Psychopharmacotherapy for mental retardation enters into new era, characterized by improved diagnostics, understanding of its pathogenetic mechanisms, and expanded therapeutic options.
Research and treatment of children and adults with mental retardation must be comprehensive and take into account how the individual studies, works, and how his relationships with other people develop. Treatment options include a wide range of interventions: individual, group, family, behavioral, physical, occupational and other types of therapy. One of the components of treatment is psychopharmacotherapy.
The use of psychotropic drugs in mentally retarded individuals requires special attention to legal and ethical aspects. In the 70s, the international community proclaimed the rights of mentally retarded persons to receive adequate medical care. These rights were set out in the Declaration of the Rights of Persons with Disabilities. The Declaration proclaimed “the right to adequate medical care” and “the same civil rights as other people.” According to the Declaration, “persons with disabilities should be provided with qualified legal assistance if necessary for the protection of these persons.”
The proclamation of the right of mentally retarded persons to adequate medical care implied close control over possible excesses in the application of restrictive measures, including in connection with the use of psychotropic drugs to suppress unwanted activity. Courts have generally held that physical or chemical restraint should only be applied to a person when there is “the occurrence or serious threat of violent behavior, injury, or suicide attempt.” In addition, courts typically require "an individualized assessment of the potential and nature of disruptive behavior, the likely effect of the medications on the individual, and the availability of alternative, less restrictive actions" to ensure that the "least restrictive alternative" has been pursued. Thus, when deciding to use psychotropic drugs in mentally retarded individuals, the possible risks and expected benefits of such a prescription should be carefully weighed. Protecting the interests of a mentally retarded patient is carried out through the involvement of an “alternative opinion” (if anamnestic data indicate the absence of criticism and the patient’s preferences) or through the so-called “replaced opinion” (if there is some information about the preferences of the individual in the present or past).
In the last two decades, the doctrine of the “least restrictive alternative” has become relevant in connection with research data on the use of psychotropic drugs in mentally retarded patients. It turned out that psychotropic drugs are prescribed to 30-50% of patients admitted to psychiatric institutions, 20-35% of adult patients and 2-7% of children with mental retardation observed on an outpatient basis. It has been established that psychotropic drugs are more often prescribed to older patients, people subject to more severe restrictive measures, as well as patients with social, behavioral problems and sleep disorders. Gender, level of intelligence, and the nature of behavioral disorders did not affect the frequency of use of psychotropic drugs in mentally retarded individuals. It should be noted that although 90% of mentally retarded people live outside psychiatric institutions, systematic studies of this population of patients are extremely rare.
Psychotropic drugs and mental retardation
Since for people with mental retardation to control behavior on long term Often psychotropic drugs, and often a combination of them, are prescribed, it is extremely important to take into account the short-term and long-term effects of these drugs in order to choose the safest ones. This primarily concerns antipsychotics, which are especially often used in this category of patients and often cause serious side effects, including irreversible tardive dyskinesia. Although antipsychotics help control inappropriate behavior by suppressing behavioral activity in general, they are also capable of selectively inhibiting stereotypies and auto-aggressive actions. To reduce auto-aggressive effects and stereotypy, opioid antagonists and serotonin reuptake inhibitors are also used. Normotimics - lithium salts, valproic acid (Depakine), carbamazepine (Finlepsin) - are useful in the correction of cyclic affective disorders and outbursts of rage. Beta blockers, such as propranolol (Anaprilin), can be effective in treating aggression and destructive behavior. Psychostimulants - methylphenidate (Ritalin), dextramphetamine (Dexedrine), pemoline (Cilert) - and alpha2-adrenergic agonists, for example, clonidine (clonidine) and guanfacine (Estulik), have a positive effect in the treatment of attention deficit hyperactivity disorder in people with mental retardation .
Combined treatment with antipsychotics, anticonvulsants, antidepressants and mood stabilizers is fraught with problems associated with pharmacokinetic and pharmacodynamic interactions. Therefore, before prescribing a combination of drugs, the doctor should inquire about the possibility of drug interactions in reference books or other sources of information. It should be emphasized that patients often take unnecessary medications for a long time, the discontinuation of which does not have an adverse effect on their condition, but allows them to avoid the side effects of these medications.
Neuroleptics. Many psychotropic drugs have been used to suppress destructive behavior, but none have been as effective as antipsychotics. The effectiveness of antipsychotics may be explained by the role of hyperactivity of the dopaminergic systems of the brain in the pathogenesis of auto-aggressive actions. Clinical trials Chlorpromazine (Aminazine), thioridazine (Sonapax), and risperidone (Rispolept) have all demonstrated the ability of these drugs to inhibit destructive actions. Open trials of fluphenazine (moditene) and haloperiaol have also demonstrated their effectiveness in correcting autoaggressive (self-injurious) and aggressive actions. However, aggression may not respond to the same extent as self-injurious behavior to antipsychotic treatment. Perhaps, with auto-aggressive actions, internal, neurobiological factors are more important, while aggressiveness is more dependent on external factors.
The main danger with the use of antipsychotics is the relatively high incidence of extrapyramidal side effects. According to various studies, approximately one to two thirds of patients with mental retardation show signs of tardive dyskinesia - a chronic, sometimes irreversible orofacial dyskinesia, usually associated with long-term use of antipsychotic drugs. At the same time, it has been shown that in a significant proportion (in some studies, a third) of patients with mental retardation, violent movements reminiscent of tardive dyskinesia occur in the absence of neuroleptic therapy. This indicates that this category of patients is characterized by a high predisposition to the development of tardive dyskinesia. The likelihood of developing tardive dyskinesia depends on the duration of treatment, the dose of antipsychotic, and the age of the patient. This problem is especially relevant due to the fact that approximately 33% of children and adults with mental retardation take antipsychotic medications. Parkinsonism and other early extrapyramidal side effects (tremor, acute dystonia, akathisia) are detected in approximately one third of patients taking antipsychotics. Akathisia is characterized by internal discomfort, forcing the patient to be in constant movement. It occurs in approximately 15% of patients taking antipsychotics. The use of antipsychotics carries the risk of neuroleptic malignant syndrome (NMS), which is rare but can lead to fatal outcome. Risk factors for NMS are male gender, use of high-potency neuroleptics. According to a recent study, the mortality rate among mentally retarded individuals with the development of NMS is 21%. In cases where neuroleptics are prescribed to patients with mental retardation, a dynamic assessment of possible extrapyramidal disorders is mandatory before treatment and during treatment using special scales: Abnormal Involuntary Movement Scale (AIMS), Dyskinesia Identification System Condensed User Scale - DISCUS, Acathisia Scale (AS) Atypical antipsychotics such as clozapine and olanzapine are less likely to cause extrapyramidal side effects, but their effectiveness in mentally retarded individuals should also be confirmed in controlled clinical trials. Although clozapine is an effective antipsychotic, it can cause agranulocytosis and epileptic seizures. Olanzapine, sertindole, quetiapine and ziprasidone are new atypical antipsychotics that will undoubtedly be used in the future to treat mentally retarded patients because they are safer than traditional antipsychotics.
At the same time, an alternative to antipsychotics has recently appeared in the form of selective serotonin reuptake inhibitors and mood stabilizers, but their use requires a more clear identification of the structure mental disorders. These drugs may reduce the need for antipsychotics in the treatment of self-harm and aggression.
Normotimics. Hypotensive drugs include lithium preparations, carbamazepine (Finlepsin), valproic acid (Depakine). Severe aggressiveness and self-harming behavior can be successfully treated with lithium even in the absence of affective disorders. The use of lithium led to a decrease in aggressive and auto-aggressive actions, both according to clinical impressions and results rating scales, in almost all clinical trials. Other mood stabilizers (carbamazepine, valproic acid) may also suppress self-injurious behavior and aggression in people with mental retardation, but their effectiveness needs to be tested in clinical trials.
Beta blockers. Propranolol (Anaprilin), a beta-adrenergic blocker, can reduce aggressive behavior associated with increased adrenergic tone. By preventing the activation of adrenergic receptors by norepinephrine, propranolol reduces the chronotropic, inotropic and vasodilatory effects of this neurotransmitter. Inhibition of the physiological manifestations of stress can itself weaken aggressiveness. Since in patients with Down syndrome the level of propranolol in the blood was higher than usual, the bioavailability of the drug in these patients may be increased for certain reasons. Although propranolol has been reported to successfully suppress impulsive temper tantrums in some mentally retarded individuals, this effect of propranolol needs to be confirmed in controlled trials.
