Mental retardation is characterized. severe mental retardation

Based on psychometric studies, according to the modern international classification of diseases, it is characterized by an intelligence quotient, the range of which is from 20 to 34 units.

According to the clinical picture and the list of disorders, this form of mental retardation is similar to a severe form of imbecility.

General characteristics of this category of children

Children with this diagnosis can partially master speech and learn basic skills for serving themselves. Vocabulary very meager, sometimes it does not exceed ten or twenty words. Almost all of them are needed to communicate their own desires and needs, their thinking is very concrete, chaotic and unsystematic.
Children are able to react only to brightly colored objects, but even here attention is very short-lived.
Phenomena and objects that are not familiar to children do not cause any response. Only those objects are satisfactorily distinguished that are well and long familiar, constantly in front of the eyes.
Diagnosis severe mental retardation in children determines the presence of rather large deviations in memory, thinking, perception of the world around, colloquial speech, motor skills make these children difficult, and sometimes practically untrainable. Only in very rare cases can some people master the counting of visible objects or group real things into a group, such as furniture or clothing. But, this is possible only in cases of a long process of special education.
Almost all children in this category have major motor impairments - their gait is slow and clumsy, the movements of the arms and legs are late and do not have amplitude.
The hands and fingers of children are especially undeveloped, which makes it difficult to pick up and manipulate small objects.
Motor failure in severe mental retardation occurs in 9 out of 10 patients.
In children, there are abnormal development of the bones of the skeleton, the shape of the skull, legs and arms, skin and internal organs.

These children are recognized as disabled. Being incompetent, guardianship of parents or other persons is obligatory over them. Until reaching the age of majority, they often stay in specialized institutions, and then they are transferred to homes for the disabled, of the appropriate profile.

Causes of the disease

damage to the fetus in the mother's womb by neurotoxic factors of an infectious, chemical, physical nature - syphilis, cytomegalovirus, ionizing radiation, and others;
the birth of a baby before a certain period is a big prematurity;
failures in the process of childbirth, as a result of which the baby could receive a birth injury or temporary asphyxia was observed;
getting in early childhood serious head injuries;
brain hypoxia;
infectious diseases, as a result of which the central nervous system child;
living in dysfunctional families and, as a result, pedagogical neglect;
manifestation of dementia of unclear etiology.

Causes due to genetics

Mental illnesses are among the reasons why genetic counseling is sought. This is understandable - more than half of the cases of mental anomalies are associated with genetic abnormalities. The main types of genetic failures that can provoke children's mental deficiency:

chromosomal abnormalities leading to gene imbalances - aneuploidy, duplications, deletions. Because of these deviations, children are born with Down syndrome, Williams syndrome and other deviations;
uniparental dimission of chromosomes, or sections of chromosomes, leads to the appearance of children with Angelman or Prader-Willi syndrome;
disturbances in the work of some genes, and mutations occurring in them. The number of genes capable of mutating exceeds a thousand. They cause autism, fragile X syndrome, Rett syndrome, which occurs only in girls.

Probably, the saying about patience and work is most suitable for those. who in the family have children with mental disabilities – severe mental retardation in children not a light one at all . Of course, there are special institutions, but where a child is brought up, everyone decides for himself.

Moderate degree of mental retardation (mild imbecility)

It - average degree mental underdevelopment, is 10% of the total number of mentally retarded. Its etiology can be both hereditary defects and the consequences of organic brain lesions. It is characterized mainly by unformed cognitive processes(concrete, inconsistent, rigid thinking) and inability to form abstract concepts. IQ is in the range of 35-49 or 54.

Static and locomotor functions. They develop with a significant delay and are not sufficiently differentiated. They have impaired coordination, accuracy and pace of movements. Movements are slow, clumsy, which interferes with the formation of a complex mechanism of running and jumping (kinetic apraxia). Mentally retarded people have difficulty reproducing even given movements or postures (apraxia posture). In this case, pathological synkinesis often appears. They have great difficulty performing activities that require switching movements or quick changes. In some, motor underdevelopment is manifested by the monotony of movements, slowness of their pace, lethargy, awkwardness. In others, increased mobility is combined with lack of focus, disorder, and uncoordinated movements. Gross defects in motor underdevelopment can prevent the formation of self-service skills that require fine finger movements: when lacing shoes, fastening buttons, tying ribbons (dressing apraxia). Most retarded people need constant help with many household chores, and some of them need supervision.

