Clinical psychiatry of early childhood. Psychiatry for the little ones

Mental retardation (MPD) is such a violation of normal development, in which a child who has reached school age continues to remain in the circle of preschool, play interests. The concept of "delay" emphasizes the temporary (discrepancy between the level of development and age) and, at the same time, the temporary nature of the lag, which with age is overcome the more successfully, the earlier adequate conditions for the education and development of children in this category are created.

In the psychological and pedagogical, as well as medical literature, other approaches are used to the category of students under consideration: "children with learning disabilities", "lagging behind in learning", "nervous children". However, the criteria on the basis of which these groups are distinguished do not contradict the understanding of the nature of the delay. mental development. In accordance with one socio-pedagogical approach, such children are called "children at risk" (G.F. Kumarina).

History of study.

The problem of mild deviations in mental development arose and acquired special significance, both in foreign and domestic science, only in the middle of the 20th century, when, due to the rapid development of various fields of science and technology and the complication of programs of general education schools, a large number of children appeared who had difficulties in learning. Teachers and psychologists attached great importance to the analysis of the causes of this poor progress. Quite often, it was explained by mental retardation, which was accompanied by the direction of such children in auxiliary schools, which appeared in Russia in 1908-1910.

However, during clinical examination, more and more often, in many of the children who poorly mastered the program of a general education school, it was not possible to detect the specific features inherent in mental retardation. In the 50s - 60s. this problem acquired special significance, as a result of which, under the guidance of M.S. Pevzner, a student of L.S. Vygotsky, a specialist in the field of clinic mental retardation, a comprehensive study of the causes of underachievement was launched. The sharp increase in academic failure against the background of the increasing complexity of training programs led her to assume the existence of some form of mental insufficiency, which manifests itself in conditions of increased educational requirements. A comprehensive clinical, psychological and pedagogical examination of persistently underachieving students from schools in various regions of the country and the analysis of a huge amount of data formed the basis of the formulated ideas about children with mental retardation (MPD).

This is how a new category of anomalous children appeared who were not subject to being sent to an auxiliary school and made up a significant part (about 50%) of the underachieving students of the general education system. The work of M.S. Pevzner "Children with developmental disabilities: the delimitation of oligophrenia from similar conditions" (1966) and the book "To the teacher about children with developmental disabilities", written jointly with T.A. Vlasova (1967), are the first in a series psychological and pedagogical publications devoted to the study and correction of mental retardation.

Thus, a complex of studies of this developmental anomaly, begun at the Research Institute of Defectology of the Academy of Medical Sciences of the USSR in the 1960s. under the leadership of T.A. Vlasova and M.S. Pevzner, was dictated by the urgent needs of life: on the one hand, the need to establish the causes of failure in public schools and find ways to combat it, on the other hand, the need to further differentiate mental retardation and other clinical disorders cognitive activity.

Comprehensive psychological and pedagogical studies of children diagnosed with mental retardation over the next 15 years made it possible to accumulate a large amount of data characterizing the originality of the mental development of children in this category. According to all studied indicators of psychosocial development, children of this category are qualitatively different from other dysontogenetic disorders, on the one hand, and from "normal" development, on the other, occupying an intermediate position between mentally retarded and normally developing peers in terms of the level of mental development. So, according to the level of intellectual development, diagnosed using the Wechsler test, children with mental retardation often find themselves in the zone of the so-called borderline mental retardation (IQ from 70 to 90 conventional units).

According to the International Classification, mental retardation is defined as "a general disorder of psychological development."

In foreign literature, children with mental retardation are considered either from purely pedagogical positions and are usually described as children with learning difficulties, or are defined as unadapted, mainly due to unfavorable living conditions, pedagogically neglected, subjected to social and cultural deprivation. This group of children also includes children with behavioral disorders. Other authors, according to the idea that developmental delay, manifested in learning difficulties, is associated with residual (residual) organic brain damage, children in this category are called children with minimal brain damage or children with minimal (mild) brain dysfunction. To describe children with specific partial learning difficulties, the term "children with attention deficit hyperactivity disorder" - ADHD syndrome - is widely used.

Despite the rather large heterogeneity related to this type of dysontogenetic disorders, they can be given the following definition.

Children with mental retardation include children who do not have pronounced developmental disabilities (mental retardation, severe speech underdevelopment, pronounced primary deficiencies in the functioning of individual analyzer systems - hearing, vision, motor system). Children of this category experience difficulties in adaptation, including school, due to various biosocial reasons (residual effects of mild damage to the central nervous system or its functional immaturity, somatic weakness, cerebrasthenic conditions, immaturity of the emotional-volitional sphere by the type of psychophysical infantilism, as well as pedagogical neglect as a result of unfavorable socio-pedagogical conditions in the early stages of the child's ontogenesis). The difficulties experienced by children with mental retardation may be due to shortcomings both in the regulatory component of mental activity (lack of attention, immaturity of the motivational sphere, general cognitive passivity and reduced self-control), and in its operational component (reduced level of development of individual mental processes, motor disorders, performance disorders). The characteristics listed above do not prevent children from mastering general educational development programs, but necessitate their certain adaptation to the psychophysical characteristics of the child.

With the timely provision of a system of correctional and pedagogical, and in some cases, medical care, it is possible to partially, and sometimes even completely overcome this deviation in development.

For the mental sphere of a child with mental retardation, a combination of deficient and intact functions is typical. Partial (partial) deficiency of higher mental functions may be accompanied by infantile personality traits and behavior of the child. At the same time, in some cases, the child suffers from working capacity, in other cases - arbitrariness in the organization of activities, in the third - motivation for various types of cognitive activity, etc.

Mental retardation in children is a complex polymorphic disorder in which different children suffer from different components of their mental, psychological and physical activity.

In order to understand what is the primary violation in the structure of this deviation, it is necessary to recall the structural and functional model of the brain (according to A. R. Luria). In accordance with this model, three blocks are distinguished - energy, a block for receiving, processing and storing information, and a block for programming, regulation and control. Harmonious work of these three blocks ensures the integrative activity of the brain and the constant mutual enrichment of all its functional systems.

It is known that in childhood, functional systems with a short time period of development show a tendency to damage to a greater extent. This is typical, in particular, for the systems of the medulla oblongata and midbrain. The signs of functional immaturity are shown by systems with a longer postnatal period of development - tertiary fields of analyzers and formations of the frontal region. Since the functional systems of the brain mature heterochronously, a pathogenic factor that acts at different stages of the prenatal or early postnatal period of a child's development can cause a complex combination of symptoms, both mild damage and functional immaturity of various parts of the cerebral cortex.

Subcortical systems provide the optimal energy tone of the cerebral cortex and regulate its activity. With non-functional or organic inferiority, neurodynamic disorders occur in children - lability (instability) and exhaustion of mental tone, impaired concentration, balance and mobility of excitation and inhibition processes, phenomena of vegetative-vascular dystonia, metabolic and trophic disorders, affective disorders. (ten)

The tertiary fields of the analyzers relate to the block for receiving, processing and storing information coming from the external and internal environment. Morpho-functional dysfunction of these areas leads to deficiency of modal-specific functions, which include praxis, gnosis, speech, visual and auditory memory.

