Disorders for which neuropsychological evaluation is recommended. Neuropsychological examination in traumatic brain injury

Identification of a neuropsychological factor that determines the nature of symptoms and syndromes resulting from brain pathology, can be carried out using a wide range of techniques for examining a subject or patient, described as methods of neuropsychological diagnostics. The problems solved with their help in the systematic analysis of violations of the mental function can be grouped as follows (Glozman):

Topical diagnosis of damage or underdevelopment (atypical development) of brain structures;

Differential early diagnosis a number of diseases of the central nervous system, differentiation of organic and psychogenic disorders of mental functioning, its individual differences, normal and pathological aging;

Description of the picture and determination of the level of mental dysfunction: determination of the affected (unformed) brain block (in the understanding of Luria’s term), the primary defect and its systemic influence;

Determination of the causes and prevention of various forms of abnormal mental functioning: disadaptation, school failure, etc.;

Assessment of the dynamics of the state of mental functions and the effectiveness of various types of targeted therapeutic or corrective effects: surgical, pharmacological, psychological and pedagogical, psychotherapeutic, etc.;

Development, based on a qualitative analysis of impaired and preserved forms of mental functioning, of a strategy and prognosis for rehabilitation or correctional measures;

Development and application of systems of differentiated methods of restorative or correctional-developmental education that are adequate to the structure of the mental defect.

Depending on the task and focus of the neuropsychological examination, the methods used can be standardized (the same tasks for all patients) or flexible ( different tasks, specific for each patient); can be grouped or selected individually to assess a highly specialized function and carried out as an individual examination; can be quantitative (psychometric), that is, focused on achieving a result (performing or failing a test in a normative manner) specified time) or quality, process-oriented and specific features performance of the task by patients, qualification of errors made during testing, and based on neuropsychological theory.

The most developed and widespread methods for assessing syndromes in neuropsychology include a system of techniques, compiled by Luria into a logically integral block and aimed at characterizing the clinical “field of factors”, that is, identifying and describing the fundamental aspects of mental losses in local brain lesions without an explicit accurate quantitative assessment of them. This scheme includes:

1) a formal description of the patient, his medical history and the results of various laboratory and instrumental examinations (EEG, biochemistry, etc.);

2) general description mental status of the patient - state of consciousness, ability to navigate in place and time, level of criticism and emotional background;

3) studies of voluntary and involuntary attention;

4) studies of emotional reactions based on the patient’s complaints, according to his assessment of faces in photographs, plot paintings;

5) studies of visual gnosis - using real objects, contour images, upon presentation of various colors, faces, letters and numbers;

6) studies of somatosensory gnosis using tests of recognition of objects by touch, by touch;

7) studies of auditory gnosis when recognizing melodies, localizing a sound source, and repeating rhythms;

8) studies of movements and actions when performing the latter according to instructions, when setting a pose, as well as assessment of coordination, results of copying, drawing, object actions, adequacy of symbolic movements;

9) speech research - through conversation, repetition of sounds and words, naming objects, understanding speech and rarely encountered words, logical and grammatical structures;

10) study of writing - letters, words and phrases;

11) reading studies - letters, meaningless and meaningful phrases and misspelled words;

12) memory studies - for words, pictures, stories;

13) research into the counting system;

14) research into intellectual processes - understanding stories, solving problems, correct endings of phrases, understanding analogies and opposites, figurative and general meaning, ability to classify.

The proposed methods are addressed primarily to the voluntary, conscious, that is, speech-mediated level of mental functions, and to a lesser extent to involuntary automated or unconscious mental functions. To expand the range of use of measuring procedures, special sensitized conditions can be additionally created - the rate of delivery of stimuli and instructions can be accelerated, the volume of stimulus material can be increased, and it may be offered in a noisy form. Behind last years The system of neuropsychological research methods has been enriched with new developments, involving both the improvement of already known techniques and the introduction of new measurement procedures into practice. Quantitative criteria for performing tests were developed, taking into account the principles of standardization of research and the comparability of the results obtained, diagnostic coefficients and age norms were introduced, justified methodological principles, contributing to the development of new research tools, including special experimental equipment (Wasserman, Dorofeeva, Meerson, Glozman).

The problem of the composition and focus of a set of techniques adequate to achieve a particular neuropsychological diagnostic goal is solved in each specific case, based on an individual approach, systematicity in the dynamic organization of functions and the comprehensiveness of the coverage of symptoms, the development of which is subject to prediction. It is advisable to plan the study so that it allows not only to record the disorder, but also to identify its mechanisms. In the case of a damaged brain, the interpretation of the results obtained should also reflect compensatory consequences, which are especially relevant when long term diseases.

Traditional neuropsychological examination includes:

• collection of anamnestic data;
• assessment of motor and sensory lateral preferences;
• motor research (kinesthetic, kinetic, spatial, tactile and somatognostic functions)
;

• visual gnosis;
• auditory gnosis and spatial representations;
• drawing;
• copying a picture, letters, numbers;
• visual and auditory-speech memory;
• speech functions;
• letter;
• reading;
• intellectual processes;
• emotional and personal processes.

