Emotional disorders in children. Symptoms and diagnosis of emotional disorders. The main causes of violations of the emotional-volitional sphere of the child

Behavioral and emotional disorders in children

Basically, it is considered that children are prone to colds and various viral diseases, although neuropsychiatric disorders in children are quite common and cause many problems for both the patients themselves and their parents.

And most importantly, they can become the foundation for further difficulties and problems in social interaction with peers and adults, in emotional, intellectual and social development, the cause of school "failure", difficulties in social adaptation.

Just as in adult patients, childhood neuropsychiatric diseases are diagnosed on the basis of a range of symptoms and signs that are specific to certain disorders.

But it should be taken into account that the diagnostic process in children is much more complicated, and some behavioral forms may not look like symptoms of mental disorders at all. Often this confuses parents and makes it possible to “hide” their heads in the sand for a long time. It is strictly forbidden to do this and it is very DANGEROUS !!!

For example, this category includes strange eating habits, excessive nervousness, emotionality, hyperactivity, aggression, tearfulness, "field" behavior, which can be regarded as part of the normal development of the child.

Behavioral disorders in children include a number of behavioral dissociative disorders, which are manifested by aggressive, defiant or inadequate actions, reaching open non-compliance with age-appropriate social norms.

Typical signs of pathology can be:

- "field" behavior, the inability to sit in one place and concentrate one's attention;

- excessive pugnacity and deliberate hooliganism,

- cruelty to other people or animals,

- intentional damage to property,

- arson

- theft

- leaving home

- frequent, causeless and severe outbursts of anger;

- causing provocative actions;

- systematic disobedience.

Any of the listed categories, if expressed sufficiently, is a cause for concern, not in itself, but as symptom of a serious illness.

Types of emotional and behavioral disorders in children

• Hyperactive behavior

• Demonstrative behavior

This type of behavioral disorder in children is manifested by intentional and conscious non-compliance with generally accepted social norms. Deviant acts are usually directed at adults.

• attention deficit
• Protest behavior

There are three forms of this pathology: negativism, obstinacy and stubbornness.

Negativism- refusal of the child to do something just because he was asked to do it. Most often it occurs as a result of improper upbringing. Characteristic manifestations include causeless crying, impudence, rudeness, or, on the contrary, isolation, alienation, and resentment.

Stubbornness- the desire to achieve one's goal in order to go against the parents, and not to satisfy a real desire.

obstinacy- in this case, the protest is directed against the norms of upbringing and the imposed lifestyle in general, and not at the leading adult.

• Aggressive behavior

Aggressive behavior is understood as purposeful actions of a destructive nature, contrary to the norms and rules adopted in society. The child causes psychological discomfort in others, causes physical damage to living and inanimate objects, etc.

• Infantile behavior

In the actions of infantile children, traits characteristic of an earlier age or a previous stage of development can be traced. With an appropriate level of physical abilities, the child is distinguished by the immaturity of integrative personal formations.

• Conformal behavior

Conformal behavior is manifested by complete submission to external conditions. Its basis is usually involuntary imitation, high suggestibility.

• Symptomatic behavior (fears, tics, psychosomatics, logoneurosis, hesitations in speech)

In this case, a violation of behavior in children is a kind of signal that the current situation is no longer unbearable for a fragile psyche. Example: vomiting or nausea as a reaction to stress.

It is always very difficult to diagnose disorders in children.

But, if the signs can be recognized in a timely manner and contact a specialist in time, and treatment and correction can be started without delay, then severe manifestations of the disease can be avoided, or, they can be minimized.

It must be remembered that childhood neuropsychiatric disorders do not go unnoticed, they leave their negative mark on the development and social opportunities of the little man.

But if professional neuropsychological assistance is provided in a timely manner, many diseases of the child's psyche are cured in full, and some can be SUCCESSFULLY ADJUSTED and feel comfortable in society.

In general, specialists diagnose children with problems such as ADHD, tics, in which the child has involuntary movements, or vocalizations, if the child tends to make sounds that do not make sense. In childhood, anxiety disorders, various fears can be observed.

With behavioral disorders, children ignore any rules, they demonstrate aggressive behavior. In the list of frequently occurring diseases, disorders related to thought disorders.

Often neurologists and neuropsychologists use the designation "borderline mental disorders" in children. This means that there is a state that is an intermediate link between deviation and norm. Therefore, it is especially important to start the correction on time and quickly get closer to the norm, so as not to eliminate gaps in intellectual, speech and social development.

The causes of mental disorders in children are different. Often they are caused by a hereditary factor, diseases, traumatic lesions.

Therefore, parents should focus on complex correctional techniques.

A significant role in the correction of behavioral disorders is assigned psychotherapeutic, neuropsychological and correctional methods.

A neuropsychologist helps a child cope with a disorder by choosing special strategies and programs for this.

Correction of behavioral disorders in children at the Neuro-Speech Therapy Center "Above the Rainbow":

This method allows the child drug-free overcome difficulties in behavior, development or communication!!! Neuropsychological correction has a therapeutic effect on the body - it improves the emotional and physical state, increases self-esteem and self-confidence, reveals internal reserves and abilities, develops additional hidden brain capabilities.

In our center, the program of neuropsychological correction integrates the latest innovative equipment and techniques to achieve the greatest and fastest results, as well as to make it possible to carry out neuropsychological correction even in the most severe cases. Educational and correctional simulations motivate even the smallest children to work, children with hyperactivity, aggression, tics, "field" behavior, Asperger's syndrome, etc.

Specialists who do not have interactive and innovative equipment in their arsenal are not able to conduct high-quality and effective neurocorrective classes with difficult children.

So, in the NeuroSpeech Therapy Center “Above the Rainbow”, a huge amount of educational equipment is integrated into the neuropsychological correction at the discretion (depending on the goals and objectives of the individual program) of the methodologist and diagnostician.

The form of conducting classes is individual.

As a result, a profile of the child's difficulties is compiled, on the basis of which a neuropsychological correction program is developed.

1. . The cerebellum, one of the parts of the brain, is responsible for the implementation of many functions in the human body, including the coordination of movements, the regulation of balance and muscle tone, as well as the development of cognitive functions. The cerebellum is the controller of our brain. It is connected to all parts of the brain and processes all the information from the senses that enters the brain. Based on this information, the cerebellum corrects movements and behavior. Neuropsychologists have found that this system does not work properly in all children with developmental and behavioral disorders. That is why children have difficulty learning skills, cannot regulate their behavior, speak poorly, and have difficulty learning to read and write. But the function of the cerebellum can now be trained.

The cerebellar stimulation program normalizes the functioning of the brain stem and cerebellum. The technique improves:

• Behavior;
• Interaction and social skills;
• all kinds of memory
• coordination, balance, gait, body awareness

The manifestation of behavioral disorders is often due to various disorders in the work of the cerebellum. That is why stimulation aimed at normalizing the functioning of the limbic system, the cerebellum and the brain stem helps to accelerate the development of speech, improve concentration, normalize behavior and, as a result, solve problems with school performance.

Widely used balance board training system Learning Breakthrough("breakthrough learning") program developer Frank Bilgow. A series of rehabilitation techniques aimed at stimulating the work of the brain stem and cerebellum.

The results are quickly manifested in the improvement of behavior, attention, speech of the child, academic success. Cerebellar stimulation significantly increases the effectiveness of any corrective exercises.

3. Neuropsychological correction with an integrated program of sensory integration and antigravity.

SENSORY INTEGRATION is a natural, neurological process of human development that begins in the womb and continues throughout life. It is important to note that the most favorable time for development is the first seven years of life.

SENSORY PROCESSING is the process by which the brain receives sensory information, processes it, and uses it for its intended purpose.
If we talk about the usual process of sensory processing, productive, natural with an "adaptive response", then the following happens:
Our nervous system takes in sensory information.
The brain organizes and processes it
Then gives us the opportunity to use it according to our environment in order to achieve "increasingly complex, targeted actions"

We need to develop sensory processing ability to:
social interaction
Pveterinary skills
Development of motor skills
Ability to concentrate

This is a system of physical exercises and special body-oriented games aimed at developing sensorimotor integration - the ability of the brain to combine and process information coming from the senses.

These classes are useful for all children, since sensorimotor integration is an obligatory stage in the mental development of every child.

The formation of sensorimotor integration begins in the prenatal period of life on the basis of three basic systems: vestibular, proprioceptive and tactile.

Very often, children experience a deficit of purposeful "correct" physical activity, so their brain does not receive enough information, babies "do not feel" their own body in space. The process of formation of sensorimotor integration is disturbed. This interferes with the development of higher mental functions (thinking, attention, perception, memory, speech, etc.).

4. integrated into the sensory integration program provides the development of a sense of rhythm and a sense of time, which are necessary for successful reading, writing and other learning activities. These classes are multi-level stimulation of all sensory systems involved in the formation of speech, reading and writing. Many children with behavioral problems, learning difficulties, balance problems, problems with motor coordination and sensory integration (the brain's processing of information from all the senses).

Although these difficulties are not always noticeable, impairments to basic functions prevent the brain from mastering more complex “advanced” activities such as speaking, reading, and writing. The brain is forced to spend too much time and energy on controlling body position and regulating simple movements.

Interaction with rhythmic music stimulates the development of a sense of rhythm, attention, stress resistance, the ability to organize one's thoughts and movements in time. All these abilities develop due to the fact that in the process of correction, stimulation is provided that improves the quality of the functioning of the brain and the quality of its connections with the body.

5. is prescribed for children with various developmental disorders: behavioral, speech delays and general development, cerebral palsy, mental retardation, hyperactivity, attention disorders, impaired development of school skills.

The ability to control the position of one's body in space is the foundation for mastering all types of learning activities.
All children with developmental disabilities have difficulties in this area. Timocco program provides visual feedback on the basis of which the child quickly learns to control his body, performing more and more complex sequences of movements.

6. A high-tech developmental technique created by the company to overcome speech, attention and behavioral disorders associated with timing and movement planning, with the development of a sense of rhythm and time.

Classes with interactive metronome are prescribed for children with behavioral and developmental problems, ADHD, autism spectrum disorders (early childhood autism), mental retardation, cerebral palsy, speech tempo disorders, children after traumatic brain injuries, spinal cord injuries, stuttering, tics, obsessive-compulsive disorder syndrome, impaired coordination movements.

It is often very difficult for children to concentrate, remember and follow instructions that consist of several parts, follow everything to the end, not be distracted and not “jump”. Such problems are associated with a sense of time and a sense of rhythm. This is the basis for mastering any learning skills, including reading, writing and counting, problem solving.

The interactive metronome stimulates the brain activity needed to process sensory information from outside. This contributes to the development of the ability to plan their activities, stabilizes behavioral reactions.