Formations of the frontal area belong to the block of programming, regulation and control. Together with the tertiary zones of the analyzers, they carry out a complex integrative activity of the brain - they organize the joint participation of various functional subsystems of the brain to build and implement the most complex mental operations, cognitive activity and conscious behavior. The immaturity of these functions leads to the emergence of mental infantilism in children, the unformedness of arbitrary forms of mental activity, and to disturbances in interanalyzer cortical-cortical and cortical-subcortical connections.

Structural-functional analysis shows that in case of mental retardation, both individual above-mentioned structures and their main functions in various combinations can be primary impaired. In this case, the depth of damage and (or) the degree of immaturity may be different. This is what determines the variety of mental manifestations found in children with mental retardation. A variety of secondary stratifications further enhance the within-group dispersion within a given category.

Causes of mental retardation.

The causes of mental retardation are manifold. The risk factors for the development of mental retardation in a child can be conditionally divided into main groups: biological and social.

Among the biological factors, two groups are distinguished: biomedical and hereditary.

Medical and biological causes include early organic lesions of the central nervous system. Most children have a history of a burdened perinatal period, associated primarily with the unfavorable course of pregnancy and childbirth.

According to neurophysiologists, active growth and maturation of the human brain is formed in the second half of pregnancy and the first 20 weeks after birth. The same period is critical, since the structures of the central nervous system become most sensitive to pathogenic influences that retard growth and prevent the active development of the brain.

Risk factors for intrauterine pathology include:

Elderly or very young mother,

The burden of the mother with chronic somatic or obstetric pathology before or during pregnancy.

All this can manifest itself in low birth weight of the child, in syndromes of increased neuro-reflex excitability, in sleep and wakefulness disorders, in increased muscle tone in the first weeks of life.

Often, mental retardation may be due to infectious diseases in infancy, traumatic brain injuries, severe somatic diseases.

A number of authors distinguish hereditary factors of mental retardation, which include congenital and including hereditary inferiority of the child's central nervous system. It is often observed in children with delayed cerebro-organic genesis, with minimal brain dysfunction. For example, according to clinicians, 37% of patients diagnosed with MMD have siblings, cousins, and parents with signs of MMD. In addition, 30% of children with locomotor defects and 70% of children with speech defects have relatives with similar disorders in the female or male line.

The literature emphasizes the predominance of boys among patients with mental retardation, which can be explained by a number of reasons:

Higher vulnerability of the male fetus in relation to pathological effects during pregnancy and childbirth;

A relatively lower degree of functional interhemispheric asymmetry in girls compared to boys, which leads to a greater reserve of compensatory capabilities in case of damage to brain systems that provide higher mental activity.

Most often in the literature there are indications of the following unfavorable psychosocial conditions that exacerbate mental retardation in children. It:

unwanted pregnancy;

Single mother or upbringing in incomplete families;

Frequent conflicts and inconsistency of approaches to education;

The presence of a criminal environment;

Low level of education of parents;

Living in conditions of insufficient material security and dysfunctional life;

Factors of a big city: noise, long commute to and from work, unfavorable environmental factors.

Features and types of family education;

Early mental and social deprivation of the child;

Prolonged stressful situations in which the child is, etc.

However, a combination of biological and social factors plays an important role in the development of ZPR. For example, an unfavorable social environment (outside and inside the family) provokes and exacerbates the influence of residual organic and hereditary factors on the intellectual and emotional development of the child.

Indicators of the frequency of mental retardation in children are heterogeneous. For example, according to the Russian Ministry of Education (1997), over 60% of first-graders are at risk of school, somatic and psychophysical maladaptation. Of these, about 35% are those who already had obvious disorders of the neuropsychic sphere already in the younger groups of the kindergarten.

The number of primary school students who do not cope with the requirements of the standard school curriculum has increased by 2-2.5 times over the past 20 years, reaching 30% or more. According to medical statistics, the deterioration in the health of students over 10 years of study (in 1994, only 15% of school-age children were recognized as healthy) becomes one of the reasons for the difficulties in their adaptation to school workloads. The intense regime of school life leads to a sharp deterioration in the somatic and psycho-neurological health of a weakened child.

The prevalence of mental retardation, according to clinicians, ranges from 2 to 20% in the population, according to some reports, it reaches 47%.

This variation is primarily due to the lack of unified methodological approaches to the formulation of the diagnosis of mental retardation. With the introduction of a comprehensive medical and psychological system for diagnosing mental retardation, its prevalence rates are limited to 3-5% among the child population. (5;6)

Clinical and psychological features of children with mental retardation.

Clinical characteristics of mental retardation.

In the clinical and psychological-pedagogical literature, several classifications of mental retardation are presented.

The outstanding child psychiatrist G. E. Sukhareva, studying children suffering from persistent school failure, emphasized that the disorders diagnosed in them must be distinguished from mild forms of mental retardation. In addition, as the author noted, mental retardation should not be identified with a delay in the rate of mental development. Mental retardation is a more persistent intellectual disability, while mental retardation is a reversible condition. Based on the etiological criterion, that is, the causes of the onset of ZPR, G. E. Sukhareva identified the following forms:

intellectual deficiency due to adverse environmental conditions, upbringing or pathology of behavior;

intellectual disorders during prolonged asthenic conditions caused by somatic diseases;

intellectual disturbances in various forms of infantilism;

secondary intellectual insufficiency due to damage to hearing, vision, defects in speech, reading and writing;

5) functional-dynamic intellectual impairments in children in the residual stage and the remote period of infections and injuries of the central nervous system. (25)

The studies of M. S. Pevzner and T. A. Vlasova made it possible to distinguish two main forms of mental retardation

mental retardation due to mental and psychophysical infantilism (uncomplicated and complicated underdevelopment of cognitive activity and speech, where the main place is occupied by underdevelopment of the emotional-volitional sphere)

mental retardation due to prolonged asthenic and cerebrosthenic conditions. (eighteen)

VV Kovalev distinguishes four main forms of ZPR. (5)

dysontogenetic form of mental retardation, in which the insufficiency is due to the mechanisms of delayed or distorted mental development of the child;

encephalopathic form of mental retardation, which is based on organic damage to brain mechanisms in the early stages of ontogenesis;

ZPR due to underdevelopment of analyzers (blindness, deafness, underdevelopment of speech, etc.), due to the action of the mechanism of sensory deprivation;

ZPR caused by defects in education and information deficit with early childhood(pedagogical neglect).

Table. Classification of forms of borderline forms of intellectual insufficiency according to V.V. Kovalev

Classification V.V. Kovaleva has great importance in the diagnosis of children and adolescents with mental retardation. However, it must be taken into account that the author considers the problem of mental retardation not as an independent nosological group, but as a syndrome in various forms of dysontogenesis (cerebral palsy, speech impairment, etc.).