The level of formed voluntary and involuntary self-regulation programs and their interaction is assessed.
The true picture of dysontogenesis of the brain organization of mental processes is revealed in many children only with the mandatory introduction of sensitized conditions into the examination. These are:

• "blind instructions"
• dynamic loads in the form of an increase in the time and pace of experimental tests,
• exclusion of visual and speech self-control (eyes closed, tongue bitten),
• use of monomanual (separately with right and left hands) performing graphic tests actual and on memory traces

During the examination:

1. The psychologist needs to establish the presence or absence in the child of such phenomena as:
   • hypo- or hypertonicity, muscle clamps, synkinesis, tics, obsessive movements, pretentious poses and rigid bodily attitudes;
   • completeness of oculomotor functions (convergence and amplitude of eye movements)
   ;
   
   • plastic (or, on the contrary, rigidity) during the performance of any action and during the transition from one task to another, exhaustion, fatigue;
   • fluctuations in attention and emotional background, affective excesses;
   • the presence of pronounced vegetative reactions, allergies, enuresis;
   • failures of breathing up to its obvious delays or noisy “pre-breaths”;
   • somatic dysrhythmias, sleep formula disorder, dysembryogenetic stigmas, etc.
2. The psychologist should note:
   • how inclined the child is to simplify a program given from the outside;
   • whether it easily switches from one program to another or inertly reproduces the previous program.
   • Does he listen to instructions to the end or does he impulsively get to work without trying to understand what is required of him?
   • How often does one get distracted by side associations and slip into regressive forms of response?
   • Is he capable of independently systematically completing what is required, or is the task available to him only after leading questions and detailed prompts from the experimenter?
   • Can he give himself or others a clearly formulated task, check the progress and outcome of its implementation;
   • Can he slow down his emotional reactions that are inadequate to the given situation?
   Positive answers to these questions, along with the child’s ability to evaluate and monitor the effectiveness of his own activities (for example, find your mistakes and try to correct them yourself) indicate the level of formation of his voluntary self-regulation, that is, whether they reflect the degree of his socialization to the maximum extent.
3. Review age dynamics in accordance with age standards that can be relied upon during the examination.
4. When studying motor functions, it was found that various types of kinesthetic praxis are fully accessible to children already at 4-5 years old, and kinetic praxis only at 7 years old. (and the test for reciprocal hand coordination is fully automated only by the age of 8).
5. Tactile functions reach their maturity by 4-5 years, while somatognostic functions - by 6.
6. Different kinds subject visual gnosis does not cause difficulties by 4-5 years; the confusion that sometimes arises is not due to the primary deficiency visual perception, but with a slow selection of words. This circumstance may also reveal itself in other samples, so it is extremely important to separate these two reasons. Up to 6-7 years of age, children demonstrate difficulties in perceiving and interpreting plot (especially serial ones) paintings
7. In the sphere of spatial concepts, structural-topological and coordinate factors mature the earliest (6-7 years), while metric concepts and the strategy of optical-constructive activity - by 8 and 9 years, respectively.
8. The volume of both visual and auditory-verbal memory (i.e., retention of all six standard words or figures after three presentations) sufficient for children as young as 5 years old;
9. By the age of 6, the strength factor for storing the required number of elements reaches maturity, regardless of its modality. However, the selectivity of mnestic activity reaches its optimal status only by 7-8 years. During visual memorization, the child, well holding the required number of reference figures, distorts their original image, unfolding it, not observing proportions, not completing some details (that is, demonstrating a lot of paragraphs and reversions), confusing the given order.
10. The same applies to auditory-speech memory:
    up to 7 years of age, even fourfold presentation does not always lead to full retention of the order of verbal elements; there is a lot of paraphasia, that is, replacement of standards with words similar in sound or meaning.
Latest of the basic factors speech activity mature in a child:

• phonemic hearing (7 years old),
• quasi-spatial verbal syntheses;
• programming of independent speech expression (8-9 years).

This is especially clearly manifested in cases where these factors should serve as a support for such complex mental functions as writing, solving semantic problems, composing, etc.

Having reflected some features of the development of neuropsychological factors in normal conditions, we will focus on the traditional for neuropsychology (developed in ancient times in the laboratory of neuropsychology at the Burdenko Institute of Chemistry, Russian Academy of Medical Sciences, under the leadership of A.R. Luria) system for assessing the productivity of mental activity.
From an ontogenetic perspective, it is directly related to the concept of the zone of proximal development:
"0" - exhibited in cases where the child, without additional explanation, completes the proposed experimental program;
"1" - if a number of minor errors are noted that are corrected by the child himself practically without the participation of the experimenter; in fact, “1” is the lower normative limit;
"2" - the child is able to complete the task after several attempts, detailed hints and leading questions;
"3" - the task is not available even after detailed repeated explanations from the experimenter.

The next requirement is related to the need to include sensitized conditions in a neuropsychological examination in order to obtain more accurate information about the state of a particular parameter of mental activity. These include:

• increasing the speed and duration of task execution;
• exclusion of visual (closed eyes) and speech (fixed language) self-control.

A necessary condition is to perform any manual tests (motor, drawing, writing) with both hands alternately. In all experiments that require the participation of the child’s right and left hands, the instructions should not specify which hand to begin performing the task with. Spontaneous activity of one or another hand at the beginning of the task provides the experimenter with additional, indirect information about the degree of formation of the child’s manual preference. The same information is contained in “sign language”: the researcher must note which hand “helps” the child enrich his speech with greater expressiveness.

Quests during diagnostic studies must alternate so that two identical (for example, memorizing two groups of 3 words and 6 words) did not follow one after another.

The child is included in a whole system of interpersonal and social relationships (parents, teachers, friends, etc.). Therefore, the success of the examination (and subsequent correction) will correlate with how fully the relevant data is presented in it. First of all, this means establishing partnership contact with parents, especially with the child’s mother. She is the one who can give you vital information about his problems.