7. . For us, this is not just a bright special effect and a fun game, first of all, it is an important tool in the hands of a specialist that helps to achieve important goals and objectives in training and correction:

1. development of fine motor skills and elimination of involuntary movements (hyperkinesis);
2. improving the pattern of walking;
3. development and consolidation of correct posture;
4. improvement of general mobility;
5. development of a sense of one's own body in space;
6. learning to listen and pay attention;
7. development of motivation;
8. discovery of the ability to improvise and creative activity;
9. development of communication skills;
10. development of perseverance in achieving the goal

8. - the most natural and effective form of work with children, therapy in the process of play. This psychotherapeutic approach is used to help children work through their psychological problems and emotionally traumatic experiences, or to overcome behavioral and developmental challenges. In the process of therapy, the child begins to better understand his feelings, develops the ability to make his own decisions, increases self-esteem, communication skills.

The specialist in a playful way solves the behavioral and emotional problems of the child:

- aggression;

- isolation;

- anxiety;

School disapproval, lack of motivation to learn;

Crisis of three years;

Teen Crisis;

Difficulties in communicating with parents and teachers;

suicide attempts;

Theft;

Stressful situations (death of parents, divorce, change of school, kindergarten);

Conflicts between children in the family;

Jealousy towards other children in the family and other family members;

In his work, the psychologist uses various approaches and methods:

Elements of fairy tale therapy;

Elements of sand and clay therapy;

Aqua animation elements;

Elements of psychodrama;

Elements of art therapy;
9. Psychological and communicative classes.

The purpose of the development of communication skills is the development of communicative competence, peer orientation, expansion and enrichment of the experience of joint activities and forms of communication with peers. We include in our communication skills development program - the ability to organize communication, including the ability to listen to the interlocutor, the ability to emotionally empathize, show empathy, the ability to resolve conflict situations; the ability to use speech; knowledge of the norms and rules that must be followed when communicating with others.

Apresyan Elena
Consultation "Emotional disorders in preschoolers"

Emotionally disturbed-volitional sphere of the child

Often, parents' concern is mainly concentrated in the field of children's physical health, when sufficient attention emotional the condition of the child is not given, and some early warning symptoms disorders in emotional in the volitional sphere are perceived as temporary, characteristic of age, and therefore, not dangerous for the life of the baby, and serve as an indicator of his attitude to his parents and to what surrounds him. Currently, along with general health problems in children, experts note with concern the growth emotional-volitional disorders, which result in more serious problems in the form of low social adaptation, a tendency to antisocial behavior, learning difficulties.

External manifestations emotional disturbances-volitional sphere in childhood

Despite the fact that you should not independently make not only medical diagnoses, but also diagnoses in the field of psychological health, but it is better to entrust this to professionals, there are a number of signs violations of the emotional-volitional sphere, the presence of which should be the reason for contacting specialists.

Disturbances in emotional- the volitional sphere of the child's personality have characteristic features of age-related manifestations. So, for example, if adults systematically note in their baby at an early age such behavioral characteristics as excessive aggressiveness or passivity, tearfulness, "stuck" on a certain emotions, it is possible that this is an early manifestation emotional disorders.

AT preschool age to the above symptoms, may be added inability to follow the norms and rules of behavior, insufficient development of independence. At school age, these deviations, along with those listed, can be combined with self-doubt, violation social interaction, a decrease in purposefulness, inadequacy of self-esteem.

It is important to understand that the existence violations should be judged not by the presence of a single sign, which may be the child's reaction to a specific situation, but by the combination of several characteristic symptoms.

The main external manifestations are as follows way:

Emotional tension. With increased emotional tension, in addition to well-known manifestations, difficulties in the organization of mental activity, a decrease in play activity characteristic of a particular age, can also be clearly expressed.

The rapid mental fatigue of the child in comparison with peers or with earlier behavior is expressed in the fact that it is difficult for the child to concentrate, he can demonstrate a clear negative attitude to situations where the manifestation of mental, intellectual qualities is necessary.

Increased anxiety. Increased anxiety, in addition to known signs, can be expressed in the avoidance of social contacts, a decrease in the desire to communicate.

Aggressiveness. Manifestations can be in the form of demonstrative disobedience to adults, physical aggression and verbal aggression. Also, his aggression can be directed at himself, he can hurt himself. The child becomes naughty and with great difficulty gives in to the educational influences of adults.

Lack of empathy. Empathy - the ability to feel and understand other person's emotions, empathize. At emotional disorders in the volitional sphere, this sign is usually accompanied by increased anxiety. An inability to empathize can also be a warning sign of a mental disorder or intellectual retardation.

Unwillingness and unwillingness to overcome difficulties. The child is lethargic, contacts with adults with displeasure. Extreme manifestations in behavior may look like a complete disregard for parents or other adults - in certain situations, the child may pretend not to hear the adult.

Low motivation to succeed. A characteristic sign of low motivation for success is the desire to avoid hypothetical failures, so the child takes on new tasks with displeasure, tries to avoid situations where there is even the slightest doubt about the result. It is very difficult to persuade him to try to do something. A common answer in this situation is: "will not work", "I do not know how". Parents may erroneously interpret this as a manifestation of laziness.

Expressed distrust of others. It can manifest itself as hostility, often accompanied by tearfulness; school-age children can manifest this as excessive criticism of the statements and actions of both peers and surrounding adults.

Excessive impulsiveness of the child, as a rule, is expressed in weak self-control and insufficient awareness of their actions.

Avoid close contact with other people. The child may repel others with remarks expressing contempt or impatience, insolence, etc.

Formation emotionally-volitional sphere of the child

Manifestation emotions parents observe from the very beginning of the child's life, with their help, communication with parents takes place, so the baby shows that he is well, or he experiences discomfort.

In the future, in the process of growing up, the child faces problems that he has to solve with varying degrees of independence. Attitude towards a problem or situation causes a certain emotional response, and attempts to influence the problem are additional emotions. In other words, if the child has to show arbitrariness in the implementation of any actions, where the fundamental motive is not "want", a "necessary", that is, to resolve the problem, an effort of will is required, in fact, this will mean the implementation of an act of will.

As you grow older emotions also undergo certain changes and develop. Children at this age learn to feel and are able to demonstrate more complex manifestations. emotions. The main feature of the correct emotionally-volitional development of the child is an increasing ability to control the manifestation emotions.

Main reasons emotional disturbances-volitional sphere of the child

Child psychologists place particular emphasis on the assertion that the development of a child's personality can occur harmoniously only with sufficient confidential communication with close adults.

Main reasons violations are:

1. transferred stresses;

2. lag in intellectual development;

3. insufficiency emotional contacts with close adults;

4. social causes;

5. films and computer games not intended for his age;

6. a number of other reasons that cause internal discomfort and a feeling of inferiority in a child.

Children's emotional disorders spheres appear much more often and brighter during periods of so-called age-related crises. Vivid examples of such points of maturation can be crises "I myself" at the age of three and "Crisis of adolescence" in adolescence.

What to do if the behavior of the baby suggests the presence of such a disorder? First of all, it is important to understand that these violations can and should be corrected. You should not rely only on specialists, the role of parents in correcting the behavioral characteristics of the child's character is very important.

An important point that allows laying the foundation for the successful resolution of this problem is the establishment of contact and trusting relationships between parents and the child. In communication, one should avoid critical assessments, show a benevolent attitude, remain calm, praise adequate manifestations of feelings more, one should be sincerely interested in his feelings and empathize.

Often, parents' concern is mainly concentrated in the field of physical health of children, when sufficient attention is not paid to the emotional state of the child, and some early alarming symptoms of disorders in the emotional-volitional sphere are perceived as temporary, characteristic of age, and therefore not dangerous.

Emotions play a significant role from the very beginning of a baby's life, and serve as an indicator of his relationship to his parents and to what surrounds him. Currently, along with general health problems in children, experts note with concern the growth of emotional and volitional disorders, which result in more serious problems in the form of low social adaptation, a tendency to antisocial behavior, and learning difficulties.

External manifestations of violations of the emotional-volitional sphere in childhood

Despite the fact that it is not necessary to independently make not only medical diagnoses, but also diagnoses in the field of psychological health, but it is better to entrust this to professionals, there are a number of signs of violations of the emotional and volitional sphere, the presence of which should be the reason for contacting specialists.

Violations in the emotional-volitional sphere of the child's personality have characteristic features of age-related manifestations. So, for example, if adults systematically note in their baby at an early age such behavioral characteristics as excessive aggressiveness or passivity, tearfulness, “stuck” on a certain emotion, then it is possible that this is an early manifestation of emotional disorders.

At preschool age, to the above symptoms, inability to follow the norms and rules of behavior, insufficient development of independence may be added. At school age, these deviations, along with those listed, can be combined with self-doubt, disruption of social interaction, a decrease in purposefulness, and inadequacy of self-esteem.

It is important to understand that the existence of violations should be judged not by the presence of a single symptom, which may be the child's reaction to a specific situation, but by the combination of several characteristic symptoms.

The main external manifestations are as follows:

Emotional tension. With increased emotional tension, in addition to well-known manifestations, difficulties in the organization of mental activity, a decrease in gaming activity characteristic of a particular age, can also be clearly expressed.

• The rapid mental fatigue of the child in comparison with peers or with earlier behavior is expressed in the fact that it is difficult for the child to concentrate, he can demonstrate a clear negative attitude to situations where the manifestation of mental, intellectual qualities is necessary.
• Increased anxiety. Increased anxiety, in addition to known signs, can be expressed in the avoidance of social contacts, a decrease in the desire to communicate.
• Aggressiveness. Manifestations can be in the form of demonstrative disobedience to adults, physical aggression and verbal aggression. Also, his aggression can be directed at himself, he can hurt himself. The child becomes naughty and with great difficulty gives in to the educational influences of adults.
• Lack of empathy. Empathy is the ability to feel and understand the emotions of another person, to empathize. With violations of the emotional-volitional sphere, this symptom is usually accompanied by increased anxiety. An inability to empathize can also be a warning sign of a mental disorder or intellectual retardation.
• Unwillingness and unwillingness to overcome difficulties. The child is lethargic, contacts with adults with displeasure. Extreme manifestations in behavior may look like a complete disregard for parents or other adults - in certain situations, the child may pretend not to hear the adult.
• Low motivation to succeed. A characteristic sign of low motivation for success is the desire to avoid hypothetical failures, so the child takes on new tasks with displeasure, tries to avoid situations where there is even the slightest doubt about the result. It is very difficult to persuade him to try to do something. A common answer in this situation is: “it won’t work”, “I don’t know how”. Parents may erroneously interpret this as a manifestation of laziness.
• Expressed distrust of others. It can manifest itself as hostility, often accompanied by tearfulness; school-age children can manifest this as excessive criticism of the statements and actions of both peers and surrounding adults.
• Excessive impulsiveness of the child, as a rule, is expressed in weak self-control and insufficient awareness of their actions.
• Avoid close contact with other people. The child may repel others with remarks expressing contempt or impatience, insolence, etc.

Formation of the emotional-volitional sphere of the child

Parents observe the manifestation of emotions from the very beginning of the child's life, with their help, communication with parents takes place, so the baby shows that he is well, or he experiences discomfort.