Opioid receptor antagonists. Naltrexone and naloxone, opioid receptor antagonists that block the effects of endogenous opioids, are used in the treatment of autoaggressive actions. Unlike naltrexone, naloxone is available in a form for parenteral administration and has a shorter T1/2. Although early open-label studies of opioid receptor antagonists demonstrated a reduction in self-injury, they were not superior to placebo in subsequent controlled trials. The possibility of developing dysphoria and negative results of controlled studies do not allow us to consider this class of drugs as a drug of choice for auto-aggressive actions. But, as clinical experience shows, in some cases these remedies can be useful.
Serotonin reuptake inhibitors. The similarity of auto-aggressive actions with stereotypies may explain the positive reaction of a number of patients to serotonin reuptake inhibitors, such as clomipramine (Anafranil), fluoxetine (Prozac), fluvoxamine (Fevarin), sertraline (Zoloft), paroxetine (Paxil), citalopram (Cipramil). Self-harm, aggression, stereotypies, and behavioral rituals may decrease under the influence of fluoxetine, especially if they develop against the background of comorbid compulsive actions. Similar results (reduction of auto-aggressive, ritual actions and perseverations) were obtained with the use of clomipramine. Double-blind trials will determine whether these agents are useful in all patients with self-injurious behaviors or whether they only help those with comorbid compulsive/perseverative behaviors. Since these drugs can cause agitation, their use may be limited to the treatment of this syndrome.
Mental retardation and affective disorders
Recent advances in the diagnosis of depression and dysthymia in mentally retarded individuals allow these conditions to be treated with more specific means. However, the response to antidepressants in mentally retarded individuals is variable. When using antidepressants, dysphoria, hyperactivity, and behavioral changes often occur. In a retrospective review of the response to tricyclic antidepressants in mentally retarded adults, only 30% of patients showed a significant benefit, and symptoms such as agitation, aggression, self-injurious behavior, hyperactivity, and irascibility remained largely unchanged.
The reaction to normothimic drugs in cyclic affective disorders in patients with mental retardation was more predictable. Although lithium is known to disrupt sodium transport in nerve and muscle cells and affect catecholamine metabolism, the mechanism of its action on affective functions remains unclear. When treating with lithium preparations, the level of this ion in the blood should be regularly monitored, a clinical blood test and a study of thyroid function should be performed. One placebo-controlled and several open-label studies of the effectiveness of lithium for bipolar disorder in people with mental retardation have yielded encouraging results. Side effects of lithium medications include gastrointestinal upset, eczema, and tremors.
Valproic acid (Depakine) and divalproex sodium (Depakote) have anticonvulsant and normothymic effects, which may be due to the drug’s effect on the level of GABA in the brain. Although cases of toxic effects of valproic acid on the liver have been described, they were usually observed in early childhood, in the first six months of treatment. However, liver function should be monitored before starting and regularly during treatment. It has been shown that the positive effect of valproic acid on affective disorders, aggression and self-harmful actions in mentally retarded individuals occurs in 80% of cases. Carbamazepine (Finlepsin), another anticonvulsant used as a mood stabilizer, may also be useful in the treatment of affective disorders in mentally retarded individuals. Since aplastic anemia and agranulocytosis may develop when taking carbamazepine, a clinical blood test should be monitored before prescribing the drug and during treatment. Patients should be alerted to early signs of intoxication and hematologic complications such as fever, sore throat, rash, oral ulcers, bleeding, petechial hemorrhages, or purpura. Despite its antiepileptic activity, carbamazepine should be prescribed with caution in patients with polymorphic seizures, including atypical absence seizures, since in these patients the drug can provoke generalized tonic-clonic seizures. Response to carbamazepine in mentally retarded persons with affective disorders not as predictable as the reaction to lithium and valproic acid.
Mental retardation and anxiety disorders
Buspirone (buspar) is an anxiolytic drug that differs in pharmacological properties from benzodiazepines, barbiturates and other sedatives and hypnotics. Preclinical studies indicate that buspirone has high affinity for serotonin 5-HT1D receptors and moderate affinity for dopamine D2 receptors in the brain. Last effect may explain the appearance of restless legs syndrome, which sometimes occurs shortly after the start of treatment with the drug. Other side effects include dizziness, nausea, headache, irritability, agitation. The effectiveness of buspirone in the treatment of anxiety in mentally retarded individuals has not been subjected to controlled trials. However, it has been shown that it may be useful in autoaggressive actions.
Mental retardation and stereotypies
Fluoxetiv is a selective serotonin reuptake inhibitor effective for depression and obsessive-compulsive disorder. Since fluoxetine metabolites inhibit the activity of CYP2D6, combination with drugs that are metabolized by this enzyme (for example, tricyclic antidepressants) may lead to side effects. Studies have shown that steady-state blood concentrations of imipramine and desipramine increase 2- to 10-fold after the addition of fluoxetine. Moreover, since fluoxetine has a long half-life, this effect may occur within 3 weeks after its discontinuation. The following side effects are possible when taking fluoxetine: anxiety (10-15%), insomnia (10-15%), changes in appetite and weight (9%), induction of mania or hypomania (1%), epileptic seizures (0.2%) . In addition, asthenia, anxiety, increased sweating, gastrointestinal disorders, including anorexia, nausea, diarrhea, and dizziness are possible.
Other selective serotonin reuptake inhibitors - sertraline, fluvoxamine, paroxetine and the non-selective inhibitor clomipramine - may be useful in the treatment of stereotypy, especially if there is a compulsive component. Clomipramine is a dibenzazepine tricyclic antidepressant with a specific anti-obsessive effect. Clomipramine has been shown to be effective in the treatment of temper tantrums and compulsive ritualistic behaviors in adults with autism. Although other serotonin reuptake inhibitors may also have beneficial effects on stereotypies in mentally retarded patients, controlled studies are needed to confirm their effectiveness.
Mental retardation and attention deficit hyperactivity disorder
Although it has been known for quite some time that almost 20% of children with mental retardation have attention deficit hyperactivity disorder, only in the last two decades have attempts been made to treat it.
Psychostimulants. Methylphenidate (Ritalin) is a mild central stimulant. nervous system- selectively reduces manifestations of hyperactivity and attention disorders in persons with mental retardation. Methylphenidate - drug short acting. The peak of its activity occurs in children after 1.3-8.2 hours (on average 4.7 hours) when taking a slow-release drug or after 0.3-4.4 hours (on average 1.9 hours) when taking taking a standard drug. Psychostimulants have a positive effect in patients with mild and moderate mental retardation. Moreover, their effectiveness is higher in patients with impulsivity, attention deficit, behavioral disorder, impaired motor coordination, and perinatal complications. Due to the stimulating effect, the drug is contraindicated in cases of severe anxiety, mental stress, and agitation. In addition, it is relatively contraindicated in patients with glaucoma, tics, and those with a family history of Tourette's syndrome. Methylphenidate may slow the metabolism of coumarin anticoagulants, anticonvulsants (such as phenobarbital, phenytoin, or primidone), phenylbutazone, and tricyclic antidepressants. Therefore, the dose of these drugs, if prescribed together with methylphenidate, should be reduced. Most Frequent adverse reactions when taking methylphenidate - anxiety and insomnia, both of them are dose-dependent. Other side effects include allergic reactions, anorexia, nausea, dizziness, palpitations, headache, dyskinesia, tachycardia, angina, cardiac arrhythmias, abdominal pain, weight loss with long-term use.
Dextramphetamine sulfate (d-amphetamine, dexedrine) is a dextrorotatory isomer of d,1-amphetamine sulfate. The peripheral effect of amphetamines is characterized by an increase in systolic and diastolic blood pressure, a weak bronchodilator effect, and stimulation of the respiratory center. When taken orally, the concentration of dextramphetamine in the blood reaches a peak after 2 hours. The half-life of dextramphetamine is approximately 10 hours. Drugs that increase acidity reduce the absorption of dextramphetamine, and drugs that reduce acidity increase it. Clinical trials have shown that dextramphetamine reduces symptoms of ADHD in children with mental retardation.
Alpha adrenergic receptor agonists. Clonidine (clonidine) and guanfacine (estulic) are α-adrenergic receptor agonists that are successfully used in the treatment of hyperactivity. Clonidine, an imidazoline derivative, stimulates α-adrenergic receptors in the brain stem, reducing the activity of the sympathetic system, reducing peripheral resistance, renal vascular resistance, heart rate and blood pressure. Clonidine acts quickly: after taking the drug orally, blood pressure decreases within 30-60 minutes. The concentration of the drug in the blood reaches its peak after 2-4 hours. With prolonged use, tolerance to the action of the drug develops. Sudden withdrawal of clonidine can lead to irritability, agitation, headache, trembling, which are accompanied by a rapid rise in blood pressure and an increase in the level of catechol-mines in the blood. Since clonidine can provoke the development of bradycardia and atrioventricular block, caution should be exercised when prescribing the drug to patients taking digitalis preparations, calcium antagonists, beta-blockers, which suppress the function of the sinus node or conduction through the atrioventricular node. The most common side effects of clonidine include dry mouth (40%), drowsiness (33%), dizziness (16%), constipation (10%), weakness (10%), sedation (10%).
