Mild mental retardation in children. Are there hallucinations in oligophrenia? Violations of the emotional-volitional sphere

My eldest daughter has mild mental retardation. This diagnosis was given to us, and three years later it was repeated, in the sixth psychiatric hospital in Moscow (now it has somehow changed its name, such as the mental health center for children and adolescents). Before that there was a pronounced delay speech development The child did not actually speak until the age of 4. This delay, in turn, was accompanied by delayed psychomotor development. The daughter sat down on her own only at 9 months old, began to crawl by the age of one, went completely on her own only at a year and four months.

Actually, until the age of 3, the child almost did not differ from his peers, except that he was somewhat slower. The daughter was not hysterical, did not do something extra-inadequate, she simply did not speak. I was stupid and believed when they told me - do not worry, he will speak. She panicked at only three years old. A neurologist advised by friends prescribed Encifabol and /pharmacy/30155-pantogam. Later - /pharmacy/2477-cortexin . As a result of the treatment, syllables appeared, but there were no words.

At the age of four, they began to study with a defectologist, and here the effect was already very noticeable - words appeared in the active stock, the daughter began to repeat new words and phrases. At the age of five, the daughter lived with her father (my ex-husband) in another city, went to the garden. There was no defectologist there - they were engaged with a kindergarten speech therapist. There was no effect as such, the year was lost.

From six to seven years old, they studied in Moscow at the Green Branch. The defectologist there was wonderful, but we were not lucky with the speech therapist - there was practically no effect from the classes. In the same year, we were sent to the PMPK, whose specialists, after talking with the child, did not want to give a referral to a speech therapy school. They asked for a psychiatric report.

The conclusion of the psychiatrist, or rather the commission of the sixth psychiatric hospital, was mental retardation of a mild degree without indications of a violation of behavior, due to other specified reasons. As I understand it, this is the reason for the OHP. Previously, they wrote us an OHR of some degree (I think the 1st), now these are elements of an OHR. Also in the history of erased dysarthria, a violation of the formation of written speech.

Like many parents, when I heard the diagnosis of UO, I didn’t believe it at first, and then I got upset. Here, too, the prospects of getting into a school of the 8th type began to clearly emerge. Disorder again. But one way or another, we went to such a school.

Separately, I will say about the school. Then it seemed to me very good - a small number of classes, good equipment, the presence of an extended day group, etc. There was only one but - in the class there were children with very different diagnoses: Down syndrome, autism, MR varying degrees. In the end, and I realized it much later, educational process was aimed at the weakest children. My child was an excellent student, and this despite the fact that she wrote (and writes)

she is with the grossest mistakes, she cannot solve problems AT ALL. The only thing that reads quite well even for a regular school.

But it was in this school that we were incredibly lucky with a speech therapist - in two years she managed to put the sounds “k”, “l”, “sh”, “g”, “c”, “h”, “u”, partially “r” ... Yes, we didn't actually have half of the alphabet. For the first school year her daughter's vocabulary had grown very, very much, but the speech itself was terribly agrammatic. The speech therapist even said that, most likely, she would still have agrammatism. But, fortunately, after the summer holidays, the daughter somehow sharply correctly inclines words, changes them according to gender, numbers, etc.

The third grade, we also additionally studied with a speech therapist, I can’t note anything significant, we automated all hissing.

Now we have a new school (we moved to live in the village) and a new speech therapist. From one meeting it became clear that she was an extra-class specialist - she drew attention to what no previous specialist had properly paid attention to. The child's facial muscles are clamped, which, as I understand it, is the cause of the erased dysarthria. It was a discovery for me that my daughter has practically no facial expressions. No, of course, she smiles and frowns, but the emotions on her face are not visible as brightly as in most people. And, for example, my child cannot fake surprise with the help of eyebrows.

Our new speech therapist said that the first thing to do would be to remove this clip, and only then refine the sounds. What made me very happy was her confidence that our speech would Full order. With regular practice, fuzzy pronunciation will go away !!! Now every day we do special exercises to relax the muscles.

As far as education is concerned, new school we went not to the fourth, but to the third grade. The focus in the Moscow school on the least strong children, as well as the fact that our teacher directly stated that "SUCH" children are not able to master mathematics, had an effect. But after all, the program for schools of the 8th type is compiled for such children, which means they can ... Grades in the Russian language and in mathematics, mainly 3 or 4, according to literary reading, oral speech, the living world - mostly 5. Now we are learning the multiplication table for 2 and 3, while we just pronounce, and then we will prescribe, difficult words from the spelling dictionary.

Socially, the daughter is well developed: she knows how to keep up a conversation, including with strangers, easily uses a cell phone, Skype, finds what she needs in search engines. She is not in conflict with other children, supports games (rarely offers her own), seeks to invite everyone to visit. What is frustrating is the obstinacy and the spirit of contradiction in relation to me. Well, this is probably typical for many children of her age. As they say, in your own country...

The child is not like his peers - his general development behind the norm, he can not cope with what is easily given to other children. It is now customary to talk about such children as a “special child”. Of course, children with intellectual disabilities are a big test for parents. It is sad and painful to realize that the baby can be an outcast in society. However, quite often mental retardation can be corrected.