In the future, in the process of growing up, the child faces problems that he has to solve with varying degrees of independence. Attitude to a problem or situation causes a certain emotional response, and attempts to influence the problem - additional emotions. In other words, if a child has to show arbitrariness in the implementation of any actions, where the fundamental motive is not “I want”, but “I must”, that is, an effort of will is required to solve the problem, in fact this will mean the implementation of an act of will.

As you grow older, emotions also undergo certain changes and develop. Children at this age learn to feel and are able to demonstrate more complex manifestations of emotions. The main feature of the correct emotional-volitional development of the child is the increasing ability to control the manifestation of emotions.

The main causes of violations of the emotional-volitional sphere of the child

Child psychologists place particular emphasis on the assertion that the development of a child's personality can occur harmoniously only with sufficient confidential communication with close adults.

The main reasons for violations are:

1. transferred stress;
2. lag in intellectual development;
3. lack of emotional contacts with close adults;
4. social causes;
5. films and computer games not intended for his age;
6. a number of other reasons that cause internal discomfort and a sense of inferiority in a child.

Violations of the children's emotional sphere manifest themselves much more often and brighter during periods of so-called age-related crises. Vivid examples of such points of growing up can be the crises of "I myself" at the age of three years and the "Crisis of transitional age" in adolescence.

Diagnosis of violations

To correct violations, timely and correct diagnosis is important, taking into account the reasons for the development of deviations. In the arsenal of psychologists there are a number of special methods and tests for assessing the development and psychological state of the child, taking into account his age characteristics.

For preschoolers, as a rule, projective diagnostic methods are used:

• drawing test;
• Luscher color test;
• the Beck Anxiety Scale;
• questionnaire "Health, activity, mood" (SAN);
• the Philips School Anxiety Test and many others.

Correction of violations of the emotional-volitional sphere in childhood

What to do if the behavior of the baby suggests the presence of such a disorder? First of all, it is important to understand that these violations can and should be corrected. You should not rely only on specialists, the role of parents in correcting the behavioral characteristics of the child's character is very important.

An important point that allows laying the foundation for the successful resolution of this problem is the establishment of contact and trusting relationships between parents and the child. In communication, one should avoid critical assessments, show a benevolent attitude, remain calm, praise adequate manifestations of feelings more, one should be sincerely interested in his feelings and empathize.

Appeal to a psychologist

To eliminate violations of the emotional sphere, you should contact a child psychologist, who, with the help of special classes, will help you learn how to respond correctly in stressful situations and control your feelings. Another important point is the work of a psychologist with the parents themselves.

In psychology, many ways to correct childhood disorders in the form of play therapy are currently described. As you know, the best learning occurs with the involvement of positive emotions. Teaching good behavior is no exception.

The value of a number of methods lies in the fact that they can be successfully used not only by specialists themselves, but also by parents interested in the organic development of their baby.

Practical methods of correction

Such, in particular, are the methods of fairy tale therapy and puppet therapy. Their main principle is the identification of a child with a fairy tale character or his favorite toy during the game. The child projects his problem onto the main character, a toy, and, in the course of the game, solves them according to the plot.

Of course, all these methods imply the obligatory direct involvement of adults in the process of the game itself.

If parents in the process of upbringing pay sufficient and proper attention to such aspects of the development of a child's personality as the emotional-volitional sphere, then in the future this will make it much easier to survive the period of teenage personality development, which, as many people know, can introduce a number of serious deviations in the child's behavior.

The work experience accumulated by psychologists shows that not only taking into account the peculiarities of age development, a thorough selection of diagnostic methods and techniques of psychological correction, allows specialists to successfully solve the problems of violations of the harmonious development of a child's personality, the decisive factor in this area will always be parental attention, patience, care and love. .

Psychologist, psychotherapist, personal well-being specialist

Svetlana Buk

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1. Question:
   Hello! Our child was diagnosed with Violation of the emotional-volitional sphere of the sphere. What to do? He is in the 7th grade, I'm afraid if we send him to study at home, he will become even worse.
   Answer:
   Hello dear mom!

   A child with a violation of the emotional-volitional sphere may have melancholy, depression, sadness or a painfully elevated mood up to euphoria, fits of anger or anxiety. And all this within the framework of one diagnosis.

   A competent psychotherapist does not work with a diagnosis, but with a specific child, with his individual symptoms and situation.

   First of all, it is important for you to level your condition. The fears and fears of parents negatively affect any child.

   And to correct, to solve the problem. Transferring to homeschooling is only an adaptation to the problem (i.e. a way to somehow live with it). To solve it, you need to come to an appointment with a psychologist-psychotherapist together with medical help.

   
   

2. Question:
   Hello. I am a mother. My son is 4 years 4 months old. We were first diagnosed with ZPPR, yesterday this diagnosis was made by a neuropathologist and put a ‘disorder of the emotional sphere against the background of the formation of the emotional sphere’. What should I do? How to correct? And what literature would you recommend for behavior correction. My name is Marina.
   Answer:
   Hello Marina!
   Imagine that your smartphone or TV is somehow not working properly.
   Does it ever occur to someone to start repairing these devices according to books or recommendations from specialists (take a soldering iron and replace the 673 transistor and 576 resistor). The human psyche is much more complex.
   Here we need versatile classes with a psychologist-psychotherapist, speech therapist, defectologist, psychiatrist.
   And the earlier you start classes, the more effective the correction will be.

   
   

3. Question:
   What are the diagnostic techniques for detecting violations in the emotional-volitional sphere of children aged 6-8?

   Answer:
   Classification by M.Bleikher and L.F.Burlachuk:
   1) observation and methods close to it (biography study, clinical conversation, etc.)
   2) special experimental methods (simulation of certain types of activities, situations, some instrumental techniques, etc.)
   3) personality questionnaires (methods based on self-assessment)
   4) projective methods.

   
   

4. Question:
   Hello Svetlana.
   Violations of the children's emotional sphere described in this article, I observed in many children about 90% - aggressiveness, lack of empathy, unwillingness to overcome difficulties, unwillingness to listen to another (headphones help a lot in this now) are the most frequent. Others are rarer but present. I am not a psychologist and perhaps I am mistaken in my observations, therefore I want to ask: is it true that 90% of them have violations of the emotional-volitional sphere?

   Answer:
   Hello dear reader!
   Thank you for your interest in the topic and the question.
   The manifestations you have noticed - aggressiveness, lack of empathy, unwillingness to overcome difficulties, unwillingness to listen to another - these are only signs. They can serve as a reason for contacting a specialist. And their presence is not a reason for diagnosing " Violations of the emotional-volitional sphere". In one way or another, every child tends to experience aggressiveness, for example.
   And in this sense, your observations are correct - most children show the above signs from time to time.

   
   

5. Question:
   Hello Svetlana!
   I would like to consult with you about the behavior of my son. We are a family of grandparents, son and me (mother). My son is 3.5 years old. I am divorced from my father, we broke up with him when the child was a little over a year old. Now we don't see each other. My son was diagnosed with dysarthria, intellectual development is normal, he is very active and sociable, but there are serious violations in the emotional-volitional sphere.
   For example, it happens that he pronounces (in the kindergarten one boy began to do this), sometimes some syllable or sound repeatedly and monotonously, and when he is told to stop doing this, he can start doing something else out of spite, for example, make a face ( how he was forbidden to do so). At the same time, in a calm tone, we explained to him that “sick” boys or “bad” boys do this. At first he starts laughing, and after another explanation and reminder that this may be fraught with some kind of punishment, especially when an adult breaks down and raises his tone, crying begins, which is abruptly replaced by laughter (definitely unhealthy), and so laughter and crying can change several times over the course of minutes.
   We also observe in the son’s behavior that he can throw toys (often (in the sense of a month or two), breaks a car or toys, abruptly throwing and breaking it. At the same time, he is very naughty (he hears, but does not listen), often every day brings loved ones.
   We all love him very much and want him to be a healthy and happy boy. Tell me, please, how should we be in such a situation when he does something out of spite? What conflict resolution methods would you recommend? How can a son be weaned from the habit of pronouncing these “articulate sounds”?
   My grandparents are intelligent people, I have the education of a teacher, economist, educator. We turned to a psychologist about a year ago, when such a picture was just beginning to appear. The psychologist explained that these are signs of a crisis. But, having now a diagnosis of dysarthria, we are forced to explain his behavior in a different way, which, by the way, did not improve, despite our implementation of the psychologist's advice, but worsened.
   Thanks in advance
   Sincerely, Svetlana

   Answer:
   Hello Svetlana!

   I recommend that you come for a consultation.
   We can contact you via skype or phone.
   It is important to switch the child, distract him to some interesting activity at such moments.
   Punishments, explanations and raising the tone are not effective.
   You write "despite our implementation of the psychologist's advice" - what exactly did you do?

   
   

The textbook on psychiatry for students of medical universities is based on the training programs for students in Ukraine, Belarus and Russia, as well as the International Classification of ICD 10. All the main sections of diagnostics, differential diagnosis, therapy of mental disorders, including psychotherapy, as well as the history of psychiatric science are presented. .

For students of medical universities, psychiatrists, medical psychologists, interns and doctors of other specialties.

V. P. Samokhvalov. Psychiatry. Phoenix Publishing. Rostov-on-Don. 2002.

The main manifestations include:

- Attention disorders. Inability to maintain attention, decreased selective attention, inability to focus on a subject for a long time, often forgetting what needs to be done; increased distractibility, excitability. Such children are fussy, restless. Even more attention is reduced in unusual situations, when it is necessary to act independently. Some kids can't even finish watching their favorite TV shows.

- Impulsiveness. AT the form of sloppy completion of school assignments, despite efforts to do them correctly; frequent shouting from a place, noisy antics during classes; intervening in the conversation or work of others; impatience in the queue; inability to lose (as a result, frequent fights with children). With age, manifestations of impulsivity may change. At an early age, this is urinary and fecal incontinence; at school - excessive activity and extreme impatience; in adolescence - hooligan antics and antisocial behavior (theft, drug use, etc.). However, the older the child, the more pronounced and noticeable impulsiveness for others.

- Hyperactivity. This is an optional feature. In some children, motor activity may be reduced. However, motor activity qualitatively and quantitatively differs from the age norm. At preschool and early school age, such children continuously and impulsively run, crawl, jump up, and are very fussy. Hyperactivity often decreases by puberty. Children without hyperactivity are less aggressive and hostile to others, but they are more likely to have partial developmental delays, including school skills.

Additional Features

Coordination disorders are noted in 50-60% in the form of the impossibility of fine movements (tying shoelaces, using scissors, coloring, writing); balance disorders, visual-spatial coordination (inability to play sports, ride a bike, play with a ball).

Emotional disturbances in the form of imbalance, irascibility, intolerance to failures. There is a delay in emotional development.

Relationships with others. In mental development, children with impaired activity and attention lag behind their peers, but strive to be leaders. It's hard to be friends with them. These children are extroverts, they are looking for friends, but they quickly lose them. Therefore, they often communicate with more "compliant" younger ones. Relationships with adults are difficult. Neither punishment, nor caress, nor praise act on them. From the point of view of parents and educators, it is precisely “ill-manneredness” and “bad behavior” that is the main reason for visiting doctors.