HISTORICAL DATA AND CLINICAL CONVERSATION

Protocol

Date of examination _________________
FULL NAME. child ______________________________________________________________________________
Date, month, year of birth ________________________________________________________________
The presence of a factor of current and/or familial left-handedness (right-handed, left-handed, ambidextrous, left-handed in the family) ________________________________________________________________
Parental complaints (legal representatives) __________________________________________
Attitude (reactions) child to their problems ________________________________________
Presence of obsessive bad habits _________________________________________________
Family composition (family members) __________________________________________________________
Parents' place of work (education, professional status):
Mother ______________________________________________________________________________
Father ______________________________________________________________________________
Social environment (the child is raised at home by his mother, grandmother, kindergarten, nursery, orphanage, etc.)
Family history:
chronic diseases (respiratory, cardiovascular, gastrointestinal, allergic, endocrine, oncological, neuropsychic, etc.) , alcoholism, occupational hazards, intoxication, drug addiction, tendency to depressive reactions:
Mother (maternal line) ____________________________________________________________
Father (paternal line) ______________________________________________________________
Course of pregnancy:
what is the count, mother's age (at the beginning of this pregnancy) _____, father's age_________
Previous pregnancies have ended :
honey. abortion, early, late miscarriage, death of a child, childbirth / indicate how many years ago)
During pregnancy: toxicosis (weak or pronounced), anemia, nephropathy, infectious diseases, Rh-conflict, edema, increased arterial pressure, bleeding, threat of miscarriage (specify deadline), acute respiratory infections, flu, honey. treatment (outpatient, inpatient)
1st half of pregnancy______________________________________________________________
2nd half of pregnancy______________________________________________________________
Childbirth: what type ___, at what stage (on time, premature, late); independent, called, operational (planned, forced).
Labor began: with the breaking of water, with contractions
Obstetrics:
stimulation, dropper, mechanical squeezing of the fetus, forceps, vacuum, C-section, anesthesia
Duration of labor (swift, fast, protracted, long, normal)
The duration of the water-free period is ____________. Apgar score __________________________
The child was born:
in the head, gluteal, leg diligence
Weight________, height of the child__________.
The child screamed (immediately after suctioning out the mucus, after patting, resuscitation was carried out)
Character of the cry: (loud, weak, beeped) ____________________________________________
Color of the skin (pink, cyanotic, cyanotic, white)
There were: umbilical cord entanglement around the neck, short umbilical cord, nodular umbilical cord, cephalohematoma, clavicle fracture, green amniotic fluid, etc.
Diagnosis at birth:
birth trauma, birth asphyxia (degree), prenatal encephalopathy, hypertensive-hydrocephalic syndrome, malnutrition (degree) and so on.
First feeding: for a day, took the breast actively, sluggishly
Discharged from the maternity hospital on __________ days, later due to the mother, child, transferred to the premature ward, hospital
Hospital treatment:______________________________________________________________
Conclusion after hospitalization (lying with mother, separately)
Feeding up to one year: breastfeeding, up to one month, artificial feeding from ______ months, mixed from ______ months.
Child development up to one year:
typical for a child motor restlessness, regurgitation (often, rarely), sleep and wakefulness disturbances, etc.
The following were noted: hyper- or hypotonicity, shuddering, tremor of the arms, chin, “pulling the head back,” etc.
Motor functions:
holds his head from _____month, sits from ______ month, crawls from ___month, walks from ____month, walks independently from ______ month.
Speech development:
humming since months, babbling since ______months, words since ______months, phrase since ______months.
I was ill for up to a year:
colds, infectious diseases, allergic reactions and etc.__________________________
Treatment: outpatient, inpatient with mother or separately
Special treatment: massage, sedative, medicine, etc.
Have you experienced any difficulties in mastering the following skills:
using the potty, walking independently, eating independently, dressing/undressing independently, falling asleep independently, etc.
Reasons for difficulties:
hospitalization, moving, divorce, birth of a second child, death of loved ones, others at the age of ___________________________________________________________________________________
Were enuresis, encopresis, specific food preferences, motor disorders, sleep disorders, etc. observed at age________
Diseases suffered during life _____________________________________________________
Head injuries, concussion, treatment (inpatient, outpatient) at the age of________ Surgeries at the age of_______
Was observed by _______________________ with a diagnosis of ____________,
Deregistered in _________________________Still present
He has been visiting children's institutions since ______ years.
Currently visiting_______________________________________________________________
Visit to a special daycare center ____________________________________________________________
During adaptation there were: increased excitability, protest reactions (active, passive), began to get sick often, etc._________________________________________________________
Play activity: liked/disliked playing with toys.
Favorite toys, games:______________________________________________________________
I was ready for school: I knew/didn’t know letters, read syllables, read well.
Counting: up to 3, 5, 10, more, performed/did not perform arithmetic operations.
Drew: could/couldn’t, bad, good, liked/didn’t like.
Wanted/didn't want to go to school
Curriculum: 1-4,1-3 regular school
Training in correctional, auxiliary, speech, etc. school
Adaptation to school _________________________________________________________________
Interest in learning: yes/no

Author Teremova M.N.

Introduction

Neuropsychology is the only discipline of psychology that studies the relationship of mental phenomena and processes with the physiological structures of the brain. In other words, neuropsychology studies human mental activity in normal and pathological condition in terms of its brain organization. This implies the main function of a neuropsychologist: to consider any psychological phenomenon (no matter whether it is normal or pathological) in a specific gender, age and sociocultural aspect from the standpoint of its cerebral support.

Neuropsychological testing can determine the extent of cognitive impairment and how it interferes with daily activities, as well as identify probable reasons the changes that have occurred. In the future, the data obtained will help NDC specialists Clinical Psychiatry monitor the progress of treatment, focusing on the severity of cognitive impairment and their changes during pharmacotherapy, as well as select behavioral methods for correcting cognitive impairment.

Chapter 1. Neuropsychological diagnostics

1.1 Definition, purposes of neuropsychological examination

Neuropsychological diagnostics is the study of mental processes using a set of special samples for the purpose of qualifying and quantitatively characterizing disorders (states) of higher mental functions (HMF) and establishing a connection between the identified defects/features and pathology or functional state certain parts of the brain or individual characteristics morpho-functional state of the brain as a whole.

With the help of neuropsychological diagnostics it is possible to determine:

• a holistic syndrome of HMF disorders caused by a breakdown (or a special condition) of one or more brain factors;
• features of the energetic, operational and regulatory components of mental processes, as well as various levels of their implementation;
• preferential lateralization of the pathological process;
• damaged and intact links of mental functions;
• various disorders of the same mental function with damage to different parts of the brain.