Guanfacine (estulic) is another alpha2-adrenergic receptor agonist that also reduces peripheral vascular resistance and slows heart rate. Guanfacine is effective in reducing symptoms of ADHD in children and may specifically improve prefrontal brain function. Like clonidine, guanfacine enhances the sedative effect of phenothiazines, barbiturates and benzodiazepines. In most cases, the side effects caused by guanfacine are mild. These include dry mouth, drowsiness, asthenia, dizziness, constipation and impotence. When choosing a drug for the treatment of ADHD in children with mental retardation, the presence of tics is not so often influential; in this category of patients they are later difficult to recognize than in normally developing children. However, if a patient with mental retardation has tics or a family history of Tourette's syndrome, then alpha2-adrenergic agonists should be considered the drugs of choice for the treatment of ADHD.
- Exercise therapy) for children with mental retardation - ( video)
- Recommendations for parents regarding the labor education of children with mental retardation - ( video)
- Is a child given a disability group for mental retardation? - ( video)
- Life expectancy of children and adults with oligophrenia
The site provides background information for informational purposes only. Diagnosis and treatment of diseases must be carried out under the supervision of a specialist. All drugs have contraindications. Consultation with a specialist is required!
Treatment and correction of mental retardation ( how to treat oligophrenia?)
Treatment and correction mental retardation ( mental retardation) - a complex process that requires a lot of attention, effort and time. However, with the right approach, you can achieve certain positive results within a few months after the start of treatment.Is it possible to cure mental retardation? remove the diagnosis of mental retardation)?
Oligophrenia is incurable. This is due to the fact that when exposed to causal factors ( provoking the disease) factors cause damage to certain parts of the brain. As is known, the nervous system ( especially its central department, that is, the head and spinal cord ) develop in the prenatal period. After birth, the cells of the nervous system practically do not divide, that is, the ability of the brain to regenerate ( recovery after damage) is almost minimal. Once damaged neurons ( nerve cells) will never be restored, as a result of which mental retardation, once developed, will remain in the child until the end of his life.At the same time, children with a mild form of the disease respond well to treatment and correctional measures, as a result of which they can receive a minimum education, learn self-care skills, and even get a simple job.
It is also worth noting that in some cases the goal of treatment is not to cure mental retardation as such, but to eliminate its cause, which will prevent the progression of the disease. Such treatment should be carried out immediately after identifying a risk factor ( for example, when examining the mother before, during or after childbirth), since the longer the causative factor affects the baby’s body, the more profound disorders of thinking he may develop in the future.
Treatment for the cause of mental retardation can be carried out:
- For congenital infections– for syphilis, cytomegalovirus infection, rubella and other infections, antiviral and antibacterial drugs can be prescribed.
- At diabetes mellitus at the mother's.
- For metabolic disorders– for example, with phenylketonuria ( violation of the metabolism of the amino acid phenylalanine in the body) eliminating foods containing phenylalanine from your diet may help solve the problem.
- For hydrocephalus– surgery immediately after identifying pathology can prevent the development of mental retardation.
Finger gymnastics for the development of fine motor skills
One of the disorders that occurs in mental retardation is a violation fine motor skills fingers At the same time, it is difficult for children to perform precise, targeted movements ( for example, holding a pen or pencil, tying shoelaces, etc.). Finger gymnastics, the purpose of which is to develop fine motor skills in children, will help correct this deficiency. The mechanism of action of the method is that frequently performed finger movements are “remembered” by the child’s nervous system, as a result of which in the future ( after repeated training) the child can perform them more accurately, while spending less effort.Finger gymnastics may include:
- Exercise 1 (counting fingers). Suitable for children with mild mental retardation who are learning to count. First you need to fold your hand into a fist, and then straighten 1 finger at a time and count them ( aloud). Then you need to bend your fingers back, also counting them.
- Exercise 2. First, the child should spread the fingers of both palms and place them in front of each other so that only the pads of the fingers touch each other. Then he needs to bring his palms together ( so that they also touch), and then return to the starting position.
- Exercise 3. During this exercise, the child should clasp his hands, with the thumb of one hand on top first, and then the thumb of the other hand.
- Exercise 4. First, the child should spread his fingers, and then bring them together so that the tips of all five fingers are gathered at one point. The exercise can be repeated many times.
- Exercise 5. During this exercise, the child needs to clench his hands into fists, and then straighten his fingers and spread them, repeating these actions several times.
Medicines ( drugs, tablets) with mental retardation ( nootropics, vitamins, antipsychotics)
The goal of drug treatment for oligophrenia is to improve metabolism at the brain level, as well as stimulate the development of nerve cells. In addition, medications may be prescribed to treat specific symptoms of the disease, which may be expressed differently in different children. In any case, the treatment regimen must be selected for each child individually, taking into account the severity of the underlying disease, its clinical form and other features.Drug treatment mental retardation
Group of drugs | Representatives | Mechanism of therapeutic action |
Nootropics and drugs that improve cerebral circulation | Piracetam | Improves metabolism at the neuronal level ( nerve cells) of the brain, increasing the rate at which they use oxygen. This may promote the patient's learning and mental development. |
Phenibut |
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Vinpocetine |
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Glycine |
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Aminalon |
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Pantogam |
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Cerebrolysin |
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Oxybral |
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Vitamins | Vitamin B1 | Required for normal development and the functioning of the central nervous system. |
Vitamin B6 | Necessary for the normal process of transmission of nerve impulses in the central nervous system. With its deficiency, such a sign of mental retardation as inhibition of thinking can progress. |
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Vitamin B12 | With a lack of this vitamin in the body, accelerated death of nerve cells may occur ( including at the level of the brain), which may contribute to the progression of mental retardation. |
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Vitamin E | Protects the central nervous system and other tissues from damage by various harmful factors ( in particular with a lack of oxygen, with intoxication, with irradiation). |
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Vitamin A | If it is deficient, the functioning of the visual analyzer may be disrupted. |
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Neuroleptics | Sonapax | They inhibit brain activity, making it possible to eliminate such manifestations of oligophrenia as aggressiveness and severe psychomotor agitation. |
Haloperidol |
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Neuleptil |
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Tranquilizers | Tazepam | They also inhibit the activity of the central nervous system, helping to eliminate aggressiveness, as well as anxiety, increased excitability and mobility. |
Nozepam |
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Adaptol |
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Antidepressants | Trittico | Prescribed for oppression psycho-emotional state child, persisting for a long time ( more than 3 – 6 months in a row). It is important to note that maintaining this condition for a long time significantly reduces the child’s ability to learn in the future. |
Amitriptyline |
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Paxil |
It is worth noting that the dosage, frequency and duration of use of each of the listed drugs is also determined by the attending physician depending on many factors ( in particular, on the general condition of the patient, the prevalence of certain symptoms, the effectiveness of the treatment, possible side effects, and so on).
Objectives of massage for mental retardation
Neck and head massage is part of the comprehensive treatment of mentally retarded children. At the same time, a full body massage can stimulate the development of the musculoskeletal system, improve the patient’s overall well-being, and improve his mood.The objectives of massage for mental retardation are:
- Improving blood microcirculation in the massaged tissues, which will improve oxygen delivery and nutrients to the nerve cells of the brain.
- Improved lymphatic drainage, which will improve the process of removing toxins and metabolic byproducts from brain tissue.
- Improving microcirculation in the muscles, which helps to increase their tone.
- Stimulates nerve endings in the fingers and palms, which can help develop fine motor skills in the hands.
- Creation of positive emotions that have a beneficial effect on the general condition of the patient.
The influence of music on children with mental retardation
Playing music or simply listening to it has a positive effect on the course of mental retardation. That is why almost all children with mild to moderate forms of the disease are recommended to include music in correctional programs. At the same time, it is worth noting that with a more severe degree of mental retardation, children do not perceive music and do not understand its meaning ( for them it's just a set of sounds), and therefore they will not be able to achieve a positive effect.Music lessons allow you to:
- Develop the child’s speech apparatus (while singing songs). In particular, children improve their pronunciation of individual letters, syllables and words.
- Develop a child's hearing. In the process of listening to music or singing, the patient learns to distinguish sounds by their tonality.
- Develop intellectual abilities. To sing a song, a child needs to perform several sequential actions at once ( take a deep breath before the next verse, wait for the right melody, choose the right voice volume and singing speed). All this stimulates the thought processes that are disturbed in children with mental retardation.
- Develop cognitive activity. In the process of listening to music, a child can learn new musical instruments, evaluate and remember the nature of their sound, and then recognize ( determine) them by sound alone.
- Teach your child to play musical instruments. This is possible only with a mild form of oligophrenia.
