all children can be trained. Preparatory programs actively identify children with insufficient maturity of brain and social functions. The mental development of a child corresponds to an earlier stage of development. This phenomenon is called mental retardation.
It is possible to adjust the pace and level of a child’s mental development provided that the brain systems are intact. However, this is not always observed. Very often there is a persistent disorder of mental development of cerebral-organic origin. With this type of mental retardation, disorders of the emotional-volitional sphere and cognitive activity are diagnosed.
Cerebroorganic mental retardation
Children with mental retardation of the cerebral-organic type are characterized by the presence of organic insufficiency of the nervous system of mild severity. The cause of organic defects may be pregnancy pathology:
- severe toxicosis;
- intoxication;
- infections;
- prematurity;
- asphyxia;
- infections;
- diseases with complications in the first years of a child’s life.
Doctors state that in 70% of children with mental retardation, the delay is of a cerebral-organic nature. In such children, the delay manifests itself in the early stages of development. They begin to crawl, walk, and talk much later than their peers. They later develop mental reactions and develop various skills.
Children with this type of mental retardation experience delayed physical development and general malnutrition. In neurological terms, the following are often observed: vegetative-vascular dystonia, hydrocephalic phenomena, disorders of cranial innervation.
Observations of the child indicate a lack of liveliness and brightness of emotions. Children do not show interest in evaluating their activities; they have a low level of aspirations, are characterized by uncriticality, poverty of imagination and creativity.
Cognitive activity is caused by deficiencies in memory, attention, thinking, passivity and slowness of mental processes.
Certain cortical functions are characterized by deficiency:
- underdevelopment of phonemic hearing;
- insufficiency of visual and tactile perception;
- immaturity of the motor side of speech;
- problems with hand-eye coordination;
- low level of development of mental processes.
In children with mental retardation of cerebral-organic origin, a number of encephalopathic disorders are often observed:
- Cerebrosthenic phenomena reflecting neurodynamic disorders and increased fatigue of the central nervous system.
- Neurosis-like phenomena: fearfulness, anxiety, tendency to fear, obsessive movements, stuttering.
- Psychomotor excitability: disinhibition, fussiness, distractibility.
- Affective disorders: unmotivated mood swings: low mood with mistrust and a tendency to; elevated mood with foolishness, importunity.
- Path-like disorders: a combination of disinhibition, affective instability with negative attitude to study.
- Various types of seizures.
- Motor retardation and emotional lethargy.
Diagnosis of mental retardation of cerebral-organic origin
Diagnosis of mental retardation involves counseling parents or other adults around the child. During the conversation, complaints and comments from adults are clarified, and the characteristics of the birth and development of the child are revealed. For correct diagnosis, a detailed description of the child’s behavior at home and in an educational institution is important.
During the conversation with the child, the level of his mental development, as well as his emotional and behavioral reactions, is determined. Standardized tests are used to determine the level of mental development. It is important to repeat the study of each mental process using a different procedure.
Neuropsychiatric diagnostics carried out by psychiatric methods will help determine the diagnosis.
Features of raising and teaching children with mental retardation
The diagnosis of mental retardation, first of all, determines a number of necessary features of raising and educating a child:
- The child must attend specialized educational institutions.
- Particular attention should be paid to the development of the cognitive sphere: attention, memory, thinking.
- Children with ZPR organic origin require specialized speech therapy sessions.
- Development classes needed fine motor skills hands, including engaging in productive activities (appliqué, drawing, modeling, etc.).
- It is necessary to conduct classes on the development and correction of the emotional sphere.
Correction of mental retardation is a complex and ambiguous phenomenon. The correction process should be accompanied by a course of medication, massage and physical therapy. It is very difficult to choose ideal correctional and developmental methods. It often takes a long time to select training methods and programs. At the same time, endless patience, attention, care, warmth and affection are required from parents.