First of all, before studying the actual techniques, you need to familiarize yourself with the anatomy nervous system and with the basics of neuropsychology. Then you need to understand the theoretical and methodological foundations of neuropsychological diagnostics; imagine the overall picture, survey; principles of constructing neuropsychological diagnostic techniques. In the future, it is necessary to acquire specific knowledge and skills in the use of neuropsychological methods for studying various higher mental functions, as well as methods for studying interhemispheric asymmetry and interhemispheric interaction. Finally, it would be useful to have an idea about modern trends in neuropsychological diagnostics in Russia and abroad.

The main block of neuropsychological diagnostic techniques was, without a doubt, created in the 1940s–1960s. A.R. Luria (Luria, 1962). However, it should be borne in mind that a number of techniques were borrowed from other authors. For example, a test for reciprocal coordination belongs to the famous Soviet psychiatrist N.I. Ozeretsky (Gurevich, Ozeretsky, 1930). Tests for spatial praxis were created by G. Head. In addition, neuropsychology has always been a dynamically developing branch of knowledge, so new ones are constantly being developed in it. methodological techniques, and A.R.’s closest students took an active part in this development. Luria - L.S. Tsvetkova, N.K. Korsakova (Kiyaschenko), E.G. Simernitskaya and others (Tsvetkova, 1985; Kiyashchenko, 1973; Simernitskaya, 1978). As an example, we can cite methods aimed at studying speech and memory disorders. In connection with the emergence of new areas of neuropsychological research, the arsenal of neuropsychologists was constantly replenished original methods, developed by foreign scientists. To study visual-constructive activity, complex (complex) figures of Rey and Osterrieth (Rey, 1941; Osterrieth, 1944) were often used, and to study interhemispheric interaction, the dichotic listening technique of D. Kimura (Kimura, 1961; 1973). Currently, modifications of the classical neuropsychological examination carried out by L.S. are used in Russia and abroad. Tsvetkova, E.D. Chomskoy, A.V. Semenovich et al. (Tsvetkova, 1998; Neuropsychological diagnostics, 1994; Neuropsychology childhood, 1998; Tsvetkova, Akhutina, 1981; Pointe, 1998; Golden, 1981).

First of all, this is the theory of systemic dynamic localization of VMF A.R. Luria and the method of syndromic analysis of their disorders (Luria, 1962, 1973). Neuropsychological diagnostics is also based on modern ideas about the psychological structure and brain organization of mental functions. Important role L.S.’s cultural-historical theory of mental development plays a role in understanding the genesis and structure of the HMF. Vygotsky, activity theory of A.N. Leontyev, the theory of the gradual formation of mental actions by P.Ya. Galperin, the ideology of a systematic approach to the study of mental phenomena. Finally, neuropsychological diagnostics were developed and applied taking into account fundamental ideas about the neurophysiological and biochemical patterns of integrative brain activity (I.P. Pavlov, P.K. Anokhin, etc.)

1.2.Principles, stages of neuropsychological diagnostics

The basic principles are:

• The principle of the primary focus of a specific technique on the study of a specific mental process or a certain link in this mental process (“functional test”).
• The principle of targeting neuropsychological techniques primarily at identifying disturbed parts of mental functions (“provocation”).
• The principle of studying any mental function (factor) using a set of techniques, the results of which complement and clarify each other (“cross-control”).
• Principle mandatory analysis not only the final result of the activity, but also the process of completing the task in its various components (neurodynamic, motivational, regulatory, operational).
• The principle of combining a qualitative analysis of identified disorders with a quantitative assessment of the severity of symptoms.
• The principle of learning - during the implementation of a specific technique, the neuropsychologist, if necessary, records the possibility of the subject mastering the method of action and its application in similar tasks.
• The principle of comparing data obtained during a neuropsychological examination with data from anamnesis, objective clinical and paraclinical studies.
• The principle of taking into account the age and premorbid characteristics of the subject.
• Note that most of the principles listed above are important not only for neuropsychological diagnostics, but also for solving diagnostic tasks in other areas of clinical psychology, for example, in pathopsychology (Zeigarnik, 1986; Workshop on pathopsychology, 1987).

On the one hand, there are general rules constructing and conducting neuropsychological examinations in general and individual techniques in particular. The examination should be carried out individually, take a certain amount of time, and include tasks of varying levels of complexity aimed at studying basic mental functions. There are quite strict rules for presenting instructions and stimulus material for neuropsychological techniques. On the other hand, each neuropsychological examination is unique: the set of techniques used, the sequence and pace of their presentation, even the nature of the instructions may vary depending on the purpose of the examination, its hypothesis, and the characteristics of the patient’s condition. Note that any neuropsychologist must be able to quickly and competently make a decision on the choice of tactical nuances of the examination.

The examination should be fairly compact and take no more than one and a half hours. Its duration, as a rule, depends on the condition and age of the subject. For example, neuropsychological examination of young children school age should not exceed 30–40 minutes. If the subject complains of fatigue, and the quality of his activity as a result noticeably deteriorates, the neuropsychologist should interrupt the examination and complete it at another time.

Almost all neuropsychological techniques are very compact, and mentally healthy adult subjects can spend from several seconds to several minutes completing them. However, when we examine patients with brain lesions, some (or most) techniques take more than long time. In general, we can say that the implementation of the technique should continue until its procedure is completed and/or the neuropsychologist has decided for himself what the qualitative features of the disorders are and the degree of their severity.

Methods can be aimed at studying a specific factor (i.e., the principle of operation of a certain area of ​​the brain), the mechanism of occurrence of disorders, or identifying phenomena observed when certain areas of the brain are damaged. The mechanisms of occurrence of some phenomena have not yet been sufficiently studied. For example, a number of motor, speech, and tactile tests are aimed at studying the kinesthetic factor. Along with this, there are tests to detect facial or color agnosia in lesions of the posterior parts of the right hemisphere, the factorial neuropsychological conditioning of which is still only speculated.