Education of persons with mental retardation
Despite mental retardation, almost all patients with mental retardation ( except deep form) may be amenable to certain training. At the same time, the general education programs of regular schools may not be suitable for all children. It is extremely important to choose the right place and type of education, which will allow the child to develop his abilities to the maximum. Regular and correctional schools, boarding schools and classes for schoolchildren with mental retardation ( PMPC recommendations)
In order for a child to develop as intensively as possible, you need to choose the right educational institution to send him to.Education for mentally retarded children can be carried out:
- IN secondary schools. This method is suitable for children with mild mental retardation. In some cases, mentally retarded children can successfully complete the first 1–2 grades of school, and no differences between them and ordinary children will be noticeable. At the same time, it is worth noting that as children grow older and the school curriculum becomes more difficult, they will begin to lag behind their peers in academic performance, which can cause certain difficulties ( low mood, fear of failure, etc.).
- In correctional schools or boarding schools for mentally retarded persons. A special school for children with mental retardation has both its pros and cons. On the one hand, educating a child in a boarding school allows him to receive much more attention from teachers than when he attends a regular school. In the boarding school, teachers and educators are trained to work with such children, as a result of which it is easier to establish contact with them, find an individual approach to them in teaching, and so on. The main disadvantage of such training is the social isolation of the sick child, who practically does not communicate with normal people ( healthy) children. Moreover, during their stay in the boarding school, children are constantly monitored and carefully cared for, to which they become accustomed. After graduating from boarding school, they may simply be unprepared for life in society, as a result of which they will need constant care for the rest of their lives.
- In special correctional schools or classes. Some general education schools have classes for mentally retarded children, in which they are taught a simplified school curriculum. This allows children to receive the necessary minimum knowledge, as well as to be among “normal” peers, which contributes to their integration into society in the future. This teaching method is suitable only for patients with mild mental retardation.
During the PMP examination, the child may be asked:
- What's his name?
- How old is he?
- Where does he live?
- How many people are in his family ( may be asked to briefly describe each family member)?
- Are there any pets at home?
- What games does your child like?
- What dishes does he prefer for breakfast, lunch or dinner?
- Can the child sing? they may be asked to sing a song or recite a short rhyme)?
Federal State Educational Standard OVZ ( federal state educational standard
Federal State Educational Standard is a generally recognized standard of education that all educational institutions in the country must adhere to ( for preschoolers, schoolchildren, students and so on). This standard regulates the work educational institution, material, technical and other equipment of the educational institution ( what personnel and how many should work there?), as well as control of training, availability of training programs, and so on.FSES OVZ is a federal state educational standard for students with disabilities. disabilities health. It regulates the educational process for children and adolescents with various physical or mental disabilities, including mentally retarded patients.
Adapted basic general education programs ( AOOP) for preschoolers and schoolchildren with mental retardation
These programs are part of the Federal State Educational Standard for Physical Education and represent the optimal method of teaching people with mental retardation in preschool institutions and schools.The main objectives of the AOOP for children with mental retardation are:
- Creation of conditions for the education of mentally retarded children in general education schools, as well as in special boarding schools.
- Creating similar educational programs for children with mental retardation who could master these programs.
- Creation of educational programs for mentally retarded children to receive preschool and general education.
- Development of special programs for children with varying degrees of mental retardation.
- Organization of the educational process taking into account the behavioral and mental characteristics of children with varying degrees of mental retardation.
- Quality control of educational programs.
- Monitoring the assimilation of information by students.
- Maximize the mental abilities of each individual child with mental retardation.
- Teach mentally retarded children self-care ( if possible), performing simple work and other necessary skills.
- Teach children to behave correctly in society and interact with it.
- Develop students' interest in learning.
- Eliminate or smooth out shortcomings and defects that a mentally retarded child may have.
- Teach parents of a mentally retarded child to behave correctly with him and so on.
Work programs for children with mental retardation
Based on basic general education programs ( regulating general principles teaching mentally retarded children) work programs are being developed designed for children with various degrees and forms of mental retardation. The advantage of this approach is that working programm takes into account as much as possible the individual characteristics of the child, his ability to learn, perceive new information and communicate in society.For example, a work program for children with a mild form of mental retardation may include training in self-care, reading, writing, mathematics, and so on. At the same time, children with a severe form of the disease are not able to read, write and count in principle, as a result of which their work programs will include only general self-care skills, training in emotion control and other simple activities.
Corrective classes for mental retardation
Correctional classes are selected for each child individually, depending on his mental disorders, behavior, thinking, and so on. These classes can be conducted in special schools ( professionals) or at home.The goals of correctional classes are:
- Teaching your child basic school skills- reading, writing, simple counting.
- Teaching children how to behave in society– Group classes are used for this.
- Speech development– especially in children who have impaired pronunciation of sounds or other similar defects.
- Teach your child to look after himself– at the same time, the teacher must focus on the dangers and risks that may await the child in Everyday life (for example, the child must learn that there is no need to grab hot or sharp objects, as this will hurt).
- Develop attention and perseverance– especially important for children with impaired ability to concentrate.
- Teach your child to control their emotions– especially if he has attacks of anger or rage.
- Develop fine motor skills of hands- if it is broken.
- Develop memory– learn words, phrases, sentences or even poems.
CIPRs for children with mental retardation
SIPR is a special individual development program, selected for each specific mentally retarded child individually. The objectives of this program are similar to those of correctional classes and adapted programs, however, when developing SIPR, not only the degree of mental retardation and its form are taken into account, but also all the features of the disease that the child has, the degree of their severity, and so on.To develop a CIPR, a child must undergo full examination from many specialists ( from a psychiatrist, psychologist, neurologist, speech therapist, etc.). During the examination, doctors will identify dysfunctions of various organs ( for example, memory impairment, fine motor skills, difficulty concentrating) and evaluate their severity. Based on the data obtained, a CIPR will be drawn up, designed to correct, first of all, those violations that are most pronounced in the child.
So, for example, if a child with mental retardation has problems with speech, hearing and concentration, but there are no motor disorders, there is no point in prescribing him many hours of classes to improve fine motor skills. To the fore in in this case should be sessions with a speech therapist ( to improve the pronunciation of sounds and words), classes to improve the ability to concentrate, and so on. At the same time, there is no point in wasting time teaching a child with severe mental retardation to read or write, since he will still not master these skills.
Methods of teaching literacy ( reading) children with mental retardation
With a mild form of the disease, the child can learn to read, understand the meaning of the text read, or even partially retell it. With a moderate form of mental retardation, children can also learn to read words and sentences, but their text reading is not meaningful ( they read, but don’t understand what they’re talking about). They are also unable to retell what they read. In severe and profound forms of mental retardation, the child cannot read.Teaching reading to mentally retarded children allows:
- Teach your child to recognize letters, words and sentences.
- Learn to read expressively ( with intonation).
- Learn to understand the meaning of the text you read.
- Develop speech ( while reading aloud).
- Create the prerequisites for teaching writing.
Teaching writing
Only children with mild illness can learn to write. With moderate mental retardation, children may try to pick up a pen, write letters or words, but will not be able to write anything meaningful.It is extremely important that before starting school, the child learns to read at least to a minimal extent. After this, he should be taught to draw simple geometric figures (circles, rectangles, squares, straight lines and so on). When he masters this, you can move on to writing letters and memorizing them. Then you can start writing words and sentences.
It is worth noting that for a mentally retarded child, the difficulty lies not only in mastering writing, but also in understanding the meaning of what is written. At the same time, some children have a pronounced impairment of fine motor skills, which prevents them from mastering writing. In this case, it is recommended to combine grammar teaching with corrective exercises that allow the development of motor activity in the fingers.
Mathematics for children with mental retardation
Teaching mathematics to children with mild mental retardation promotes the development of thinking and social behavior. At the same time, it is worth noting that math skills children with imbecility ( moderate degree of oligophrenia) are very limited - they can perform simple mathematical operations ( add, subtract), however, it is not able to solve more complex problems. Children with severe and profound mental retardation do not understand mathematics in principle.Children with mild mental retardation may:
- Count natural numbers.
- Learn the concepts of “fraction”, “proportion”, “area” and others.
- Master the basic units of measurement of mass, length, speed and learn to apply them in everyday life.
- Learn to shop, calculate the cost of several items at once and the amount of change required.
- Learn to use measuring and calculating instruments ( ruler, compass, calculator, abacus, clock, scales).
Pictograms for children with mental retardation
Pictograms are unique schematic pictures that depict certain objects or actions. Pictograms allow you to establish contact with a mentally retarded child and teach him in cases where it is impossible to communicate with him through speech ( for example, if he is deaf, and also if he does not understand the words of others).The essence of the pictogram technique is to associate a certain image in the child ( picture) with any specific action. For example, a picture of a toilet can be associated with the desire to go to the toilet. At the same time, a picture depicting a bath or shower can be associated with water procedures. In the future, these pictures can be attached to the doors of the corresponding rooms, as a result of which the child will better navigate the house ( if he wants to go to the toilet, he will independently find the door through which he needs to enter for this).
