Lecture No. 2. Forms, causes and degrees of mental retardation

3. Degrees of mental retardation.

4. Forms of oligophrenia.

5. Forms of dementia.

1. Forms of mental retardation.

The first attempt to differentiate mental retardation was made by Philippe Pinel in 1806, who designated mental retardation with the term “idotia” and identified four of its types. It was in this taxonomy that the division of dementia into congenital and acquired forms was first outlined, which still exists today. Mental retardation, according to modern clinical and psychological-pedagogical concepts, can be represented by two main forms of oligophrenia and dementia. These forms differ in the duration of action of the pathogenic (harmful) factor.

At mental retardation the pathogenic effect occurs in the prenatal, natal or early postnatal period (the first 2-3 years of life, when the most important mental functions are not yet formed), which causes such a picture mental development as underdevelopment, and this underdevelopment has the character of a total lag in the development of all mental functions and non-progression (lack of increase) of an intellectual defect. Among the forms of mental retardation, oligophrenia, or general mental underdevelopment, is the most common. The greatest insufficiency, in this case, is found in higher mental functions and cognitive sphere personality, because physiological basis their formations are the upper layers of the cerebral cortex, which are affected. The compensatory capabilities of such children are sharply limited (although not completely excluded) due to the fact that organic brain damage is diffuse in nature, i.e. the entire area is affected upper layers cerebral cortex. This criterion refers to the most typical part of mental retardation, and not to the entire range of these conditions. So, D.N. Isaev argues that “..with mental retardation, totality and predominant underdevelopment of the phylo- and ontogenetically youngest brain systems do not always occur. Mental underdevelopment may be due to a predominant lesion of more ancient deep formations, which impede the accumulation of life experience and learning.”

At dementia the pathogenic factor acts on the central nervous system in the period after 2-3 years, when most of the brain systems have already been formed and the disorder bears signs of damage to previously formed functions. At the same time, those functions that have recently taken shape or are in a sensitive period of formation receive the greatest damage. Thus, another feature of the development of children with dementia is a certain asynchrony (unevenness) in the development of mental functions, due to the preservation of some functions and the collapse of others.

If signs of underdevelopment are combined with signs of damage, we speak of dementia of oligophrenic origin .

2. Causes of mental retardation.

Causes of mental retardation

The causes of oligophrenia can be various factors of an exogenous (external) and endogenous (internal) nature that cause organic disorders of the brain.

Classification of brain lesions by time of occurrence:

prenatal (before childbirth);

intrapartum (during childbirth);

postnatal (after childbirth).

Classification of brain lesions by pathogenic factors:

hypoxic (due to oxygen deficiency);

toxic (metabolic disorders);

inflammatory (encephalitis and meningitis with rubella, toxoplasmosis);

traumatic (accidents, as well as compression of the brain during childbirth, with hemorrhages);

chromosomal genetic (Down's disease, Felling's disease, etc.);

intrasecretory hormonal;

degenerative;

intracranial neoplasms (tumors).

Of particular note is a group of factors that also lead to mental retardation - alcoholism, drug addiction, and substance abuse. Firstly, the breakdown products of alcohol and drugs (toxins), thanks to the common circulatory system of the mother and fetus, poison the developing fetus. Secondly, long-term use of alcohol and drugs (as well as their substitutes) cause irreversible pathological changes in the genetic apparatus of the parents and cause chromosomal and endocrine diseases child.

Causes of dementia

1) dementia as a result of severe trauma, brain tumors or the action of a toxic substance (for example, carbon monoxide), low activity of the thyroid gland, encephalitis, lack of vitamin B12, AIDS, etc., which destroy brain cells, develops suddenly in young people;

2) most typical reason: progressive diseases. However, the disease develops slowly and affects people over 60 years of age, as senile dementia as a result of Alzheimer's disease, Pick's disease, cyanide dementia, Parkinson's disease (uncommon), but dementia is not a normal part of aging, it is a severe decline in mental abilities that progresses over time. While healthy older adults sometimes do not remember details, those with dementia may completely forget recent events;

3) dementia as a result of vascular disorders of the brain (in the post-stroke period);

4) dementia developing as a result of mental illness (schizophrenia, epilepsy).