Neuropsychological examination is carried out individually. Any mental function (or its components) is not just studied using a set of techniques, but is assessed for different levels complexity, randomness and different composition afferent links (for example, only relying on leading afferentation). There are special methods for complicating (sensitizing) neuropsychological techniques: accelerating the pace of execution, eliminating visual control, increasing the volume of activity, complicating the characteristics of the stimulus material, minimizing speech mediation, etc.

Chapter 2. Client case

2.1. Conducting a neuropsychological examination, writing a report

Neuropsychological examination was carried out according to the diagnostic album of N.Ya. Semago.

F.I. child: Varvara.

Age: 6 years 8 months. (born October 17, 2008)

Date of examination: 06/09/2015

The girl’s mother came for consultation with complaints of reading difficulties and low self-esteem.

As a result of the survey, the following features of psychological development were identified.

The girl makes contact well, understands and assimilates instructions for tasks from the first presentation, begins to work hastily, often without fully listening to the question, and during a conversation periodically hesitates in her speech. Emotional reactions and behavior are adequate to the examination situation.

The stock of general knowledge and ideas is somewhat below the age norm: he cannot give his full name and residential address.

Predominant dominance of the left hemisphere is revealed in the processing of incoming information, right hand, right eye, right ear, right leg prevailing, as evidenced by the performance of tests to study manual and sensory preferences.

In the sphere of movements and actions, there is insufficient dexterity of the fingers and hands. The test for reciprocal coordination is performed with a knock, cannot simultaneously change the movement of both hands, the fist is twisted. Kinetic praxis was disrupted when entering an activity; after changing the stereotype, the errors were insignificant. At the beginning of the activity there was an expansion of the activity program.

In visual-object perception, an inversion of the perception vector is manifested. Scanning objects is chaotic. Difficulties are observed in recognizing both overlaid and crossed out figures (uses perceptually close substitutions).

The weakness of the spatial factor determines the mirror perception and performance of movements, graphic tasks, and complicates the understanding of prepositional constructions (“in”, “on”, “for”, “under”, etc.).

The perception of rhythms and their reproduction were normal; there were isolated disturbances in rhythm reproduction due to impulsivity. The perception of household noises outside the window is recognized. Confuses sounds (B-P, D-T, Z-S, G-K - reproduces, BPB, DTD, ZSS - swaps places, can insert another letter).

Auditory verbal memory corresponds to age standards. Word learning curve: 6,7,6,6,7. Single replacements of words with similar meanings (cat-cat, brother-son).

The child has access to basic mental operations, generalizes and excludes based on categorical features, consistently composes a story based on a series of plot pictures, and is able to construct an independent coherent story highlighting the main idea.

Severe impairment of expressive speech – limited vocabulary development, use of a small set of formulaic words, fluency of speech is impaired, against the background of which stuttering could appear, particularly in anxious situations. Understanding speech is not difficult. Characterized by adequate use of non-verbal cues, gestures, and the desire to communicate.

The girl’s level of self-esteem is normal, but we can talk about anxiety, emotional dependence, and a feeling of discomfort, which was especially evident at the beginning of her activities.

Against the backdrop of a deficit in the work of these factors, well-developed functional systems, which are compensatory in relation to the weakened:

1. the “image-representation” factor allows the girl to recognize the essential features of objects quite well and focus on visual images.
2. factor of auditory-verbal memory and volume of acoustic perception, characterized good opportunities remember a fairly large amount of information and differentiate it correctly by ear.
3. mental features are developed within the age norm, the girl has access to operations of generalization and comparison based on categorical features, she understands connections and relationships by analogy well.

Conclusion: on the background good development intelligence and emotional-personal sphere, insufficient development of the following factors is revealed:

• insufficiency of the spatial factor;
• deficiency of kinetic and kinesthetic factors.
• Deficiency of the energy component of mental activity.

1) psychological and pedagogical correction, including activation of the sensorimotor level, development of spatial concepts, speech and self-regulation;

2) classes with a speech therapist.

BIBLIOGRAPHY

1. Balashova E.Yu. , Kovyazina M.S. Neuropsychological diagnostics in questions and answers 2012.

2. Semago N.Ya., Semago M.M. Diagnostic album for development assessment cognitive activity child. Preschool and primary school age.

Scheme of neuropsychological examination of a child

The experience of neuropsychological counseling of children with developmental disabilities has proven the adequacy and information content of this particular approach to this population. Firstly, the differential diagnostic task is almost unambiguously solved: as a result of the examination, basic pathogenic factors are identified, and not the current level of knowledge and skills. After all, outwardly, the pathocharacterological characteristics of the child, and pedagogical neglect, and the primary failure of phonemic hearing can manifest themselves in the same way - “a deuce in Russian.” Secondly, only a neuropsychological analysis of such a deficiency can reveal the mechanisms underlying it and approach the development of specific, specially oriented corrective measures. Let us emphasize this indispensable condition: it is the syndromic approach that is important, otherwise, as experience shows, distortions, one-sidedness of results, and an abundance of artifacts are inevitable.

The entire set of proposed methods has been repeatedly tested on models of normal, subpathological and pathological development.

We note in the general view several points that are important for qualifying a child’s disability.

1. The psychologist must establish the presence or absence in the child of such phenomena as:

Hypo- or hypertonicity, muscle tension, synkinesis, tics, obsessive movements, pretentious poses and rigid bodily attitudes; completeness of oculomotor functions (convergence and amplitude of eye movements)

Plasticity (or, on the contrary, rigidity) during the performance of any action and during the transition from one task to another, exhaustion, fatigue; fluctuations in attention and emotional background, affective excesses;

Severe vegetative reactions, allergies, enuresis; failures of breathing up to its obvious delays or noisy “pre-breathing”; somatic dysrhythmias, sleep formula disorder, dysembryogenetic stigmas, etc.