On the other hand, pictograms can also be used to communicate with a child. So, for example, in the kitchen you can keep pictures of a cup ( jug) with water, plates of food, fruits and vegetables. When a child feels thirsty, he can point to water, while pointing at a picture of food will help others understand that the child is hungry.
The above were just some examples of the use of pictograms, but using this technique you can teach a mentally retarded child a wide variety of activities ( brush your teeth in the morning, make and spread your bed yourself, fold things, etc.). However, it is worth noting that this technique will be most effective for mild mental retardation and only partially effective for moderate degrees of the disease. At the same time, children with severe and profound mental retardation are practically not amenable to learning using pictograms ( due to a complete lack of associative thinking).
Extracurricular activities for children with mental retardation
Extracurricular activities are activities that take place outside of class ( like all lessons), and in a different setting and according to a different plan ( in the form of games, competitions, travel, etc.). Changing the method of presenting information to mentally retarded children allows them to stimulate the development of intelligence and cognitive activity, which has a beneficial effect on the course of the disease.Goals extracurricular activities can be:
- adaptation of the child in society;
- application of acquired skills and knowledge in practice;
- speech development;
- physical ( sports) child development;
- development of logical thinking;
- developing the ability to navigate in unfamiliar areas;
- psycho-emotional development of the child;
- the child’s acquisition of new experiences;
- development of creative abilities ( for example, while hiking, playing in the park, in the forest, and so on).
Homeschooling children with mental retardation
Education for mentally retarded children can be done at home. Both parents themselves and specialists can take direct part in this ( speech therapist, psychiatrist, teachers who know how to work with such children, and so on).On the one hand, this teaching method has its advantages, since the child receives much more attention than when teaching in groups ( classes). At the same time, during the learning process, the child does not have contact with peers, does not acquire the communication and behavior skills he needs, as a result of which in the future it will be much more difficult for him to integrate into society and become a part of it. Therefore, teaching mentally retarded children exclusively at home is not recommended. It is best to combine both methods, when the child attends an educational institution during the day, and in the afternoon the parents study with him at home.
Rehabilitation and socialization of children with mental retardation
If the diagnosis of mental retardation is confirmed, it is extremely important to start working with the child in a timely manner, which, in mild forms of the disease, will allow him to get along in society and become a full member of it. In the same time, Special attention should be given to the development of mental, mental, emotional and other functions that are impaired in children with mental retardation. Classes with a psychologist ( psychocorrection)
The primary task of a psychologist when working with a mentally retarded child is to establish friendly, trusting relationships with him. After this, in the process of communicating with the child, the doctor identifies certain mental and psychological disorders that predominate in this particular patient ( for example, instability of the emotional sphere, frequent tearfulness, aggressive behavior, inexplicable joy, difficulties in communicating with others, etc.). Having established the main disorders, the doctor tries to help the child get rid of them, thereby speeding up the learning process and improving his quality of life.Psychocorrection may include:
- psychological education of the child;
- help in realizing your “I”;
- social education ( teaching rules and norms of behavior in society);
- assistance in experiencing psycho-emotional trauma;
- creation of favorable ( friendly) family situation;
- improving communication skills;
- teaching a child to control emotions;
- training in coping skills life situations and problems.
Speech therapy classes ( with a speech pathologist)
Speech disorders and underdevelopment can be observed in children with varying degrees of mental retardation. To correct them, classes are prescribed with a speech therapist who will help children develop speech abilities.Classes with a speech therapist allow you to:
- Teach children to pronounce sounds and words correctly. To do this, the speech therapist uses various exercises, during which children have to repeatedly repeat those sounds and letters that they pronounce the worst.
- Teach your child to form sentences correctly. This is also achieved through sessions during which the speech therapist communicates with the child orally or in writing.
- Improve your child's performance in school. Speech underdevelopment can be the cause of poor performance in many subjects.
- Stimulate general development child. While learning to speak and pronounce words correctly, the child simultaneously remembers new information.
- Improve the child's position in society. If a student learns to speak correctly and correctly, it will be easier for him to communicate with classmates and make friends.
- Develop the child's ability to concentrate. During classes, the speech therapist may have the child read aloud increasingly longer texts, which will require longer concentration of attention.
- Expand lexicon child.
- Improve understanding of spoken and written language.
- Develop abstract thinking and imagination of the child. To do this, the doctor may give the child books with fairy tales or fictional stories to read aloud, and then discuss the plot with him.
Didactic games for children with mental retardation
During observations of mentally retarded children, it was noted that they are reluctant to study any new information, but with great pleasure they can play all kinds of games. Based on this, a didactic methodology was developed ( teaching) games, during which the teacher conveys certain information to the child in a playful way. The main advantage of this method is that the child, without realizing it, develops mentally, mentally and physically, learns to communicate with other people and acquires certain skills that he will need in later life.For educational purposes you can use:
- Games with pictures– children are offered a set of pictures and asked to choose from them animals, cars, birds, and so on.
- Games with numbers– if the child already knows how to count in various objects ( for blocks, books or toys) you can stick the numbers from 1 to 10 and mix them up, and then ask the child to put them in order.
- Games with animal sounds– the child is shown a series of pictures with images of animals and asked to demonstrate what sounds each of them makes.
- Games that promote the development of fine motor skills– you can draw letters on small cubes, and then ask the child to assemble a word from them ( name of animal, bird, city, etc.).
Exercises and physical therapy ( Exercise therapy) for children with mental retardation
The purpose of exercise therapy ( physical therapy) is a general strengthening of the body, as well as correction of physical defects that a mentally retarded child may have. Select a program physical activities should be individually or uniting children with similar problems in groups of 3 – 5 people, which will allow the instructor to pay enough attention to each of them.The goals of exercise therapy for oligophrenia may be:
- Development of fine motor skills of the hands. Since this disorder is most common in mentally retarded children, exercises to correct it should be included in every training program. Some of the exercises include clenching and unclenching your hands into fists, spreading and closing your fingers, touching your fingertips to each other, alternately bending and straightening each finger separately, and so on.
- Correction of spinal deformities. This disorder occurs in children with severe mental retardation. To correct it, exercises are used that develop the muscles of the back and abdomen, joints of the spine, water procedures, exercises on the horizontal bar and others.
- Correction of movement disorders. If a child has paresis ( in which he weakly moves his arms or legs), exercises should be aimed at developing the affected limbs ( flexion and extension of arms and legs, rotational movements of them, and so on).
- Development of movement coordination. To do this, you can perform exercises such as jumping on one leg, long jumps ( after the jump, the child must maintain balance and remain on his feet), throwing a ball.
- Development of mental functions. To do this, you can perform exercises consisting of several successive parts ( for example, put your hands on your belt, then sit down, stretch your arms forward, and then do the same in reverse order).
To play sports, mentally retarded children are recommended to:
- Swimming. This helps them learn to solve complex sequential problems ( come to the pool, change clothes, wash, swim, wash and get dressed again), and also forms a normal attitude towards water and water procedures.
- Skiing. Develop motor activity and the ability to coordinate the movements of arms and legs.
- Biking. Helps develop balance, concentration and the ability to quickly switch from one task to another.
- Trips ( tourism). A change of environment stimulates the development of cognitive activity in a mentally retarded patient. At the same time, when traveling there is physical development and strengthening the body.
Recommendations for parents regarding the labor education of children with mental retardation
Labor education of a mentally retarded child is one of the key points in the treatment of this pathology. After all, it is the ability for self-care and work that determines whether a person will be able to live independently or will need the care of strangers throughout his life. The labor education of a child should be carried out not only by teachers at school, but also by parents at home.The development of work activity in a child with mental retardation may include:
- Self-care training– the child needs to be taught to dress independently, observe personal hygiene rules, take care of his appearance, eat food, and so on.
- Training for feasible work- already with early years Children can independently organize things, sweep the street, vacuum, feed pets or clean up after them.
- Teamwork training– if parents go to perform any simple work (for example, picking mushrooms or apples, watering the garden), the child should be taken with you, explaining and clearly demonstrating to him all the nuances of the work being performed, as well as actively cooperating with him ( for example, instruct him to fetch water while watering the garden).
- Versatile training– parents should teach their child a variety of types of work ( even if at first he is unable to do any work).
- The child’s awareness of the benefits of his work– parents should explain to the child that after watering the garden, vegetables and fruits will grow there, which the child can then eat.