The most informative for psychologists and teachers is the classification of K.S. Lebedinskaya. On the basis of a comprehensive clinical, psychological and pedagogical study of underachieving junior schoolchildren, the author developed a clinical systematics of mental retardation.

As well as the classification of V.V. Kovalev, classification by K.S. Lebedinskaya is based on the etiological principle and includes four main options for mental retardation: (6)

Mental retardation of constitutional origin;

Delayed mental development of somatogenic origin;

Delayed mental development of psychogenic origin;

Delayed mental development of cerebral-organic genesis.

Each of these types of mental retardation has its own clinical and psychological structure, its own characteristics of emotional immaturity and cognitive impairment, and is often complicated by a number of painful symptoms - somatic, encephalopathic, neurological. In many cases, these painful signs cannot be regarded only as complicating, since they play a significant pathogenetic role in the formation of the ZPR itself.

The presented clinical types of the most persistent forms of mental retardation mainly differ from each other precisely in the peculiarity of the structure and the nature of the ratio of the two main components of this developmental anomaly: the structure of infantilism and the features of the development of mental functions.

Clinical and psychological characteristics of children with mental retardation

Mental retardation of constitutional origin

Mental retardation of constitutional origin is diagnosed in children with manifestations of mental and psychophysical infantilism. In the psychological literature, it means developmental retardation, manifested by the preservation in the adult state of the physical structure or character traits inherent in childhood.

The prevalence of mental infantilism, according to some authors, is 1.6% among the child population.

Its causes are most often relatively mild brain damage: infectious, toxic, and others, including trauma and fetal asphyxia.

In clinical practice, two forms of mental infantilism are distinguished: simple and complicated. In further studies, four of its main variants were identified: harmonic (simple), disharmonic, organic and psychogenic infantilism.

Harmonic (simple) infantilism is manifested in a uniform delay in the pace of physical and mental development of the individual, which is expressed in the immaturity of the emotional-volitional sphere that affects the behavior of the child and his social adaptation. The name "harmonic infantilism" was proposed by G.E. Sukhareva. (25; 26)

His clinical picture is characterized by features of immaturity, "childhood" in somatic and mental form. Children in growth and physical development lag behind their peers by 1.5-2 years, they are characterized by lively facial expressions, expressive gestures, fast, jerky movements. At the forefront is tirelessness in the game and fatigue when performing practical tasks. Especially quickly they get bored with monotonous tasks that require holding focused attention for quite a long time (drawing, counting, reading, writing). With a full-fledged intellect, insufficiently expressed interests in writing, reading, and counting are noted.

Children are characterized by a weak ability to mental stress, increased imitation, suggestibility. However, by the age of 6-7, the child already understands and regulates his behavior quite well, depending on the need to perform this or that work.

Children with infantile behavioral traits are dependent and uncritical of their behavior. In the classroom, they “turn off” and do not complete assignments. They may cry over trifles, but quickly calm down when switching attention to a game or something that gives them pleasure. They like to fantasize, replacing and displacing life situations that are unpleasant for them with their fictions.

Disharmonious infantilism may be associated with endocrine diseases. So, with insufficient production of the hormone of the adrenal glands and hormones of the gonads at the age of 12-13 years, there may be a delay in puberty in both boys and girls. At the same time, peculiar features of the psyche of a teenager are formed, characteristic of the so-called hypogenital infantilism. More often, the features of immaturity are manifested in boys. Adolescents are slow, get tired quickly, performance is very uneven - higher in the morning. Memory loss is detected. Attention quickly dissipates, so the student makes many mistakes. The interests of adolescents with a hypogenital form of infantilism are peculiar: for example, boys are more interested in quiet activities. Motor skills and abilities are not well developed, they are clumsy, slow and clumsy. These children with good intellect are distinguished by great erudition, but they cannot always use their knowledge in the classroom, as they are very absent-minded and inattentive. Prone to fruitless discussions on any topic. They are very touchy, painfully experiencing their failures in school and difficulties in communicating with peers. I feel better in the society of adults, where they are known as erudite. Signs of hypogenital infantilism in the appearance of a teenager are not tall, fullness, a “moon-shaped” face, and a squeaky voice.

Endocrine forms of infantilism also include pituitary dwarfism (dwarfism). In such children, there is a combination of signs of an immature child's psyche with features of old-fashionedness, pedantry, a tendency to reasoning and instructing. School failure is often the result of weakness of willpower, slowness, attention and logical memory disorders. The child cannot long time concentrate, get distracted, which often leads to errors in tasks. He slowly learns new material, but, having mastered it, he operates well with the rules, the multiplication table, reads at a sufficient pace, and has a good mechanical memory. Children suffering from pituitary dwarfism show some lack of independence, require the guardianship of elders. Sometimes these children experience adverse reactions: a persistent decrease in mood, sleep disturbance, limited communication with peers, reduced academic performance, refusal to attend school. If this condition does not go away after a short period of time, it is necessary to contact a neuropsychiatrist.

The neuropathic variant of complicated infantilism is characterized by the presence of weak mental traits. Usually these children are very timid, timid, dependent, overly attached to their mother, difficult to adapt in children's educational institutions. Such children from birth fall asleep with great difficulty, having restless sleep. Timid, shy by nature, it is difficult for them to get used to the children's team. In class, they are very passive, do not answer questions in front of strangers. In their intellectual abilities, they are sometimes ahead of their peers, but they do not know how to show their knowledge - there is uncertainty in the answers, which worsens the teacher's understanding of their true knowledge. These children often have a fear of a verbal answer. Their performance is quickly depleted. Infantilism also manifests itself in complete practical ineptitude. Motor skills are marked by angularity and slowness.

Against the background of these mental traits, so-called school neuroses may arise. The child is reluctant to attend school. Any somatic disease is met with joy, as it becomes possible to stay at home. This is not laziness, but the fear of separation from the familiar environment, mother. The difficulty of adapting to school leads to a decrease in the assimilation of educational material, memory and attention deteriorate. The child becomes lethargic and distracted.

Psychogenic infantilism, as a special variant of infantilism, has not been sufficiently studied in domestic psychiatry and psychology. This option is considered as an expression of the abnormal formation of personality in the conditions of improper upbringing. (5) It usually happens in families where there is one child who is taken care of by several adults. This often prevents the child from developing independence, will, skills, and then the desire to overcome the slightest difficulties.

With normal intellectual development, such a child learns unevenly, because he is not accustomed to work, does not want to independently perform and check tasks.

Adaptation in the team of this category of children is difficult due to such character traits as selfishness, opposing oneself to the class, which leads not only to conflict situations, but also to the development of a neurotic state in the child.