Various pathophenomena of this circle, as well as a number of other similar ones, always indicate a prepathological state of the subcortical formations of the brain, which necessarily requires targeted correction. After all, the above, in fact, is a reflection of the basal, involuntary level of human self-regulation. Moreover, the level is largely strictly genetically programmed, i.e. functioning against the will and desire of the child. Meanwhile, its full status largely predetermines the entire subsequent path of development of higher mental functions (HMF). This is due to the fact that by the end of the first year of life, these structures practically reach their “adult” level and become the fulcrum for ontogenesis as a whole.

2. First of all, using a neuropsychological technique, it is necessary to take into account and strictly record all the individual properties of the subjects, all the features of their behavior during the examination. This will make it possible to more accurately assess the nature of their impairments and make it possible to establish what influence personal and other extra-intellectual factors have on the process of completing tasks.

The following indicators are of greatest interest:

1. Features of child communication with the experimenter: is it easy to make contact, does he ask questions and what kind, tells something about himself, etc. If the child is overly shy, withdrawn, or does not make contact well, it is advisable to begin his examination with the nonverbal part of the technique. Bright cubes and pictures usually arouse interest in the child and relieve constraint and fear. When the child gets used to it a little and stops being inhibited, you can offer him the verbal part to complete the task. At the same time, you should not demand detailed answers from him; it is important to find out only how much he understands, knows various objects and phenomena, knows how to generalize, and compare them with each other. When qualifying a defect, it is necessary to take into account the fact that the low quantitative indicators obtained by the child on verbal subtests, in this case, are most likely a consequence of speech inhibition.

Sociable children usually react very violently to all questions and tasks, often ask again, clarify, give examples from their own lives, etc. On the one hand, all this can serve as additional information for the experimenter, and on the other hand, it increases the examination time and disrupts it rhythm. In some cases, such children should be tactfully stopped and asked to answer only to the point.

2. Features of motivation: do the tasks arouse interest, what is the reaction to failure, how does the child assess his capabilities and achievements.

For children with strong cognitive motivation, any interruption of activity can cause an experience of failure and a feeling of dissatisfaction. Therefore, in cases where a child takes a very long time to navigate a task, searches for the most correct solution and does not fit into the allotted time limit, it is necessary to allow him to complete the task to the end and fix his individual pace of work. Quantitative assessment should be output in a standard manner.

Must be noted , how inclined the child is to simplify a program given from the outside; does it easily switch from one program to another or inertly reproduces the previous one. Does he listen to instructions to the end or does he impulsively get to work without trying to understand what is required of him? How often does he get distracted by side associations and slip into regressive forms of response? Is he capable of independently systematically carrying out what is required under the conditions of “deaf instructions”, or is the task available to him only after leading questions and detailed prompts from the experimenter, i.e. after the initial task is divided into subroutines.

Finally, is he able to give himself or others a clearly formulated task, check the progress and outcome of its implementation; slow down your emotional reactions that are not adequate to the given situation? Positive answers to these questions, along with the child’s ability to evaluate and monitor the effectiveness of his own activities (for example, to find his mistakes and try to correct them on his own), indicate the level of formation of his voluntary self-regulation, i.e., to the maximum extent reflects the degree of his socialization, in contrast to those basal processes mentioned above.

The sufficiency of the listed parameters of mental activity indicates the functional activity of the prefrontal (frontal) parts of the brain, primarily its left hemisphere. And, although the final maturation of these brain structures extends according to neurobiological laws up to 12-15 years, by the age of 7-8 years all the necessary prerequisites for their optimal status within the appropriate age range already exist.

Speaking about the child’s understanding of instructions and their implementation, it is necessary to emphasize that the primary task is to differentiate primary difficulties from those (secondary) that are associated with, for example, insufficient memory or phonemic hearing. In other words, you must be absolutely convinced that the child not only understood, but also remembered everything you said regarding the upcoming task.

3. Dynamic characteristics of activity: impulsiveness, disinhibition, haste in completing tasks or lethargy, slowness, exhaustion. Examination of children with increased exhaustion and low performance should be carried out in several stages, giving them significant breaks for rest. Sometimes it makes sense to postpone the experiment to another day. Such children perform snacks very slowly and often do not fit into the allotted time limit. Therefore, it is advisable not to interrupt the child, not to limit the time he completes tasks in order to find out whether he is in principle able to cope with them, but be sure to take into account the individual completion time. Low scores on subtests that have time limits should be considered a consequence of the slow pace of mental activity.

4. Features of attention: distractibility, fluctuations in attention, self-control indicators.

5. Motor characteristics: speed of movement, coordination, strength muscle tone, accuracy of movements, etc.

6. Speech features: difficulties in pronunciation, incorrect use of words, slips of the tongue, unformed phrases, speech inertia, violation of the regulatory function of speech, etc.

7. Ways to complete tasks: decides by trial and error or applies logical methods of analysis, whether the found method transfers to a similar task, etc.

Thus, in contrast to the standard procedure for a test study, when only the result of completing a task is noted, it makes sense to record in detail and carefully the entire course of the experiment, recording, if possible, everything that the subject does and says. In this case, of great importance is the fact that the purity of the test itself is practically not compromised, and any additions and changes made by the experimenter are used for qualitative analysis of the data obtained.

For example, with a qualitative analysis of the implementation of the labyrinth technique, three main types of violations can be identified.

1. Impaired coordination of movements, disinhibition, poor self-control - the child quickly passes almost all labyrinths, but with very a large number mistakes (often lifts the pencil from the paper, crosses the lines, goes outside the maze).

2. Slowness, weakness of muscle tone - the child goes through all the mazes almost without errors, but at a very slow pace, not within the allotted time limits.

3. Violation of activity planning, poor extrapolation - the child cannot go through the maze, does not move from his place, or blindly enters all its sections.

In the above cases quantification, received by a test subject for one or another subtest, becomes an indicator of the degree of qualitative violations identified in him.