Is it lagging behind or developing differently?

Children develop in different ways. The norms according to which the diagnosis of the mental development of children is carried out are rather arbitrary and are average indicators. If a child develops at a different pace, this is not a reason to believe that the baby has gross violations of the development of the intellect. Cases when in early age a person had a discrepancy with the norms of mental and intellectual development, and at an older age he showed outstanding results in the field of knowledge - not uncommon. Even a speech delay is not evidence of a child lagging behind - many children do not speak at all until the age of two, but at this time they are forming a passive vocabulary - after two, such children immediately begin to speak well and a lot. Therefore, if there is one or two deviations from age norms, do not panic. It is necessary to sound the alarm when a complex of signs of mental retardation is observed.

Let's define what mental retardation is. First of all, the development of children with mental retardation occurs against the background of rather strong deviations in the conditioned reflex activity of the brain. They have an imbalance in the processes of inhibition and excitation, the signaling system of the brain also works with disturbances. This greatly affects cognitive abilities - children have no or poorly expressed attention, curiosity (craving for knowledge), there is an underdevelopment of cognitive interests, will.
It is worth distinguishing between mental retardation itself and mental retardation. Mental retardation implies more gross violations of the intellectual and psycho-emotional sphere. AT severe cases correction of such violations is almost impossible - we are talking about severe cases of cretinism, oligophrenia. But, I must say that in fact such cases are quite rare. Children with mental retardation are distinguished by a number of features, and at the same time, correction of their development is not only possible, but also quite successful: in some cases, children can catch up with their peers in their development.

Causes of mental retardation

Exists whole complex reasons that, individually or collectively, can lead to developmental delays. Often, children with intellectual disabilities suffer from birth defects in hearing, vision, speech apparatus. With such defects, initially the child's intellectual abilities could be within the normal range, but they did not develop from the first days of life due to reduced hearing and vision. Accordingly, there was a lag in mental development. Correction in this case is very successful.

Very often, the causes of mental retardation are the severe course of pregnancy, during which there was a prolonged oxygen starvation of the fetus; birth trauma, asphyxia at birth; some infectious and somatic diseases a child at an early age, intoxication, genetic damage due to alcoholism or drug addiction of parents.

In a very large percentage of mild cases of mental retardation, upbringing, or rather its complete absence, is to blame. It is known that mental retardation occurs if parents do not deal with the child, do not talk to him; if for some reason the child at an early age was isolated from the mother. Here, too, the correction is successful in most cases.

Development of mentally retarded children

Mentally retarded children need more time to absorb the material. Difficulties with isolating the main thing, with the awareness of cause-and-effect relationships, the slow pace of recognizing the known affect the learning ability of the baby, slowing down and complicating the learning process.

But this does not mean that the development of mentally retarded children is impossible or unnecessary. On the contrary, such children must be approached in a special way and developmental classes should be very carefully planned, which should be more intense. But a different kind of intensity is required here.

First of all, parents need to stock up on patience and faith in their child. Most importantly, never compare your child to other children. Even for healthy child with intellectual development within the normal range, the comparison is harmful - for special children it is catastrophically dangerous! As a result, the child withdraws into himself, begins to consider himself hopeless, falls into a neurosis or becomes aggressive.

In order to successfully correct the lag in intellectual development, testing should be carried out regularly. The so-called diagnostics of the mental development of children is a set of special tests-standards with which a child must normally cope upon reaching a certain age. Small deviations in one direction or another should not cause concern for parents. If the child clearly does not reach the norm, corrective exercises in this area are necessary. Remember that mental development is uneven and there is a chance to develop the intellect and psycho-emotional sphere to an adult state. But to overcome mental retardation, even in weak form It may take years and you have to be ready for it.

Of course, the development of mentally retarded children is a daily painstaking work that requires Great love, patience, self-sacrifice. Parents need to constantly tell their child about the world, the interconnection of things, give food for thought, encourage them to use knowledge in practice. Scientists believe that a child with mental retardation should be surprised as much as possible - this awakens curiosity and a desire for knowledge. You should not even think about what the child will not understand - you need to talk with him about everything, tell him why it happens this way and not otherwise, show him.

Distracted attention, inability and inability to concentrate it on one thing is one of the main causes of mental retardation. Constantly training mindfulness, encouraging it by all means in physiological terms (when the process of brain formation is underway - up to 3-6 years), you can restore broken connections and bring them back to normal. The education of attention is so important that the rule applies here - if the child is busy with something, classes are being conducted with him, he has focused on the game - you can’t even distract him with food, sleep, and so on. For children with mental retardation, it is extremely important to protect the emerging focus and concentration.

In parallel with developing activities, it is useful to take drugs that strengthen the nervous system and stimulate its development. From this point of view, a decoction of dioica nettle, eleutherococcus extract, royal jelly, strawberries, blueberries, B vitamins.