Special attention should be given to children with so-called microsocial neglect. These children have an insufficient level of development of skills, abilities and knowledge against the background of a full-fledged nervous system due to a long stay in conditions of a lack of information, not only intellectual, but also very often emotional. Not favorable conditions upbringing (with chronic alcoholism of parents, in conditions of neglect, etc.) cause a slow formation of the communicative-cognitive activity of children at an early age. L.S. Vygotsky repeatedly emphasized that the process of formation of the child's psyche is determined by the social situation of development, which is understood as the relationship between the child and the social reality surrounding him. (2; 3) In dysfunctional families, the child experiences a lack of communication. This problem arises with all its acuteness at school age in connection with school adaptation. With intact intellect, these children cannot independently organize their activities: they experience difficulties in planning and isolating its stages, they cannot adequately evaluate the results. There is a pronounced violation of attention, impulsivity, lack of interest in improving their performance. Tasks are especially difficult when it is necessary to perform them according to verbal instructions. On the one hand, they experience increased fatigue, and on the other hand, they are very irritable, prone to affective outbursts and conflicts.

With appropriate training, children with infantilism are able to receive secondary or incomplete secondary education, they have access to vocational education, secondary special education and even higher education. However, in the presence of unfavorable environmental factors, negative dynamics are possible, especially in complicated infantilism, which can manifest itself in the mental and social maladjustment of children and adolescents.

So, if we evaluate the dynamics of the mental development of children with infantilism as a whole, then it is predominantly favorable. As experience shows, the manifestation of pronounced personal emotional-volitional immaturity tends to decrease with age.

Delayed mental development of somatogenic origin

The causes of this type of mental retardation are various chronic diseases, infections, childhood neuroses, congenital and acquired malformations. somatic system. With this form of mental retardation, children may have a persistent asthenic manifestation, which reduces not only the physical status, but also the psychological balance of the child. Children are inherent fearfulness, shyness, self-doubt. Children of this category of ZPR do not communicate much with their peers because of the guardianship of parents who try to protect their children from unnecessary, in their opinion, communication, so they have a low threshold for interpersonal relationships. With this type of mental retardation, children need treatment in special sanatoriums. Further development and education of these children depends on their state of health.

Delayed mental development of psychogenic origin

Its appearance is due to unfavorable conditions of upbringing and education, which prevent the correct formation of the child's personality. We are talking about the so-called social genesis, when unfavorable conditions of the social environment arise very early, have a long-term effect, traumatizing the child's psyche, accompanied by psychosomatic disorders, vegetative disorders. K. S. Lebedinskaya emphasizes that this type of mental retardation should be distinguished from pedagogical neglect, which is largely due to shortcomings in the process of teaching a child in kindergarten or school. (6)

The development of the personality of a child with mental retardation of psychogenic origin goes according to the main three options.

The first option is mental instability arising as a result of hypoprotection. The child is brought up in conditions of neglect. The shortcomings of education are manifested in the absence of a sense of duty, responsibility, adequate forms of social behavior, when, for example, in difficult situations, he fails to cope with affect. The family as a whole does not stimulate the mental development of the child, does not support his cognitive interests. Against the background of insufficient knowledge and ideas about the surrounding reality, which hinders the assimilation of school knowledge, these children show the features of pathological immaturity of the emotional and volitional spheres: affective lability, impulsiveness, increased suggestibility.

The second option - in which hyper-custody is expressed - pampering education, when the child does not instill the traits of independence, initiative, responsibility, conscientiousness. Often this happens with late born children. Against the background of psychogenic infantilism, in addition to the inability to volitional effort, the child is characterized by egocentrism, unwillingness to work systematically, installation on constant help, and the desire to always be warded.

The third option is an unstable parenting style with elements of emotional and physical abuse in the family. Its occurrence is provoked by the parents themselves, who are rude and cruel to the child. One or both parents can be despotic, aggressive towards their own son or daughter. Against the background of such intra-family relationships, pathological personality traits of a child with mental retardation are gradually formed: timidity, fearfulness, anxiety, indecision, lack of independence, lack of initiative, deceit, resourcefulness and, often, insensitivity to someone else's grief, which leads to significant problems of socialization.

Delay of mental development of cerebral-organic genesis. The last among the considered type of mental retardation occupies the main place within the boundaries of this deviation. It occurs most often in children, and it also causes the most pronounced disturbances in children in their emotional-volitional and cognitive activity in general.

This type combines signs of immaturity of the child's nervous system and signs of partial damage to a number of mental functions. She distinguishes two main clinical and psychological options for mental retardation of cerebral-organic origin.

In the first variant, features of the immaturity of the emotional sphere predominate according to the type of organic infantilism. If encephalopathic symptoms are noted, they are represented by mild cerebrasthenic and neurosis-like disorders. At the same time, higher mental functions are not sufficiently formed, exhausted and deficient in the control of voluntary activity.

In the second variant, damage symptoms dominate: “there are persistent encephalopathic disorders, partial disturbances of cortical functions and severe neurodynamic disorders (inertness, tendency to perseveration). The regulation of the mental activity of the child is violated not only in the field of control, but also in the field of programming cognitive activity. This leads to a low level of mastery of all types of voluntary activity. The child delays the formation of object-manipulative, speech, play, productive and educational activities.

The prognosis of mental retardation of cerebral-organic genesis largely depends on the state of higher cortical functions and the type of age-related dynamics of its development. As I.F. Markovskaya, with the predominance of general neurodynamic disorders, the prognosis is quite favorable. (11) When they are combined with a pronounced deficiency of individual cortical functions, a massive psychological and pedagogical correction is necessary, carried out in a specialized kindergarten. Primary persistent and extensive disorders of programming, control and initiation of arbitrary types of mental activity require their differentiation from mental retardation and other serious mental disorders.

Differential diagnosis of mental retardation and similar conditions

Many domestic scientists dealt with the issues of differential diagnosis of mental retardation and conditions similar to it (M. S. Pevzner, G. E. Sukhareva, I. A. Yurkova, V. I. Lubovsky, S. D. Zabramnaya, E. M. Mastyukova, G. B. Shaumarov, O. Monkevicienė, K. Novakova and others).

In the early stages of a child's development, it is difficult to distinguish between cases of gross speech underdevelopment, motor alalia, oligophrenia, mutism, and delayed speech development.

It is especially important to distinguish between mental retardation and mental retardation of cerebral-organic genesis, since in both cases, children have deficiencies in cognitive activity in general and pronounced deficiencies in modal-specific functions.

Let us dwell on the main distinguishing features that are significant for distinguishing between mental retardation and mental retardation.

1. For violations of cognitive activity in mental retardation, partiality, mosaicism in the development of all components of the child's mental activity are characteristic. With mental retardation, there is a totality and hierarchy of violations of the mental activity of the child. A number of authors use such a definition as "diffuse, diffuse damage" to the cerebral cortex to characterize mental retardation.

2. In comparison with mentally retarded children, children with mental retardation have much higher potential for the development of their cognitive activity, and especially higher forms of thinking - generalization, comparison, analysis, synthesis, abstraction, abstraction. However, it must be remembered that some children with mental retardation, like their mentally retarded peers, find it difficult to establish causal relationships and have imperfect generalization functions.

3. The development of all forms of mental activity of children with mental retardation is characterized by the spasmodic nature of its dynamics. While in mentally retarded children this phenomenon has not been experimentally detected.