Based on psychometric studies, according to the modern international classification of diseases, it is characterized by an intelligence coefficient, the range of which is from 20 to 34 units.

According to the clinical picture and the list of disorders, this form of mental retardation is similar to a severe form of imbecility.

General characteristics of this category of children

• Children with this diagnosis can partially master speech and learn basic skills to care for themselves. Lexicon very meager, sometimes it does not exceed ten or twenty words. Almost all of them are needed to report own desires and needs, their thinking is very specific, chaotic and unsystematic.
• Children are able to react only to brightly colored objects, but even here their attention is very short-lived.
• Phenomena and objects that are unfamiliar to children do not cause any response. Only those objects that are well and long-term familiar and that are constantly before the eyes are distinguished satisfactorily.
• Diagnosis heavy mental retardation in children determines the presence of quite large deviations in memory, thinking, perception of the surrounding world, colloquial speech, motor skills make these children difficult, and sometimes almost unteachable. Only in very rare cases can some people master counting visible objects or combine real things into a group, such as furniture or clothing. But this is only possible in cases of a long process of special training.
• Almost all children in this category have noticeable large movement disorders– their gait is slow and awkward, movements of the arms and legs are delayed and have no amplitude.
• Children's hands and fingers are particularly underdeveloped, making it difficult to pick up and manipulate small objects.
• Motor impairment in severe mental retardation is observed in 9 out of 10 patients.
• Children have abnormal development of skeletal bones, shape cranium, legs and arms, skin And internal organs.

These children are recognized as disabled. Being legally incompetent, they must be under the guardianship of their parents or other persons. Until they reach adulthood, they often stay in specialized institutions, and then they are transferred to homes for the disabled of the appropriate profile.

Causes of the disease

• damage to the fetus in the mother's womb by neurotoxic factors of an infectious, chemical, physical nature - syphilis, cytomegalovirus, ionizing radiation and others;
• the birth of a baby before a certain time is a major prematurity;
• disruptions during the birth process, as a result of which the baby could receive a birth injury or temporary asphyxia was observed;
• receiving serious head injuries in early childhood;
• brain hypoxia;
• infectious diseases that resulted in damage to the child’s central nervous system;
• living in dysfunctional families and, as a consequence, pedagogical neglect;
• manifestation of dementia of unknown etiology.
  

Causes due to genetics

Mental illness is one of the reasons why people seek genetic counseling. This is understandable - more than half of the cases of mental abnormalities are associated with genetic disorders. The main types of genetic failures that can provoke childhood mental disability:

• chromosomal abnormalities leading to imbalance of genes - aneuploidy, duplications, deletions. Due to these abnormalities, children are born with Down syndrome, Williams syndrome and other abnormalities;
• uniparental dimission of chromosomes, or sections of chromosomes, leads to the appearance of children with Angelman or Prader-Willi syndrome;
• disturbances in the functioning of certain genes, and mutations occurring in them. The number of genes that can mutate exceeds a thousand. They cause autism, fragile X syndrome, and Rett syndrome, which occurs only in girls.

Probably, the saying about patience and work is most suitable for those. who has children in the family with mental disabilities – severe mental retardation in children not a light burden at all . Of course, there are special institutions, but where to raise a child, everyone decides for himself.

A person can work successfully and gain new knowledge thanks to cognitive functions brain. In children, especially in the first year of life, there is often a violation of this function, which jeopardizes their normal existence. Problem associated with severe mental retardation. It is difficult, both for the child himself and for his relatives. Knowing the symptoms of pathology will allow adults to promptly notice existing abnormalities in the baby and seek help from a specialist.

Causes

Mental retardation is most often detected in children under 3 years of age, but in some cases the diagnosis is made at school age.

The pathology is classified into a separate category - oligophrenia. It manifests itself in problems with speech, motor skills, social adaptation and the ability to acquire new knowledge and skills.

The disease is often non-progressive in nature, that is, it does not develop over time. But sometimes, in the absence therapeutic measures, the pathology is progressing. Against the background of the disease, other symptoms may also appear. psychological disorders. Patients diagnosed with severe mental retardation have similar characteristics to people with Down syndrome or autism.