Partial developmental delays. Despite a normal IQ, many children do poorly in school. The reasons are inattention, lack of perseverance, intolerance for failures. Partial delays in the development of writing, reading, counting are characteristic. The main symptom is a discrepancy between a high intellectual level and poor school performance. The criterion for a partial delay is considered to be skills lagging behind the due ones by at least 2 years. However, it is necessary to exclude other causes of failure: perceptual disorders, psychological and social causes, low intelligence and inadequate teaching.

behavioral disorders. They are not always observed. Not all children with conduct disorders may have impaired activity and attention.

Bed-wetting. Sleep disturbances and drowsiness in the morning.

Violations of activity and attention can be divided into 3 types: with a predominance of inattention; with a predominance of hyperactivity; mixed.

Diagnostics

It is necessary to have inattention or hyperactivity and impulsivity (or all manifestations at the same time) that do not correspond to the age norm.

Behavior features:

1) appear up to 8 years;

2) are found in at least two areas of activity - school, home, work, play, clinic;

3) are not caused by anxiety, psychotic, affective, dissociative disorders and psychopathy;

4) cause significant psychological discomfort and maladjustment.

Carelessness:

1. Inability to focus on details, mistakes due to inattention.

2. Inability to maintain attention.

3. Inability to listen to the addressed speech.

4. Inability to complete tasks.

5. Low organizational skills.

6. Negative attitude to tasks that require mental stress.

7. Loss of items needed to complete the task.

8. Distractibility to extraneous stimuli.

9. Forgetfulness. (Of the listed signs, at least six must persist for more than 6 months.)

Hyperactivity and impulsivity(out of the signs listed below, at least four must persist for at least 6 months):

Hyperactivity: the child is fussy, restless. Jumps up without permission. Runs aimlessly, fidgets, climbs. Cannot rest, play quiet games;

Impulsivity: Shouts out an answer before hearing the question. Can't wait in line.

Differential Diagnosis

To make a diagnosis, you need: a detailed history of life. Information must be obtained from everyone who knows the child (parents, caregivers, teachers). Detailed family history (presence of alcoholism, hyperactivity syndrome, tics in parents or relatives). Data about the child's behavior at present.

Information about the child's progress and behavior in an educational institution is required. There are currently no informative psychological tests to diagnose this disorder.

Violations of activity and attention do not have clear pathognomonic signs. Suspicion of this disorder can be based on the history and psychological testing, taking into account diagnostic criteria. For the final diagnosis, a trial appointment of psychostimulants is shown.

The phenomena of hyperactivity and inattention can be symptoms of anxiety or depressive disorders, mood disorders. The diagnosis of these disorders is based on their diagnostic criteria. The presence of an acute onset of a hyperkinetic disorder at school age may be a manifestation of a reactive (psychogenic or organic) disorder, a manic state, schizophrenia, or a neurological disease.

Drug treatment is effective in 75-80% of cases, with a correct diagnosis. Its action is mostly symptomatic. Suppression of symptoms of hyperactivity and attention disorders facilitates the intellectual and social development of the child. Drug treatment is subject to several principles: only long-term therapy is effective, ending in adolescence. The selection of the drug and the dose are based on the objective effect, and not on the patient's feelings. If the treatment is effective, then it is necessary to take trial breaks at regular intervals to find out if the child can do without drugs. It is advisable to arrange the first breaks during the holidays, when the psychological burden on the child is less.

Pharmacological substances used to treat this disorder are CNS stimulants. Their mechanism of action is not completely known. However, psychostimulants not only calm the child, but also affect other symptoms. The ability to concentrate increases, emotional stability, sensitivity to parents and peers appear, social relations are being established. Mental development may improve dramatically. Currently, amphetamines (dexamphetamine (Dexedrine), methamphetamine), methylphenidate (Ritalin), pemoline (Zielert) are used. Individual sensitivity to them is different. If one of the drugs is ineffective, they switch to another. The advantage of amphetamines is a long duration of action and the presence of prolonged forms. Methylphenidate is usually taken 2-3 times a day, it often has a sedative effect. The intervals between doses are usually 2.5-6 hours. Prolonged forms of amphetamines are taken 1 time per day. Doses of psychostimulants: methylphenidate - 10-60 mg / day; methamphetamine - 5-40 mg / day; pemoline - 56.25-75 mg / day. Begin treatment usually with low doses with a gradual increase. Physical dependence usually does not develop. In rare cases, the development of tolerance is transferred to another drug. It is not recommended to prescribe methylphenidate to children under 6 years of age, dexamphetamine - to children under 3 years of age. Pemoline is prescribed for the ineffectiveness of amphetamines and methylphenidate, but its effect may be delayed, within 3-4 weeks. Side effects - decreased appetite, irritability, epigastric pain, headache, insomnia. In pemoline - increased activity of liver enzymes, possible jaundice. Psychostimulants increase heart rate, blood pressure. Some studies indicate a negative effect of drugs on height and body weight, but these are temporary violations.

With the ineffectiveness of psychostimulants, imipramine hydrochloride (Tofranil) is recommended in doses of 10 to 200 mg / day; other antidepressants (desipramine, amphebutamon, phenelzine, fluoxetine) and some antipsychotics (chlorprothixene, thioridazine, sonapax). Antipsychotics do not contribute to the social adaptation of the child, so the indications for their appointment are limited. They should be used in the presence of severe aggressiveness, uncontrollability, or when other therapy and psychotherapy are ineffective.

Psychotherapy

A positive effect can be achieved through psychological assistance to children and their families. Rational psychotherapy with an explanation to the child of the reasons for his failures in life is advisable; behavioral therapy with teaching parents methods of reward and punishment. Reducing psychological tension in the family and at school, creating a favorable environment for the child contribute to the effectiveness of treatment. However, as a method of radical treatment of activity and attention disorders, psychotherapy is ineffective.

Control over the child's condition should be established from the beginning of treatment and carried out in several directions - the study of behavior, school performance, social relationships.

Hyperkinetic conduct disorder (F90.1).

The diagnosis is made by meeting the criteria for hyperkinetic disorder and the general criteria for conduct disorder. It is characterized by the presence of dissocial, aggressive or defiant behavior with a pronounced violation of the relevant age and social norms, which are not symptoms of other mental conditions.

Therapy

Applicable psychostimulants are amphetamine (5-40 mg/day) or methylphenidate (5-60 mg/day), neuroleptics with a pronounced sedative effect. The use of normothymic anticonvulsants (carbamazepines, valproic acid salts) in individually selected doses is recommended. Psychotherapeutic techniques are largely socially conditioned and are of an auxiliary nature.

Conduct disorders (F91).

They include disorders in the form of destructive, aggressive or antisocial behavior, in violation of the norms and rules accepted in society, with harm to other people. Violations are more serious than quarrels and pranks of children and adolescents.

Etiology and pathogenesis

Conduct disorder is based on a number of biopsychosocial factors:

connection with parental attitudes. Poor or mistreatment of children influences the development of maladaptive behavior. Etiologically significant is the struggle of parents among themselves, and not the destruction of the family. An important role is played by the presence of mental disorders, sociopaths or alcoholism in parents.

Sociocultural theory - the presence of difficult socio-economic conditions contributes to the development of behavioral disorders, as they are considered acceptable in terms of socio-economic deprivation.

Predisposing factors are the presence of minimal dysfunction or organic brain damage; rejection by parents, early placement in boarding schools; improper upbringing with strict discipline; frequent change of educators, guardians; illegitimacy.

Prevalence

It is quite common in childhood and adolescence. It is determined in 9% of boys and 2% of girls under the age of 18 years. The ratio of boys and girls ranges from 4:1 to 12:1. It is more common in children whose parents are asocial individuals or suffer from alcoholism. The prevalence of this disorder correlates with socioeconomic factors.

Clinic

Conduct disorder must last at least 6 months, during which there are at least three manifestations (diagnosis is made only until the age of 18):

1. Stealing something without the knowledge of the victim and fighting more than once (including forging documents).

2. Escapes from the house for the whole night at least 2 times, or once without returning (when living with parents or guardians).

3. Frequent lying (except when lying to avoid physical or sexual punishment).

4. Special participation in arson.

5. Frequent absenteeism of lessons (work).

6. Unusually frequent and severe outbursts of anger.

7. Special penetration into someone else's house, room, car; deliberate destruction of another's property.

8. Physical cruelty to animals.

9. Forcing someone to have sexual relations.

10. Use of weapons more than once; often the instigator of fights.

11. Theft after a fight (for example, hitting the victim and snatching the purse; extortion or armed robbery).

12. Physical cruelty to people.

13. Defiant provocative behavior and constant, outright disobedience.

Differential Diagnosis

Separate acts of antisocial behavior are not enough to make a diagnosis. Bipolar disorder, schizophrenia, general developmental disorder, hyperkinetic disorder, mania, depression should be excluded. However, the presence of mild, situationally specific phenomena of hyperactivity and inattention; low self-esteem and mild emotional manifestations does not rule out a diagnosis of conduct disorder.

Emotional disorders specific to childhood (F93).

The diagnosis of emotional (neurotic) disorder is widely used in child psychiatry. In terms of frequency of occurrence, it is second only to behavioral disorders.

Etiology and pathogenesis

In some cases, these disorders develop when the child has a tendency to overreact to everyday stressors. It is assumed that such features are inherent in the character and are genetically determined. Sometimes such disorders arise as a reaction to constantly anxious and overprotective parents.

Prevalence

It is 2.5% for both girls and boys.

Therapy

No specific treatment has been identified to date. Some types of psychotherapy and work with families are effective. In most forms of emotional disorders, the prognosis is favorable. Even severe disorders gradually improve and resolve over time without treatment, leaving no residual symptoms. However, if an emotional disorder that began in childhood continues into adulthood, then it more often takes the form of a neurotic syndrome or an affective disorder.

Phobic anxiety disorder of childhood (F93.1).

Minor phobias are usually typical of childhood. The fears that arise are related to animals, insects, darkness, death. Their prevalence and severity varies with age. With this pathology, the presence of pronounced fears characteristic of a certain phase of development is noted, for example, fear of animals in the preschool period.

Diagnostics

The diagnosis is made if: a) the onset of fears corresponds to a certain age period; b) the degree of anxiety is clinically pathological; c) anxiety is not part of a generalized disorder.

Therapy

Most childhood phobias go away without specific treatment, provided the parents take a consistent approach of supporting and encouraging the child. Simple behavioral therapy with desensitization of situations that cause fear is effective.

Social anxiety disorder (F93.2)

Caution in front of strangers is normal for children aged 8-12 months. This disorder is characterized by persistent, excessive avoidance of contact with strangers and peers, interfering with social interaction, lasting more than 6 months. and combined with a distinct desire to communicate only with family members or persons whom the child knows well.