There are violations that can only be identified through a qualitative analysis of the child’s performance of the methodology’s tasks. These violations usually lead to a decrease in quantitative indicators on several subtests at once. This is a slow pace of mental activity (the performance of all subtests that have time limits suffers), psychomotor disinhibition combined with poor self-control (low scores are available on all subtests that require concentration, accuracy, and good attention) and a violation of planning and activity regulation (a child with difficult to cope with all tasks that require a thorough analysis of conditions, preliminary orientation in the task, drawing up a program of action).

The opposite also occurs, when a low quantitative score on one or more subtests itself indicates a certain qualitative type of violation.

3. As is known, the development of mental functions and their individual components (factors) proceeds according to the laws of heterochrony and asynchrony. In this regard, it is necessary to conduct a brief review of the age dynamics (“development coefficients”) of the most important psychological factors (in accordance with age standards that were obtained during a neuropsychological examination of well-performing students in public schools and preschool institutions: children from 4 to 12 years old were examined) .

When studying motor functions, it was found that various types of kinesthetic praxis are fully accessible to children already at 4-5 years old, and kinetic praxis only at 7 years old (and the test for reciprocal hand coordination is fully automated only by 8 years old).

Tactile functions reach their maturity by 4 -5 years, while somatognostic functions - by 6. Various types of objective visual gnosis cease to cause difficulties in a child by 4 - 5 years; It must be emphasized here that the confusion that sometimes arises is not due to a primary deficit in visual perception, but to a slow selection of words. This circumstance may also reveal itself in other samples, so it is extremely important to separate these two reasons. Up to 6-7 years of age, children demonstrate difficulties in perceiving and interpreting plot (especially serial) pictures.

In the sphere of spatial representations, structural-topological and coordinate factors mature the earliest (6 - 7 years), while metric representations and the strategy of optical-constructive activity - by 8 and 9 years, respectively.

The volume of both visual and auditory-verbal memory (i.e., retention of all six standard words or figures after three presentations) is sufficient in children already at 5 years old; By the age of 6, the strength factor for storing the required number of elements reaches maturity, regardless of its modality. However, only by the age of 7-8 years does the selectivity of mnestic activity reach its optimal status.

Thus, in visual memory, a child, having well retained the required number of reference figures, distorts their original image, unfolding it, not observing proportions, not completing some details (i.e., demonstrates a lot of paragraphs and reversions), confusing the given order. The same is true for auditory-verbal memory: up to the age of 7, even four-time presentation does not always lead to full retention of the order of verbal elements; a lot of paraphasia occurs, i.e. replacing standards with words that are similar in sound or meaning.

The most recent of the basic factors of speech activity in a child mature: phonemic hearing (7 years), quasi-spatial verbal synthesis and programming of independent speech utterance (8-9 years). This is especially clearly manifested in cases where these factors should serve as a support for such complex mental functions as writing, solving semantic problems, composing, etc.

Having reflected some features of the development of neuropsychological factors in normal conditions, we will dwell on the traditional system for assessing the productivity of mental activity in neuropsychology. From an ontogenetic perspective, it is directly related to the concept of the zone of proximal development:

“O” - is set in cases where the child, without additional explanation, completes the proposed experimental program;

“1” - if a number of minor errors are noted that are corrected by the child himself practically without the participation of the experimenter; in fact, “1” is the lower normative limit;

“2” - the child is able to complete the task after several attempts, detailed hints and leading questions;

“3” - the task is not available even after detailed repeated explanations from the experimenter.

4. The next requirement is related to the need to include in the neuropsychological examination sensitization conditions to obtain more accurate information about the state of a particular parameter of mental activity. These include: increasing the speed and time of task completion; exclusion of visual (closed eyes) and verbal (fixed tongue) self-control.

The success of performing any task under sensitized conditions (including memory traces) primarily indicates that the child’s process under study is automated, and therefore, among other advantages, can be a basis for corrective measures.

A necessary condition is also to perform any manual tests (motor, drawing, writing) with both hands alternately. I would like to emphasize that the use of bimanual tests is close in information content to dichotic listening, tachistoscopic experiment, etc., and neglecting them is an inadequate qualification of the existing phenomenology.

5. In all experiments , requiring the participation of the subject’s right and left hands, the instructions should not specify which hand to begin performing the task with. Spontaneous activity of one or another hand at the beginning of the task provides the experimenter with additional, indirect information about the degree of formation of the child’s manual preference. The same information is contained in “sign language”: the researcher must note which hand “helps” the child enrich his speech with greater expressiveness.

6. Most samples are given in several versions. This allows, on the one hand, to use a number of them for dynamic research, and on the other hand, to select a test option that is adequate to the child’s age.

Tasks should be alternated so that two identical ones (for example, memorizing two groups of 3 words and memorizing 6 words) do not follow one another.

7. It is extremely important to take the fact as an axiom , that the child is always included in a whole system of interpersonal and social relationships (parents, teachers, friends, etc.). Therefore, the success of your survey (and subsequent correction) will clearly correlate with how fully the relevant data is presented in it. First of all, this means establishing partnership contact with parents, especially with the child’s mother. It is she who can give you the most important information about his problems, and subsequently become one of the central participants in the correction process.

Conducting a psychological examination of children has a number of features . First of all, it should be noted that young children, and especially children with disabilities mental development, do not always easily and willingly come into contact with the experimenter and engage in activities to complete tasks. Therefore, one should refrain from a negative assessment of the child’s mental capabilities in cases where there is not sufficient confidence that it was possible to establish optimal contact with the child, achieve his feasible participation in the experiment and provide the necessary motivation for the child’s activities in completing tasks.

The reasons for a number of child’s refusals to complete a task may be not so much his intellectual incapacity as the degree of neuroticism, the presence of fears, depressive moods or certain characterological characteristics. The inclusion of a child of the first year of life in the examination situation is achieved by attracting his attention to bright new sounding objects, intense emotional-speech influence and the elimination of all objects that distract the child’s attention. Before the examination begins, it is necessary to allow the child to get used to the researcher, otherwise he may give a negative reaction to an unfamiliar person, which will significantly complicate the possibility of further contact.