In contrast to mental retardation, in which mental functions proper suffer - generalization, comparison, analysis, synthesis - with mental retardation, the prerequisites for intellectual activity suffer. These include such mental processes as attention, perception, the sphere of images-representations, visual-motor coordination, phonemic hearing, and others.

When examining children with mental retardation in conditions that are comfortable for them and in the process of purposeful upbringing and education, children are able to fruitfully cooperate with adults. They accept the help of an adult and even the help of a more advanced peer. This support is even more effective if it is in the form of play tasks and is focused on the child's involuntary interest in the activities being carried out.

Game presentation of tasks increases the productivity of children with mental retardation, while for mentally retarded preschoolers it can serve as a reason for the child to slip off the task involuntarily. This happens especially often if the proposed task is at the limit of the capabilities of a mentally retarded child.

Children with mental retardation have an interest in object-manipulative and play activities. The play activity of children with mental retardation, in contrast to that of mentally retarded preschoolers, is more emotional in nature. The motives are determined by the goals of the activity, the ways to achieve the goal are chosen correctly, but the content of the game is not developed. It lacks its own design, imagination, the ability to present the situation mentally. Unlike normally developing preschoolers, children with mental retardation do not move to the level of a role-playing game without special training, but “get stuck” at the level of a story-based game. At the same time, their mentally retarded peers remain at the level of subject-play actions.

Children with mental retardation are characterized by a greater brightness of emotions, which allows them to concentrate for a longer time on tasks that are of direct interest to them. At the same time, the more the child is interested in completing the task, the higher the results of his activity. This phenomenon is not observed in mentally retarded children. The emotional sphere of mentally retarded preschoolers is not developed, and the excessively playful presentation of tasks (including during a diagnostic examination), as already mentioned, often distracts the child from solving the task itself and makes it difficult to achieve the goal.

The majority of children with mental retardation of preschool age master visual activity to varying degrees. In mentally retarded preschoolers without special training, visual activity does not occur. Such a child stops at the level of presuppositions of objective representations, i.e., at the level of scribbling. At best, some children have graphic stamps - schematic images of houses, "cephalopod" images of a person, letters, numbers randomly scattered over the plane of a sheet of paper.

In the somatic appearance of children with mental retardation, there is basically no dysplasticity. While in mentally retarded preschoolers it is observed quite often.

In the neurological status of children with mental retardation, there are usually no gross organic manifestations, which is typical for mentally retarded preschoolers. However, even in children with a delay, neurological microsymptoms can be seen: a venous network expressed on the temples and bridge of the nose, slight asymmetry of facial innervation, hypotrophy of certain parts of the tongue with its deviation to the right or left, revival of tendon and periosteal reflexes.

Pathological hereditary burden is more typical for the anamnesis of mentally retarded children and is practically not observed in children with mental retardation.

Of course, that's not all features taken into account when distinguishing between mental retardation and mental retardation. Not all of them are equal in their importance. However, knowledge of these aforementioned signs allows one to clearly differentiate both states under consideration.

Sometimes it is necessary to differentiate between mental retardation and a mild degree of organic dementia. With mental retardation, there is no such disorder of activity, personal decay, gross non-criticality and complete loss of functions that are noted in children with organic dementia, which is a differential sign.

Of particular difficulty is the distinction between mental retardation and severe speech disorders of cortical origin (motor and sensory alalia, early childhood aphasia). These difficulties are due to the fact that in both conditions there are similar external signs and the primary defect should be distinguished - whether it is a speech disorder or intellectual deficiency. This is difficult, since both speech and intellect belong to the cognitive sphere of human activity. In addition, they are inextricably linked in their development. Even in the works of L. S. Vygotsky, when indicating the age of 2.5-3 years, it is said that it is during this period that “speech becomes meaningful, and thinking becomes speech”. (2; 3)

Therefore, if a pathogenic factor acts during these periods, it always affects both of these areas of the child's cognitive activity. But even in the early stages of a child's development, a primary lesion can delay or disrupt the development of cognitive activity as a whole.

For differential diagnosis, it is important to know that a child with motor alalia, unlike a child with mental retardation, is characterized by extremely low speech activity. When trying to make contact with him, he often shows negativism. In addition, it must be remembered that with motor alalia, sound pronunciation and phrasal speech suffer most of all, and the possibilities of mastering the norms of the native language are permanently violated. Communication difficulties in a child are growing more and more as, with age, speech activity requires more and more automation of the speech process. (13)

Difficulties for diagnosis are the distinction between mental retardation and autism. A child with early childhood autism (EAA) usually has impairments in all forms of pre-verbal, non-verbal, and verbal communication. From a child with mental retardation, such a baby differs in inexpressive facial expressions, lack of eye contact (“eye to eye”) with the interlocutor, excessive shyness and fear of novelty. In addition, in the actions of children with RDA, there is a pathological stuck on stereotyped movements, refusal to act with toys, unwillingness to cooperate with adults and children.

Conclusion. Mental retardation (MPD) is one of the most common forms of mental disorders. This is a violation of the normal pace of mental development. The term "delay" emphasizes the temporary nature of the disorder, that is, the level of psychophysical development as a whole may not correspond to the passport age of the child.(1)

Specific manifestations of mental retardation in a child depend on the causes and time of its occurrence, the degree of deformation of the affected function, and its significance in the general system of mental development.

Thus, it is possible to single out the following most important groups of causes that can cause CRA:

Causes of a biological nature that prevent the normal and timely maturation of the brain;

A general lack of communication with others, causing a delay in the child's assimilation of social experience;

The absence of a full-fledged, age-appropriate activity that gives the child the opportunity to “appropriate” social experience, the timely formation of internal mental actions;

Social deprivation that prevents timely mental development.

All deviations in such children from the side of the nervous system are variable and diffuse and are temporary. In contrast to mental retardation, with mental retardation, there is a reversibility of an intellectual defect.

This definition reflects both biological and social factors of the emergence and deployment of such a state in which the full development of the organism is difficult, the formation of a personally developed individual is delayed, and the formation of a socially mature personality is ambiguous.

Sometimes students are difficult to teach and nurture, and main reason this is served by a special, in contrast to the norm, state of the mental development of the individual, which has received the name in defectology "mental retardation" (ZPR). Every second chronically underachieving child has a ZPR.

The essence of the disease

AT general view this state is characterized by a slow development of thinking, memory, perception, attention, speech, emotional-volitional aspect. Due to the limitation in mental and cognitive abilities, the child is not able to successfully fulfill the tasks and requirements imposed on him by society. For the first time, these limitations are clearly manifested and noticed by adults when the child comes to school. He cannot conduct stable purposeful activity, he is dominated by play interests and play motivation, while there are pronounced difficulties in distributing and switching attention. Such a child is not able to make mental efforts and strain when performing serious tasks, which quickly leads to school failure in one or more subjects.