Features of a child and adolescent with mental retardation ( manifestations, symptoms, signs)

Mentally retarded children are characterized by:

• impaired thinking;
• impaired concentration;
• violations of cognitive activity;

• speech disorders;
• communication problems;
• visual disturbances;
• hearing impairment;
• sensory development disorders;
• memory impairment;
• movement disorders ( motor disorders);
• violations mental functions;
• behavioral disorders;
• violations of the emotional-volitional sphere.

Disorders of mental development and thinking, intellectual disorders ( basic violation)

Disorders of mental development and thinking in oligophrenia are characterized by:

• Violation of perception of information. With a mild degree of the disease, the perception of information ( visual, written or verbal) is much slower than normal. Also, the child needs more time to “comprehend” the data received. With moderate oligophrenia, this phenomenon is even more pronounced. Even if a child can perceive any information, he cannot analyze it, as a result of which his ability for independent activity is limited. In severe oligophrenia, damage to sensitive organs is often observed ( eye, ear). Such children cannot perceive certain information at all. If these sense organs work, the data perceived by the child is not analyzed by him. He may not distinguish colors, not recognize objects by their outlines, not distinguish between the voices of relatives and strangers, and so on.
• Inability to generalize. Children cannot make connections between similar items, draw conclusions from data, or pick out small details in any general flow of information. With a mild form of the disease, this is expressed slightly, while with moderate oligophrenia, children have difficulty learning to arrange clothes in groups, distinguish animals from a set of pictures, and so on. In a severe form of the disease, the ability to somehow connect objects or associate them with each other may be completely absent.
• Violation of abstract thinking. Everything they hear or see is taken literally. They do not have a sense of humor, they cannot understand the meaning of "winged" expressions, proverbs or sarcasm.
• Violation of the sequence of thinking. This is most pronounced when trying to complete a task consisting of several stages ( for example, take a cup out of the cupboard, put it on the table and pour water from a jug into it). For a child with a severe form of oligophrenia, this task will be impossible ( he can take the cup, put it in its place, go up to the jug several times and take it in his hands, but he will not be able to connect these objects). At the same time, in moderate and mild forms of the disease, intensive and regular training sessions can help develop sequential thinking, which will allow children to perform simple and even more complex tasks.
• Slow thinking. To answer a simple question e.g. how old is he), a child with mild form disease can think about the answer for several tens of seconds, but in the end it usually gives the correct answer. With moderate oligophrenia, the child will also think about the question for a very long time, but the answer may be meaningless, unrelated to the question. In a severe form of the disease, the answer from the child may not be received at all.
• Inability to think critically. Children are not aware of their actions, they cannot assess the importance of their actions and their possible consequences.

Cognitive Disorders

Concentration disorder

With a mild degree of mental retardation, it is difficult for a child to sit still, for a long time to do the same thing ( for example, they cannot read a book for several minutes in a row, and after reading they cannot retell what was said in the book). At the same time, an absolutely opposite phenomenon can be observed - when studying a subject ( situations) the child overly focuses on its smallest details, while not evaluating the subject ( situation) generally.

With moderately severe oligophrenia, it is extremely difficult to attract the attention of a child. If this can be done, after a few seconds the child is again distracted, switching to another activity. In a severe form of the disease, it is not possible to attract the attention of the patient at all ( only in exceptional cases can the child react to any bright objects or loud, unusual sounds).

Violation / underdevelopment of speech and problems in communication

Speech impairment in children with mental retardation is characterized by:

• Silence. With a mild form of the disease, complete dumbness is relatively rare, usually in the absence of the necessary corrective programs and classes. With imbecility ( moderately severe oligophrenia) dumbness may be associated with damage to the speech apparatus or hearing impairment ( if the child is deaf, he will also not be able to memorize words and pronounce them). With severe mental retardation, children usually cannot talk. Instead of words, they utter incomprehensible sounds. Even if they manage to learn a few words, they are not able to use them correctly.
• Dyslalia. It is characterized by a speech disorder, consisting in the incorrect pronunciation of sounds. At the same time, children may not pronounce some sounds at all.
• Stuttering. It is typical for oligophrenia of mild and moderate severity.
• Lack of expressiveness of speech. With a mild form of the disease, this deficiency can be eliminated with the help of classes, while with more severe forms it is impossible to do so.
• Impaired speech volume control. This can be seen in hearing loss. Normally, when a person speaks and hears his speech, he automatically controls its volume. If the oligophrenic does not hear the words he utters, his speech will be too loud.
• Difficulties in building long phrases. Starting to say one thing, the child can immediately switch to another phenomenon or object, as a result of which his speech will be meaningless and incomprehensible to others.

visual impairment

Severe visual impairment can be observed with deep oligophrenia, which is often combined with defects in the development of the visual analyzer. In this case, the child may not distinguish colors, see objects distorted, or even be blind.

It should also be noted that visual impairment strabismus, blindness and so on) may be associated with an underlying disease that causes mental retardation ( for example, when hereditary syndrome Bardet-Biedl, in which children can be born already blind).

Are there hallucinations in oligophrenia?