The reasons that can lead to the occurrence of pathology are still not fully understood. Factors that provoke the occurrence of pathology are divided into external and internal or endogenous and exogenous. The causes of pathology include:

Pathology can develop against the background of:

• unfavorable environmental conditions;
• increased levels of radiation;
• parental use of drugs or alcoholic beverages;
• low level of income.

In the latter case, the patient does not receive the necessary microelements from food.

Classification of the disease

With mental retardation in children, not only cognitive, but also psychological functions brain. Therefore, it is difficult for the patient to be in organized groups. Mild degrees of pathology are difficult to diagnose before the age of one, since at this time the child does not yet know how to talk and analyze information.

The degrees of pathology are usually classified depending on the child’s level of intelligence (IQ). The results of the intelligence assessment are deciphered as follows:

Together with the level of intelligence, the type of his behavior and the presence of accompanying psychological disorders. In children with severe forms of the disease, the following disorders are noted:

All desires of patients with idiocy are related to the satisfaction of natural needs. The behavior of children with severe mental retardation is characterized by lethargy, lethargy, or uncontrolled motor activity.

Idiocy is further divided into 3 groups:

With complete idiocy, a person lacks almost all desires, and the functions of perception of the surrounding world are impaired. In behavior they are similar to animals: they scream loudly, react inadequately to external stimuli, and cannot take care of themselves.

In the typical form of the disease, the instincts of patients are more pronounced. They can communicate their desires or discomfort using gestures or sounds. In this case, speech skills are completely absent.

Speech idiots are able to respond to external stimuli and pronounce individual sounds. Skills for cognitive activity are missing.

Programs for children

The program for children with severe mental retardation is developed by specialists of several profiles - teachers, neurologists, psychologists, pediatricians. Orthopedists, speech therapists and physiotherapists also participate in the treatment of children.

The main goal of therapy is to teach patients basic self-care skills and help them adapt to environment. For this purpose, many specialized centers have been created in which children are taught according to a simplified scheme. Rehabilitation takes place with the help of equipment for stimulating nerve fibers, professional massage therapists and kinesiotherapists. These activities increase the chance of teaching the child the necessary skills.

Teenagers are also trained in specialized centers. primary goal curricula– teach the patient to navigate in time and space, as well as independently perform basic actions - go to the toilet, perform simple work on the computer.

People with moderate or mild dementia are able to care for themselves and work in jobs that do not require intellectual abilities.

Because of functional disorders in the brain, the life expectancy of such patients is reduced. However, constant monitoring by specialists, timely medical events can improve the survival prognosis for children with any degree of mental retardation. Children with severe forms of pathology, as a rule, need outside help throughout their lives. How more pronounced symptoms disease, the higher the risk of death.

Therapy

Treatment of mentally retarded children will be successful only with complex influence, that is, not only with individual approach training must be combined with medications. To correct the pathological condition, children are prescribed nootropics - Piracetam, Aminalon, Pantogam. Purpose of reception nootropic drugs– speed up metabolism in brain cells. For the same purpose, patients are prescribed B vitamins and amino acids.

In case of disturbed behavior, the patient is recommended to take tranquilizers or antipsychotics. The dosage and treatment regimen for drugs in this group are determined by a psychiatrist. Instead of medications, for example, nootropics can be used medicines natural origin – Chinese lemongrass, ginseng tincture. Plants activate work nervous system. However, stimulants in some cases provoke psychosis. Therefore, accepting funds traditional medicine is possible only after consultation with doctors.

Reduce the risk of having a child with severe mental retardation Counseling of married couples with a geneticist is possible. If there is a risk of having a sick baby, then couples are recommended to undergo prenatal testing, which includes:

• ultrasonography;
• amniocentesis;
• study of fetoprotein in maternal blood serum.

Amniocentesis can detect genetic and metabolic abnormalities in the fetus. This analysis V mandatory prescribed to all pregnant women over 35 years of age.

Thanks to the rubella vaccine being included in the schedule national vaccinations, managed to eliminate one of the causes of severe mental pathology. A vaccine against cytomegalovirus infection, which in some cases also leads to dementia.