Etiology and pathogenesis

There is a genetic predisposition to this disorder. In families of children with this disorder, similar symptoms were observed in mothers. Psychological trauma, physical damage in early childhood can contribute to the development of the disorder. Differences in temperament predispose to this disorder, especially if the parents support the child's modesty, shyness, and withdrawal.

Prevalence

Social anxiety disorder is uncommon, predominantly seen in boys. It can develop as early as 2.5 years of age, after a period of normal development or a state of minor anxiety.

Clinic

A child with social anxiety disorder has persistent recurrent fear and/or avoidance of strangers. This fear takes place both among adults and in the company of peers, combined with normal attachment to parents and other relatives. Avoidance and fear go beyond age criteria and are combined with social functioning problems. Such children avoid contact for a long time even after meeting. They slowly "thaw"; usually only natural in the home environment. For such children, reddening of the skin, difficulty in speech, and slight embarrassment are characteristic. Fundamental disturbances in communication and intellectual decline are not observed. Sometimes timidity and shyness complicate the learning process. The true abilities of a child can manifest themselves only under exceptionally favorable conditions of upbringing.

Diagnostics

The diagnosis is made on the basis of excessive avoidance of contact with strangers for 6 months. and more, interfering with social activity and relationships with peers. Characteristic is the desire to deal only with familiar people (family members or peers whom the child knows well), a warm attitude towards family members. The age of manifestation of the disorder is not earlier than 2.5 years, when the phase of normal anxiety towards strangers passes.

Differential Diagnosis

The differential diagnosis is made with adjustment disorder, which is characterized by a clear association with recent stress. At separation anxiety symptoms are manifested in relation to persons who are subjects of attachment, and not in the need to communicate with strangers. At severe depression and dysthymia there is isolation in relation to all persons, including acquaintances.

Therapy

Psychotherapy preferred. Effective development of communication skills in dancing, singing, music lessons. Parents are explained the need to restructure relationships with the need to stimulate the child to expand contacts. Anxiolytics are given in short courses to overcome avoidance behavior.

Sibling rivalry disorder (F93.3).

It is characterized by the appearance of emotional disorders in young children following the birth of a younger sibling.

Clinic

Rivalry and jealousy may manifest as marked competition between children for the attention or love of their parents. This disorder must be combined with an unusual degree of negative feelings. In more severe cases, this may be accompanied by open cruelty or physical injury to the younger child, humiliation and spite towards him. In milder cases, the disorder manifests itself in the form of unwillingness to share anything, lack of attention, friendly interactions with the younger child. Emotional manifestations take various forms in the form of some regression with the loss of previously acquired skills (control of bowel and bladder function), a tendency to infantile behavior. Often such a child copies the behavior of an infant in order to attract more attention from parents. Often there is a confrontation with parents, unmotivated outbursts of anger, dysphoria, marked anxiety or social withdrawal. Sometimes sleep is disturbed, the demand for parental attention often increases, especially at night.

Diagnostics

Sibling rivalry disorder is characterized by a combination of:

a) evidence of sibling rivalry and/or jealousy;

b) began within the months following the birth of the youngest (usually the next in a row) child;

c) emotional disturbances that are abnormal in degree and/or persistence and associated with psychosocial problems.

Therapy

The combination of individual rational and family psychotherapy is effective. It is aimed at easing stressful influences, normalizing the situation. It is important to encourage the child to discuss relevant issues. Often, due to such techniques, the symptoms of disorders soften and disappear. For the treatment of emotional disorders, antidepressants are sometimes used, taking into account individual indications and in minimal dosages, anxiolytics in short courses to facilitate psychotherapeutic measures. It is important tonic and biostimulating treatment.

Disorders of social functioning with onset specific to childhood and adolescence (F94).

A heterogeneous group of disorders that share common disorders of social functioning. A decisive role in the occurrence of disorders is played by a change in adequate environmental conditions or the deprivation of a favorable environmental impact. There are no significant gender differences in this group.

Selective mutism (F94.0).

Characterized by a persistent refusal to speak in one or more social situations, including in childcare settings, with the ability to understand spoken language and to speak.

Etiology and pathogenesis

Selective mutism is a psychologically determined refusal to speak. Maternal overprotection may be a predisposing factor. Some children develop the disorder after an emotional or physical trauma experienced in early childhood.

Prevalence

It occurs rarely, in less than 1% of patients with mental disorders. Equally common or even more common in girls than boys. Many children have delayed speech onset or articulation problems. Children with selective mutism are more likely than children with other speech disorders to have enuresis and encopresis. Mood swings, compulsive traits, negativism, behavioral disorders with aggression in such children appear more at home. Outside the home, they are shy and silent.

Clinic

Most often, children speak at home or with close friends, but are silent at school or with strangers. As a result, they may experience poor academic performance or become the target of peer attacks. Some children outside the home communicate using gestures or interjections - "hmm", "uh-huh, uh-huh".

Diagnostics

Diagnostic criteria:

1) normal or almost normal level of speech understanding;

2) sufficient level in speech expression;

3) demonstrable evidence that the child can speak normally or almost normally in some situations;

4) duration more than 4 weeks;

5) there is no general developmental disorder;

6) the disorder is not due to the lack of sufficient knowledge of the spoken language required in a social situation in which there is an inability to speak.

Differential Diagnosis

Very shy children may not talk in unfamiliar situations, but they spontaneously recover when the embarrassment passes. Children who find themselves in a situation where they speak another language may be reluctant to switch to the new language. The diagnosis is made if the children have fully mastered the new language, but refuse to speak both their native and the new language.

Therapy

Successful individual, behavioral and family therapy.

Tic disorders (F95).

Tiki- involuntary, unexpected, repetitive, recurrent, non-rhythmic, stereotyped motor movements or vocalizations.

Both motor and vocal tics can be classified as either simple or complex. Common simple motor tics include blinking, neck twitching, nose twitching, shoulder twitching, and facial grimacing. Common simple vocal tics include coughing, sniffing, grunting, barking, snorting, hissing. Common complex motor tics are tapping oneself, touching oneself and/or objects, jumping up and down, crouching, gesticulating. The usual complex of vocal tics includes the repetition of special words, sounds (palilalia), phrases, curses (coprolalia). Tics tend to be experienced as irresistible, but they can usually be suppressed for varying periods of time.

Tics often occur as an isolated phenomenon, but they are often associated with emotional disturbances, especially obsessive or hypochondriacal phenomena. Specific developmental delays are sometimes associated with tics.

The main feature of distinguishing tics from other movement disorders is the sudden, rapid, transient and limited nature of movements in the absence of a neurological disorder. Characterized by the repetition of movements and their disappearance during sleep, the ease with which they can be voluntarily caused or suppressed. The lack of rhythm allows them to be distinguished from stereotypy in autism or mental retardation.

Etiology and pathogenesis

One of the most important factors in the occurrence of tics is a violation of the neurochemical regulation of the central nervous system. Head trauma plays a role in the occurrence of tics. The use of psychostimulants enhances existing tics or causes them to appear, which suggests the role of dopaminergic systems, in particular, an increase in dopamine levels in the onset of tics. In addition, the dopamine blocker haloperidol is effective in treating tics. The pathology of noradrenergic regulation is proven by the worsening of tics under the influence of anxiety and stress. No less important is the genetic conditioning of disorders. Currently, there is no satisfactory explanation for variations in the course, reactions to pharmacological drugs, family history in tic disorders.

Transient tic disorder (F95.0).

This disorder is characterized by the presence of single or multiple motor and/or vocal tics. Tics appear many times a day, almost every day for a period of at least 2 weeks, but no more than 12 months. There should be no history of Gilles de la Tourette syndrome or chronic motor or vocal tics. The onset of the disease before the age of 18 years.

Etiology and pathogenesis

Transient tic disorder is most likely either of an unexpressed organic or psychogenic origin. Organic tics are more common in a family history. Psychogenic tics most often undergo spontaneous remission.

Prevalence

From 5 to 24% of school-age children suffered this disorder. The prevalence of tics is not known.

Clinic

This is the most common type of tic and is most common at 4–5 years of age. Tics usually take the form of blinking, grimacing, or twitching of the head. In some cases tics occur as a single episode, in others there are remissions and relapses over a period of time.

The most common manifestation of tics:

1) Face and head in the form of grimacing, wrinkling the forehead, raising the eyebrows, blinking the eyelids, squinting, wrinkling the nose, trembling nostrils, clenching the mouth, baring the teeth, biting the lips, protruding the tongue, protruding the lower jaw, tilting or shaking the head, twisting the neck, head rotation.

2) Hands: rubbing, twitching fingers, twisting fingers, clenching hands into a fist.

3) Body and lower limbs: shrugging shoulders, twitching legs, strange gait, swaying torso, bouncing.

4) Respiratory and digestive organs: hiccups, yawning, sniffing, noisy blowing of air, wheezing, increased breathing, belching, sucking or smacking sounds, coughing, clearing the throat.

Differential Diagnosis

Tics should be differentiated from other movement disorders (dystonic, choreiform, athetoid, myoclonic movements) and neurological diseases. (Huntington's chorea, Sydenham's chorea, parkinsonism etc.), side effects of psychotropic drugs.

Therapy

From the very beginning of the disorder, there is no clarity, whether the tick disappears spontaneously or progresses, turning into a chronic one. Since drawing attention to tics exacerbates them, it is recommended that they be ignored. Psychopharmacological treatment is not recommended unless the disorder is severe and does not result in disability. Behavioral psychotherapy aimed at changing habits is recommended.

A type of tic disorder in which there are or have been multiple motor tics and one or more vocal tics that do not occur simultaneously. The onset is almost always noted in childhood or adolescence. The development of motor tics before the voice tics is characteristic. Symptoms often worsen during adolescence, and elements of the disorder often persist into adulthood.

Etiology and pathogenesis

A large role is played by both genetic factors and disorders of the neurochemical function of the central nervous system.

Prevalence

Clinic

The presence of either motor or vocal tics is characteristic, but not both together. Tics appear many times a day, almost every day, or intermittently for more than one year. Start before the age of 18. Tics do not occur only during intoxication with psychoactive substances or due to known diseases of the central nervous system (eg, Huntington's disease, viral encephalitis). Types of tics and their localization are similar to transient ones. Chronic vocal tics are less common than chronic motor tics. Vocal tics are often not loud or strong, and consist of noises created by contraction of the larynx, abdomen, and diaphragm. Rarely they are multiple with explosive, repetitive vocalizations, coughing, grunting. Like motor tics, vocal tics can be spontaneously suppressed for a while, disappear during sleep, and intensify under the influence of stress factors. The prognosis is somewhat better in children who become ill at the age of 6–8 years. If the tics involve the limbs or trunk, and not just the face, the prognosis is usually worse.

Differential Diagnosis

It should also be done with tremors, mannerisms, stereotypes, or bad habit disorders (head tilting, body swaying), more common in childhood autism or mental retardation. The arbitrary nature of the stereotypy or bad habits, the lack of subjective distress about the disorder, distinguishes them from tics. Treatment of attention deficit hyperactivity disorder with psychostimulants exacerbates existing tics or accelerates the development of new tics. However, in most cases, after discontinuation of drugs, tics stop or return to the level that existed before treatment.