For the classical course of mental retardation, the development of hallucinations is not typical. At the same time, when oligophrenia is combined with schizophrenia, signs characteristic of the latter disease, including hallucinations, may appear. Also, this symptom can be observed with psychoses, with severe mental or physical overwork, and with the use of any toxic substances ( alcoholic beverages, drugs) even in small amounts. The latter phenomenon is due to the inferior development of the central nervous system and the brain in particular, as a result of which even a negligible amount of alcohol can cause a patient to visual hallucinations and other mental disorders.

hearing loss ( deaf children with mental retardation)

The development and education of a deaf mentally retarded child proceeds even more slowly, since he cannot perceive the speech of the people around him. With complete deafness, children, as a rule, cannot speak ( without hearing the speech, they cannot repeat it), as a result of which, even with a mild form of the disease, they express their emotions and feelings only with a kind of lowing and screaming. With partial deafness or deafness in one ear, children can learn to speak, but during a conversation they may mispronounce words or speak too loudly, which is also associated with the inferiority of the auditory analyzer.

Sensory Development Disorders

Sensory development disorders can manifest as:

• Slow visual perception. To evaluate an object seen ( understand what it is, why it is needed, and so on), a mentally retarded child needs several times more time than a normal person.
• Narrowness of visual perception. Normally, older children can simultaneously perceive ( notice) up to 12 items. At the same time, patients with oligophrenia can perceive no more than 4-6 objects at the same time.
• Violation of color perception. Children may not be able to distinguish between colors or shades of the same color.
• Violation of touch. If you close your child's eyes and give him a familiar object ( like his personal cup), he can easily recognize her. At the same time, if you give the same cup, but made of wood or other material, the child will not always be able to accurately answer what is in his hands.

Memory disorders

With moderate oligophrenia, the listed violations are more pronounced. The child hardly remembers the information received, and when it is reproduced, it may get confused in dates and other data. At the same time, with deep oligophrenia, the patient's memory is extremely poorly developed. He can recognize the faces of the closest people, can respond to his name or ( rarely) memorize a few words, although he does not understand their meaning.

movement disorders ( motor disorders)

Movement disorders in mentally retarded children can manifest themselves as:

• Slow and clumsy movements. When trying to take an object from the table, the child can bring his hand to it very slowly, clumsily. Such children also move very slowly, they can often stumble, their legs can tangle, and so on.
• Motor restlessness. This is another type of movement disorder, in which the child does not sit still, constantly moves, performs simple movements with his arms and legs. At the same time, his movements are uncoordinated and senseless, sharp and sweeping. During a conversation, such children may accompany their speech with excessively pronounced gestures and facial expressions.
• Violation of coordination of movements. Children with a mild and moderate form of the disease take a long time to learn to walk, to take objects in their hands, to maintain balance in a standing position ( some of them may develop these skills only by adolescence).
• Inability to perform complex movements. Children with mental retardation have considerable difficulty if they need to perform two consecutive, but various movements (for example, toss the ball up and hit it with your hand). The transition from one movement to another is slowed down, as a result of which the ball thrown up will fall, and the child will not “have time” to hit it.
• Violation of fine motor skills. Precise movements requiring increased concentration attention, are given to oligophrenics extremely hard. For a child with mild disease, tying their shoelaces can be a difficult and sometimes impossible task ( he will take hold of the shoelaces, twist them in his hands, try to do something with them, however final goal will never be reached).

Violations of mental functions and behavior

Children with mental retardation may experience:

• Psychomotor agitation. AT this case the child is mobile, can pronounce various incomprehensible sounds and words ( if he knows them), move from side to side, and so on. At the same time, all his movements and actions are devoid of any meaning, disorderly, chaotic.
• impulsive actions. Being in a state of relative rest ( e.g. lying on the couch), the child may suddenly stand up, go to the window, walk around the room, or perform some similar aimless action, and then return to the previous activity ( lie back on the couch).
• stereotypical movement. During training, the child memorizes certain movements ( e.g. waving a hand in greeting), after which it repeats them constantly, even without any obvious need ( for example, when he is himself indoors, when he sees an animal, bird or any inanimate object).
• Repetition of the actions of others. At an older age, children with mild mental retardation may begin to repeat the movements and actions they have just seen ( provided that they are trained in these actions). So, for example, seeing a person who pours water into a cup, the patient can immediately take the cup and also start pouring water for himself. At the same time, due to the inferiority of thinking, he can simply imitate these movements ( while not having a jug of water in hand) or even take a jug and start pouring water on the floor.
• The repetition of the words of others. If the child has a certain vocabulary, he, having heard a word familiar to him, can immediately repeat it. At the same time, unfamiliar or too long words children do not repeat instead, they can make incoherent sounds).
• Complete immobility. Sometimes a child can lie absolutely still for several hours, after which it can also suddenly begin to perform any actions.

