All about minimal brain dysfunction in children: symptoms, diagnosis and treatment of MMD. Manifestations and treatment of minimal brain dysfunction in children

With minimal brain dysfunction in children there is a delay in development. Many educators and parents tend to consider this as a difficulty in adapting to school or kindergarten.

However, the reason lies in the violation of the higher mental functions of the child, which is reflected in many characteristics associated with mental activity and behavior.

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General concept

MMD is a whole complex of various psycho-emotional disorders.

Pathology manifests itself in the form of a special condition of the child under the influence of disruption of the central nervous system, when there are deviations in the perception of the world around, behavior, emotional sphere and disorder of the autonomic functions of the brain.

This syndrome first described in 1966 by G. S. Clemens. According to statistics, MMD occurs in 5% of all primary school children and in 20-22% of preschool children, that is, the syndrome is widespread. In most cases, the disease is temporary and treatable.

The reasons

The syndrome develops due to brain dysfunction. In turn, this is influenced by possible injuries of the cerebral cortex or anomalies in the development of the child's nervous system.

At the age of 3 to 6 years, in most cases, the cause is the incorrect upbringing of the child from a social and pedagogical point of view by his parents and teachers, that is, no one takes care of the child.

To provoking factors also include:

Most children with MMD were brought up in dysfunctional families.

Symptoms and signs

What is typical for children with MMD? This disease can develop from infancy, but the first noticeable symptoms appear in the preschool period when kindergarten preparation takes place.

The child has poor concentration, poor memory and other problems, despite a normal level of intelligence.

Consider the different types of syndrome in more detail:

At babies You can notice the following signs of MMD:

increased sweating;
rapid breathing and heartbeat;
increased moodiness;
frequent regurgitation and;
sleep problems;
anxiety.

At schoolchildren additional symptoms appear:

conflict;
absent-mindedness (things are often lost);
low academic performance;
bad memory;
increased irritability.

What is hyperkinetic conduct disorder in children? find out right now.

Diagnostics

For diagnosis, please contact to a neurologist or pediatric educator. First, the medical history is studied, a survey of parents is conducted and the behavior of the child himself is analyzed.

positron emission tomography;
rheoencephalography;
electroencephalography;
echoencephalography;
neurosonography.

Methods of treatment and correction

Each individual case of MMD requires an individual approach to treatment. based on the clinical picture.

Therapy should be comprehensive and include medication, psychotherapy and pedagogy.

Medicines

Nootropic drugs are used in the treatment, which reduce the excitatory effect amino acids on the brain (Pikamilon, Piracetam, Pantogam). To improve academic performance and mental development, Pyracizin and Glycine are used.

It is possible to use antidepressants and sedatives (valerian tincture, motherwort tincture, Diazepam). Enuresis is treated with Adiuretin.

Psychotherapy and Pedagogy

It is necessary to create favorable conditions for the child at home and outside it, so that he felt comfortable. Parents and teachers should not perceive his behavior as selfishness or capriciousness - this is a mental disorder, and the child is not to blame for this.

However, you can not indulge all his whims, and teach discipline. Control over his life is important, but so that he does not feel it. You can not go to extremes and strongly scold or, on the contrary, feel sorry for the child. There must be a measure in everything.

Within the family, quarrels and conflicts that can adversely affect his condition should be avoided.

You also need to be consistent in education and training and do not overwork child with a lot of tasks.

Preference should be given to activities that require increased concentration, such as clay modeling or drawing.

It will be useful adhere to the regime That is, go to bed, get up and eat at the same time. At the same time, it is better to avoid a lot of contact with other people - this tires the child and makes him more withdrawn.

The computer, TV and tablet reduce concentration, but there are special applications specifically for children with MMD.

Also important channel excess energy in hyperactive children. To do this, you can enroll your child in the pool, in the football section or another active sport.

Physical education will benefit in any case. In parallel, it is recommended to take the child to a child psychologist who will monitor the patient's condition and help in his treatment.

Forecast

For all children with MMD prognosis favorable. According to statistics, from 30 to 50% "outgrow" this syndrome and become full members of society.

However, in some children, the consequences remain for the rest of their lives in the form of various complexes and psycho-emotional deviations, since the character and mental state of an adult is "tied" to childhood.

Such people may become impatient, moody, irritable, or experience adaptation problems in the new team.

It is extremely important to cure a child in childhood, since the adult psyche is practically not amenable to therapy.

Prevention

To prevent the occurrence of MMD, it is necessary to observe preventive measures:

during pregnancy, eat right and avoid stress;
a pregnant mother to give up bad habits (smoking, alcohol);
provide the child with favorable conditions at home;
regularly engage with the child and develop all his abilities;
avoid scandals, conflicts and stressful situations within the family;
regularly visit a pediatrician for preventive examinations (1-2 times a year).

Minor brain dysfunction common problem in today's society.

Many children do not receive the attention of their parents and suffer from it. In other cases, pathologies can develop even in the prenatal period.

Anyway The child needs help as soon as possible.. You should go through all the necessary studies and find the cause of the disease, and then undergo a course of therapy so that the child becomes a full member of society.

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For citation: Zavadenko N.N., Suvorinova N.Yu., Ovchinnikova A.A., Rumyantseva M.V. Treatment of minimal brain dysfunctions in children: therapeutic possibilities of Instenon // RMJ. 2005. No. 12. S. 828