Attention disorders. Everyone is distracted. It is difficult to attract, is characterized by instability and distractibility. Extremely weak active attention prevents the achievement of the goal. At favorable conditions it can be significantly improved, it is possible to achieve more active involvement in classes with the teacher, switching in the process of performing the mastered activity.

Violations of the processes of sensation and perception. The sensory sphere is very disturbed. The development of visual, auditory and other analyzers lags behind. Often there are gross anomalies of vision and hearing. However, even with their safety, many do not know how to use them. Objects and phenomena are perceived in general terms. There is no activity of perception, they do not know how to highlight the features of the perceived and compare them with those of another object. The inability to analyze, search, cover completely perceived information leads to chaotic non-purposeful activity. As a result, they do not independently orient themselves in situations and require constant guidance. Correction of the emerging abilities of the sensory sphere can improve the habilitation of these children.

Thinking disorders. The moderately mentally retarded have a very limited supply of information and ideas. They have difficulty operating with existing ideas. Their thinking is concrete, inconsistent, stiff. The development of even visual thinking suffers. The formation of abstract concepts is either inaccessible or sharply limited to the most elementary generalizations. They can be taught to group clothes, animals. They manage to establish differences only on specific objects. They are completely incapable of operating with abstract concepts. Conceptual generalizations are formed with great difficulty or occur at the situational level.

These mental disorders are manifested in the extremely inadequate use of objects in solving visual and practical problems: everyday, playful, constructive, in which a visual or represented sample acts as a means of solution. Such patients do not know how to analyze the subject, apply the methods of comparison, transfer, targeted search. They are difficult to establish links between the individual parts of the problem. Because of this, there is no focus, speed and accuracy of reactions, switchability from one action to another; They don't have self-control.

It is not possible to compose a coherent story based on the plot of the most elementary picture: most often, individual depicted objects are named. They cannot arrange the pictures in order, united by a single plot, and understand the sequence of what is happening. Judgments are poor, and are a repetition of heard advice, recommendations.

Some moderately mentally retarded learn all the letters, merge them into syllables, and even read short texts. But they don't comprehend what they read. They perceive it in fragments and therefore convey the content in fragments that are not interconnected. Assimilate the material unconsciously, mechanically. They master the ordinal count, perform the simplest arithmetic operations on a specific material. An abstract score within the first ten is not possible for them. They cannot solve problems: the condition of the problem is not kept in memory, and semantic connections are not established.

The main difficulties of moderate mental retardation in solving problems: 1. poor acceptance of the task, due to the absence or insufficiently strong motivation, avoidance of the task, mental passivity; 2. lack of orientation in the task, i.e. understanding the links between the links; 3. inability to "meaningfully" organize their activities to complete the task, i.e. sequential transition from one action to another, the implementation of the connection between actions, the inability to correctly use visual means to solve the problem.

Speech disorders. Patients slowly, 3-5 years late, develop understanding and use of speech, and its final formation is limited. The development of speech usually corresponds to the degree of mental retardation. At the same time, the child understands the speech of the interlocutor is very limited, satisfactorily capturing intonations, gestures and facial movements.

In the future, especially under the influence of teachers, speech develops, but its understanding is ultimately determined by personal experience. Expressive speech is limited to single words or short sentences. The lexicon is poor, consists of the most frequently used words and expressions. After several years of training, they learn the designations of household items, vegetables.

The pronunciation side of speech is defective, speech is almost devoid of modulations, pronounced tongue-tied tongue, there are violations of the structure of many words and agrammatisms. The most common prepositions are used, children confuse prepositions, replace them.

They manage to develop the ability to use their speech for communication purposes. In the process of communication, they know how to ask others for the items they need, they dare to ask questions. In rare cases, the child's speech is a stream of meaningless clichés uttered in a previously heard intonation (echolalic speech). The origin of this disorder is associated with a predominant lesion of the frontal lobe of the cerebral cortex or with hydrocephalus. In 20% of moderately mentally retarded children, speech does not appear at all due to damage to the speech zones of the cortex.