Violations of the emotional-volitional sphere

Children with mental retardation may experience:

• Decreased motivation. The child does not show initiative for any actions, does not seek to learn new things, to learn the world and yourself. They do not have any "their" goals or aspirations. Everything they do, they do only according to what they are told by those close to them or those around them. At the same time, they can do absolutely everything that they will be told, since they are not aware of their actions ( cannot critically evaluate them).
• Easy suggestibility. Absolutely all people with oligophrenia are easily influenced by others ( because they cannot distinguish between lies, jokes or sarcasm). If such a child goes to school, classmates may mock him, forcing him to do abnormal things. This can significantly traumatize the child's psyche, leading to the development of deeper mental disorders.
• Slow development of the emotional sphere. Children begin to feel something only by 3 - 4 years or even later.
• Limitation of feelings and emotions. Children with severe illness may experience only primitive feelings ( fear, sadness, joy), while with a deep form of oligophrenia, they may also be absent. At the same time, patients with mild or moderate mental retardation may experience much more feelings and emotions ( can empathize, feel sorry for someone, and so on).
• Chaotic emergence of emotions. Feelings and emotions of oligophrenics can arise and change suddenly, without any apparent reason (the child has just laughed, after 10 seconds he is already crying or behaving aggressively, and in another minute he is laughing again).
• "Surface" feelings. Some children very quickly experience any life joys, hardships and hardships, forgetting about them within a few hours or days.
• "Intense" feelings. The other extreme in mentally retarded children is the over-expressed experience of even the most minor problems ( for example, dropping a mug on the floor, a child may cry because of this for several hours or even days).

Is aggression characteristic of mental retardation?

Children with a severe form of the disease also often show outbursts of anger. They can be aggressive towards others, but harm themselves relatively rarely. Often their aggressive mood can change to the exact opposite ( they become calm, quiet, friendly), but any word, sound or image can again provoke an outbreak of aggression or even rage in them.

With moderate mental retardation, children can also be aggressive towards others. The child may scream at the “offender”, cry, gesticulate menacingly with his hands, but this aggression rarely turns into open form (when a child seeks to harm someone physically). Outbursts of anger can be replaced by other emotions after a few minutes or hours, but in some cases the child may be in a bad mood for a long time ( days, weeks or even months).

With a mild form of oligophrenia, aggressive behavior is extremely rare and is usually associated with some kind of negative emotions, experiences or events. Wherein close person can quickly calm the child ( to do this, you can distract him with something fun, interesting), as a result of which his anger is replaced by joy or another feeling.

Is physical development impaired in children with mental retardation?

At the same time, it is worth noting that physical underdevelopment and developmental anomalies may be associated with the cause of mental retardation itself. So, for example, with oligophrenia caused by alcoholism or drug addiction of the mother, a child can be born with different congenital anomalies, physical deformities, underdevelopment of individual parts of the body, and so on. The same is typical for oligophrenia caused by various intoxications, some genetic syndromes, injuries and irradiation of the fetus with radiation in the early stages of intrauterine development, maternal diabetes, and so on.

As a result of long-term observations, it was noticed that the more severe the degree of oligophrenia, the higher the probability that the child has certain physical anomalies skull development, chest, spine , oral cavity, external genitalia and so on.

Signs of mental retardation in newborns

At the same time, it is worth noting that the identification of certain predisposing factors and symptoms may prompt the doctor to think about the possible mental retardation of the child at the first examination ( immediately after birth).

On the increased likelihood the presence of oligophrenia may indicate:

• Maternal predisposing factors- alcoholism, drug use, the presence of chromosomal syndromes in close relatives ( like other children), diabetes and so on.
• The presence of signs of mental retardation in the mother or father- people with a mild form of the disease can start families and have children, but the risk of having ( their children) oligophrenia increased.
• Newborn skull deformities- with microcephaly ( reduction in the size of the skull) or in congenital hydrocephalus ( an increase in the size of the skull as a result of the accumulation of a large amount of fluid in it) the probability of having mental retardation in a child is close to 100%.
• Congenital developmental anomalies- defects in the limbs, face, oral cavity, chest or other parts of the body can also be accompanied by a severe or deep form of mental retardation.

Diagnosis of mental retardation

Which doctor diagnoses and treats mental retardation?

At the same time, it is worth noting that in almost 100% of cases, oligophrenics have not only mental, but also other disorders ( neurological, sensory organ damage, and so on). In this regard, a psychiatrist never treats a sick child on his own, but constantly sends him for consultations to specialists from other fields of medicine who help him choose the most adequate treatment suitable for each specific case.

When diagnosing and treating a mentally retarded child, a psychiatrist may prescribe a consultation:

• neurologist ( enroll) ;
• defectologist-speech therapist ( enroll) ;
• psychologist ( enroll) ;
• psychotherapist ( enroll) ;
• ophthalmologist ( ophthalmologist) (enroll) ;
• otorhinolaryngologist ( ENT doctor) (enroll) ;
• dermatologist ( enroll) ;
• pediatric surgeon ( enroll) ;
• neurosurgeon ( enroll) ;
• endocrinologist ( enroll) ;
• infectiologist ( enroll) ;
• manual therapist ( enroll) and other specialists.