Minimal brain dysfunction (MBD) in children is the most common form of neuropsychiatric disorders in childhood. According to domestic and foreign studies, the incidence of MMD among children of preschool and school age reaches 5-20%.
Currently, MMD are considered as the consequences of early local brain damage, expressed in the age-related immaturity of individual higher mental functions and their disharmonic development. With MMD, there is a delay in the rate of development of the functional systems of the brain that provide such complex integrative functions as speech, attention, memory, perception, and other forms of higher mental activity. In terms of general intellectual development, children with MMD are at the normal level, but at the same time they experience significant difficulties in schooling and social adaptation. Due to focal damage, underdevelopment or dysfunction of certain parts of the cerebral cortex, MMD in children manifests itself in the form of disorders in motor and speech development, the formation of writing skills (dysgraphia), reading (dyslexia), counting (dyscalculia). Apparently, the most common variant of MMD is Attention Deficit Hyperactivity Disorder (ADHD).
The term "minimal brain dysfunction" became widespread in the 1960s, when it began to be used in relation to a group of conditions of various etiologies and pathogenesis, accompanied by behavioral disorders and learning difficulties that were not associated with a general lag in intellectual development. The use of neuropsychological methods in the study of behavioral, cognitive and speech disorders observed in children with MMD made it possible to establish a certain relationship between the nature of the disorders and the localization of the focal CNS lesion. Of great importance is the research in which the role of the mechanisms of heredity in the occurrence of MMD has been confirmed.
Due to the variety of clinical manifestations, the heterogeneity of the factors underlying the etiology and pathogenesis of MMD, for the latest revision of the International Classification of Diseases ICD-10 recommended by the World Health Organization (WHO, 1994), diagnostic criteria were developed for a number of conditions previously considered within the framework of MMD (Table 1). Thus, with the scientific study of MMD, there is a more and more distinct tendency to distinguish them into separate forms. However, it should be noted that in clinical practice it is often necessary to observe a combination of symptoms in children that belong not to one, but to several diagnostic headings for MMD according to the ICD-10 classification.
Age dynamics
minimal brain dysfunction
The study of the anamnesis shows that at an early age, many children with MMD have a hyperexcitability syndrome. Manifestations of hyperexcitability occur more often in the first months of life, in 20% of cases they are set aside for later periods (older than 6–8 months). Despite the correct regimen and care, a sufficient amount of food, the children are restless, they have an unreasonable cry. It is accompanied by excessive motor activity, autonomic reactions in the form of redness or marbling of the skin, acrocyanosis, increased sweating, tachycardia, and increased respiration. During a cry, one can observe an increase in muscle tone, a tremor of the chin, hands, clonuses of the feet and legs, and a spontaneous Moro reflex. Sleep disturbances (difficulty falling asleep for a long time, frequent spontaneous awakening, early awakening, startling), feeding difficulties and gastrointestinal disturbances are also characteristic. Children do not take the breast well, are restless during feeding. Along with impaired sucking, there is a predisposition to regurgitation, and in the presence of functional neurogenic pylorospasm, vomiting. The tendency to loose stools is associated with increased excitability of the intestinal wall, leading to increased intestinal motility under the influence of even minor stimuli. Diarrhea often alternates with constipation.
At the age of one to three years, children with MMD are characterized by increased excitability, motor restlessness, sleep and appetite disturbances, weak weight gain, and some lag in psychoverbal and motor development. By the age of three, attention is drawn to such features as motor awkwardness, increased fatigue, distractibility, motor hyperactivity, impulsivity, stubbornness, and negativism. At a younger age, they often have a delay in the formation of neatness skills (enuresis, encopresis).
As a rule, the increase in MMD symptoms is timed to the beginning of attending a kindergarten (at the age of 3 years) or school (6-7 years). This pattern can be explained by the inability of the central nervous system to cope with the new demands placed on the child under conditions of increased mental and physical stress. An increase in the load on the central nervous system at this age can lead to behavioral disorders in the form of stubbornness, disobedience, negativism, as well as neurotic disorders, and a slowdown in psychoverbal development.
In addition, the maximum severity of MMD manifestations often coincides with critical periods of psychoverbal development. The first period includes the age of 1–2 years, when there is an intensive development of cortical speech zones and the active formation of speech skills. The second period falls on the age of 3 years. At this stage, the child's stock of actively used words increases, phrasal speech improves, attention and memory actively develop. At this time, many children with MMD show delayed speech development and articulation disorders. The third critical period refers to the age of 6–7 years and coincides with the beginning of the formation of written language skills (writing, reading). Children with MMD of this age are characterized by the formation of school maladaptation and behavioral problems. Significant psychological difficulties often cause various psychosomatic disorders, manifestations of vegetative-vascular dystonia.
Thus, if hyperexcitability, motor disinhibition or, conversely, slowness, as well as motor awkwardness, absent-mindedness, distractibility, restlessness, increased fatigue, behavioral characteristics (immaturity, infantilism, impulsivity) predominate among children with MMD at preschool age, then schoolchildren at the foreground are learning difficulties and behavioral disorders. Children with MMD are characterized by weak psycho-emotional stability in case of failures, self-doubt, low self-esteem. Often they also have simple and social phobias, irascibility, bullying, oppositional and aggressive behavior. In adolescence, a number of children with MMD develop behavioral disorders, aggressiveness, difficulties in relationships in the family and school, academic performance deteriorates, and cravings for alcohol and drugs appear. Therefore, the efforts of specialists should be directed to the timely detection and correction of MMD.
Treatment of MMD
Drug therapy occupies an important place in the treatment of MMD along with the methods of psychological and pedagogical correction. Drug therapy is prescribed according to individual indications in cases where cognitive impairment and behavioral problems in a child with MMD are so pronounced that they cannot be overcome only with the help of psychological and pedagogical measures. Currently, various groups of drugs are used in the treatment of MMD, including CNS stimulants (methylphenidate, dextroamphetamine, pemoline), nootropic drugs (cerebrolysin, encephabol, etc.).
Clinical trials have shown high clinical efficacy of Instenon in the treatment of encephalopathies of various origins and cerebrovascular accidents. Therefore, at present, the main indications for its appointment are ischemic stroke, cerebral vascular crises, the consequences of cerebrovascular accidents, dyscirculatory, post-traumatic, post-hypoxic encephalopathy. It should be noted that the indications given relate mainly to the neuropsychiatric pathology of adults and the elderly.
Meanwhile, the use of Instenon has broad prospects in child psychoneurology, and primarily in the treatment of MMD. Thus, Instenon has been shown to be highly effective in the treatment of ADHD and the consequences of a closed craniocerebral injury in children.
Characteristics of Instenon
Instenon is a combined neurometabolic drug, which consists of three components: etamivan, hexobendin, etofilin. Etamivan has a pronounced activating effect on the limbic-reticular complex. Disorders of the functional state of the limbic-reticular complex are considered as one of the mechanisms in the pathogenesis of MMD in children. Etamivan improves the integrative activity of the brain by increasing the activity of the ascending reticular formation. Activation of the reticular formation of the brain stem serves as a trigger for maintaining adequate functioning of the neuronal complexes of the cortex and subcortical stem structures, as well as their interaction.
Hexobendin increases the "energy status" of the nerve cell, increases the transport and consumption of glucose and oxygen by brain cells due to anaerobic glycolysis and activation of pentose cycles. Stimulation of anaerobic oxidation provides an energy substrate for the synthesis and metabolism of neurotransmitters and activation of synaptic transmission. According to modern concepts, an important role in the pathogenesis of MMD is played by the functional insufficiency of a number of neurotransmitter systems of the brain. In addition, hexobendin supports adequate regulation of cerebral blood flow.
Etofillin activates myocardial metabolism with an increase in cardiac output, which improves perfusion pressure and microcirculation in the nervous tissue. At the same time, systemic arterial pressure does not change significantly. Its activating effect on the central nervous system is manifested in the stimulation of subcortical formations, structures of the midbrain and brainstem.
According to the literature, allergic reactions when prescribing Instenon are extremely rare. Side effects occur in some cases, mainly with an underestimation of possible contraindications (epileptic syndromes, increased intracranial pressure), as well as with rapid intravenous administration of the drug.
Study Characteristics
and groups of patients
At the clinical bases of the Department of Nervous Diseases of the Pediatric Faculty of the Russian State Medical University and the Department of Nervous Diseases and Neurosurgery of the Vladivostok State Medical University, a comprehensive examination of 86 children (73 boys and 13 girls) aged 4 to 12 years with various forms of MMD was carried out. Examination and treatment of children with MMD were carried out on an outpatient basis.
In an open controlled study, all patients were divided into two groups:
1st group - 59 children with MMD (50 boys, 9 girls) who were treated with Instenon;
2nd group (control) - 27 children with MMD (23 boys, 4 girls), who were prescribed low doses of multivitamins.
The duration of treatment for all patients was 1 month. The following criteria were used in the selection of patients in the study groups.
Inclusion Criteria:
1. Children with MMD aged 4 to 12 years (boys and girls).
2. The patient's symptomatology meets the diagnostic criteria for the following conditions (according to the ICD-10 classification, WHO, St. Petersburg, 1994), considered within the MMD:
F90.0 Attention deficit hyperactivity disorder (ADHD)
F80 Delayed speech development
F81 Developmental disorders of school skills:
– delay in the formation of reading skills (dyslexia),
– delay in the formation of writing skills (dysgraphia),
- delay in the formation of counting skills (dyscalculia).
F82 Disorders of the development of motor skills (dyspraxia).
3. Symptoms persist for at least 6 months in such a degree of severity that indicates poor adaptation of the child.
4. Insufficient adaptation manifests itself in various situations and types of environment (at home and at school or a preschool institution), despite the correspondence of the level of the general level of the child's intellectual development to normal age indicators.
5. Consent of parents and the child to participate in the study.
Criteria for exclusion from the study:
1. Children under 4 and over 12 years of age.
2. The presence of pronounced focal neurological symptoms and / or signs of intracranial hypertension.
3. Significant reduction in vision and hearing.
4. History of severe neuroinfections (meningitis, encephalitis), epileptic seizures.
5. The presence of symptoms of chronic somatic diseases, anemia, endocrine diseases (in particular, hyper- and hypothyroidism, diabetes mellitus).
6. Mental disorders caused by mental retardation, autism, affective disorders, psychopathy, schizophrenia.
7. Difficulties in the family environment as the main cause of the child's behavioral disorders and learning difficulties (conflicts between parents, frequent punishments, overprotection, etc.).
8. The use of any psychotropic drugs (sedatives, nootropics, antidepressants, etc.) during the three months preceding this study.
Children with MMD were divided into three age groups: 4–6 years old, 7–9 years old, and 10–12 years old (Table 1). The main clinical manifestations of MMD in the examined group of children are presented in Table 2. In addition, this table gives a description of the pathological conditions associated with MMD among patients of different age groups. As can be seen from the presented data, the vast majority of patients had a combination of several clinical variants of MMD. Thus, delayed speech development in children aged 4–6 years was often accompanied by ADHD. Among children 7–9 and 10–12 years old, ADHD was usually combined with schooling difficulties (dysgraphia, dyslexia, dyscalculia). Often, children with MMD also had developmental dyspraxia (23–30% of cases) and behavioral disorders (21–24%).
Since the distribution of children with MMD in three age groups turned out to be uneven, the presented frequency of occurrence of the main and concomitant clinical manifestations in these groups only partly reflects the age-related dynamics of the symptoms of MMD. Nevertheless, when moving from the younger group of children to the older ones, certain patterns can be traced in the evolution of the clinical manifestations of MMD. First of all, this concerns ADHD: among children 4–6 and 7–9 years old, its combined form with hyperactivity and attention disorders prevailed, while in children 10–12 years old, signs of hyperactivity were much less pronounced and were observed much less frequently, and therefore among them, the ADHD variant with a predominance of attention disorders was more common. At the age of 4–6 years, a characteristic variant of MMD was a delay in speech development, some children had stuttering, and after 7 years, speech disorders were replaced by difficulties in the formation of written speech in the form of dyslexia and dysgraphia.
Quite often, among children with MMD, such concomitant disorders as enuresis (usually primary nocturnal, in some cases daytime or combined daytime and nighttime), encopresis, headaches, anxiety disorder in the form of simple and social phobias, obsessions and tics were observed. In this regard, when evaluating the effectiveness of the treatment, we took into account the dynamics of not only the main, but also the accompanying clinical manifestations of MMD.
Instenon was administered in tablet form orally, 2 times a day after breakfast and lunch; composition of 1 tablet: hexobendin - 20 mg, etamivan - 50 mg, etophyllin - 60 mg. The selection of the dose was carried out individually depending on the age of the patient with a gradual increase according to the scheme shown in table 3. A slow increase in the dose of Instenon was recommended to reduce the likelihood of side effects of the drug. If side effects appeared, it was recommended to return to the previous dose (in this case, the doctor had to make a note in the appropriate form about the nature of the side effects, the date of their occurrence and the dose of the drug used).
Children with MMD in the control group are given a low-dose multivitamin solution for oral administration, 1 teaspoon once a day in the morning.
Instenon was used as monotherapy, concomitant therapy was not prescribed. Concomitant therapy was also not recommended for children in the control group.
On the eve of the start of the course of treatment (day 0) and at the end of it (day 30), children with MMD underwent a comprehensive examination, which included:
1. Questioning of parents using a structured questionnaire.
2. General examination with a detailed analysis of complaints and examination of the neurological status.
3. Psychological study: study of the sphere of attention, auditory-speech and visual memory (using various modifications of methods selected for three age groups).