Memory disorders. Memory is underdeveloped: its volume is small, but to adolescence it can increase, reaching levels found in mildly mentally retarded children. Long-term memory improves better than short-term memory. When playing back captured material, distortion often occurs. Arbitrary memory is broken. Both logical and mechanical memory suffer. Children with moderate mental retardation under the program of a correctional school (8th type) are not taught.

A small part of them (mainly due to a good mechanical memory) masters the basic skills necessary for reading, writing and elementary counting. Educational programs (in special classes in special schools or boarding schools) can give them the opportunity to develop limited potential and expand the range of self-care skills and orientation in the immediate environment. Hardly mastered knowledge is applied mechanically, like memorized clichés.

As a result of training through a visual multiple display with a gradual complication of the task for several years, it is possible to prepare adolescents for work and life in a work team. In addition to labor lessons, it is necessary to consolidate reading and numeracy skills related to labor processes. Moderately mentally retarded adults who are calm and manageable are usually capable of simple practical work with constant guidance from the instructor. Independent labor activity is not available to them.

Emotional-volitional disorders. Independent living is not possible. However, such people may be mobile, physically active, and most show signs of social development, i.e. are able to establish contacts, communicate, participate in elementary social activities organized by educators.

The most typical personality traits of the moderately mentally retarded are: lack of initiative, independence, inertia of the psyche, a tendency to imitate others, a combination of suggestibility with negativism, instability in activity combined with inertia and stiffness.

The relative safety of their affective life is manifested in their sensitivity to evaluation by other people. Violations of the emotional-volitional sphere include the lack of emotional diversity, the lack of differentiation of feelings, as well as their inertia and stiffness. Their self-assessment is distinguished by its originality: they put themselves in the first place, their comrade - in the second, the educator - in the third. This can be explained by their better understanding of peers, in comparison with adults. As a result of the corrective process, their self-esteem can often be changed. They begin to give credit to their teachers.

The impulses, even if they arise as the personality matures, are weak and quickly exhausted.

characteristic asynchrony development of different areas of the psyche: some have a higher level of visual-spatial skills compared to the results of tasks that depend on the development of speech. Others combine considerable clumsiness with some success in social interaction and basic conversation. The levels of speech development vary: some patients can take part in simple conversations, others have a speech reserve sufficient only to communicate their basic needs. Some patients never acquire the ability to use speech, although they can understand simple instructions and to learn manual signs, allowing to some extent to compensate for the insufficiency of their speech. Such asynchrony in the development of different areas of the psyche of moderately mentally retarded children is apparently etiologically related to the consequences of organic brain lesions.

A small number of children lack the need for communication. Most have developmental disorders that have a major impact on clinical picture: some are good-natured and friendly; others are dysphoric, vicious, aggressive; the third - stubborn, lazy; the fourth - lethargic, aspontane, inactive.

In many, there is an increase and perversion of drives, including the disinhibition of sexuality. They tend to be impulsive. Often there are epileptiform seizures. Moderately mentally retarded children have neurological symptoms(paresis, paralysis), as well as signs of bodily malformations: underdevelopment of limbs, fingers, head formation disorders, underdevelopment of internal organs, hypogenitalism, defects of the face, eyes, ears. Possible somatic manifestations of associated diseases ( bronchial asthma, gastric ulcer).

Most persons with moderate mental retardation are able to do without assistance. The main mental disorders are sometimes complicated by another neuropsychic pathology - neuroses, psychoses. However, the limited development of their speech makes it difficult to identify.

Severe mental retardation (oligophrenia in the degree of severe imbecility) occurs in 5-7% of children with intellectual disabilities. It is possible to identify the main signs of a defect already in the first months and years of life. AT International classification diseases (ICD-10) severe (code F 72) include mental disorders with an IQ of 20 to 35.