Prognosis for mental retardation
The prognosis for this pathology directly depends on the severity of the disease, as well as on the correctness and timeliness of the therapeutic and corrective measures taken. So, for example, if you regularly and intensively work with a child who has been diagnosed with a moderate degree of mental retardation, he can learn to speak, read, communicate with peers, and so on. At the same time, the absence of any training sessions can provoke a deterioration in the patient’s condition, as a result of which even mild degree mental retardation can progress, becoming moderate or even severe. Is a child given a disability group for mental retardation?
Since the ability for self-care and a full life of a mentally retarded child is impaired, he can receive a disability group, which will allow him to enjoy certain advantages in society. At the same time, one or another disability group is assigned depending on the degree of oligophrenia and the general condition of the patient.Children with mental retardation may be assigned:
- 3 disability group. Issued to children with mild mental retardation who can take care of themselves, are amenable to learning and can attend regular schools, but require increased attention from the family, others and teachers.
- Disability group 2. Issued to children with moderate mental retardation who are forced to attend special correctional schools. They are difficult to train, do not get along well in society, have little control over their actions and cannot be responsible for some of them, and therefore often need constant care, as well as the creation of special living conditions.
- 1st disability group. Issued to children with severe and profound mental retardation, who are practically unable to learn or care for themselves, and therefore require continuous care and guardianship.
Life expectancy of children and adults with oligophrenia
In the absence of other diseases and developmental defects, the life expectancy of mentally retarded people directly depends on the ability to self-care or on the care they receive from others.Healthy ( physically) people with mild mental retardation can take care of themselves, are easy to train, and can even get a job, earning money to feed themselves. Due to this average duration their lives and causes of death are practically no different from those among healthy people. The same can be said about patients with moderate mental retardation, who, however, can also be trained.
At the same time, patients with severe forms of the disease live much shorter than ordinary people. First of all, this may be due to multiple defects and congenital anomalies developments that can lead to the death of children during the first years of life. Another reason for premature death may be a person’s inability to critically evaluate his actions and the environment. In this case, patients may be in dangerous proximity to fire, operating electrical appliances or poisons, or fall into the pool ( while not knowing how to swim), get hit by a car ( accidentally running out onto the road) and so on. That is why the duration and quality of their lives directly depend on the attention from others.
There are contraindications. Before use, you should consult a specialist.Mental illnesses in children treatment
EARLY CHILDHOOD AUTISM
MENTAL RETARDATION
Mental retardation is understood as congenital or acquired at an early age, a general underdevelopment of the psyche with a predominance of an intellectual defect. Another definition, used mainly in foreign psychiatry, identifies three main criteria for mental retardation: An intelligence level lower than 70. The presence of significant impairments in two or more areas of social adaptation. This condition is observed with childhood.
What are the symptoms of mental retardation?
Failure intellectual activity with oligophrenia, it affects everyone to one degree or another mental processes, primarily educational. Perception is slowed down and narrowed, active attention is impaired. Memorization is usually slow and fragile. The vocabulary of children with mental retardation is poor, speech is characterized by imprecise use of words, undeveloped phrases, an abundance of cliches, agrammatism and pronunciation defects. In the emotional sphere, there is underdevelopment of higher emotions (aesthetic, moral emotions and interests). The behavior of such children is characterized by a lack of stable motivations, dependence on the external environment, random environmental influences, and insufficiently suppressed elementary instinctive needs and drives. People with mental retardation are also characterized by a reduced ability to predict the consequences of their actions.
There are several degrees of mental retardation:
(IQ=50-70). Children with this degree of retardation are usually learning. During the preschool period, their communication skills may be sufficiently developed, and the delay in the development of the sensory and motor spheres may be minimally expressed. That is why they are not too different from healthy children until later in life. During school age, with proper efforts on the part of parents and teachers, they can master the program up to the 5th grade inclusive. As adults, they may have acquired enough social and vocational skills to achieve a minimum of independence, but will always need guidance and assistance in difficult social or economic situations.
Moderate mental retardation(IQ=35-49). With this type of mental retardation, learning some skills is possible. During preschool, they may learn some speech or other communication skills. They hardly develop more complex social skills. In this regard, and also because of the insufficient development of the motor sphere, they can be trained in low-skilled types of labor, and they can work only in specially adapted conditions. They can also be taught self-care skills. In everyday life they need supervision and guidance.
Severe mental retardation.(IQ=20-34) Children with this degree of mental retardation are characterized by a sharp underdevelopment of not only the intellectual, but also the motor sphere. They have practically no speech, and they are incapable of learning and education in preschool age. At an older age, they can be taught a few words or other simple ways of communication. They may also benefit from some basic hygiene habits. As adults, they are able to perform some elements of self-care with outside supervision.
Profound mental retardation(IQ less than 20). With this degree of oligophrenia, minimal development of sensory and motor functions is possible. Patients with this level of mental retardation require constant care throughout their lives. They are not learning, they lack speech and recognition of objects (for example, parents or caregivers).
Children with mental retardation are more likely to have a variety of behavioral disorders than healthy children. The greater the degree of retardation, the greater the likelihood of their development.
How common is mental retardation?
According to generally accepted estimates, mental retardation affects approximately 2.5 - 3% of the total population. According to data published in the early 90s, there were about 7.5 million people with mental retardation in the world. Undoubtedly, today these figures are much higher. Moreover, only 13% of this number have mental retardation more pronounced than Mild mental retardation
.
What are the causes of mental retardation?
Mental retardation can be caused by any factor that has a damaging effect on brain development during the prenatal period, during childbirth or in the first years of life. To date, more than a hundred probable causes of mental retardation have been discovered, despite this, in a third of people with this condition, its cause remains unclear. Most cases of mental retardation are caused by three main causes, namely: Down syndrome, fetal alcohol syndrome and chromosomal pathology in the form of the so-called “fragile X chromosome”. All causes of mental retardation can be divided into the following groups:
- Genetic and chromosomal pathology Pathology of pregnancy, for example due to the use of alcohol or drugs by the pregnant mother, her malnutrition, infection with rubella, HIV infection, some viral infections, as well as many other diseases of the mother during pregnancy. Pathological birth leading to brain damage to the baby. Severe diseases of the central nervous system during the first three years of a child’s life, for example, brain infections - meningitis and encephalitis, intoxication with neurotropic poisons such as mercury, as well as severe brain injuries. Social and pedagogical neglect, which, although it does not serve as a direct cause of mental retardation, nevertheless sharply increases the influence of all the factors described above.
Can mental retardation be treated?
Based on the fact that oligophrenia in its essence is not a disease, but Pathological condition. which clinically manifests itself much later than the moment of exposure to the damaging factor, the main efforts should be preventive, that is, aimed at combating the causes of early brain damage. In other words, it is easier and more expedient to prevent mental retardation than to subsequently try to influence an already defective brain. Nevertheless, a child with mental retardation can be helped. Modern methods rehabilitation comes down primarily to training and education, that is, the development, based on the child’s capabilities, of skills necessary for life. Treatment with psychopharmacological agents can be used as additional method, especially in the presence of complications, such as behavioral disorders.
ATTENTION DEFICIENCY SYNDROME
EARLY CHILDHOOD AUTISM
DEVELOPMENTAL DELAYS
Conditions classified as mental development delays (MDD) are part of a broader concept - “borderline intellectual disability.” They are characterized primarily by: a slow pace of mental development; mild impairments of cognitive activity, differing in structure and quantitative indicators from mental retardation; a tendency towards compensation and reverse development; personal immaturity; These conditions differ from mental retardation - oligophrenia, in which the totality, persistence and irreversibility of a mental defect are noted, and the leading symptom is a violation of intellectual activity itself, especially the abstract component of thinking.
One of the options for developmental delays is the so-called Mental infantilism. which is characterized by mental immaturity, especially pronounced in the emotional and volitional spheres. This immaturity is rarely noticeable during the preschool period, but can be a source of serious problems from the moment the child enters school. The activities of such children are characterized by a predominance of emotions, play interests and weakness of intellectual interests. children are not capable of activities requiring volitional effort, they cannot organize their activities and subordinate them to the requirements of the school. All this creates the phenomenon of “school immaturity”, which emerges with the beginning of education.
In addition to infantilism, there are a number of other variants of mental development delays, of which it is worth noting the delays that arise when there is a lag in the development of individual components of mental activity, such as speech, psychomotor skills, and mechanisms. determining the development of so-called school skills (reading, counting, writing). Due to this, there are delays Speech development, reading, writing, counting
.
What is the prognosis for developmental delays?
The prognosis for such conditions depends on the cause that caused them. With uncomplicated forms of mental retardation, especially with infantilism, the prognosis can be considered quite favorable. With age. especially with properly organized upbringing and training, the features of mental infantilism can be smoothed out to the point of complete disappearance, and intellectual deficiency can be compensated. The most positive changes are revealed by 10 - 11 - summer age. If mental development delays are based on any serious organic deficiency of the central nervous system, everything depends on the severity of the underlying defect and the rehabilitation measures taken.