The inclusion of older children in the examination situation is most easily achieved by using a plot-based combination of various tasks into one common “game”. To do this, a character or a series of characters is introduced into the examination and all further tasks are performed as if for these characters: “houses, Christmas trees, trains”, etc. are built for them. In this case, the characters are used to evaluate the child’s actions, they are happy or crying, they come closer when approved or hide when an action is incorrect, and sometimes they say something, advise, or ask. Children aged 1 to 2 years are recommended to be examined in close proximity to their mother, preferably with the child sitting on her lap. Otherwise, the anxiety that arises in children of this age in an unfamiliar situation can greatly complicate the examination. Children over two years old adapt much faster to the experimental situation, more easily come into contact with the researcher and willingly get involved in activities with toys that are new to them. At the same time, the presence of the mother is often optional and sometimes undesirable. It is worth starting the study with easy tasks that are most likely to be interesting for the child (such as putting objects of different sizes into one another). Then he can be offered a series of complex and more boring tasks for memorization, identification, recognition, attention, as well as generalization. As soon as the first signs of fatigue appear, it is worth switching the child’s attention to an easier task or even giving him a rest. If over time the child becomes more and more disinhibited, you can try to limit the freedom of his movements or, conversely, distract him and switch him to performing simple physical exercises that calm the nervous system. In cases where a child refuses to complete tasks, you should try to attract him to the activity using whispered speech or demonstrate tasks non-verbally, and also avoid using imperative statements such as “do”, “say”, etc. in your own speech. To find out the child’s reaction to failures and difficulties, you can artificially create a situation of failure, but this should be done with special care so as not to provoke too strong and poorly controlled affect.

Finally, the study should be conducted in such a way that the child leaves the researcher in a good mood and strives to continue the studies next time. There should be no specific rule in the order in which tasks are presented to the child. It is important to keep the child interested and complete each task quickly. You should replace one task with another if signs of boredom appear. For special purposes: determining the state of voluntary regulation of behavior and the degree of subordination of the child to the demands of an adult, as well as to expand ideas about the characteristics of emotional response, you can require the child to complete an uninteresting task to the end.

Interpretation of neuropsychological research data is carried out as a result of the analysis of protocol records, drawing out the individual state of mental functions from the profile.

The assessment of a child’s potential is based on the following facts:

1) intensity (severity) and extensiveness (prevalence) of mental dysfunctions;

2) identification of the leading factor preventing implementation tasks(see criteria for qualitative assessment);

3) the child’s receptivity to the help offered during the experiment.

The experimenter can answer the first two questions by studying the so-called individual “profile” of neuropsychological characteristics: identifying the most typical, frequently repeated score, identifying the most affected functions that ensure the formation of a particular school skill.

The possibility of answering the third question was initially provided for by a special organization of neuropsychological research. Most of the tasks included in the study are presented in 2 versions. In the first case, the instructions do not differ from those used in adult research practice. If performed incorrectly, the same task is given in a game situation that provides not only emotional stimulation, but also the inclusion of speech and semantic mediation of the action (for example: “You are a commander, and your fingers are soldiers, command: one, two...”, etc.). P.). After such an organization, as a rule, the results of completing the task improve and the score increases. This new result is entered into the study protocol and marked accordingly on the individual “profile” graph. Thus, the effectiveness of assistance and, most importantly, its types become important data for assessing the child’s potential capabilities.

At qualitative analysis state of the HMF, first of all, it is necessary to identify the leading factor that complicates the implementation of a given psychological operation. Such leading factors may be:

1) violation of individual cortical functions. In addition to partial violations of the specific functions listed above, children's learning difficulties can be caused by general nonspecific disorders of brain activity, reflecting discordination of cortical-subcortical functional relationships.

2) neurodynamic disorders; Disorders of general neurodynamics, manifested in increased exhaustion, disturbances in the pace and mobility of mental processes, and impaired performance of the asthenic type, come to the fore.

The criterion for qualitative and quantitative assessment was based on the degree of severity of the qualitative indicators of HMF disorders identified above. For this purpose, a five-point rating scale was developed.

About points- there are no neurodynamic disorders.

1 point- neurodynamic disorders of mild severity manifest themselves in a slower pace of task completion while maintaining the structure of a given psychological operation.

2 points- moderate neurodynamic disorders reflect a high degree of depletion of the tested function, manifested in mild deautomation of a motor stereotype or other skill, the presence of unstable and non-specific errors.

3 points- gross neurodynamic disorders, manifested in perseveratory phenomena by the presence of structural disorders given operation(the degree of expression of which also reflects the connection with the degree of severity of exhaustion of general neurodynamics).

4 points- extreme degree of gross disturbances in neurodynamics, primary disturbances in the structure of a given operation (lack of connection with the phenomena of exhaustion of general neurodynamics); the practical impossibility of completing the task.

3) violations of higher forms of regulation; in other clinical variants of mental dysontogenesis, disturbances in the voluntariness and purposefulness of cognitive activity are more significant: absence or instability of attitude (motivation) for cognitive activity, difficulties in planning a given mental operation, instability of voluntary attention and control. These aspects of conscious activity, as is known, are provided primarily by the work of the frontal and frontal-subcortical brain systems.

When qualitatively and quantitatively assessing violations of higher forms of regulation, it is necessary to focus not only on the nature of violations of voluntary control, programming and initiation, but also on the child’s receptivity to help from the experimenter. Thus, the content of the score will reflect both the severity of the violations and the content and effectiveness of auxiliary measures.

About points- there are no violations.

1 point- the child is quite goal-oriented; if there are difficulties, he independently finds ways to overcome them (slows down the pace, traces the images with his finger, accompanies the action with pronunciation, etc.).