The main signs of severe intellectual insufficiency

in an adult suffering from severe mental retardation corresponds to the level of development of a child of 3-5 years
The early and subsequent development of the child is disturbed: later he begins to hold his head, sit, walk, talk, motor awkward, clumsy, unable to run and jump, assemble a constructor and mosaic, write and draw
Speech is grossly defective, the child is able to learn about 15-20 simple words, however, uses them mostly mechanically, unconsciously. More often, it is not the meaning of words that is captured, but intonation, facial expressions and gestures related to the basic needs of the patient (cooking, censure for misconduct)
Motor awkwardness, characteristic of children, persists in adults with severe mental retardation, making it difficult to perform complex movements that require accuracy, coordination, and attention. But simple everyday skills - dressing (except for fastening buttons and tying shoelaces), eating, carrying objects, are fixed with sufficient diligence and are performed well under the supervision of relatives or educators.
Thinking in oligophrenia is chaotic, unsystematic. If a child has severe mental retardation, he can sometimes distinguish well-known objects in the picture, and with prolonged training, even combine them (animals, clothes), but such memorization is purely mechanical. The child is not able to compose a story based on a plot picture, he cannot solve even the simplest task, he does not distinguish objects by size, color, shape
There is no logical memory, mechanical memory is sharply reduced.
The behavior of persons with severe mental retardation is usually disturbed - they can be either euphoric and complacent, or angry, aggressive, disinhibited
If oligophrenia is diagnosed in the degree of pronounced imbecility, then socially this indicates that such patients cannot live and serve themselves on their own, they need constant care, supervision, guardianship.

Principles of care for patients with severe mental retardation

The main approaches to treatment, rehabilitation, education are similar to similar activities with. This is the treatment of concomitant diseases, and regular physical activity in the fresh air, and reflexology, and massage, and music therapy. Only with pronounced imbecility, such an approach allows you to achieve better results, master the basic skills of self-service and neatness.

Severe mental retardation is not a sentence, and with the right corrective measures, much can be achieved. I want to wish perseverance and patience to relatives and friends, acquaintances and strangers who somehow participate in the fate of children and adults with intellectual disabilities. Even if there is a deep or severe mental retardation, do not despair. Helping, giving a piece of ourselves to others, we become richer internally and spiritually, we become PEOPLE.

Characteristics of mental retardation

Plan

1. Signs of mental retardation

2. Types of mental retardation

3. Degrees of mental retardation

1. Signs of mental retardation

Mental retardation is a pronounced, irreversible systemic impairment of cognitive activity that occurs as a result of diffuse organic damage to the cerebral cortex.

This definition should emphasize the presence of three features:

1) organic diffuse damage to the cerebral cortex;

2) systemic impairment of intelligence;

3) the severity and irreversibility of this violation.

The lack of at least one of these signs will indicate that we are not dealing with mental retardation, but with some other type of dysontogenesis. Really:

Underdevelopment of mental activity in the absence of organic damage to the cerebral cortex is a sign of pedagogical neglect, which can be corrected;

Local damage to the brain can cause loss or disorders of one or another mental function (impaired hearing, speech, spatial gnosis, visual perception, etc.), but the intellect as a whole is preserved and there is a possibility of compensation for the defect;

Functional disorders of brain structures can lead to shortcomings in cognitive activity of a temporary nature, which under certain conditions can be eliminated;

An inexpressive decrease in intelligence limits a person's ability to master certain types of complex cognitive activity, but does not affect the success of independent social adaptation individual;

Organic damage to the brain does not necessarily cause a violation of cognitive functions, but can cause disorders in the emotional-volitional sphere and disharmonic development.

It should be noted that not all defectologists agree with the above definition. For example, L.M. Shipitsyna believes that with mild mental retardation, organic brain damage does not always occur. Some scholars expand the concept of mental retardation at the expense of those cases when developmental delay is predetermined by unfavorable social conditions, deprivation, and pedagogical neglect. Indeed, pedagogical neglect can be so profound that it leads to irreversible changes in higher nervous activity.

The child misses the sensitive periods of the formation of the most important higher mental functions, in particular speech, and actually stops at the natural stage of development.

By definition, D.M. Isayevata (2005), mental retardation is a combination of etiologically different (hereditary, congenital, acquired in the first years of life), non-progressive pathological conditions who find themselves in a general mental underdevelopment with a predominance of an intellectual defect and lead to a complication of social adaptation.

2. Types of mental retardation

Depending on the time of occurrence, mental retardation is divided into two types - oligophrenia and dementia.

Oligophrenia- this is a type of mental retardation that occurs as a result of organic damage to the brain in the prenatal, natal or early (up to three years) period of childhood and ends up in total mental underdevelopment.

It is important to note that oligophrenia is determined not by etiological factors, but by the early influence of these factors on the brain. That is, very diverse hereditary, congenital, acquired harmfulness in the prenatal and early postnatal periods predetermine the general mental underdevelopment. Clinical manifestations oligophrenia does not depend on the causes of its occurrence, unlike dementia, in which the structure of the defect is to a certain extent determined by etiological factors.