Severe mental retardation is an incurable diagnosis. Children and adults with this disease need outside help throughout their lives, because they cannot fully cope with self-care skills, like people with mild to moderate disease. There are several forms of dementia: complete, speech and typical. In the first case, patients are not amenable to learning and cannot express their desires with the help of facial expressions and gestures, and their life expectancy is much shorter than that of healthy people.

Characteristics of mental retardation

Plan

1. Signs of mental retardation

2. Types of mental retardation

3. Degrees of mental retardation

1. Signs of mental retardation

Mental retardation is a severe, irreversible systemic impairment of cognitive activity that occurs as a result of diffuse organic damage to the cerebral cortex.

In this definition, the presence of three characteristics should be emphasized:

1) organic diffuse damage to the cerebral cortex;

2) systemic intellectual impairment;

3) the severity and irreversibility of this disorder.

The lack of at least one of these signs will indicate that we are not dealing with mental retardation, but with some other type of dysontogenesis. Really:

Underdevelopment of mental activity in the absence of organic damage to the cerebral cortex is a sign of pedagogical neglect, which can be corrected;

Local damage to the brain can cause loss or disorder of one or another mental function (impaired hearing, speech, spatial gnosis, visual perception and the like), but at the same time the intelligence as a whole is preserved and there is the possibility of compensation for the defect;

Functional disorders of brain structures can lead to temporary defects in cognitive activity, which under certain conditions can be eliminated;

An insignificant decrease in intelligence limits a person’s ability to master certain types of complex cognitive activities, but does not affect the success of independent social adaptation individual;

Organic brain damage does not necessarily cause impairment of cognitive functions, but can cause disorders of the emotional-volitional sphere and disharmonious development.

It should be noted that not all defectologists agree with this definition. For example, L.M. Shipitsyna believes that with mild mental retardation there is not always organic damage to the brain. Some scientists expand the concept of mental retardation to include those cases where developmental delay is predetermined by unfavorable circumstances. social conditions, deprivation, pedagogical neglect. Indeed, pedagogical neglect can be so deep that it leads to irreversible changes in higher nervous activity.

The child misses the sensitive periods of formation of the most important higher mental functions, in particular speech, and actually stops at the natural stage of development.

According to the definition of D.M. Isaevata (2005), mental retardation is a combination of etiologically different (hereditary, congenital, acquired in the first years of life), non-progressive pathological conditions, which result in general mental underdevelopment with a predominance of intellectual defect and lead to complications in social adaptation.

2. Types of mental retardation

Depending on the time of occurrence, mental retardation is divided into two types - mental retardation and dementia.

Mental retardation is a type of mental retardation that occurs as a result of organic damage to the brain in the prenatal, natal or early (up to three years) period of childhood and results in total mental underdevelopment.

It is important to note that oligophrenia is not defined etiological factors, but the early influence of these factors on the brain. That is, a very diverse hereditary, congenital, acquired harmfulness in the prenatal and early postnatal periods predetermine general mental underdevelopment. The clinical manifestations of oligophrenia do not depend on the causes of its occurrence, unlike dementia, in which the structure of the defect is to a certain extent determined by etiological factors.

For example, the pathogenesis and psychological characteristics children with traumatic dementia and dementia that resulted from neuroinfection, while mental retardation predetermined by trauma or infection have the same symptoms.

As you know, the brain of a newborn child has not yet completed its formation. The formation of cork structures, the establishment of connections between cortical neurons, and the myelination of nerve fibers occur in parallel with the mental development of the individual and largely depend on the experience that the child acquires.

Through bad influence On the cerebral cortex in the early period, neurons turn out to be immature or blocked and cannot fully perform their functions, which complicates the process of forming connections between them. Neurodynamics in oligophrenia is characterized by weakness of the obturator function of the cerebral cortex, instability of connections, inertia and weakness nervous processes, insufficiency of internal inhibition, excessive irradiation of excitation, difficulties in the formation of complex conditioned reflexes.