Clinical and psychological methods: qualitative and quantitative assessment of the analyzed indicators
1. The structured questionnaire is intended for questioning parents and allows you to characterize in detail the general condition and behavior of a child with MMD. Completing the questionnaire provides not only fixation of certain symptoms, but also a conditional assessment of the degree of their severity in points. This approach not only makes it possible to give a quantitative description of the existing disorders along with a qualitative one, but also makes it possible to trace the dynamics of the state. The questionnaire contains a list of questions on 72 symptoms that can be observed in MMD. After one or both parents complete the table, the specialist analyzes the data. Responses are evaluated as follows: no symptom - 0 points, little expressed - 1 point, significant - 2 points, very pronounced - 3 points. All questions are grouped on special scales, which include a list of symptoms combined with each other. Behavioral characteristics ratings on scales are calculated by summing individual symptom scores and then dividing the resulting sum by the number of responses received. According to the results of filling out the questionnaire for each patient, scores were determined on the following scales: cerebral symptoms; psychosomatic disorders; anxiety, fears and obsessions; movement disorders; speech disorders; Attention; emotional-volitional disorders; behavioral disorders; aggressiveness and reactions of the opposition; difficulties in schooling (in children from 7 years old); reading and writing disorders (in children from 7 years old).
2. General and neurological examination. In addition to the neurological examination, which was carried out according to the generally accepted scheme, the main tasks from the M.B. Denckla for the study of motor skills and the coordination sphere. This technique consists of two sections: tests for walking along the line, tests for maintaining balance; tasks for the alternation of limb movements. The quality of performance is assessed by a point system, taking into account the number of errors, the presence of involuntary movements and synkinesis. The second section also evaluates the execution time of twenty consecutive movements.
3. The psychological study was based on an assessment of the functions of attention and memory. It was no coincidence that a special place was given to the evaluation of the functions of attention and memory in children with MMD. Attention and memory are complex integrative processes that rely on a number of brain structures and are widely represented in various parts of the CNS. This is what makes them very vulnerable and explains the significant prevalence of impaired attention and memory among children with MMD.
Attention research. Attention is an independent integral component among other cognitive functions. But at the same time, attention is a multidimensional concept that includes such components as sustained attention and selective attention, inhibition of impulsive actions, selection of necessary reactions with control over their implementation. The subjects were offered a number of tasks designed to assess various characteristics of attention: a correction test, the "coding" subtest from D. Veksler's methodology for studying intelligence in children, and a fragment of the Raven test. For three age groups, tests of varying complexity were selected.
It should be noted that the performance of tasks in all of the above methods, in addition to attention, also requires the participation of other higher mental functions and cognitive processes, in particular memory, visual-spatial perception, spatial (constructive) thinking, hand-eye coordination, and, therefore, can be considered and as a characteristic of the latter, which is especially important when examining children with various types of MMD.
Memory research. To study memory, an adapted version of the neuropsychological technique "Luria-90" was used, which allows assessing the state of auditory-speech and visual memory in children under conditions of immediate and delayed reproduction. The study of auditory-speech memory was carried out using traditional tests for memorization of two groups of three words and a group of five words in a given order. To study visual memory, tests were used to memorize five letters and five figures.
Therapeutic
effectiveness of instenon
Analysis of the effectiveness of Instenon in the studied groups of patients with MMD was carried out in two stages: 1. Individual assessment of the effectiveness of therapy for each patient; 2. Statistical processing of research data. Statistical analysis of the dynamics of all quantitative characteristics in the studied groups of patients with MMD before and after treatment with Instenon was carried out using the nonparametric Wilcoxon test for pairwise related samples.
In the course of an individual assessment of the results of treatment in each patient, the criteria for a positive effect were taken as follows:
regression of complaints noted during the first examination;
improvement of behavior characteristics according to the questionnaire for parents and school performance;
positive dynamics in the neurological status according to the results of the study of motor skills and the coordinating sphere according to the method of M.B. Denckla;
positive dynamics of indicators of psychological testing.
Results
and their discussion
In the group of children who received a course of Instenon, the results of treatment were as follows (Table 4): a clear positive effect was achieved in 71% of cases, in the remaining 29% there was no significant change in the condition of the patients. In the control group, a positive effect was observed only in 15% of cases, there was no dynamics - in 85%.
Table 5 characterizes the dynamics of the general condition and behavior of children with MMD who received a course of treatment with Instenon, according to a survey of their parents. The presented results indicate a significant improvement in indicators for 8 out of 11 analyzed scales. At the same time, in the control group of children with MMD, no significant dynamics of assessments was determined on all 11 scales.
During treatment with Instenon, most of the examined children showed a decrease in the severity of cerebrosthenic symptoms: increased fatigue, capriciousness, tearfulness, mood swings, poor appetite, headaches, sleep disturbances in the form of difficulty falling asleep, restless superficial sleep with disturbing dreams. In some cases, this was accompanied by a regression of psychosomatic disorders: causeless pain in the abdomen or in various parts of the body, enuresis, encopresis, parasomnias (night terrors, sleepwalking, sleepwalking).
One of the important aspects of Instenon's action was its effectiveness in overcoming anxiety, fears and obsessions in children with MMD, including fear of being alone, fear of strangers, new situations, refusal to attend kindergarten or school due to fear of failure in learning and communication. as well as tics and compulsions (sucking fingers, biting nails, biting lips, picking nose, pulling hair, clothes, etc.).
When parents assessed motor disorders in children with MMD, there was a decrease in clumsiness, awkwardness, poor coordination of movements and difficulties in fine motor skills (poorly fastens buttons, ties shoelaces, draws poorly).
The characteristics of attention improved, the disturbances of which before treatment usually manifested themselves in the form of difficulties in concentrating it when doing homework and schoolwork, during games, being easily distracted, inability to complete tasks independently, to complete the task, and also in the fact that children answered questions not thinking, without listening to them to the end, they often lost their things in kindergarten (school) or at home. At the same time, many children with MMD experienced a regression of emotional-volitional disorders (the child behaves inappropriately for his age, like a small child, shy, afraid of not being liked by others, overly touchy, unable to stand up for himself, considers himself unhappy).
Particularly noteworthy is the decrease in the group of children with MMD who completed the course of Instenon, the severity of behavioral disorders (teasing, explaining, being sloppy, untidy, noisy, disobedient at home, not listening to the teacher or teacher, hooligans in kindergarten or at school, deceiving adults) and manifestations of aggressiveness and oppositional reactions (tempered, behavior is unpredictable, quarrels with children, threatens them, fights with children, is impudent and openly disobeys adults, refuses to comply with their requests, deliberately commits acts that irritate other people, deliberately breaks and spoils things, abuses with pets).
Despite the fact that in the group of children treated with Instenon, when analyzing the results of a parental survey, no significant dynamics of assessments on the scales of "disorders of oral speech", "difficulties in schooling", "impaired reading and writing" were found, in some patients by the end of the course Treatment improved speech (in a subgroup of children aged 4–6) and school performance (among children aged 7–12). Apparently, it is advisable to conduct separate studies aimed at assessing the effect of Instenon on speech functions in children with speech development delays, as well as reading, writing and counting in children with dyslexia, dysgraphia and dyscalculia using special testing methods.
When examining the neurological status in children with MMD, it is usually not possible to detect characteristic focal neurological symptoms. But at the same time, they are distinguished by their motor clumsiness, which corresponds to "soft" neurological symptoms in the form of discoordination of movements according to the type of elements of static-locomotor and dynamic ataxia, dysdiadochokinesis, insufficiency of fine motor skills, the presence of synkinesis. As follows from the data presented in Table 6, in the group of children treated with Instenon, when examining motor skills according to the M.B. Denckla showed a significant improvement in scores for both walking and balance tests and alternation tasks. This indicated a decrease in the severity of impaired coordination of movements and praxis.
When performing tasks for walking and balance, the number of errors (deviations from the line when walking), the severity of staggering, and the use of auxiliary hand settings decreased. In tests for the alternation of limb movements, a decrease in hypermetry, dysrhythmia, mirror movements, synkinesis was recorded. In the control group, there were no significant changes in the corresponding scores, and, consequently, no improvement in motor functions.
Since it is typical for children with MMD to lag behind their peers in the speed of performing small movements of the limbs, special attention was paid to assessing the time to perform tests for 20 consecutive movements in the right and left 2-5 fingers of the thumb on the thumb - 8 tasks in total). On the 30th day in children with ADHD who received treatment with Instenon, there was a significant decrease in the execution time in 4 out of 8 proposed tasks, while in the control group - only in one task.
The results of the study of the sphere of attention in children with MMD before and after treatment are shown in Table 7. Maintained attention (the ability to maintain the necessary response during prolonged and repetitive activities) was assessed in the patients examined by us using a correction test. Directed attention (the ability to respond discretely to specific stimuli in different ways) was examined using the "coding" subtest. From the presented data, it follows that Instenon had a pronounced positive effect on the indicators of both maintained and directed attention in children with MMD. At the same time, taking multivitamins had practically no effect on the sphere of attention in the control group of patients.
When performing a correction test, the number of errors (omissions) made in its three consecutive parts and the total number of errors were taken into account (Fig. 1). After treatment with Instenon, the number of mistakes made by children with MMD significantly decreased, while in the control group this indicator did not change significantly. The graphs presented in Figure 1, showing the number of errors in children with MMD in the 1st, 2nd and 3rd parts of the task, can be considered as a kind of "performance curves", reflecting changes in the concentration of attention in its three successive parts, equivalent in complexity . Therapy with Instenon contributed to the improvement of working capacity in children with MMD and its maintenance at a stable level during the transition from the 1st part of the correction test to the 2nd and 3rd, as evidenced by the alignment of the curve due to the disappearance of fluctuations in the quality of the task. In the control group, the dynamics of maintained attention indicators was practically absent (the two curves on the graph for Day 0 and Day 30 almost coincide). As for the time to complete the correction test, it decreased in both groups.
Important in addressing the issues of clinical diagnosis of MMD in children is a neuropsychological examination, and above all - assessment of the state of auditory-speech and visual memory. As neuropsychological studies have shown, among children with MMD, there are often disorders of both auditory-speech memory and visual memory.
Based on the results shown, scores were calculated for a number of memory parameters, and then the total scores for auditory-speech and visual memory. For auditory-speech memory, the volume, inhibition of auditory traces, the strength of auditory traces, the reproduction of the order of stimuli, the reproduction of the sound structure of words, regulation and control were evaluated, for visual memory - the volume, the reproduction of the order of visual stimuli, the reproduction of spatial configuration, the phenomenon of mirror movements, the strength of visual traces, regulation and control of visual memory. The higher the total scores, the greater the severity of memory impairment and the number of errors made by the subjects.
As can be seen from Table 8, against the background of treatment with Instenon in children with MMD, the characteristics of auditory-speech memory significantly improved, and the indicators of visual memory remained stable. On the other hand, in the control group, attention is drawn to the tendency to worsen the indicators of both auditory-speech and visual memory upon re-examination. Thus, Instenon had a significant positive effect on the state of auditory-speech memory in children with MMD.
Side effects
It is important to note that undesirable side effects in the group of examined children with MMD during treatment with Instenon were observed rarely, were not persistent and significantly pronounced. Their occurrence was related to 1-2 weeks of treatment and required a slower and more gradual increase in dose, or they regressed on their own without changing the dose of the drug. Often they occurred when the parents inaccurately followed the prescription regimen with a gradual increase in dose, taking the drug in the morning and afternoon. In total, during treatment with Instenon, side effects were recorded in 12 (20%) patients who experienced the appearance of excitability, irritability, tearfulness (8 people), headaches (4) or abdominal pain (2) of slight intensity, nausea (2) , sleep-talking (1), transient pruritus (1). In 2 children with MMD, parents noted a decrease in appetite after the 1st week of treatment and until the end of the course of Instenon.
conclusions
Based on the results obtained, it can be concluded that the treatment of children with various types of MMD with Instenon in 71% of cases was accompanied by a positive effect, which manifested itself in improving the characteristics of behavior, as well as indicators of motor skills, attention and memory, organization functions, programming and mental control. activities. With strict adherence to the Instenon prescription regimen (gradual increase in dose, administration in the morning and afternoon hours), the risk of unwanted side effects is minimal.
Considering the main mechanisms of the genesis of MMD, it should be noted that the use of Instenon, as one of the most effective drugs of the nootropic series, which has a beneficial effect on the higher mental and motor functions that are not sufficiently formed in patients with MMD, is especially important in childhood, when the processes of morphofunctional development of the central nervous system continue, its plasticity and reserve capabilities are great.