The study of students with mental retardation showed that the basis of school difficulties is not intellectual insufficiency, but impaired mental performance. This is manifested in the difficulties of long-term concentration on cognitive tasks, in the low productivity of activity during the study period, in excessive fussiness or lethargy, and in disturbances in switching attention. Children with mental retardation have a qualitatively different structure of the defect, unlike children, in their violation there is no totality in the underdevelopment of mental functions. Children with mental retardation better accept the help of adults and are able to transfer the shown mental techniques to a new, similar task. Such children need to be provided with comprehensive assistance from psychologists and teachers, which includes an individual approach to learning, classes with a teacher of the deaf, a psychologist, along with drug therapy.

Developmental delay has a form determined by heredity. For children with this type of mental retardation, a harmonious immaturity of the physique and at the same time the psyche is characteristic, which indicates the presence of harmonic psychophysical infantilism. The mood of such a child is mostly positive, he quickly forgets insults. At the same time, due to the immature emotional-volitional sphere, the formation of educational motivation does not work. Children quickly get used to school, but do not accept the new rules of behavior: they are late for classes, they play in the lessons and involve their neighbors in the desk, turn letters in notebooks into flowers. Such a child does not divide grades into “good” and “bad”, he rejoices at having them in his notebook.

From the very beginning of study, the child turns into a persistently underachieving student, for which there are reasons. Due to the immature emotional-volitional sphere, he performs only what is connected with his interests. And because of the immaturity of intellectual development in children of this age, mental operations, memory, speech are not sufficiently formed, they have a small stock of ideas about the world and knowledge.

For the constitutional ZPR, the prognosis will be favorable with a targeted pedagogical impact in an accessible game form. Work on the correction of development and an individual approach will remove the above problems. If you need to leave children for the second year of study, this does not injure them, they will easily accept the new team and get used to the new teacher painlessly.

Children of this type of disease give birth to healthy parents. Developmental delay occurs due to previous diseases that affect brain function: chronic infections, allergy, dystrophy, persistent asthenia, dysentery. Initially, the child's intellect was not disturbed, but because of his distraction, he becomes unproductive in the process of learning.

At school, children of this type of mental retardation experience serious difficulties in adapting, they cannot get used to the new team for a long time, they get bored and often cry. They are passive, inactive and lack of initiative. They are always polite with adults, adequately perceive situations, but if they are not provided with a guiding influence, they will be disorganized and helpless. Such children at school have great difficulties with learning, arising from a reduced achievement motivation, no interest in the proposed tasks, there is an inability and unwillingness to overcome difficulties in their implementation. In a state of fatigue, the child's answers are thoughtless and absurd, affective inhibition often occurs: children are afraid to answer incorrectly and prefer to remain silent. Also, with severe fatigue, a headache increases, appetite decreases, pain occurs near the heart, which children use as a reason to refuse to work if difficulties arise.

Children with somatogenic mental retardation need systematic medical and educational assistance. It is best to place them in sanatorium-type schools or in ordinary classes to create a medical-pedagogical regimen.

Children of this type of mental retardation are distinguished by normal physical development, they are somatically healthy. As has become clear from research, many children have brain dysfunction. The reason for their mental infantilism is a socio-psychological factor - unfavorable conditions of upbringing: monotonous contacts and habitat, emotional deprivation (lack of maternal warmth, emotional relationships), deprivation, poor individual motivation. As a result, the child's intellectual motivation decreases, there is a superficiality of emotions, lack of independence in behavior, and infantilism in relationships.

This childhood anomaly is often formed in dysfunctional families. In an asocial-permissive family, there is no proper supervision of the child; there is emotional rejection along with permissiveness. Due to the lifestyle of the parents, the baby has impulsive reactions, involuntary behavior, his intellectual activity is extinguished. This state often becomes fertile ground for the emergence of stable asocial attitudes, the child is pedagogically neglected. In an authoritarian-conflict family, the atmosphere of a child is saturated with conflicts between adults. Parents influence the baby through suppression and punishment, systematically injuring the child's psyche. He becomes passive, dependent, downtrodden, feels increased anxiety.

not interested in productive activities, have unstable attention. Their behavior manifests bias, individualism, or excessive humility and adaptability.

The teacher must show interest in such a child, in addition, it is necessary to have individual approach and intensive learning. Then the children will easily fill in the gaps in knowledge in an ordinary boarding school.

Mental retardation (MPD) in children is a complex disorder in which different children suffer from different components of their mental, psychological and physical activity.

Mental retardation refers to the “borderline” form of impaired development of the child. With mental retardation, there is an uneven formation of various mental functions, a combination of both damage and underdevelopment of individual mental functions with intact ones is typical. The depth of damage and/or the degree of immaturity may also be different.

Partial (partial) violation of higher mental functions may be accompanied by infantile personality traits and behavior of the child.

Causes of ZPR.

1. Biological:

pathology of pregnancy (severe toxicosis, infection, intoxication and injury), intrauterine fetal hypoxia;

prematurity;

asphyxia and trauma during childbirth;

diseases of an infectious, toxic and traumatic nature in the early stages of a child's development;

genetic conditioning.

2. Social:

long-term limitation of the child's life;

unfavorable conditions of upbringing, frequent psychotraumatic situations in a child's life.

There are also various combinations of several factors of different origin. K. S. Lebedinskaya (Selection of children to an auxiliary school: A guide for the teacher / Comp.: T. A. Vlasova, K. S. Lebedinskaya, V. F. Machikhina. - M .: Education, 1983.

ZPR classification.

Several classifications of mental retardation are presented in the specialized literature.

Recently, there are 4 main types of ZPR:

1. mental retardation of constitutional genesis (hereditary mental and psychophysical infantilism).

The emotional-volitional sphere is located on more early stage development that does not correspond to the actual age of the child. Children behave like younger children. They have observed

Elevated mood background

gaming interests. Their emotions are bright, however, superficial and unstable.

These children experience learning difficulties associated with the immaturity of the motivational sphere and the personality as a whole. These children cannot study in a regular general education mass school and need corrective and developmental education. Today, in many mass schools for the education and development of such children - with mental retardation - KRO classes are being created. Usually KRO students catch up with their peers during elementary school and in the 5th grade can study with ordinary children. In KRO classes, they develop emotionally and personally in the presence of specialists. A speech therapist, a psychologist, a defectologist, and a special teacher-defectologist work with them.

2. mental retardation of somatogenic genesis (due to infectious, somatic diseases of the child or chronic diseases mother).

Due to long-term somatic insufficiency of various somatic origin.

chronic infections

allergic conditions

Congenital or acquired malformations of the somatic sphere (heart, kidneys, lungs, etc.)

Children's neuroses

Asthenia (weakness)

All this can lead to a decrease in tone, often has delays in physical and emotional development (somatogenic infantilism, which, as a rule,

due to a number of neurotic layers: insecurity, timidity, a sense of one's physical inferiority and limitations)

Such children, "domestic", - as a result of this, their social circle is limited, interpersonal relationships are violated, which interfere with their socialization.

These children require sanatorium conditions - conditions for rest. sleep, proper diet, medication.

3. mental retardation of psychogenic genesis (due to unfavorable conditions of education, frequent psycho-traumatic situations in a child's life).

It is associated with unfavorable conditions of education that prevent the correct formation of the child's personality.

What are these unfavorable environmental conditions?