Therefore, the mental development of an oligophrenic child is carried out on an abnormal basis. Early period damage to the cerebral cortex leads to more pronounced underdevelopment of functions that have more a long period ripening, which, in turn, determines the hierarchy in which regulatory systems and highest level organization of any mental function. The primary defect in oligophrenia is associated with total underdevelopment of the brain, especially in the phylogenetically youngest associative zones.

Secondary defect in oligophrenia, for V.V. Lebedinsky, has a circular character, predetermined by two coordinates of underdevelopment: “from bottom to top” - insufficiency of elementary mental functions creates an unfavorable basis for the genesis of verbal-logical thinking; “from top to bottom” - underdevelopment of higher forms of thinking prevents the restructuring of elementary mental processes, in particular, the formation of logical memory, voluntary attention, reference perception, and the like. The formation of a secondary defect is predetermined by cultural deprivation.

In the structure of dysontogenesis in oligophrenia, there is a violation of interanalyzer connections and, accordingly, isolation of individual functions. Characteristic of oligophrenic children is the separation of speech from action, comprehension, understanding of material from its memorization.

Oligophrenia has a residual (non-progressive) character, that is, it does not have a tendency to progress - to deepen the degree of severity. This circumstance and relative preservation at mild degree motivational-need, emotional-volitional sphere, purposefulness of activity, absence of encephalopathic and psychotic disorders provide the possibility of satisfactory dynamics of development and the effectiveness of pedagogical influence. But with oligophrenia, phenomena of underdevelopment are observed in the dynamics of mental development at all stages.

The following are the main signs of oligophrenia:

The presence of an intellectual defect, which combines with disorders of motor skills, speech, perception, memory, attention, emotional sphere, arbitrary forms of behavior;

Total intellectual deficiency, that is, underdevelopment of all neuropsychic functions, impaired mobility of mental processes;

The hierarchy of an intellectual defect, that is, the overwhelming insufficiency of abstract forms of thinking against the background of underdevelopment of all neuropsychic processes. Underdevelopment of thinking is reflected in the course of all mental processes: perception, memory, attention. First of all, all functions of abstraction and generalization, comparisons based on essential features, and understanding of figurative meaning suffer; components of mental activity associated with the analytical and synthetic activity of the brain are disrupted.

At the same time, higher mental functions, which are formed later and are characterized by volition, are less developed than elementary ones. In the emotional-volitional sphere, this turns out to be the underdevelopment of complex emotions and voluntary forms of behavior. Consequently, oligophrenia is characterized by non-progression, totality and hierarchy of mental development disorders, and relative preservation of the personal aspect of cognitive activity. This marked type of mental retardation differs from dementia.

Dementia is a type of mental retardation that occurs as a result of damage to the cerebral cortex in the period after two to three years and results in a significant decrease in intellectual capabilities and a partial collapse of already formed mental functions.

Since the formation of the cerebral cortex is mainly completed at the age of 16-18, the phenomena of degradation are accompanied by mental underdevelopment

The nature of desontogenesis in dementia is determined by the combination of a gross violation of a number of formed mental functions with ontogenetic underdevelopment early formations(frontal systems), as a result, the frontal-subcortical interaction suffers. Along with the partial loss of individual cortical functions, disorders of the emotional sphere are primarily observed, often with disinhibited trains, severe disturbances in purposeful activity and the personality as a whole.

Damage leads to insulation phenomena individual systems, the collapse of complex hierarchical connections, often with a gross regression of intelligence and behavior.

Dementia is characterized by partial impairment of mental functions. This means that some of them are more damaged, while others are less. Complications of cognitive activity are predetermined not so much by disturbances in thinking, but by gross disorders of focus, attention, memory, perception, emotions, as well as the extremely low intensity of the desire for achievement. In dementia, neurodynamic processes are significantly affected, resulting in inertia of thinking, rapid exhaustion, and disorganization. mental activity generally.

Moderate degree of mental retardation (mild imbecility)

This is an average degree of mental underdevelopment, accounting for 10% of the total number of mentally retarded people. Its etiology can be both hereditary defects and the consequences of organic brain damage. It is characterized mainly by unformed cognitive processes(concrete, inconsistent, slow thinking) and inability to form abstract concepts. IQ ranges from 35-49 or 54.