Methods of examination of a child with mental retardation

When interviewing parents, the doctor may ask:

• Were there mentally retarded children in the family? If among the next of kin there were oligophrenics, the risk of having this disease the child is elevated.
• Did any of the next of kin suffer from chromosomal diseases (Down syndrome, Bardet-Biedl, Klinefelter and so on)?
• Did the mother take any toxins while carrying the baby? If the mother smoked, drank alcohol, or took psychotropic/narcotic drugs, she was at increased risk of having a child with mental retardation.
• Was the mother exposed to radiation during pregnancy? This could also contribute to the development of oligophrenia in a child.
• Does the child's memory suffer? The doctor can ask the baby what he ate for breakfast, what book was read to him at night, or something like that. normal child (able to speak) will easily answer these questions, while it will be difficult for an oligophrenic.
• Does the child have outbursts of aggression? Aggressive, impulsive behavior during which the child can hit other people, including parents) is characteristic of a severe or deep degree of oligophrenia.
• Is the child characterized by frequent and causeless mood swings? This may also indicate the presence of oligophrenia, although it is also observed in a number of other mental disorders.
• Does the child have birth defects development? If yes, which ones and how many?

The examination of the child includes:

• Speech assessment. By the age of 1 year, children should speak at least a few words, and by the age of two they should be able to communicate more or less. Speech impairment is one of the main signs of oligophrenia. To assess speech, the doctor may ask the baby simple questions- how old is he, what grade of school he is in, what are the names of his parents and so on.
• Hearing assessment. The doctor can whisper the child's name, assessing his reaction to this.
• Vision assessment. To do this, the doctor can place a bright object in front of the child's eyes and move it from side to side. Normally, the child should follow a moving object.
• Thinking speed assessment. To test this, the doctor may ask the child a simple question ( for example, what are the names of his parents). A mentally retarded child may be late in answering this question ( after a few tens of seconds).
• Assessment of the ability to concentrate. The doctor can give the child some bright object or picture, call him by name or ask some question that requires a complex answer ( For example, what would the child like to eat for dinner?). For an oligophrenic, it will be extremely difficult to answer this question, since his emotional-volitional sphere is violated.
• Assessment of fine motor skills. For rate this indicator the doctor can give the baby a felt-tip pen and ask him to draw something ( for example the sun). Healthy child will do it easily if you have reached the appropriate age). At the same time, with mental retardation, the child will not be able to complete the task assigned to him ( he can drive a felt-tip pen over paper, draw some lines, but the sun will never draw).
• Assessment of abstract thinking. Older children may be asked by the doctor to describe what the child would do in a fictional situation ( like if he could fly). A healthy child can easily “fantasize” a lot of interesting things, while an oligophrenic child will not be able to cope with the task due to the complete absence of abstract thinking.
• Examination of the child. During the examination, the doctor tries to identify any defects or anomalies in the development, deformation various parts body and other abnormalities that can be observed in severe forms of mental retardation.

What tests may be needed to diagnose mental retardation?

For mental retardation, the doctor may prescribe:

• tests to determine the level of intelligence ( e.g. Wechsler test);
• psychological age tests;
• EEG ( electroencephalogram) (enroll);
• MRI ( magnetic resonance imaging) (enroll).

Tests to determine iq and psychological age in mental retardation ( Wechsler test)

The degree of mental retardation depending on iq

It is worth noting that the healthy people iq must be at least 70 ( ideally over 90).

To determine the iq level, many methods have been proposed, the best of which is the test ( scale) Wexler. The essence of this test is that the subject is asked to solve several tasks ( build a series of numbers or letters, count something, find an extra or missing number / letter, perform certain actions with images, and so on). How more tasks the patient performs correctly, the higher his iq level will be.

In addition to determining iq, the doctor can also determine the psychological age of the patient ( for this there are also many various tests ). Psychological age does not always correspond to biological ( that is, the number of years that have passed since the birth of a person) and allows you to assess the degree of development of the child. The fact is that the psychological maturation of a person occurs as he learns, introduces him into society, and so on. If the child does not learn the basic skills, concepts and rules of behavior in society ( what is typical for mentally retarded children), his psychological age will be below the norm.

The psychological age of the patient depending on the degree of oligophrenia

Consequently, the thinking and behavior of a patient with severe mental retardation corresponds to those of a three-year-old child.

Basic diagnostic criteria for mental retardation

The diagnostic criteria for oligophrenia include:

• Delayed psycho-emotional development and thought processes.
• Decreased iq level.
• Mismatch of biological age with psychological age ( the latter is significantly below the norm).
• Violation of the patient's adaptation in society.
• Behavioral disorders.
• The presence of a cause that led to the development of mental retardation ( not necessary).

Does an EEG show mental retardation?

The essence of the method is as follows. The patient comes to the doctor's office and after a short conversation lies down on the couch. Special electrodes are attached to his head, which will register electrical impulses emitted by brain cells. After installing the sensors, the doctor starts the recording device and leaves the room, leaving the patient alone. In this case, the patient is forbidden to stand up or speak during the entire procedure ( unless the doctor asks for it).

During the study, the doctor can contact the patient using radio communication, ask him to perform certain actions ( raise your arm or leg, touch your finger to the tip of your nose, and so on). Also, in the room in which the patient is located, the light may periodically turn on and off or certain sounds and melodies can be heard. This is necessary in order to assess the reaction of individual sections of the cerebral cortex to external stimuli.