Literature
1. Volkova L.S., Lalaeva R.I., Mastyukova E.M., Grinshpun B.M. etc. Speech therapy. Moscow, 1995.– T. 1.– 384 p.
2. Glezerman T.B. Brain dysfunction in children. Moscow, 1983, 239 p.
3. Zhurba L.S., O.V. Timonina, T.N. Stroganova, I.N. Posikera. Clinical and genetic, ultrasound and electroencephalographic studies of the syndrome of hyperexcitability of the central nervous system in young children. Moscow, Ministry of Health of the Russian Federation, 2001, 27 p.
4. Zavadenko N.N. How to understand a child: children with hyperactivity and attention deficit. Moscow, 2000, 112 p.
5. Zavadenko N.N., Suvorinova N.Yu., Grigoryeva N.V. Attention deficit hyperactivity disorder in children: modern approaches to pharmacotherapy. Psychiatry and psychopharmacotherapy, 2000, volume 2, no. 2, p. 59–62
6. Kemalov A.I., Zavadenko N.N., Petrukhin A.S. The use of Instenon in the treatment of the consequences of a closed craniocerebral injury in children. Pediatrics and Pediatric Surgery of Kazakhstan, 2000, No. 3, p.52–56
7. Korsakova N.K., Mikadze Yu.V., Balashova E.Yu. Underachieving Children: Neuropsychological Diagnosis of Learning Difficulties in Primary School Students. Moscow, 1997, 123 p.
8. Kotov S.V., Isakova E.V., Lobov M.A. et al. Complex therapy of chronic cerebral ischemia. Moscow, 2001, 96 p.
9. International Classification of Diseases (10th revision). Classification of mental and behavioral disorders. - St. Petersburg, 1994. - 300 p.
10. Ravich–Shcherbo I.V., Maryutina T.M., Grigorenko E.K. Psychogenetics. Moscow, 1999, 447 p.
11. Simernitskaya E.G. Neuropsychological method of express diagnostics "Luriya-90". Moscow, 1991, 48 p.
12. Filimonenko Yu., Timofeev V. Guide to the methodology for the study of intelligence in children by D. Veksler. - St. Petersburg, 1993. - 57 p.
13. Yakhno N.N., Damulin I.V., Zakharov V.V. Encephalopathy. Moscow, 2001, 32 p.
14. Denckla M.B. Revised neurological examination for subtle signs. Psychopharma. Bull., 1985, Vol.21, pp.773–789
15. Gaddes W.H., Edgell D. Learning disabilities and brain function. A neuropsychological approach. New York et al., 1994, 3rd ed., 594 p.