Therapy

Depends on the severity and frequency of tics, subjective experiences, secondary disturbances at school, and the presence of other comorbid psychotic disorders.

Psychotherapy plays a major role in treatment.

Small tranquilizers are ineffective. In some cases, haloperidol is effective, but the risk of side effects of this drug, including the development of tardive dyskinesia, should be taken into account.

It is characterized as a neuropsychiatric disease with multiple motor and vocal tics (blinking, coughing, pronunciation of phrases or words, such as “no”), either increasing or decreasing. It occurs in childhood or adolescence, has a chronic course and is accompanied by neurological, behavioral and emotional disorders. Gilles de la Tourette's syndrome is most often hereditary.

Gilles de la Tourette first described this disease in 1885, having studied it at Charcot's clinic in Paris. Modern ideas about the Gilles de la Tourette syndrome were formed thanks to the work of Arthur and Elaine Shapiro (60-80s of the XX century).

Etiology and pathogenesis

The morphological and mediator bases of the syndrome were revealed in the form of diffuse disorders of functional activity, mainly in the basal ganglia and frontal lobes. Several neurotransmitters and neuromodulators have been suggested to play a role, including dopamine, serotonin, and endogenous opioids. The main role is played by the genetic predisposition to this disorder.

Prevalence

Data on the prevalence of the syndrome are contradictory. Fully expressed de la Tourette syndrome occurs in 1 in 2000 (0.05%). The lifetime risk of disease is 0.1–1%. In adulthood, the syndrome begins 10 times less frequently than in childhood. Genetic evidence suggests an autosomal dominant inheritance of Gilles de la Tourette syndrome with incomplete penetrance. The sons of mothers with de la Tourette's syndrome are at the greatest risk of developing this disease. Familial accumulation of Gilles de la Tourette's syndrome, chronic tic and obsessive-compulsive disorder is shown. Carrying the gene that causes Gilles de la Tourette's syndrome in males is accompanied by an increased likelihood of obsessive-compulsive disorder in females.

Clinic

The presence of multiple motor and one or more vocal tics is characteristic, although not always simultaneously. Tics occur many times during the day, usually in fits and starts almost daily or With breaks for a year or more. The number, frequency, complexity, severity, and localization of tics vary. Vocal tics are often multiple, with explosive vocalizations, sometimes using obscene words and phrases (coprolalia), which may be accompanied by obscene gestures (copropraxia). Both motor and vocal tics can be voluntarily suppressed for a short time, aggravated by anxiety and stress, and appear or disappear during sleep. Tics are not associated with non-psychiatric illnesses such as Huntington's disease, encephalitis, intoxication, and drug-induced movement disorders.

The syndrome of Gilles de la Tourette proceeds in waves. The disease usually begins before the age of 18, tics of the muscles of the face, head or neck appear at 6–7 years of age, then within a few years they spread from top to bottom. Voice tics usually appear at 8–9 years of age, and obsessions and complex tics join at 11–12. 40-75% of patients have features of attention deficit hyperactivity disorder. Over time, the symptoms stabilize. There is a frequent combination of the syndrome with partial developmental delays, anxiety, aggressiveness, obsessions. Children with Gilles de la Tourette syndrome often have learning difficulties.

Differential Diagnosis

Most difficult with chronic tics. For tic disorders, repetition, speed, irregularity, involuntariness are typical. At the same time, some patients with de la Tourette's syndrome believe that a tick is an arbitrary reaction to the sensation that precedes it. This syndrome is characterized by an undulating course with onset in childhood or adolescence.

- Sydenham's chorea (small chorea) is a neurological complication of rheumatism, with choreic and athetotic (slow worm-like) movements, usually of the hands and fingers and movements of the trunk.

- Huntington's chorea is an autosomal dominant disorder that presents with dementia and chorea with hyperkinesis (irregular, spastic movements, usually of the limbs and face).

- Parkinson's disease- This is a disease of late age, characterized by a mask-like face, gait disturbances, increased muscle tone ("gear wheel"), rest tremor in the form of "pill rolling".

- Drug-induced extrapyramidal disorders develop during treatment with neuroleptics, it is most difficult to diagnose late neuroleptic hyperkinesis. Since antipsychotics are used in the treatment of Gilles de la Tourette's syndrome, it is necessary to describe in detail all the disorders that the patient has before starting drug treatment.

Therapy

It is aimed at reducing tic manifestations and social adaptation of the patient. An important role is played by rational, behavioral, individual, group and family types of psychotherapy. Restraint training (or "like-like" type of tic fatigue) is recommended, even in the face of successful medical treatment.

Drug treatment is by far the main method of therapy. Treatment begins only after a complete examination, with minimal doses of drugs with a gradual increase over several weeks. Preferably start with monotherapy. So far, haloperidol has been the drug of choice. It blocks D2 receptors in the basal ganglia. Children are prescribed with 0.25 mg / day, increasing by 0.25 mg / day. weekly. Therapeutic range is 1.5 to 5 mg/day, depending on age. Pimozide, which has a greater affinity for the striatal nerve pathways than for the mesocortical pathways, is sometimes preferred. It has fewer side effects than haloperidol, but is contraindicated in heart disease. Doses from 0.5 to 5 mg / day. Other antipsychotics are also used - fluorophenazine, penfluridol.

Clonidine is an effective alpha2-adrenergic receptor stimulant. Its action is associated with the stimulation of presynaptic receptors of noradrenergic endings. It significantly reduces excitability, impulsivity and attention disorders. Dose 0.025 mg / day. with a subsequent increase every 1-2 weeks to the average therapeutic from 0.05 to 0.45 mg / day.

Applicable drugs that affect serotonergic transmission - clomipramine (10-25 mg / day), fluoxetine (5-10 mg / day), especially in the presence of obsessions. Perhaps sertraline, paroxetine are effective, but experience with their use is insufficient. The effect of exposure to benzodiazepines, antagonists of narcotic analgesics, and some psychostimulants is being studied.

Other emotional and behavioral disorders, usually beginning in childhood and adolescence (F98).

Nonorganic enuresis (F98.0).

It is characterized by involuntary urination during the day and / or at night, not appropriate for the mental age of the child. It is not due to a lack of control over bladder function due to a neurological disorder, epileptic seizures, or a structural anomaly of the urinary tract.

Etiology and pathogenesis

Bladder control develops gradually and is influenced by neuromuscular features, cognitive function, and possibly genetic factors. Violations of one of these components can contribute to the development of enuresis. Children with enuresis are about twice as likely to have developmental delays. 75% of children with non-organic enuresis have close relatives suffering from enuresis, which confirms the role of genetic factors. Most enuretic children have an anatomically normal bladder, but it is "functionally small". Psychological stress can exacerbate enuresis. The birth of a sibling, the beginning of schooling, the breakup of a family, and moving to a new place of residence play a big role.

Prevalence

Enuresis affects more men than women at any age. The disease occurs in 7% of boys and 3% of girls at the age of 5 years, in 3% of boys and 2% of girls at the age of 10 years and in 1% of boys and is almost completely absent in girls at the age of 18 years. Daytime enuresis is less common than nocturnal enuresis, in about 2% of 5-year-olds. Unlike nocturnal enuresis, daytime enuresis is more common in girls. Mental disorders are present in only 20% of children with non-organic enuresis, most often they occur in girls or in children with daytime and nocturnal enuresis. In recent years, descriptions of rare forms of epilepsy appear more and more often in the literature: an epileptic variant of enuresis in children (5-12 years old).

Clinic

Non-organic enuresis can be observed from birth - "primary" (in 80%), or occur after a period of more than 1 year, acquired bladder control - "secondary". Late onset usually occurs between 5 and 7 years of age. Enuresis may be monosymptomatic or associated with other emotional or behavioral disturbances, and constitutes the primary diagnosis if urinary incontinence occurs several times a week, or if other symptoms show a temporal association with enuresis. Enuresis is not associated with any particular phase of sleep or time of night, but more often occurs randomly. Sometimes it occurs when it is difficult to transition from non-REM to REM sleep. Emotional and social problems resulting from enuresis include low self-esteem, feelings of inadequacy, social limitations, stiffness, and family conflicts.

Diagnostics

The minimum chronological age for diagnosis should be 5 years and the minimum mental age 4 years.

Involuntary or voluntary urination into bed or clothing may occur during the day (F98.0) or night (F98.01) or occur during the night and day (F98.02).

At least two episodes per month for children aged 5-6 and one event per month for older children.

The disorder is not associated with a physical illness (diabetes, urinary tract infections, epileptic seizures, mental retardation, schizophrenia and other mental illnesses).

The duration of the disorder is at least 3 months.

Differential Diagnosis

It is necessary to exclude possible organic causes of enuresis. Organic factors are most commonly found in children who have daytime and nocturnal enuresis associated with frequent urination and an urgent need to empty the bladder. They include: 1) violations of the genitourinary system - structural, neurological, infectious (uropathy, cystitis, hidden spina bifida, etc.); 2) organic disorders that cause polyuria - diabetes or diabetes insipidus; 3) disorders of consciousness and sleep (intoxication, somnambulism, epileptic seizures), 4) side effects of treatment with certain antipsychotic drugs (thioridazine, etc.).

Therapy

Due to the polyetiology of the disorder, various methods are used in the treatment.

Hygiene requirements include toilet training, limiting fluid intake 2 hours before bedtime, sometimes waking up at night to use the toilet.

behavioral therapy. In the classical version - conditioning by a signal (bell, beep) the time of the onset of involuntary urination. The effect is observed in more than 50% of cases. In this therapy, hardware methods are used. It is reasonable to combine this treatment option with praise or reward for longer periods of abstinence.

Medical treatment

However, the effect is not always long lasting. There are reports of the effectiveness of the use of Driptan (the active substance is oxybutrin), which has a direct antispasmodic effect on the bladder and a peripheral M-anticholinergic effect with a decrease in hypertonicity of the parasympathetic nervous system. Doses 5 - 25 mg / day.

Traditional options for psychotherapy for enuresis in some cases are not effective.

Inorganic encopresis (F98.1).

Nonorganic encopresis is fecal incontinence at an age when bowel control should be physiologically developed and when toilet training is completed.

Bowel control develops sequentially from the ability to abstain from bowel movements at night, then during the day.

The achievement of these features in development is determined by physiological maturation, intellectual abilities, and the degree of culture.

Etiology and pathogenesis

Lack of or inadequate toilet training can lead to delayed bowel habits. Some children suffer from insufficiency of the contractile function of the intestine. The presence of a concomitant mental disorder is often indicated by bowel movements in the wrong places (with a normal discharge consistency). Sometimes encopresis is associated with neurodevelopmental problems, including an inability to sustain attention, easy distractibility, hyperactivity, and poor coordination. Secondary encopresis is sometimes a regression associated with stressors (birth of a sibling, divorce of parents, change of residence, start of schooling).