Static and locomotor functions. They develop with a significant delay and are not sufficiently differentiated. Their coordination, accuracy and pace of movements are impaired. Movements are slow and clumsy, which interferes with the formation of a complex mechanism of running and jumping (kinetic apraxia). Mentally retarded people have difficulty reproducing even given movements or postures (postural apraxia). In this case, pathological synkinesis often appears. They have great difficulty performing activities that require switching movements or quick changes. In some, motor underdevelopment is manifested by monotony of movements, slowness of their pace, lethargy, and awkwardness. In others, increased mobility is combined with lack of focus, disorder, and lack of coordination of movements. Severe defects in motor underdevelopment can interfere with the formation of self-care skills that require fine movements of the fingers: when lacing shoes, fastening buttons, tying ribbons (apraxia of dressing). Most developmentally delayed people need constant assistance in many household chores, and some of them in supervision.

Attention disorders. Everyone's attention is impaired. It is difficult to attract, is unstable and distractible. Extremely weak active attention prevents the achievement of the goal. Under favorable conditions, it can be significantly improved; it is possible to achieve more active inclusion in classes with the teacher, switching in the process of performing the mastered activity.

Disturbances in the processes of sensation and perception. The sensory sphere is very impaired. The development of visual, auditory and other analyzers lags behind. There are often gross anomalies of vision and hearing. However, even if they are preserved, many do not know how to use them. Objects and phenomena are perceived in general outline. There is no activity of perception, they are not able to identify the features of what they perceive and compare them with those of another object. The inability to analyze, search, and fully comprehend perceived information leads to chaotic, unfocused activity. As a result, they cannot navigate the situation on their own and require constant guidance. Correction of emerging sensory abilities can improve the habilitation of these children.

Thought disorders. The moderately mentally retarded have a very limited supply of information and ideas. They have difficulty operating with existing ideas. Their thinking is concrete, inconsistent, and slow-moving. The development of even visual thinking suffers. The formation of abstract concepts is either inaccessible or sharply limited to the most elementary generalizations. They can be taught to group clothes and animals. They are able to establish differences only on specific objects. They are completely incapable of operating with abstract concepts. Conceptual generalizations are formed with great difficulty or occur at the situational level.

These thinking disorders are manifested in the extremely inadequate use of objects when solving visual and practical problems: everyday life, play, constructive, in which a visual or represented example acts as a means of solution. Such patients do not know how to analyze a subject, apply techniques of comparison, transfer, and targeted search. They are made difficult by establishing connections between individual parts of the task. Because of this, there is a lack of focus, speed and accuracy of reactions, switching from one action to another; They do not have developed self-control.

It is not possible to compose a coherent story based on the plot of the most elementary picture: most often the individual objects depicted are named. They cannot arrange pictures in order, united by a single plot, and understand the sequence of what is happening. Judgments are poor, and are a repetition of heard advice and recommendations.

Some moderately mentally retarded people learn all the letters, combine them into syllables, and even read short texts. But they do not comprehend what they read. They perceive it fragmentarily and therefore convey the content in unrelated passages. They assimilate the material unconsciously, mechanically. They master ordinal counting and perform simple arithmetic operations on specific material. They fail to count abstractly within the top ten. They cannot solve problems: the condition of the problem is not retained in memory, and semantic connections are not established.

The main difficulties of moderate mental retardation when solving problems: 1. weak acceptance of the task due to the absence or insufficiently strong motivation, avoidance of the task, mental passivity; 2. lack of orientation in the task, i.e. understanding the connections between links; 3. inability to “meaningfully” organize one’s activities to complete a task, i.e. sequential transition from one action to another, making connections between actions, inability to correctly use visual aids to solve a problem.

Speech disorders. Patients develop understanding and use of speech slowly, with a delay of 3-5 years, and its final formation is limited. Speech development usually corresponds to the degree of mental retardation. At the same time, the child understands the interlocutor’s speech to a very limited extent, satisfactorily capturing intonations, gestures and facial movements.

In the future, especially under the influence of teachers, speech develops, but its understanding is ultimately determined personal experience. Expressive speech is limited to single words or short sentences. The vocabulary is poor, consisting of the most frequently used words and expressions. After several years of training, they learn the names of household items and vegetables.