1) early onset

2) long-acting

3) that have a traumatic effect on the child's psyche. This can lead to persistent shifts in his neuropsychic sphere, violations of the autonomic functions (disturbances in the peripheral sphere - the child blushes, sweats), and then - to violations of mental functions, etc. First of all, emotional development.

4. mental retardation of cerebral-organic genesis (this type combines signs of immaturity of the child's nervous system and signs partial violation a number of mental functions).

These children have organic lesions of the brain are not spilled, but focal, local and do not cause persistent impairment of cognitive activity - they do not lead to mental retardation. This variant of the CPR is the most common - up to 90%. In the 90s, children with type 4 mental retardation were called "children with a temporary mental retardation or a minimal delay in pr." Blinova L.N. Diagnosis and correction in the education of children with mental retardation: Proc. Benefit. - M.: Publishing house of NTs ENAS, 2004. - 136s.

Features of the manifestation of ZPR.

Children with mental retardation are the most difficult to diagnose, especially in the early stages of development.

In children with mental retardation in the somatic state, there are frequent signs of physical development delay (underdevelopment of muscles, insufficiency of muscle and vascular tone, growth retardation), the formation of walking, speech, neatness skills, stages of play activity is delayed.

These children have features of the emotional-volitional sphere (its immaturity) and persistent impairments in cognitive activity.

Emotionally-volitional immaturity is represented by organic infantilism. Children with mental retardation do not have the liveliness and brightness of emotions typical of a healthy child; they are characterized by a weak will and a weak interest in evaluating their activities. The game is distinguished by the poverty of imagination and creativity, monotony, monotony. These children have low performance as a result of increased exhaustion.

In cognitive activity, there are observed: weak memory, instability of attention, slowness of mental processes and their reduced switchability. For a child with mental retardation, a longer period is needed to receive and process visual, auditory and other impressions.

Children with mental retardation are characterized by a limited (much poorer than in normally developing children of the same age) general information about the environment, insufficiently formed spatial and temporal representations, poor vocabulary, unformed skills of intellectual activity.

The immaturity of the functional state of the central nervous system is one of the reasons that children with mental retardation are not ready for schooling by the age of 7. By this time, as a rule, they have not formed the main mental operations, they do not know how to navigate tasks, do not plan their activities. Such a child hardly masters reading and writing skills, often mixes letters that are similar in outline, and has difficulty writing text on his own.

In the conditions of a mass school, children with mental retardation naturally fall into the category of consistently underachieving students, which further traumatizes their psyche and causes a negative attitude towards learning. This in some cases leads to conflict between the school and the child's family. In this situation, it is especially important to send a child with such problems to the psychological, medical and pedagogical commission in time in order to conduct a qualified diagnosis.

We present only the main comparative characteristics, which help professionals to distinguish children with mental retardation from normally developing children and from children with mental retardation. The most characteristic feature of these children is the discrepancy between the level of visually effective operations and verbal-logical thinking. All tasks that require the involvement of logical thinking and explanation are performed by them much worse than by normally developing children. When performing the same task according to a visual model, the quality of its performance improves, and a child with mental retardation shows a higher level of mental activity than a child with mental retardation. For example, when performing a classification task, having correctly grouped objects by gender, they often cannot name this group by the corresponding concept, cannot explain the principle by which they were combined.

In practical psychology, the fact of the appearance of mental retardation is often associated with the negative impact of the school, teachers, the concept of psychological neglect is introduced. The main psycho-traumatic factor is the education system itself (I.V. Dubrovina). In such a situation, when the student's personality is considered as a learning object, various kinds of didactogeny are possible. We can talk about the predisposition of some children to pedagogical influences and about their specific development. Any pedagogical influence that does not take into account individual features personality of the child, can be a direct cause of CRA. Practice shows that often a student's poor academic performance is identified with a delay in his mental development. As a result of the deformed pedagogical influence, states of mental retardation arise, so the role of the “school factor” cannot be ignored.

According to T.A. Vlasova, the stability of the ZPR depends, firstly, on the period of influence of the determining factor and, secondly, on its qualitative characteristics. These data must be taken into account when determining the priorities for the formation of the ZPR. "Clinical characteristics of children with mental retardation"; Compiled by: Doctor of Psychology T.A. Vlasova, candidate of psychological sciences K.S. Lebedinskaya and V.F. Machikhina. - 1993

A special issue in the problem of ZPR, noted by T.A. Vlasova, consists in prognostic heterogeneity. Experimental data distinguish the following forecast options:

1) gradual improvement of development;

2) the same dynamics, interrupted by age crises;

3) development of a persistent non-rough defect;

4) regression of state formation.

Each forecast option is determined by the intensity and duration of the impact of the shaping factors. Children with mental retardation represent a heterogeneous group in terms of the level of psychophysiological development. In the examined children with mental retardation, as a rule, the following syndromes are manifested:

1) attention deficit hyperactivity disorder (ADHD);

2) syndrome of mental infantilism;

3) cerebrosthenic syndrome;

4) psychoorganic syndrome.

These syndromes can occur both in isolation and in various combinations.

Taking into account the fact that changes in the neurophysiological development of the structural and functional organization of the brain are recorded in children with mental retardation, it should be said that such children have objective grounds for mental development disorders. Reader: "Children with disabilities: problems and innovative trends in education and upbringing": - M .: 1995. - 426s

Syndrome ADHD. The main manifestation of this syndrome is attention disorder. The underlying cause of ADHD is a disorder of the central nervous system, which can be caused by genetic or environmental factors.

The manifestations of this syndrome in children combine: a weakening of directed attention, a decrease in concentration and concentration, an increase in instability and distractibility of attention with pronounced changes in behavior, motor disinhibition, uncoordinated processes of excitation and inhibition. combination of attention disorders and hyperkinetic disorders leads to a pronounced school and even general social maladjustment of such children.

Syndrome of mental infantilism. With mental infantilism, the emotional sphere of children is at an earlier stage of development. The child's emotions are bright, the motive for getting pleasure prevails. The causes of the manifestations of infantilism are associated with the slow maturation of the fronto-diencephalic systems of the brain, the slower development of the structures of the left hemisphere, which also manifests itself in intellectual underdevelopment, namely, the predominance of visual-effective and visual-figurative thinking, the slowness of the formation of abstract-logical thinking.

The main manifestations of the syndrome of mental infantilism are: inadequate self-esteem, lack of formation of the motivational sphere, manifested in the impossibility of subordinating motives, desires; uncoordinated emotional processes. Emotional immaturity is characterized by the absence or insufficiency of emotional reactions. For children of this category, the immaturity of psychomotor skills is also characteristic, which manifests itself in the unformedness of fine movements.

Cerebrosthenic syndrome. Children with this syndrome have an increase intracranial pressure, neurological disorders, dysfunction vegetative system(metabolism), sleep disorder, etc. The imbalance of processes at the mental level is manifested in changes and a sharp change in the child's mood, instability of the emotional tone.