Minimal brain dysfunction in children is a set of minor disorders of the central and autonomic nervous system, which is accompanied by a child's maladaptation in society and reversible disorders in the emotional, volitional, intellectual and behavioral spheres. This syndrome is characterized by smoothing of symptoms as the child grows up or its complete disappearance under favorable environmental conditions.

MMD in children is often associated with birth trauma, which led to hypoxia and, accordingly, to the formation of some neurological and mental disorders of a transient nature.

Brain dysfunction in this disorder is not a contraindication to studying at a regular school, gymnasium, university, since, often, children with MMD cope well with many physical and mental stresses. The main condition is a sparing regime - moderate mental stress, allowing the child to take regular breaks to restore psycho-emotional balance. Usually, brain dysfunction normalizes by the age of 7-8, but there are cases of its occurrence at an older age (14-16 years), which indicates a strong load on the child, due to which chronic stress is formed.

Minimal brain dysfunction may be due to the following reasons:

genetic predisposition;
chronic stress;
Improper nutrition of the mother during pregnancy;
Avitaminosis;
Bad habits;
Weak generic activity;
Rapid childbirth;
Fetal hypoxia;
Injuries during childbirth;
Severe concomitant diseases of the child (heart disease, bronchial asthma);
Intrauterine infections;
Rhesus conflict between mother and fetus during pregnancy (for example, the fetus had a blood type “+” and the mother had “-”).

From the above reasons, we can conclude that the immaturity of the brain in children is closely related to intrauterine pathology. Therefore, if there is a suspicion of minimal dysfunction, it is necessary to conduct a thorough conversation with both the child and the parents in order to make a diagnosis of MMD.

Clinical picture in children

Symptoms of minimal brain dysfunction can be erased up to school age, which makes timely diagnosis difficult due to late visits to the doctor.

The clinical picture is diverse and manifests itself in the form of:

Poor assimilation of information;
absent-mindedness;
fatigue;
Attention deficit disorder (the child starts several things at once, but gives up everything, often loses things, cannot concentrate on subjects that require enhanced memorization);
restlessness;
Decreased concentration;
Delays in speech development;
Inability to build long sentences or remember heard and / or read text;
Awkward movements;
memory deterioration;
Violations of fine motor skills (it is difficult for a child to sew, tie shoelaces, fasten buttons, etc.);
Emotional lability (mood changes from depressive to euphoric due to minor things);
Deterioration of spatial orientation (such children often confuse where is “left” and where is “right”);
Often - infantilism, hysterical manifestations, avoiding responsibility and fulfilling duties.