The pronunciation side of speech is defective, speech is almost devoid of modulations, pronounced tongue-tiedness, there are violations of the structure of many words and agrammatism. The most common prepositions are used, children confuse prepositions and replace them.

They manage to develop the ability to use their speech for communication purposes. In the process of communication, they know how to ask others for the items they need and dare to ask questions. In rare cases, the child’s speech is a stream of meaningless cliches pronounced in previously heard intonation (echolalic speech). The origin of this disorder is associated with a predominant lesion of the frontal lobe of the cerebral cortex or with hydrocephalus. In 20% of moderately mentally retarded children, speech does not appear at all due to damage to the speech areas of the cortex.

Memory disorders. Memory is not developed enough: its volume is small, but adolescence it can increase, reaching the level found in mildly mentally retarded children. Long-term memory improves better short term memory. When reproducing captured material, distortion often occurs. Voluntary memorization is impaired. Both logical and mechanical memory suffers. Children with moderate mental retardation according to the correctional school program (8th type) are unteachable.

A small part of them (mainly due to good mechanical memory) master the basic skills necessary for reading, writing and basic calculation. Educational programs(in special classes of correctional schools or boarding schools) can give them the opportunity to develop limited potential and expand the range of self-service skills and orientation in the immediate environment. Hardly acquired knowledge is applied mechanically, like memorized cliches.

As a result of training through repeated visual demonstrations with gradual complication of the task over several years, it is possible to prepare adolescents for work and life in a work community. In addition to labor lessons, it is necessary to strengthen reading and numeracy skills related to labor processes. Moderately mentally retarded adults, calm and amenable to guidance, are usually capable of simple practical work with constant instructions from an instructor. Independent labor activity is not available to them.

Emotional-volitional disorders. Independent living is not possible. However, such people may be mobile, physically active and most show signs of social development, i.e. are able to establish contacts, communicate, and participate in basic social activities organized by educators.

The most typical personality traits of moderately mentally retarded people are: lack of initiative, independence, inertia of the psyche, a tendency to imitate others, a combination of suggestibility with negativism, instability in activity combined with inertia and stiffness.

The relative integrity of their affective life is reflected in their sensitivity to other people's assessments of them. Violations of the emotional-volitional sphere include a lack of emotional diversity, undifferentiated feelings, as well as their inertia and stiffness. Their self-esteem is unique: they put themselves in first place, their friend in second, and their teacher in third. This can be explained by their better understanding of peers compared to adults. As a result of the correction process, their self-esteem can often be changed. They begin to give credit to their teachers.

Even if impulses arise as the personality matures, they are weak and quickly depleted.

Characteristic asynchrony development different areas mental health: some have a higher level of visual-spatial skills compared to the results of tasks that depend on the development of speech. In others, considerable clumsiness is combined with some success in social interaction and basic conversation. Levels of speech development vary: some patients can take part in simple conversations, others have a speech reserve sufficient only to communicate their basic needs. Some patients never acquire the ability to use speech, although they can understand simple instructions and learn manual signs to compensate, to some extent, for their speech deficits. Such asychrony in the development of different spheres of the psyche of moderately mentally retarded children is apparently etiologically related to the consequences of organic brain lesions.

A small proportion of children have no need for communication. The majority have developmental disorders that have a major impact on clinical picture: some are good-natured and friendly; others are dysphoric, angry, aggressive; still others are stubborn and lazy; the fourth are sluggish, aspontaneous, inactive.

Many experience increased and perverted drives, including disinhibition of sexuality. They are prone to impulsive actions. Epileptiform seizures often occur. In moderately mentally retarded children, neurological symptoms(paresis, paralysis), as well as signs of physical malformations: underdevelopment of limbs, fingers, disturbances in the formation of the head, underdevelopment of internal organs, hypogenitalism, defects of the face, eyes, ears. Possible somatic manifestations associated diseases ( bronchial asthma, stomach ulcer).

Most people with mild mental retardation are able to cope without assistance. Basic mental disorders sometimes complicated by other neuropsychic pathologies - neuroses, psychoses. However, the limited development of their speech makes it difficult to identify.