Prevalence

This disorder occurs in 6% of three-year-olds and 1.5% of 7-year-olds. 3-4 times more common in boys. Approximately 1/3 of children with encopresis also have enuresis. Most often, encopresis occurs during the daytime, if it occurs at night, the prognosis is poor.

Clinic

The decisive diagnostic sign is the act of defecation in inappropriate places. The excretion of excrement (in bed, clothes, on the floor) is either arbitrary or involuntary. Frequency of at least one manifestation per month for at least 6 months. Chronological and mental age of at least 4 years. The disorder must not be associated with a physical illness.

Primary encopresis: if the disorder was not preceded by a period of control of bowel function of at least 1 year.

Secondary encopresis: The disorder was preceded by a period of control of bowel function lasting 1 year or more.

In some cases, the disorder is due to psychological factors - disgust, resistance, inability to obey social norms, while there is normal physiological control over defecation. Sometimes the disorder is observed due to the physiological retention of feces with secondary overflow of the intestine and discharge of feces in inappropriate places. This delay in defecation may occur as a result of conflicts between parents and the child in learning to control the bowels or because of the painful act of defecation.

In some cases, encopresis is accompanied by smearing of feces on the body, the environment, or there may be the insertion of a finger into the anus and masturbation. There are often accompanying emotional and behavioral disorders.

Differential diagnosis

When making a diagnosis, it is important to consider: 1) encopresis caused by an organic disease (colon agangliosis), spina bifida; 2) chronic constipation, including fecal overload and subsequent soiling with semi-liquid feces as a result of "bowel overflow".

However, in some cases, encopresis and constipation may coexist, in which case the diagnosis of encopresis is made with an additional somatic coding for the constipating condition.

Therapy

Effective psychotherapy is aimed at reducing tension in the family and alleviating the emotional reactions of a person suffering from encopresis (emphasis on increasing self-esteem). Continuous positive reinforcement is recommended. With fecal incontinence associated with impaired bowel function, secondary to a period of retention of feces (constipation), the patient is taught the rules of hygiene. Measures are being taken to relieve pain during bowel movements (anal fissures or hard stools), in these cases, pediatrician supervision is necessary.

Eating disorder in infancy and childhood (F98.2).

Manifestations of malnutrition are specific to infancy and early childhood. They include food refusal, extreme fastidiousness in the presence of adequate quantity and quality of food, and a nursing person; in the absence of organic disease. Rumination chewing (repeated regurgitation without nausea and gastrointestinal disturbances) can be noted as a concomitant disorder. This group includes regurgitation disorder in infancy.

Etiology and pathogenesis

The existence of several etiological factors (various disorders of the relationship between mother and child) is assumed. As a result of inadequate relationships with the mother, the child does not receive sufficient emotional satisfaction and stimulation and is forced to seek satisfaction on his own. The inability to swallow food is interpreted as an attempt by the infant to restore the process of feeding and provide satisfaction that the mother is unable to provide him. Overstimulation and tension are considered as possible causes.

Dysfunction of the autonomic nervous system plays a certain role in this disorder. A number of children with this disorder have gastroesophageal reflux or hiatal hernia, and sometimes frequent regurgitation is a symptom of intracranial hypertension.

Prevalence

Occurs rarely. Observed in children from 3 months. up to 1 year and in mentally retarded children and adults. It is equally common among girls and boys.

Clinic

Diagnostic criteria

Recurrent regurgitation without vomiting or associated gastrointestinal illness lasting at least 1 month following a period of normal function.

Decrease in body weight or inability to achieve the desired body weight.

With obvious manifestations, the diagnosis is not in doubt. Partially digested food or milk again enters the mouth without vomiting, retching. The food is then re-swallowed or ejected from the mouth. Characteristic posture with tension and arched back, head backwards. The child makes sucking movements with his tongue, and it seems that he enjoys his activity.

The infant is irritable and hungry between periods of burping.

Usually, this disease has spontaneous remissions, but severe secondary complications can develop - progressive malnutrition, dehydration, or a decrease in resistance to infections. There is a deterioration in well-being, an increase in underdevelopment or developmental delays in all areas. In severe cases, mortality reaches up to 25%.

The disorder may manifest as abnormal pickiness, atypical malnutrition or overeating.

Differential Diagnosis

Differentiate with congenital anomaly or infections of the gastrointestinal tract, which can cause regurgitation of food.

This disorder should be distinguished from:

1) conditions when a child takes food from adults other than nursing persons or caregivers;

2) an organic disease sufficient to explain the refusal of food;

3) anorexia nervosa and other eating disorders;

4) general mental disorder;

5) eating difficulties or eating disorders (R63.3).

Therapy

Complications are mainly treated (alimentary dystrophy, dehydration).

It is necessary to improve the psychosocial environment of the child, to carry out psychotherapeutic work with persons caring for the child. Behavioral therapy with aversive conditioning is effective (at the time of the onset of the disorder, an unpleasant substance is given, for example, lemon juice), this has the most pronounced effect.

Several studies report that if patients are given as much food as they want, the severity of the disorder decreases.

Eating inedible (pika) in infancy and childhood (F98.3).

It is characterized by persistent nutrition with non-food substances (dirt, paints, glue). Pika may occur as one of many symptoms as part of a mental disorder, or may occur as a relatively isolated psychopathological behavior.

Etiology and pathogenesis

The following reasons are assumed: 1) the result of an abnormal relationship between mother and child, affecting the unsatisfactory state of oral needs; 2) specific nutritional deficiency; 3) cultural factors; 4) the presence of mental retardation.

Prevalence

The disease is most common among children with mental retardation, but can also be observed in young children with normal intelligence. The frequency of occurrence is 10–32.3% of children from 1 to 6 years of age. It occurs equally frequently in both sexes.

Clinic

Diagnostic criteria

Repeated consumption of non-food substances for about 1 month.

Does not meet the criteria for disorders in the form of autism, schizophrenia, Klein-Levin syndrome.

Eating inedible substances is considered pathological from the age of 18 months. Usually children try paints, plaster, ropes, hair, clothes; others prefer mud, animal feces, rocks and paper. The clinical consequences can sometimes be life threatening, depending on which item is swallowed. With the exception of mentally retarded children, the peak usually passes by adolescence.

Differential Diagnosis

Non-nutritional substances can be eaten by patients with disorders such as autism, schizophrenia and some physical disorders (Klein-Levin syndrome).

Eating unusual and sometimes potentially dangerous substances (food for animals, garbage, drinking toilet water) is a common pathology of behavior in children with underdevelopment of some organ (psychosocial dwarfism).

Therapy

Treatment is symptomatic and includes psychosocial, behavioral and/or family approaches.

Behavioral therapy using aversive techniques or negative reinforcement (weak electrical stimuli, unpleasant sounds, or emetics) is most effective. Positive reinforcement, modeling, corrective therapy are also used. Increased attention of parents to a sick child, stimulation and emotional education play a therapeutic role.

Secondary complications (eg, mercury poisoning, lead poisoning) should be treated.

Stuttering (F98.5).

Characteristic features - frequent repetition or prolongation of sounds, syllables or words; or frequent stops, indecision in speech with violations of its smoothness and rhythmic flow.

Etiology and pathogenesis

The exact etiological factors are not known. A number of theories have been put forward:

1. Theories of "stuttering block"(genetic, psychogenic, semantic). The basis of the theory is the cerebral dominance of speech centers with a constitutional predisposition to the development of stuttering due to stress factors.

2. Theories of the beginning(include relapse theory, needs theory, and anticipation theory).

3. learning theory based on an explanation of the principles of the nature of reinforcement.

4. cybernetic theory(speech is an automatic process of the type of feedback. Stuttering is explained by the failure of feedback).

5. The theory of changes in the functional state of the brain. Stuttering is a consequence of incomplete specialization and lateralization of language functions.

Recent studies have shown that stuttering is a genetically inherited neurological disorder.

Prevalence

Stuttering affects 5 to 8% of children. The disorder is 3 times more common in boys than girls. Boys are more stable.

Clinic

Stuttering usually begins before the age of 12, in most cases there are two acute periods - between 2-4 and 5-7 years. It usually develops over several weeks or months, starting with the repetition of initial consonants or whole words that are the beginning of a sentence. As the disorder progresses, repetition becomes more frequent with stuttering on more important words and phrases. Sometimes it may be absent when reading aloud, singing, talking to pets or inanimate objects. The diagnosis is made when the duration of the disorder is at least 3 months.

Clonic-tonic stuttering (violated rhythm, tempo, fluency of speech) - in the form of a repetition of initial sounds or syllables (logoclonia), at the beginning of speech, clonic convulsions with a transition to tonic.

Tonic-clonic stuttering characterized by a violation of the rhythm, fluency of speech in the form of hesitation and stops with a frequent increase in vocals and severe respiratory disorders associated with speech. There are additional movements in the muscles of the face, neck, limbs.

During stuttering, there are:

Phase 1 - preschool period. The disorder appears episodically with long periods of normal speech. After such a period, recovery may occur. During this phase, stuttering occurs when children are agitated, upset, or need to talk a lot.

Phase 2 occurs in elementary school. The disorder is chronic with very short periods of normal speech. Children realize and painfully experience their lack. Stuttering concerns the main parts of speech - nouns, verbs, adjectives and adverbs.

Phase 3 begins after 8–9 years and lasts until adolescence. Stuttering occurs or intensifies only in certain situations (calling to the board, shopping in a store, talking on the phone, etc.). Some words and sounds are more difficult than others.

Phase 4 occurs in late adolescence and adulthood. Expressed fear of stuttering. Word substitution and bouts of verbosity are typical. Such children avoid situations that require verbal communication.

The course of stuttering is usually chronic, with periods of partial remissions. From 50 to 80% of children with stuttering, especially in mild cases, recover.

Complications of the disorder include reduced school performance due to shyness, fear of speech disorders; restrictions on career choice. For those suffering from chronic stuttering, frustration, anxiety, and depression are typical.

Differential Diagnosis

Spasmodic dysphonia is a speech disorder similar to stuttering, but is distinguished by the presence of an abnormal breathing pattern.

Slurring of speech in contrast to stuttering, it is characterized by erratic and dysrhythmic speech patterns in the form of fast and sharp flashes of words and phrases. With fuzzy speech, there is no awareness of their shortcoming, while stutterers are acutely aware of their speech impairment.

Therapy

Includes several areas. The most typical are distraction, suggestion and relaxation. Stutterers are taught to speak simultaneously with rhythmic movements of the hand and fingers, or in a slow singsong and monotone. The effect is often temporary.

Classical psychoanalysis, psychotherapeutic methods are not effective in the treatment of stuttering. Modern methods are based on the point of view that stuttering is a form of learned behavior that is not associated with neurotic manifestations or neurological pathology. As part of these approaches, it is recommended to minimize the factors that increase stuttering, reduce secondary impairments, convince the stutterer to speak, even with stuttering, freely, without embarrassment and fear, in order to avoid secondary blocks.