Autonomic disorders are also common:

increased heart rate, feeling of palpitations;
Increasing the frequency of respiratory movements;
sweating;
Gastrointestinal disorders: diarrhea, heartburn, nausea, sometimes vomiting;
Sometimes - muscle twitching, convulsions;
Sleep problems, difficulty falling asleep, insomnia.

Clinical picture in adults

If MMD was not diagnosed in time or treatment was carried out, but under the influence of environmental factors, the person again fell into a stressful state, the clinical picture will be an extended neurotic disorder:

memory impairment;
Difficulty in assimilation of information;
restlessness;
excessive irritability;
Mood lability;
impulsive behavior;
Aggressiveness;
Fatigue;
awkwardness of movement;
Absent-mindedness.

Adults may experience TIA (transient cerebrovascular accident), which is a transient ischemic attack. It is often the result of concomitant systemic diseases (diabetes mellitus, atherosclerosis), the presence of head injury or spinal injury (which may be due to the pathology of labor). The attack lasts from a few seconds to several hours and is accompanied by visual impairment, headache, dizziness, numbness. Neurological examination revealed pathological reflexes of Babinsky and Rossolimo.

It is necessary to distinguish PMNC from stroke (acute cerebrovascular accident). With stroke, the symptoms are persistent and do not go away within a day, there will be characteristic changes in the MRI and CT picture.

Stem structures and the cerebral cortex are targets for MMD

The immaturity of the cerebral cortex often leads to the fact that the child becomes lethargic and inhibited. In addition to physical inactivity, there will be emotional poverty, muscle weakness, impaired memory and attention. This is due to dysfunction of the brain stem structures, which do not properly influence the cerebral cortex, causing hypodynamic syndrome in the child. Dysfunction of the cerebral cortex leads to a delay in speech development (srr), weakness of thinking and the development of convulsive seizures. ZRR, in turn, is manifested by a small vocabulary, difficulties with reproduction and construction of long phrases.

The main thing when teaching such a child is patience and breaking the topic into logical parts, between which one could take a break for rest.

Diagnosis of MMD

This disease is dealt with by a neurologist, who must determine the nature of cerebral disorders. He collects a thorough anamnesis, checks reflexes. In parallel, the child is observed by a pediatrician who evaluates his mental state, excludes the presence of inflammatory diseases. Laboratory research methods do not reveal deviations from normal values. The neurologist prescribes instrumental methods:

EEG. Electroencephalography allows you to detect violations in the transmission of nerve impulses;
Rheoencephalography. Allows you to assess the blood flow of the brain;
echoencephalography. Assesses the state of brain structures;
CT and MRI. It also allows you to visualize the structures of the brain and exclude their pathology.

MMD Criteria:

Three components are evaluated:

1) Attention Deficit (4 out of 7):

1) often asks again; 2) easily distracted; 3) poor concentration; 4) often confused; 5) takes on several cases at once, but does not bring them to the end; 6) does not want to hear; 7) works relatively well in a calm environment.

2) Impulsivity (3 out of 5):

1) interferes with the lesson to the teacher and students; 2) emotionally labile; 3) does not tolerate queues; 4) talkative; 5) offends other children.

3) Hyperactivity (3 out of 5):

1) likes to climb on towering objects; 2) does not sit still; 3) fussy; 4) makes a loud noise when performing any activity; 5) is always in motion.

If the symptomatology lasts more than six months, and its peak falls on 5-7 years, then we can talk about the diagnosis of MMD.

Differential Diagnosis

Considering that MMD is a transient dysfunction of the central and autonomic systems, it is necessary to differentiate it from more serious pathological conditions, in particular:

neuroinfections;
Mental illness - bipolar personality disorder, schizophrenia, other psychoses;
Poisoning;
Oncology.

Treatment and correction

Treatment of MMD is complex and includes psychotherapy, medication and physical therapy. Medicines are rarely resorted to, since MMD can be managed with the help of a psychologist and the creation of an appropriate environment in the family. The child needs to provide an "output" of his energy in the form of walking to the sports section. If he is inactive and lethargic, then physical activity is also prescribed, but in moderation to maintain vitality. Parents should be talked about how to properly treat their child. He should not be overly indulged, but it is not worth using brute force either. It is necessary to help him develop the correct daily routine, limit his time at the computer and phone, spend more time with the child and play educational games with him. If he has problems with speech, you need to contact a speech therapist. Moreover, the earlier parents turned to a specialist, the faster speech development will be restored. Unfortunately, MMD is rarely diagnosed, although it occurs quite often. The consequences of untreated dysfunction result in neurotic disorders, psychosis, and depression. And already with such a neglected MMD, normotimics, sedatives, antidepressants, tranquilizers and neuroleptics are used, depending on the clinical picture of the disease. The prognosis is usually favorable.

Prevention

Preventive measures are aimed at improving the quality of life of the expectant mother. She needs to ensure peace, sufficient consumption of foods with a high content of trace elements and vitamins. During pregnancy, it is recommended to abandon bad habits, as they negatively affect the fetus, causing hypoxia in it. When a child was born and faced with severe stress for the first time (for many children, going to kindergarten or school is tantamount to a global catastrophe), you need to have a conversation with him, talk with the teacher about your child's characteristics.

Is MMD dangerous in children and how to treat it

Doctors often encounter such a diagnosis as MMD in a child. As a rule, this happens when passing a medical examination before entering the first grade. Minimal brain dysfunction is a neuropsychiatric disorder, so this diagnosis should not be ignored. How to identify such a deviation in a child and deal with it?

What is MMD related to?

When identifying MMD in children, parents should understand that there are some violations in the work of the brain of their child. Of course, it is difficult to say from the child himself that something is wrong with him, but in some cases this violation nevertheless makes itself felt, manifesting either excessive activity or unreasonable lethargy.

MMD syndrome in a child occurs as a result of microdamage to the cerebral cortex, which leads to disruption of the functioning of the nervous system. The main cause of such a violation is oxygen starvation of the brain even during childbirth ...

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The term "minimal brain dysfunction in modern medicine" appeared only in the middle of the last century. This syndrome manifests itself as dysregulation of different levels of the central nervous system. Such disturbances lead to changes in the emotional and vegetative system. The syndrome can be diagnosed in adults, but, in the vast majority of cases, it is observed in children.

It is interesting! According to some data, the number of children with minimal brain dysfunction is 2%, and according to another - 21%. This contradiction suggests that there is no clear clinical description of this syndrome.

According to the views of neurologists of the 21st century, the term "minimal brain dysfunction" does not exist, and in the ICD-10 it corresponds to a group of disorders called "Hyperkinetic behavioral disorders" under the code F90.

But, rather out of habit, doctors and patients continue to operate with the old concept.

What is this diagnosis - minimal brain dysfunction syndrome (MMD)

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The question "MMD in children - what is it?" every year becomes more and more relevant. This is a neuropsychiatric pathology, often found in children of different ages. Delays in the development of oral and written speech, impaired posture, dermatosis, vegetative-vascular dystonia are diagnosed in many children.