How can you help a child with mental retardation?
The first step is timely identification of mental retardation. As a rule, this pathology is first detected by doctors in children's clinics. They refer you for consultation to a specialist with a narrow profile - a child psychiatrist, speech therapist or psychologist. One of the rehabilitation methods can be for children to attend specialized groups in kindergartens (groups for children with mental retardation or speech therapy groups). There they are treated by specialists - speech therapists, defectologists, as well as educators with special training. Only a medical-pedagogical commission - MPC - can refer a child to such an institution.
Naturally, the efforts of teachers and doctors should be supported by the homework of parents and children. It is worth emphasizing once again that with proper attention of parents to this problem, delays in mental development tend to smooth out and even completely disappear by school age. If some elements of developmental delay persist until entering school, then the child can study in a specialized class with an adapted program without experiencing significant problems, which is important for the formation of adequate self-esteem and self-esteem.
ATTENTION DEFICIENCY SYNDROME
EARLY CHILDHOOD AUTISM
ATTENTION DEFICIENCY SYNDROME
Attention Deficit Disorder is a common childhood disorder that is usually characterized by severe and long-lasting symptoms such as decreased ability to concentrate for long periods of time, poor impulse control, and hyperactivity (not in all cases). Attention deficit disorder (ADD) also has a subtype that is characterized by hyperactivity.
ADD is a disease with a complex structure. It affects, according to various estimates, from 3 to 6% of the population. Impaired attention, impulsivity and often hyperactivity are typical signs of the disease. In boys, this pathology is detected three times more often than in girls, although it is believed that in the latter this syndrome is diagnosed unreasonably rarely.
What are the main symptoms of ADD?
A child may have attention deficit disorder if he:
- overly excitable or constantly appears agitated restless distractible cannot wait for one's turn in games blurts out answers to questions has serious difficulty following instructions cannot concentrate on anything for long tends to move from one activity to another too often cannot play quiet games is often overly talkative, constantly interrupts others, does not listen to what is said to him, often loses things, tends to engage in dangerous games
What are the causes of ADD?
It has not yet been proven that there is a single cause for all cases of attention deficit disorder. The main modern hypotheses include: The presence of a genetic predisposition (this theory has the most convincing evidence). Brain damage due to trauma, e.g. protracted labor Toxic damage to the central nervous system, for example, bacterial or viral toxins, alcohol (if the mother consumed it during pregnancy) There is an opinion according to which food allergy can also lead to the development of attention deficit disorder. This is not scientifically proven, although there is evidence that a specially tailored diet can reduce the symptoms of ADD.
What is the long-term prognosis for this disease?
Current evidence suggests that ADD is a long-term and difficult-to-treat condition. In many children, hyperactivity symptoms can significantly decrease with age.
Undiagnosed and untreated ADD is believed to increase the risk of problems such as learning difficulties, low self-esteem, and social and family problems. Adults with attention deficit disorder untreated since childhood are more likely to get divorced, more likely to experience problems with the law, and more likely to resort to alcohol and drug abuse.
What types of treatment are there for ADD?
There is no single treatment method that can immediately solve all problems. A systematic, comprehensive approach is used, which includes following methods(but not limited to them)
- Drug therapy Teaching the child and his parents various methods of behavior control Creating a special “supportive” environment Specific diet (this method is not recognized by everyone)
ATTENTION DEFICIENCY SYNDROME
EARLY CHILDHOOD AUTISM
EARLY CHILDHOOD AUTISM
The most striking manifestations of early childhood autism syndrome are the following.
Autism as such, that is, the child’s extreme, “extreme” loneliness, decreased ability to establish emotional contact, communication and social development. Characterized by difficulties in establishing eye contact, interaction with gaze, facial expressions, gestures, and intonation. It is common for children to have difficulty expressing their emotional states and their understanding of the states of other people.
Stereotypic behavior associated with an intense desire to maintain constant, familiar living conditions. It is expressed in resistance to the slightest changes in the environment, the order of life, fear of them, in absorption in monotonous actions - motor and speech: shaking hands, jumping, repeating the same sounds and phrases. Characterized by an addiction to the same objects, the same manipulations with them, a preoccupation with stereotypical interests, the same game, the same topic in drawing and conversation.
Speech development disorder. primarily its communicative function. Speech in such children is not used for communication. Thus, a child can enthusiastically recite the same poems, but not turn to parents for help even in the most necessary cases. Characterized by echolalia (immediate or delayed repetition of heard words and phrases). There is a long-term lag in the ability to correctly use personal pronouns in speech - the child can call himself “you”, “he”. Such children do not ask questions and may not respond to requests, that is, avoid verbal interaction as such.
How common is childhood autism?
This is a fairly rare disease. It occurs with a frequency of 3-6 per 10,000 children, being found in boys 3-4 times more often than in girls.
What are the causes of early childhood autism?
To date, more than 30 factors have been identified that can lead to the formation of early childhood autism syndrome. It is believed that this syndrome is a consequence of a special pathology, which is based on a failure of the central nervous system. This deficiency can be caused by a wide range of reasons: genetic conditions, chromosomal abnormalities, organic damage to the nervous system (as a result of pathology of pregnancy or childbirth), early onset schizophrenic process.
Can this condition be treated?
Treatment of early childhood autism is a very difficult task. The efforts of a whole “team” of specialists are aimed at solving it, which optimally should include a child psychiatrist, psychologist, speech therapist, speech pathologist and, naturally, the child’s parents. Main directions therapeutic effects are:
- Training in communication skills Correction of speech disorders Exercises aimed at developing motor skills Overcoming intellectual underdevelopment Resolving intra-family problems that may hinder the full development of the child Correction of psychopathological symptoms and behavioral disorders - if any. Achieved by using special pharmacological drugs.
Standards for the treatment of mental retardation in children
Protocols for the treatment of mental retardation in children
Mental retardation in children
Profile: pediatric.
Stage: hospital
Duration of treatment: 30 days.
ICD codes:
F70 Mental retardation mild degree
F71 Moderate mental retardation
F72 Mental retardation is severe.
Definition: Mental retardation (mental underdevelopment) is used abroad to refer to various forms of intellectual impairment, regardless of the nature of the disease in which it occurs.
Classification:
1. mild mental retardation;
2. moderate mental retardation;
3. severe mental retardation;
4. profound mental retardation;
5. unspecified mental retardation;
6. other types of mental retardation.
Risk factors:
1. the health status of the parents and working conditions at the beginning of pregnancy;
2. the presence of gestosis, illnesses suffered by the mother, medications taken during pregnancy, the course of labor (duration, forceps, asphyxia), the condition of the newborn after childbirth (jaundice, convulsions, shuddering);
3. timeliness of the main stages of motor and mental development;
4. hereditary factor.
Admission: planned.
Indications for hospitalization:
1. delayed mental development in the form of pronounced emotional-volitional disorders and motor skills (delay in the formation of static-motor acts, lack of motor-adaptive movements, weak interest in others, toys, speech);
2. diagnostics of the delay level;
3. solution social issues.
The required scope of examination before planned hospitalization:
1. consultation: neurologist, psychologist, geneticist, endocrinologist, psychiatrist.
Diagnostic criteria:
1. the presence of biological inferiority of the brain, established on the basis of anamnesis, mental, neurological and somatic status;
2. characteristic structure of diffuse dementia with obligatory insufficiency of conceptual thinking and underdevelopment of personality;
3. non-progression of the state with positive, although to varying degrees, slowed down dynamics of mental development.
List of main diagnostic measures:
1. Biochemical blood test for phenylketonuria, histidinemia, homocystinuria, galactosemia, fructosuria;
2. Consultation with a neurologist;
3. General analysis blood (6 parameters);
4. General urine analysis;
5. Definition total protein;
6. Determination of ALT, AST;
7. Determination of bilirubin;
9. Examination of stool for worm eggs.
List of additional diagnostic measures:
1. Neuropsychological testing;
2. Chromosome analysis (karyotyping);
3. Consultation with a geneticist;
4. Consultation with a psychiatrist;
5. Consultation with an endocrinologist;
6. Consultation with a psychologist;
7. Consultation with a speech therapist;
8. Blood test for intrauterine infections (toxoplasmosis, herpes, cytomegalovirus);
9. Microreaction.
Treatment tactics:
Medication and correctional and educational measures.
Drug treatment:
1. Psychomotor stimulants (tonic effect on the cortex, reticular formation without interfering with the metabolism of nerve cells: adaptol 300 mg per tablet, regardless of meals, for a course of several days to 2-3 months, from 0.5 to 1 tablet X 3 times a day depending on age.