An effective method of self-therapy is based on the premise that stuttering is a behavior that can be changed. This approach includes desensitization, which reduces emotional reactions, fear of stuttering. Since stuttering is something a person does, and a person can learn to change what he does.

Drug treatment is of an auxiliary nature and is aimed at stopping the symptoms of anxiety, severe fear, depressive manifestations, and facilitating communication interactions. Applicable soothing, sedative, restorative agents (preparations of valerian, motherwort, aloe, multivitamins and vitamins of group B, magnesium preparations). In the presence of spastic forms, antispasmodics are used: mydocalm, sirdalud, myelostan, diaphene, amizil, theofedrin. Tranquilizers are used with caution, mebicar 450–900 mg/day is recommended, in short courses. Dehydration courses bring a significant effect.

Alternative drug treatment options:

1) In the clonic form of stuttering, pantogam is used from 0.25 to 0.75 - 3 g / day, courses lasting 1-4 months.

2) Carbamazepines (mainly tegretol, timonil or finlepsin-retard) with 0.1 g / day. up to 0.4, g / day. within 3-4 weeks, with a gradual dose reduction to 0.1 g / day. as a maintenance treatment, lasting up to 1.5-2 months.

Comprehensive treatment of stuttering also includes physiotherapy, courses of general and specialized speech therapy massage, speech therapy, psychotherapy using a suggestive method.

Fluent speech (F98.6).

A fluency disorder that involves a disturbance in the speed and rhythm of speech, resulting in speech becoming incomprehensible. Speech is erratic, non-rhythmic, consisting of fast and abrupt flashes, which usually contain incorrectly composed phrases (periods of pauses and flashes of speech are not related to the grammatical structure of the sentence).

Etiology and pathogenesis

The cause of the disorder is unknown. Individuals with this disorder have similar occurrences among family members.

Prevalence

There is no information on prevalence. More common in boys than girls.

Clinic

The disorder begins between the ages of 2 and 8 years. Develops over several weeks or months, worsens in situations of emotional stress or pressure. It takes at least 3 months to make a diagnosis.

Speech is fast, speech flashes make it even more incomprehensible. About 2/3 of children recover spontaneously by adolescence. In a small percentage of cases, there are secondary emotional disturbances or negative family reactions.

Differential Diagnosis

Speech excitedly should be differentiated from stuttering, other developmental speech disorders, characterized by frequent repetition or lengthening of sounds or syllables, which impairs fluency. The main differential diagnostic feature is that when speaking excitedly, the subject usually does not realize his disorder, even in the initial stage of stuttering, children are very sensitive to their speech defect.

Therapy

In most cases, with moderate and severe severity, speech therapy is indicated.

Psychotherapeutic techniques and symptomatic treatment are indicated in the presence of frustration, anxiety, signs of depression, and difficulties in social adaptation.

Family therapy is effective, aimed at creating adequate conditions for the patient in the family.

Emotional disorders

Emotions play an important role in a child's life: they help him perceive reality and respond to it. Emotions are manifested in the behavior of an infant from the very first hours of his life, conveying to an adult information that the child likes, angers or upsets him. Gradually, from primitive emotions (fear, pleasure, joy), the child moves to more complex feelings: joy and delight, surprise, anger, sadness. At preschool age, a child can already convey more subtle shades of experiences with the help of a smile, posture, gesture, voice intonation.

On the other hand, a five-year-old child differs from a two-year-old in the ability to hide and restrain his feelings, to control them. Learning to control emotions occurs gradually with the development of the child's personality, and normally by school age a small person should already be able to subordinate his primitive emotions (anger, fear, displeasure) to reason. However, the number of children and adolescents with disorders in the emotional sphere has been steadily increasing in recent years. According to A. I. Zakharov, by the end of elementary school, more than 50% of children are diagnosed with certain nervous diseases that are the result of emotional disorders.

The causes of emotional disorders in children and adolescents can be:

1. Features of the physical development of the child, diseases suffered in infancy

2. Delays in mental development, lagging behind the age norms of intellectual development

3. Features of family education

4. Features of nutrition, economic situation of the family raising a child

5. Social environment, especially in the children's team

6. The nature of the predominant activity of the child

Most clearly emotional deviations are manifested in crisis periods of development. At the same time, negative qualities are, as a rule, only an extreme degree of manifestation of the positive qualities necessary for survival in society.

The main disorders of emotional development include:

Anxiety, timidity, fears

Aggression

Increased emotional exhaustion

Problems in the field of communication

depression and distress

As early as 1-2 years of age, children may show a tendency to anxiety. In my practice, I have met children with a tendency to frequent mood swings, tearfulness, decreased appetite, thumb sucking, touchiness and sensitivity. All this was an expression of internal emotional tension, anxiety.

Anxiety often turns into fears (phobias). In young children, this is a fear of strangers, animals, loud sounds, in adolescents, more general fears (fear of losing their loved ones, fear of the “end of the world” or death). The reason for the emergence of fears can be both the characteristics of the child's personality (the formation of anxious and suspicious character traits), and some single or recurring psychotraumatic situation (dog attack, death of a loved one, etc.). It should be borne in mind that children's fears are not unequivocally dangerous or "harmful" for the child - a child who is not afraid of anything is defenseless in the face of life situations. The teacher should pay special attention to the child's passive experience of fear, which leads to depression and depression.

Aggressiveness as a manifestation of high anxiety, it can act as a formed character trait or as a reaction to environmental influences. In any case, the origins of child and adolescent aggressiveness are in their environment, in the style of parental behavior and upbringing. A small child is not able to "respond" to his offender - an adult, he gradually accumulates negative emotions, irritation, protest against the "harassment" of adults, and in adolescence this can result in one of the forms of aggression (according to A. Bass and A. Darki) :

Physical

Verbal (rudeness, foul language)

Indirect (shift of an aggressive reaction to an outside person or object)

Suspicion

Negativism

Guilt

Based on practical experience, I can say that aggressive behavior is often provocative. Kirill S. from the junior detachment seemed to be deliberately trying to anger the leaders: he dresses more slowly than others, refuses to wash his hands, does not make the bed on time, and so on - until he pisses off the adults, hears a scream, rude treatment. After that, he could cry, and the counselors began to console him, affectionately persuade him. Thus, Cyril's main goal has always been to attract the attention of adults.

Increased emotional exhaustion and depression lead to a decrease in appetite, high fatigue, a decrease in vital activity, productivity of thinking, a decrease in the ability to concentrate. Often these phenomena have catastrophic consequences for the life of the organism.

Teenagers who are in a depressed state often hide their real emotions behind ostentatious boredom, aggressiveness, whims, and deviant behavior. Suicidal behavior can be a consequence of depression.

Difficulties in communication as one of the types of emotional disorders in children are represented by autistic and affective behavior.

Affective behavior is manifested in increased resentment, stubbornness, isolation, emotional instability. Such behavior is a sign of a child's poor adaptation to the world around him, the cause of serious emotional and personal problems in the future.

Often the roots of emotional disorders and psychoneuroses must be sought in the family environment - a callous, or too "kind", anxious mother, the so-called "pendulum" education, the transfer of their childhood fears by parents to their own children - reliably ensure the formation of anxiety, the development of phobias or aggression from the side child.

One of my classmates during the summer practice in the camp had difficulties in communicating with the child. Alexei initially behaved introvertedly, shunned other children, and was often depressed. After some time, the counselors still managed to establish contact with the boy, he became more open and sociable. The child's bad mood was explained by the difficulties of adapting to the camp. However, a pattern later emerged: every time after the arrival of his parents, Alyosha again became gloomy, anxious, and moved away from the detachment.

There are also many examples from history when family upbringing, the social environment closest to the child, formed a number of emotional and neurotic disorders of their personality:

Peter the Great:

First impressions, childhood impressions, are the strongest; they educate, build a person. They will point out to us a child endowed with extraordinary nature, fiery passion, and they will say that this child, as soon as he began to understand, was in the midst of painful, irritating impressions; ... the closest beings, starting with the mother, feed him with complaints of persecution, of untruth ..., keep it tender blossoming plant under the scorching, withering wind of enmity, hatred. We will be told that this child has finally been cleared up in his soul...they announced that the persecution is over, he is declared king...and suddenly, after this, terrible bloody scenes of rebellion...again persecution, again incessant complaints. What a destructive poison he took and in what quantity! It is said that ten-year-old Peter maintained amazing calmness and firmness during the Streltsy rebellion: so much the worse - it would be better if he screamed, cried, threw himself in despair, broke his arms! He was firm and calm; and where does this shaking of the head come from; why these convulsions in the face, these grimaces ... from which it was not in his power to resist?

Tsar Ivan the Terrible

Tsar Ivan ... by nature ... received a lively and flexible mind, thoughtful and a little mocking .... But the circumstances amidst which Ivan's childhood passed, early spoiled this mind, gave it an unnatural, painful development. Ivan was orphaned early..., from childhood he saw himself among strangers. A feeling of orphanhood, abandonment, loneliness was cut into his soul early and deeply .... Hence his timidity…. Like all people who grew up among strangers, Ivan early acquired the habit of walking around, looking around and listening. This developed in him suspicion, which over the years turned into a deep distrust of people.

... He was caressed like a sovereign and insulted like a child. But in the environment in which his childhood went, he could not always immediately and directly reveal a feeling of annoyance or anger, break his heart. This need to restrain himself ... fed in him irritability and hidden, silent anger against people ...

The ugly scenes of boyar violence ... turned his timidity into nervous fearfulness, from which developed a tendency to exaggerate the danger .... The instinct of self-preservation was working stronger and stronger in him. All the efforts of his lively mind were turned to the development of this coarse feeling.

A teacher working with children who have difficulties in the development of the emotional sphere, at the diagnostic stage, it is necessary to determine the features of family education, the attitude of others towards the child, his level of self-esteem, the psychological climate in the peer group. At this stage, methods such as observation, conversation with parents and students are used.

Such children need friendly and understanding communication, games, drawing, outdoor exercises, music, and most importantly, attention to the child. Parents of such children should be advised to follow the daily routine.

When dealing with children who are experiencing emotional difficulties, parents and educators can offer the following recommendations:

build work individually, with special attention to the proper organization of activities;

if possible, ignore the defiant behavior of a child with attention deficit disorder and encourage his good behavior;

provide the child with the opportunity to quickly seek help from a teacher in cases of difficulty;

provide an opportunity for motor "relaxation": physical labor, sports exercises;

strive to teach the child not to suppress his emotions, but to correctly direct, show his feelings;

show the child adequate forms of response to certain situations or phenomena of the external environment;

create a positive mood background, a healthy psychological climate;

try to simulate a situation of success for the child, encourage a variety of interests;

develop high self-esteem, develop self-confidence.

Remember: the child's feelings cannot be judged, it is impossible to demand that he not experience what he is experiencing. As a rule, violent affective reactions are the result of prolonged restraint of emotions. Here it is necessary to take into account not just the modality of emotions (negative or positive), but, above all, their intensity.