MMD in children - what is it? This pathology is accompanied by a violation of such important brain functions as memory, attention and thinking. Children with MMD are unable to master the usual education programs. Teachers call this phenomenon "disappointment of the preschool-school period." Neurologists call the complex of such disorders the term MMD - minimal brain dysfunctions.

What is MMD in children, and what are its manifestations

Almost from the first days of life, children with MMD are characterized by increased excitability, neurotic and vegetative reactions, and unmotivated hyperkinetic behavior. Such children are mainly registered with a neurologist with ...

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Minimal brain dysfunction in children

Minimal brain dysfunction is quite common in children. According to various sources, from 2 to 25% of children suffer from minimal brain dysfunction. Minimal brain dysfunction refers to a number of conditions in children of a neurological nature: impaired coordination of movements, hyperactivity, emotional lability, minor speech and motor disorders, increased distractibility, absent-mindedness, behavioral disorders, learning difficulties, etc.

Unclear? Nothing, now we will try to decipher this abracadabra.
Let's make a reservation right away that doctors can "call" MMD with a variety of diagnoses: hyperactivity, attention deficit, chronic brain syndrome, organic brain dysfunction, mild infantile encephalopathy, psychomotor retardation, etc. In addition, children with MMD are the subject of close attention of psychologists, teachers , defectologists, speech therapists, like children who are difficult to learn or pedagogically ...

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Treatment of the disease may be associated with some complications. Basically, minimal brain dysfunction is treated using the following methods:

Motor activity to improve baby's dexterity and coordination.

Correction with the help of pedagogical and psychological techniques. It includes limiting being at the computer and watching TV, a detailed daily routine, positive communication with the child - more praise and encouragement.

Treatment with medications. Do not self-medicate, as medications may have side effects or contraindications. There are several groups of drugs that treat brain dysfunction: these are nootropics, CNS stimulants, tricyclic antidepressants. With the help of such therapy, the activity of higher brain mental functions and neurotransmitter work are improved.

Correction and treatment of the disease depends on what are the main psycho-neurological signs, and how they ...

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Such children are either too noisy, fast, inattentive and restless, or vice versa quiet, slow, "lazy". Although in both cases in intellectual development they are not inferior to their peers.

Causes of MMD.

The causes of the development of MMD are the pathology of childbirth and a complicated perinatal history. So such a child in an early history may have:
C-section
rapid or rapid labor
fetal asphyxia or hypoxia
birth injuries of the spine, including the cervical spine
perinatal encephalopathy

Years later, all this can lead to a weakening of one or another function of the body. The diagnosis of MMD usually appears at the age of 6-7 years, when the child's nervous system receives a serious load, attending preparatory classes or starting school.

Manifestations of MMD.

MMD is always a complex of symptoms, a set of problems that is individual for each child. Pay attention to the following...

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MMD in children

MMD in children (minimal brain dysfunction) are mild functional disorders in the brain. This diagnosis can only be made by a neurologist, and write in the baby’s medical record one or all at once: MMD, increased intracranial pressure, hyperactivity, ADHD (attention deficit and hyperactivity disorder), ADHD (attention deficit disorder with hyperactivity) and so on. Further.

Outwardly, MMD in children can manifest itself in different ways (depending on the characteristics of the child's psyche), but these manifestations are based on something in common: the child is not able to regulate his behavior and control his attention.

The following features are typical for a child with this disorder:

1. Carelessness:

- hears when it is called, but does not respond to the call;

- can't concentrate even on...

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In pediatric neurology, MMD appeared relatively recently - this is how mild changes in the central nervous system are designated. On the one hand, the violations are minor, but, on the other hand, they can cause a lot of problems for the kids, as well as their parents.

Other children

They say about some babies: “You can give birth to such babies at least every year!” They sleep well, eat well, practically do not get sick and do not torment their parents with their constant whims. But other newborns, it would seem, do nothing but test their beloved mother for strength. The sleep of such babies is intermittent and short, they are tormented by endless dysbacteriosis and colds, and indeed, their medical record from birth will compete with that of an adult. All these manifestations are just the main signs of MMD. In general, this violation is always a complex of symptoms, and here are just some of them ...

The kid is very restless. He cries a lot, gets nervous and screams without visible...

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Minimal brain dysfunction - a full basket of neurological diagnoses

Some children have difficulty mastering the school curriculum, and many educators and psychologists tend to call this school maladjustment, because. cannot find a good reason for such a state.

With a more detailed examination of the child, it can be revealed that his abilities and skills suffer due to not gross violations of higher mental functions. The totality of such disorders is currently commonly referred to as the syndrome of minimal brain dysfunction or MMD.

This concept appeared relatively recently - in the middle of the last century, and it covers a number of symptoms combined into a syndrome that manifests itself as disorders of the central and autonomic nervous system, and affects various areas of the child's psyche: emotional, behavioral, motor, intellectual, etc.

Neurological symptoms are also observed, but almost all disorders disappear or ...

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Key words: minimal brain dysfunction, hyperkinetic chronic brain syndrome, minimal brain damage, mild childhood encephalopathy, mild brain dysfunction, childhood hyperkinetic response, activity and attention disturbance, hyperkinetic conduct disorder, attention deficit hyperactivity disorder

We continue our fascinating tour of the city of pediatric neurology ... After an entertaining walk through the PEP (perinatal encephalopathy) park, we move to one of the most popular areas of the "old city" called MMD. Type in any Internet search the phrase "MMD in children" - there are from 25 to 42 thousand pages of answers! Here and popular literature, and strict scientific articles, shining with evidence, and how many terrible statistics! “... Minimal brain dysfunction (MMD) is the most common form of neuropsychiatric disorders in childhood. According to domestic and foreign studies, the frequency ...

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We will not be mistaken if we say that we all love our restless kids.

It is the immediacy of childhood that touches parents, kids enchant us with their indefatigable energy, their active interest in learning about life.

Yes, it is necessary to follow the younger generation.

Sometimes it is enough for you to look away, as the child is already checking the pills in the medicine cabinet or hosting in the linen closet. But even the fastest, most restless children have quite calm periods when they are concentrated on some business - they draw, sculpt, paint or make something archival from the designer.

If your child simply cannot physically sit still for more than a minute, cannot concentrate his attention, starts doing something and immediately quits, it is possible that a diagnosis of minimal brain dysfunction (MMD) will appear in his medical record when he sees a doctor.

Synonyms for this term are:

But, whatever the name of the pathology, ...

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Hello dear parents!

I propose to discuss the topic, I think that it is interesting and relevant for many of you, and we will talk about minimal brain dysfunction (MMD), about its causes, consequences and ways to help children with this diagnosis.

1. What is minimal brain dysfunction (MMD)?

First, MMD is associated with a consequence of early brain damage in children. Of course, some of the parents may be quite aware of what it is, but there are probably mothers among the readers who know little about minimal brain dysfunction and have not yet thought about what it leads to.

It sounds serious enough, I agree, but it’s true that they say that “he who is armed is protected”, in this context, it is the parent who knows what kind of help his child needs if the neurologist puts minimal brain dysfunction. Let's try to start delving deeper into this topic.

In the 1960s, it became widespread...