The whole procedure usually lasts no more than an hour, after which the doctor removes the electrodes, and the patient can go home. Received data ( written on special paper) the doctor carefully studies, trying to identify any deviations characteristic of mentally retarded children.

Can an MRI detect mental retardation?

The study is carried out using a special apparatus ( magnetic resonance imaging). The essence of the procedure is as follows. At the appointed time, the patient comes to the clinic where the examination will be carried out. First, he lies down on a special retractable table of the tomograph in such a way that his head is located in a strictly defined place. Next, the table moves to a special compartment of the apparatus, where the study will be carried out. During the entire procedure which can last up to half an hour) the patient must lie absolutely still ( don't move your head, don't cough, don't sneeze). Any movement can distort the quality of the received data. After the procedure is over, the patient can go home immediately.

The essence of the MRI method lies in the fact that during the patient's stay in a special compartment of the apparatus, a strong electromagnetic field is created around his head. As a result, the tissues of various organs begin to radiate a certain energy, which is recorded by special sensors. After processing the received data, the information is presented on the doctor's monitor in the form of a detailed layered image of the brain and all its structures, the bones of the skull, blood vessels and so on. After examining the data obtained, the doctor can identify certain disorders that could cause mental retardation ( for example, lesions of the brain after an injury, a decrease in the mass of the brain, a decrease in the size of certain lobes of the brain, and so on.).

Despite its safety, MRI has a number of contraindications. The main one is the presence of any metal objects in the patient's body ( splinters, dentures, dental crowns and so on). The fact is that magnetic resonance imaging is a strong electromagnet. If a patient is placed in it, in whose body there are metal objects, this can lead to very disastrous consequences ( up to damage internal organs and tissues of the patient).

Differential Diagnosis ( differences) mental retardation and autism, dementia, mental retardation ( mental retardation, borderline mental retardation in preschoolers)

• From autism. Autism is a disease that occurs as a result of underdevelopment of certain structures of the brain. People with autism are withdrawn, do not like to communicate with others and may outwardly resemble mentally retarded patients. At the same time, unlike oligophrenia, autism does not show any pronounced disturbances in thought processes. Moreover, people with autism may have very extensive knowledge of various areas science. Another distinguishing feature is the ability to concentrate. With oligophrenia, children cannot do the same thing for a long time ( they have increased distractibility), while autistic people can sit in the same place for hours, repeating the same action.
• From dementia. Dementia is also characterized by impaired thought processes and the loss of all life skills and abilities. Unlike mental retardation, dementia does not develop in early childhood. Main hallmark is that with mental retardation, a child cannot acquire new knowledge and skills due to brain damage. In dementia, previously healthy ( mentally and psycho-emotionally) a person begins to lose the skills he already had and forget the information that he once knew.
• From ZPR ( delays mental development, borderline mental retardation). ZPR is characterized insufficiently advanced thinking, attention and emotional-volitional sphere in children preschool age (up to 6 years old). The reasons for this may be unfavorable circumstances in the family, lack of attention from parents, social isolation ( lack of communication with peers), psycho-emotional trauma and experiences in early childhood, less often - minor organic lesions of the naked brain. At the same time, the child retains the ability to learn and receive new information However, his mental functions are less developed than those of his peers. Important diagnostic criterion is the fact that the ZPR must be fully completed by the time of admission to the first grade of the school. If, after 7-8 years of life, the child has signs of impaired thinking, they are not talking about mental retardation, but about oligophrenia ( mental retardation).

Mental retardation in children with cerebral palsy

The essence of cerebral palsy lies in the violation motor functions patient associated with damage to his brain in the prenatal period, during childbirth or immediately after birth. There can also be many reasons for the development of cerebral palsy ( trauma, intoxication, fetal oxygen starvation, irradiation, and so on), but all of them contribute to developmental disorders or damage ( destruction) certain parts of the brain.

It should be noted that the same causal factors can lead to the development of oligophrenia. That is why the identification of signs of mental retardation in patients with cerebral palsy is one of the physician's primary tasks.

With a combination of these two pathologies, violations of mental, cognitive and psycho-emotional functions in a child are more pronounced than with isolated oligophrenia. Most often, severe or profound mental retardation occurs, but even with a moderate and mild degree of the disease, patients cannot serve themselves ( due to impaired motor function). That is why any child with cerebral palsy and mental retardation needs permanent care from birth and throughout life. Such children are extremely difficult to learn, and the information they receive is quickly forgotten. Their emotions may be weakly expressed, however, in severe forms of oligophrenia, unreasonable aggression towards others may appear.

Differential diagnosis of alalia and oligophrenia ( mental retardation)

AT medical practice it is customary to distinguish two forms of alalia - motor ( when a person understands the speech of others, but cannot reproduce it) and sensory ( when a person does not understand what they hear). An important feature is the fact that with alalia, the child’s hearing organ is not damaged ( that is, he normally hears the speech of others) and there are no mental disabilities ( that is, he is not mentally retarded). At the same time, speech impairment in oligophrenia is associated with underdevelopment of the hearing organ ( deafness) or with the inability of the child to memorize and reproduce the sounds, words he heard.