In the mental sphere, this syndrome manifests itself, first of all, in severe and excessive fatigue, especially during mental stress. A child can objectively withstand mental stress for a limited time. The rapid onset of fatigue, in turn, leads to exhaustion of the nervous system, resulting in neurological and autonomic disorders.

The process of teaching children with cerebrosthenia syndrome involves the dosage of educational loads, a decrease in the rate of mastering educational material.

Psycho-organic syndrome. Associated with lesions of brain structures: frontal, central, temporal, temporo-parietal or occipital regions. The earlier brain disorders occurred, the deeper the defect in mental development and the more combinatorial will be its manifestations. In psychoorganic syndrome, the most pronounced are disorders of the central and peripheral nervous system, which in the mental sphere is manifested in the inertia and slowness of intellectual activity, motor imbalance, and emotional instability. Volitional regulation of states is formed with a noticeable lag and disturbances.

Thus, mental retardation can be considered as a polysymptomatic type of change in the rate and nature of a child's development, including various combinations of disorders and their manifestations.

Nevertheless, a number of significant features can be distinguished in the mental status of a child with mental retardation:

1) in the sensory-perceptual sphere - the immaturity of various systems of analyzers (especially auditory and visual), the inferiority of visual-spatial orientation;

2) in the psychomotor sphere - imbalance of motor activity (hyper- and hypoactivity), impulsivity, difficulty in mastering motor skills, impaired coordination of movement;

3) in the mental sphere - the predominance of simpler mental operations (analysis and synthesis), a decrease in the level of logic and abstractness of thinking, difficulties in the transition to abstract analytical forms of thinking;

4) in the mnemonic sphere - the predominance of mechanical memory over abstract-logical, direct memorization - over indirect, a decrease in the volume of short-term and long-term memory, a significant decrease in the ability to involuntary memorization;

5) in speech development-- limitation vocabulary, especially active, slowdown in mastering the grammatical structure of speech, pronunciation defects, difficulties in mastering written speech;

6) in the emotional-volitional sphere - the immaturity of emotional-volitional activity, infantilism, lack of coordination of emotional processes;

7) in the motivational sphere - the predominance of game motives, the desire for pleasure, maladjustment of motives and interests;

8) in the characterological sphere - an increase in the likelihood of accentuating characterological features and an increase in the likelihood of psychopathic manifestations. "Clinical characteristics of children with mental retardation"; Compiled by: Doctor of Psychology T.A. Vlasova, candidate of psychological sciences K.S. Lebedinskaya and V.F. Machikhina. - 1993

Mental retardation in children (the disease is often referred to as mental retardation) is a slow rate of improvement of some mental functions: thinking, emotional-volitional sphere, attention, memory, which lags behind generally accepted norms for a particular age.

The disease is diagnosed in the preschool or primary school period. It is most often detected during pre-testing before entering school. It is expressed in the limited ideas, lack of knowledge, inability to intellectual activity, the predominance of gaming, purely children's interests, immaturity of thinking. In each individual case, the causes of the disease are different.

In medicine, they define different reasons mental retardation in children:

1. Biological:

• pregnancy pathologies: severe toxicosis, intoxication, infections, injuries;
• prematurity;
• asphyxia during childbirth;
• infectious, toxic, traumatic diseases at an early age;
• genetic predisposition;
• trauma during childbirth;
• lagging behind peers in physical development;
• somatic diseases (disturbances in the work of various organs);
• damage to certain parts of the central nervous system.

2. Social:

• limitation of life for a long time;
• mental trauma;
• unfavorable living conditions;
• pedagogical neglect.

Depending on the factors that eventually led to mental retardation, several types of the disease are distinguished, on the basis of which a number of classifications have been compiled.

Types of mental retardation

In medicine, there are several classifications (domestic and foreign) of mental retardation in children. The most famous are M. S. Pevzner and T. A. Vlasova, K. S. Lebedinskaya, P. P. Kovaleva. Most often in modern domestic psychology, the classification of K. S. Lebedinskaya is used.

1. Constitutional ZPR determined by heredity.
2. Somatogenic CRA acquired as a result of a disease that has affected the brain functions of the child: allergies, chronic infections, dystrophy, dysentery, persistent asthenia, etc.
3. Psychogenic mental retardation is determined by the socio-psychological factor: such children are brought up in unfavorable conditions: a monotonous environment, a narrow social circle, lack of maternal love, poverty of emotional relationships, deprivation.
4. Cerebral organic mental retardation observed in the case of serious, pathological abnormalities in the development of the brain and is most often determined by complications during pregnancy (toxicosis, viral diseases, asphyxia, alcoholism or drug addiction of parents, infections, birth injuries, etc.).

Each of the species according to this classification differs not only in the causes of the disease, but also in the symptoms and course of treatment.

ZPR symptoms

With confidence, it is possible to make a diagnosis of mental retardation only on the threshold of the school, when there are obvious difficulties in preparing for the educational process. However, with careful observation of the child, the symptoms of the disease can be noticed earlier. These may include:

• lagging skills and abilities from peers: the child cannot perform the simplest actions characteristic of his age (shoes, dressing, personal hygiene skills, independent food);
• unsociableness and excessive isolation: if he shuns other children and does not participate in common games, this should alert adults;
• indecision;
• aggressiveness;
• anxiety;
• during infancy, such children begin to hold their heads later, take their first steps, and speak.

With a delay in mental development in children, manifestations of mental retardation and signs of a violation in the emotional-volitional sphere, which is very important for the child, are equally possible. Often there is a combination of them. There are cases when a baby with mental retardation practically does not differ from the same age, but most often the retardation is quite noticeable. The final diagnosis is made by a pediatric neurologist during a targeted or preventive examination.

Differences from mental retardation

If by the end of junior (grade 4) school age the signs of mental retardation remain, doctors begin to talk about either mental retardation (MR) or constitutional infantilism. These diseases are:

• with UO, mental and intellectual underdevelopment is irreversible, with mental retardation, everything is fixable with the proper approach;
• children with mental retardation differ from the mentally retarded in the ability to use the help that is provided to them, independently transfer it to new tasks;
• a child with mental retardation tries to understand what he has read, whereas with VR there is no such desire.

When making a diagnosis, do not give up. Modern psychology and pedagogy can offer comprehensive assistance to such children and their parents.

Treatment of mental retardation in children

Practice shows that children with mental retardation may well become students of an ordinary general education school, and not a special correctional one. Adults (teachers and parents) should understand that the difficulties of teaching such children at the very beginning of school life are not at all the result of their laziness or negligence: they have objective, rather serious reasons that must be jointly and successfully overcome. Such children should be provided with comprehensive assistance from parents, psychologists, teachers.

It includes:

• individual approach to each child;
• classes with a psychologist and a teacher of the deaf (who deals with the problems of teaching children);
• in some cases - drug therapy.

Many parents find it difficult to accept the fact that their child, due to the nature of their development, will learn more slowly than other children. But this must be done to help the little schoolboy. Parental care, attention, patience, coupled with the qualified help of specialists (a teacher-defectologist, a psychotherapist) will help to provide him with targeted education, create favorable conditions for learning.