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defectologist Shishkova Margarita Igorevna || personal site

See section Materials for students and defectologists

What are PEP and MMD and how to help children with such a diagnosis?

The most common neurological diagnoses for more than a decade have been PEP, MMD, SPNR (excessive neuro-reflex excitability syndrome), ADHD (attention deficit hyperactivity disorder). They are in the medical records of almost all children. Unfortunately, doctors do not often condescend to explain incomprehensible abbreviations. As a result of this, parents sometimes do not know about the diagnosis of their baby and, moreover, do not know what to do about it. If the doctor did not explain the terminology, then the defectologist has to decipher the diagnoses. At the first consultation, a highly professional specialist will ask parents about how the pregnancy and childbirth proceeded, what records the neurologist made in the child’s chart, how the stages of early development went.

PEP - perinatal encephalopathy, defeat ...

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MMD evolution

In the neonatal period, children with MMD are characterized by a syndrome of increased neuro-reflex excitability (anxiety, increased activity, sleep and appetite disturbance, chin and hand tremor).

At the age of 1 to 3 years, children are overly excitable, motorally disinhibited, somewhat lagging behind in psychoverbal and motor development, and stubborn. Often they have a delay in the formation of neatness skills (enuresis, encopresis). After 4-5 years, the manifestations of these disorders decrease or disappear altogether. Very often, parents do not pay attention to these manifestations and do not turn to specialists in a timely manner. Therefore, a big surprise for them are the complaints of educators, and then teachers about uncontrollability, inattention, the inability of the child to cope with the requirements.

At the age of 3 to 5 years, others begin to pay attention to the unusual behavior of the child. In this age period, the active development of attention, memory, and speech begins. If a...

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MMD in Children: Facts and Misconceptions of Child Neurology (Myth #2)

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In childhood, all children have mobility, lively facial expressions, often changing moods, impressionability and excessive attention to everything new. If your child has these qualities and properties of the nervous system overly sharpened and elevated, then you can diagnose him in absentia with “minimal brain dysfunction”. This term became popular in the 1960s. At that time, it was used in relation to children experiencing learning difficulties, as well as suffering from pronounced behavioral disorders.

MMD - what is it?

Minimal brain dysfunction is a type of neuropsychiatric disorder in childhood. This disorder occurs in 5% of preschoolers and 20% of schoolchildren.

The main symptoms of MMD are disinhibition of attention, increased ...

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Some children have difficulty mastering the school curriculum, and many educators and psychologists tend to call this school maladjustment, because. cannot find a good reason for such a state.

Neurological symptoms are also observed, but almost all disorders disappear or are significantly smoothed out with age.

What provokes the development of the syndrome in children

The main reasons for the development of minimal brain dysfunction affect the fetus during pregnancy, or after childbirth, very rarely in early childhood. The main factors influencing the appearance of cerebral dysfunction are:

Complex of syndromes due to MMD

Minimal brain dysfunction most clearly begins to manifest itself at the time of preparing children for school or in elementary grades.

It can be observed that the child does not absorb new information well and remembers it hard, he has problems with handwriting and writing in general.

And it's not at all that your child has a low intellectual level or does not want to learn, the problem is that MMD affects every sphere of life.

With minimal brain dysfunction, the following symptoms and syndromes are observed:

Sphere of attention: voluntary memorization is impaired, concentration and volume are reduced. It manifests itself mainly in the fact that the child is absent-minded, cannot do the same thing for a long time, especially if it requires mental stress.
Speech sphere: the first thing you should pay attention to is the articulation of the child - the fuzzy pronunciation of words, sounds. You can also notice that the child sometimes does not perceive other people's speech well, and does not absorb information by ear (violation of hearing-speech memory). This manifests itself in the poverty of the speech reserve, the difficulty of retelling what was heard or read, there are difficulties with building long sentences.
: manifest themselves mainly in the difficulties of mechanical memorization, i.e. through repeated repetition.
motor sphere: in such children it is often possible to observe violations of fine motor skills of the hands. This is mainly manifested in the general awkwardness of movements and handling of objects. It is difficult for a child to fasten small buttons, tie shoelaces, use scissors, sew, at school there are difficulties with the accuracy of handwriting and reading speed.
Spatial orientation: such children often confuse “left” and “right”, they can write all letters in a mirror, etc.
emotional sphere: . In children with this disorder, mood changes rapidly from depressive to euphoric. There may be unreasonable outbursts of aggression, anger, irritability, both towards others and towards oneself. You can observe the features of infantilism (capriciousness), lack of independence.

In infants, the main symptoms of the syndrome are as follows:

increased tearfulness and capriciousness;
increased heart rate, sweating, breathing rate;
the presence of spasms and;
disorders of the gastrointestinal tract (gastrointestinal tract): frequent regurgitation, diarrhea, etc .;
difficulty sleeping and falling asleep.

The main syndromes that occur in school-age children, on the basis of minimal brain dysfunctions:

(fidgeting in a chair, inability to sit in one place);
the child leaves games and other things unfinished, cannot concentrate on one thing for a long time, starts many actions at once;
often loses things, falls, collides with objects and others;
enters into conflicts, is capricious, aggressive towards relatives and himself;
there are problems with subjects that require a high concentration of attention, long-term mental operations (mathematics, compositions, memorizing poems).

Symptoms in adults:

difficulties in learning new information and skills;
awkwardness in movements (uncertain gait, frequent falls);
impulsive behavior;
high irritability;
violation of voluntary attention;
rapid and unexpected mood swings over a short period of time.

Hypodynamic syndrome as a manifestation of MCD

According to statistics, every fourth child suffering from brain dysfunction has a hypodynamic syndrome.

This disorder manifests itself in the general lethargy and lethargy of the child. The fact is that due to a birth injury, the subcortical structures of the brain are affected, because of this, the stimulation of the cerebral cortex is insufficient, which is manifested by drowsiness, lethargy, etc.

Hypodynamic syndrome affects most areas of a child's health:

muscle structures suffer, as a result of which muscle hypotonia is observed, their underdevelopment, which affects the coordination of movements and strength;
due to a reduced motivational level, attention, memory and cognitive abilities suffer;
the emotional sphere is impoverished, more often the face of such a child is indifferent, there are no vivid emotional reactions in everyday life.

In no case should children with such a disorder be forced to do something at a level that is not currently available to them. It is important to be patient with their pace of thinking, responding and acting.

For example, in outdoor games you need to adhere to the maximum reaction speed of the child, but then be sure to give a break and encourage in every possible way. First of all, such children should be fascinated by what they are interested in, and based on their interests, build an educational program, a program of physical development and leisure.

Treatment and correction

Correction of violations in MMD is carried out in three areas: psychotherapeutic, medication and physical.

Drugs are rarely used in the treatment of minimal brain dysfunction in children and are mainly used as maintenance therapy. The main method of therapy will be a certain physical activity and psychotherapeutic effects.

Among other things, the following correction methods are needed:

Usually, the prognosis for minimal brain dysfunction is more favorable than for gross mental disorders. If the diagnosis was made accurately and on time, parents and teachers interact actively and were able to develop the necessary tactics for communicating with the child, then with age, almost all violations will be compensated for a person, and he will be able to live a full life.

In some cases, there may be negative consequences of MMD, they are mainly associated with an incorrect diagnosis or the negative influence of the close environment. In these cases, the child may develop depression, complexes and other mental disorders.