The difference between mental retardation and schizophrenia

Childhood schizophrenia is characterized by a severe course accompanied by delirium ( the child says incoherent words or sentences) and hallucinations ( the child sees or hears something that is not really there, in connection with which he may panic, scream in fear or be in unreasonable good mood ). Also, the child may have problems communicating with peers ( children with schizophrenia are closed, have poor contact with others), problems with sleep, with concentration, and so on.

Many of these symptoms also occur in children with mental retardation ( especially in the atonic form of the disease), which greatly complicates differential diagnosis. In this case, schizophrenia may be indicated by such signs as delusions, hallucinations, perversion, or complete absence emotions.

Mental retardation in children, which begins to show symptoms around 3.5 years of age, can be caused by various reasons. The factors for the occurrence of the pathology of intellectual development are diverse, but most often these are:

1. Organic brain damage during childbirth.
2. Cerebral palsy.
3. Genetic metabolic disorders.
4. Down syndrome (translocation or trisomy of 21 pairs of chromosomes).
5. Neuroinfection resulting in extensive damage to neurons (neurosyphilis, tuberculous meningitis, viral encephalitis).
6. Intoxication with heavy metals and other foreign substances, especially at an early age.
7. Hydrocephalus.
8. Endocrinopathy (dysfunction of the thyroid gland).
9. Rubivirus infection during pregnancy (rubella).
10. Coma states caused by prolonged hypoxia of the brain.

With microcephaly, a malformation of intrauterine development, the volume of the brain is reduced, and, accordingly, the number of neurons and connections between them is reduced. Hydrocephalus is swelling of the brain, accompanied by an increase in pressure inside the skull. Hydrostatic pressure damages neurons and can also lead to mental retardation. Transferred infections of the central nervous system in some cases are reflected in mental abilities child.

signs

Signs of mental retardation in children are a weak ability to learn, as well as the absence or weakening of the child's reaction to the words of parents, memory loss, logical thinking. Building connections between events in life is broken.

The perception of information is difficult, which is associated with a violation of the processes of memorization, short-term and long-term memory. Speech, behavioral and hygiene skills are underdeveloped. By school age, it is extremely difficult to master the skills of reading, counting, and writing.

There is a lag in mental development, the course of which can progress, regress or be stable. emotional sphere in young patients, as a rule, it is not affected; children are able to experience both negative and positive emotions. The ability to self-care depends on the degree of mental deficiency of the individual child. There are several degrees of mental disorders.

Mild degree of mental retardation

Mild degree of mental retardation (code F70 according to ICD-10). Such children are characterized by preserved learning ability, but reduced memory potential compared to healthy children. A child with a mild degree of mental retardation may misjudge the actions and feelings of others, making the illness similar to Asperger's syndrome.

Children experience problems in social skills (communication, games with other children) and feel inferior, they are dependent on their parents. The right approach teacher in teaching such a child will improve the prognosis of the disease. Mild mental retardation, the symptoms of which do not interfere with self-service learning, can be corrected in special schools of the 8th type.

As a result, growing children, upon reaching adulthood, are able to work and master the simplest skills of conducting household, letters. Im available physical work and monotonous work without the need to make decisions. Upon reaching the age of 18, the state provides such patients with housing.

moderate mental retardation

Moderate mental retardation (ICD-10 F71) is characterized by less independence from the help of other people than mild mental retardation. However, social skills, when appropriately adjusted, are also instilled, although children remain dependent on parents and guardians.

In adulthood, they are capable of work, mainly physical, which does not require complex coordination of actions. Signs of mental retardation in adult patients: some inhibition of thought processes, slowness in movements, lack of critical thinking.

Severe retardation

In severe cases (ICD code: F72), the patient's speech is limited to a couple of dozen words to express their own needs. There are also movement disorders, gait is discoordinated. The process of memorizing surrounding objects is difficult and requires repeated repetition. Counting skills are taught visible objects. Upon reaching adulthood, people are not able to fully take responsibility for themselves and need care provided by neuropsychiatric boarding schools.

Profound mental impairment (F73) may present with severe movement disorders. Patients lag behind in physical development, their speech is not formed. Children often suffer from enuresis. In adulthood, care for such patients is carried out by psycho-neurological boarding schools.

Diagnostics

Mental retardation, the symptoms of which are similar to those of other diseases of the psycho-intellectual sphere, needs differential diagnosis with such diseases as:

• Asperger's syndrome;
• socio-pedagogical neglect (Mowgli's syndrome) and intense psychotrauma;
• hepatic encephalopathy.

How to determine mental retardation in a child? Psychoneurologists use various methods to test the intellectual abilities of the child: assessment of household skills, social adaptation. The history of pregnancy (, rubella in the mother), past neuroinfections, traumatic brain injuries are being studied.

A test for mental retardation (IQ) is carried out, which determines the intelligence quotient in points. The child's perception is assessed artistic images in pictures, learning abilities, incl. to counting and speech, the state of mental development of the child. The degree of coordination of movements is analyzed.