2. Drugs that stimulate mental development and improve brain metabolism - encephabol 0.25 mg tablet.
3. Antidepressants – amitriptyline, L-dopa preparations.
4. General strengthening: multivitamins.
5. Preparations of calcium, phosphorus, iron, phytin, phosphrene.
6. Sedative, neuroleptic drugs (dizepam tablet 2 mg, 5 mg, solution 10 mg/2.0);
7. Anticonvulsants: phenobarbital 0.01 mg/year of life, valproic acid preparations 20-25 mg/kg/day, lamotrigine, carbamazepines (finlepsin).
The course of treatment is 1 month.
List of essential medications:
1. Amitriptyline 25 mg, 50 mg tablet;
2. Dizepam 10 mg/2 ml amp.; 5 mg, 10 mg tablet;
3. Valproic acid 150 mg, 300 mg, 500 mg tab.
List of additional medications:
1. Preparations L-dopa 50 mg tablet;
2. Multivitamins;
3. Phenobarbital 50 mg, 100 mg tablet.
Criteria for transfer to the next stage of treatment:
1. stabilization and improvement of impaired functions;
2. rehabilitation;
3. maintenance therapy;
4. observation by a psychologist.
A handicapped child is a great misfortune for a family. Is it possible to prevent such a misfortune? Is it possible to soften it? Our conversation with Doctor of Medical Sciences, pediatrician Lev KORONEVSKY was about this.
At the very beginning
A child’s congenital disease sometimes lurks at the very beginning of his life and depends on unfavorable conditions of intrauterine development. Such conditions are sometimes created due to severe illnesses of the mother. Gross disturbances in the activity of her cardiovascular system, severe chronic diseases kidneys and liver lead to a delay in the delivery of oxygen to the fetus, and to this it is very sensitive.
A woman suffering from such diseases should consult with a therapist and obstetrician-gynecologist and decide with them whether she can give birth and what measures to take to strengthen her own health.
Anomalies of fetal development, and subsequently, as a consequence, mental retardation of the child can cause infectious diseases pregnant woman, and among them primarily toxoplasmosis.
If such a woman consults a doctor in a timely manner and undergoes a course of treatment, she will be able to give birth healthy child. And if not? Toxoplasma, like many viruses, has the most intense effect on young tissue and multiplies intensively in it. They will fall on the fetus, and the child will subsequently have to suffer much more than his mother suffered.
It has been established that rubella contracted by the mother in the first months of pregnancy causes severe damage to the fetus. The mother's illness with epidemic hepatitis and influenza is not indifferent to the unborn child.
Some medications used by the mother without permission during pregnancy can also have a harmful effect on the development of the fetus. Severe consequences for the mental development of the child often arise due to attempts to terminate pregnancy using various non-medical methods. Alcohol certainly has a harmful toxic effect on fetal development.
Mental development can be affected by various diseases that a child suffers in early childhood. This is not only inflammation of the brain and its membranes, head bruises, but also chronic severe gastrointestinal infections.
The culprit is an extra chromosome
It is known that the hereditary properties of a person are transmitted from parents to children through his reproductive cells. The nucleus of each cell consists of special thread-like structures, the so-called chromosomes, in which the most elementary units of heredity - genes - are located.
The chromosome set of human cells consists of 46 chromosomes, forming 23 pairs. This number of chromosomes is present in all cells of the body, with the exception of germ cells, where there are half as many chromosomes - 23. In a female germ cell there are 22 non-sex chromosomes and one sex chromosome, the so-called X chromosome. Each male sperm cell has 22 non-sex chromosomes and, in addition, 50 percent of them have an X chromosome and 50 percent have a small, so-called Y chromosome. When female and male germ cells merge, the total number of chromosomes is restored. Fertilized eggs, consisting of 44 chromosomes and two X chromosomes, are future women, and eggs, consisting of 44 chromosomes and one sex X chromosome and one small Y chromosome, are future men.
In this process, worked out by nature with the greatest precision, disturbances may still occasionally occur. For still unknown reasons, during cell division, any pair of chromosomes may not separate, and sex cells arise, the nucleus of which contains extra chromosomes. After their fertilization, the fetus develops and a child is born, in whose body cells there are extra chromosomes. The presence of extra chromosomes entails diseases that are characterized by impaired physical and mental development. These types of chromosomal disorders include Down syndrome.
More often such children are born to older mothers. Sometimes the birth of a child is preceded by a long break in pregnancy - up to 10 years or more.
Prevention of mental retardation is not only a feasible elimination of the causes that give rise to it. Let's say that this was not possible, the baby is sick. Don’t consider that all is lost, don’t give in to trouble!
The child should be under constant supervision of a neurologist. Currently, there are a number of means, the skillful selection and combination of which can improve the condition of such a patient.
Timely treatment and proper upbringing make it possible to achieve great success in the development of a child, prevent possible disability, and achieve, if not complete mental health, then as close to it as possible.
From early childhood, the characteristics of such children appear. External signs physical underdevelopment: the child has a small head with a sloping nape or, conversely, an increased head size, an elongated head.
The eye shape may be slanted. The palpebral fissures are narrow, and the third eyelid seems to hang over them. The earlobe is often fused, the teeth are irregular, unsightly, the skin is dry, flaky, sharply shortened fingers, a crooked little toe, irregular foot structure - widened spaces between the toes, especially between the big and second.
None of these signs in itself indicates a disease - after all, similar features are possible in completely healthy people. Only a combination of a number of signs of physical underdevelopment with mental retardation should be alarming and require special medical consultation.
What to do?
The development of movements plays a huge role in the general and mental development of a child. In sick children, from the very first months of life, there is a delay in the development of movements - they later begin to hold their heads, stand, and walk. Their movements are awkward, clumsy. Along with general motor retardation, they sometimes experience unnecessary movements - twitching of individual muscles of the face or torso.
Fine hand movements are especially impaired in such children. Therefore, such children do not serve themselves well. The ability to dress, wash, and make a bed requires special long-term and patient training.
Proper education is one of the most important conditions overcome these shortcomings. In some families, such children are overprotected and everything is done for them, and this further hinders the development of their motor skills. Parents must have patience, endurance and actively fight the disease. You need to teach your child literally every little detail: how to lace up shoes, fasten buttons, put on a dress. It is useful for such a child to cut out and paste pictures, to sculpt the simplest figures from plasticine according to the model proposed by adults.
Daily special exercises for the fingers and hands are absolutely necessary: for example, clench your hand into a fist and unclench it, be able to show only one finger, tap alternately with two fingers on a smooth surface.
Human speech and thinking are closely related. The speech of mentally retarded children is often slurred, fluency and tempo are impaired, the vocabulary is poor, the phrase is constructed in a primitive manner and is grammatically incorrect. Sometimes speech at first seems normal, even rich, but, observing more carefully, you can notice that it consists of ready-made, memorized expressions: the child does not understand the meaning of the words he pronounces. One of the most important ways to combat mental retardation is the development of speech.
Normally developing children, as early as 4-5 years old, show great interest in everything around them and usually ask countless questions, listening carefully to the answers. A retarded child is lethargic, passive, and not inquisitive. It is necessary to stimulate and increase his activity in every possible way, to introduce him to the objects and phenomena of the surrounding reality, to ask questions first for the child, then as if together with him, gradually ensuring that he becomes the same “why” as his peers.
Game as a remedy
The main form of cognition for young children is play. Fine developing child While playing, he actively gets acquainted with the properties of objects and acquires various skills.
A retarded child usually cannot play independently. He does not even know how to use toys differentiatedly, showing interest only in their individual properties - color, sound. Even if he creates the simplest game situation, his play usually turns out to be very monotonous. For example, a girl spends hours rocking, wrapping or unwrapping a doll without introducing any options into this activity.
Sick children show a tendency to monotonous, stereotypical actions. They have no initiative, they do not plan their game, and in a collective game they do not understand the general plan, rules, distribution of roles.
The game develops all aspects of the child’s personality - thinking, will, imagination, emotions. That is why a family where a retarded child is growing up should pay special attention to this side of his life. We must understand that this is not about simple entertainment, but essentially about medicine. Adults should play with the child and thereby involve him in the game, teach him how to use toys, gradually moving from elementary games to more detailed, plot-based ones.
The earlier work with a child begins, the easier it is to achieve success in his mental development. Even noticeably expressed mental retardation can be well compensated.
The girl was under our supervision for many years. We noted a significant delay in the development of motor skills, speech, and thinking at the age of three. The mother worked persistently and patiently with the child, doing all the exercises that we talked about. She managed to fully prepare the girl for entering a auxiliary school, but even then she did not rely only on schoolwork. The daily, patient work at home continued. Now the girl is 19 years old, she graduated from this school and has been working as a registrar for three years, coping well with her duties.
Medicine does not yet have the means to treat mental retardation. Educational measures in combination with medications remain the main weapon in the fight against such lesions. In patient and loving hands, this weapon acquires great power.