For example, the pathogenesis and psychological features children with traumatic dementia and dementia that arose as a result of neuroinfection, while oligophrenias predetermined by trauma or infection have the same symptoms.

As you know, the brain of a newborn child has not yet completed its formation. Formation of cork structures, establishing connections between cortical neurons, myelination nerve fibers are carried out in parallel with the mental development of the individual and largely depend on the experience that the child acquires.

Through a harmful effect on the cerebral cortex in the early period, neurons are immature or blocked and cannot fully perform their functions, which complicates the process of forming connections between them. Neurodynamics in oligophrenia is characterized by a weakness in the obturator function of the cerebral cortex, instability of connections, inertia and weakness of nervous processes, insufficiency of internal inhibition, excessive irradiation of excitation, and difficulties in the formation of complex conditioned reflexes.

Therefore, the mental development of an oligophrenic child is carried out on an abnormal basis. Early period damage to the cerebral cortex leads to a more pronounced underdevelopment of functions that have a longer period of ripening, which, in turn, determines the hierarchy in which the regulatory systems and the highest level of organization of any mental function primarily suffer. The primary defect in oligophrenia is associated with a total underdevelopment of the brain, especially phylogenetically in the youngest associative zones.

Secondary defect in oligophrenia, for V.V. Lebedinsky, has a circular character, predetermined by two coordinates of underdevelopment: "from the bottom up" - the insufficiency of elementary mental functions creates an unfavorable basis for the genesis of verbal-logical thinking; "from top to bottom" - the underdevelopment of higher forms of thinking prevents the restructuring of elementary mental processes, in particular, the formation of logical memory, voluntary attention, reference perception, and the like. The formation of a secondary defect is predetermined by cultural deprivation.

In the structure of dysontogenesis in oligophrenia, there is a violation of interanalyzer connections and, accordingly, isolation of individual functions. Characteristic for oligophrenic children is the isolation of speech from action, comprehension, understanding of the material from its memorization.

Oligophrenia has a residual (non-progredient) character, that is, it does not tend to progress - to deepen the degree of severity. This circumstance and relative preservation with a mild degree of motivational-need, emotional-volitional sphere, purposefulness of activity, absence of encephalopathic and psychotic disorders provide the possibility of satisfactory development dynamics and the effectiveness of pedagogical influence. But with oligophrenia in dynamics mental development phenomena of underdevelopment are observed at all stages.

There are such main signs of oligophrenia:

The presence of an intellectual defect that combines with impaired motor skills, broadcasting, perception, memory, attention, emotional sphere, arbitrary forms of behavior;

The totality of intellectual insufficiency, that is, the underdevelopment of all neuropsychic functions, impaired mobility of mental processes;

The hierarchy of an intellectual defect, that is, the overwhelming insufficiency of abstract forms of thinking against the background of the underdevelopment of all neuropsychic processes. Underdevelopment of thinking is reflected in the course of all mental processes: perception, memory, attention. First of all, all the functions of abstraction and generalization, comparisons on essential grounds, understanding of figurative meaning suffer; the components of mental activity associated with the analytical and synthetic activity of the brain are disturbed.

At the same time, higher mental functions, which are formed later and are characterized by arbitrariness, are less developed than elementary ones. In the emotional-volitional sphere, this turns out to be the underdevelopment of complex emotions and arbitrary forms of behavior. Consequently, oligophrenia is characterized by non-progredient, totality and hierarchy of mental development disorders, the relative preservation of the personal aspect of cognitive activity. This marked type of mental retardation differs from dementia.

Dementia- this is a type of mental retardation that occurs as a result of damage to the cerebral cortex in the period after two or three years and turns out to be an expressive decrease in intellectual capabilities and a partial disintegration of already formed mental functions.

Since the formation of the cerebral cortex is mainly completed at the age of 16-18, the phenomena of degradation are accompanied by mental underdevelopment.

The nature of desontogenesis in dementia is determined by the combination of a gross violation of a number of formed mental functions with underdevelopment of ontogenetic early formations (frontal systems), as a result, frontal-subcortical interaction suffers. Along with the partial loss of individual cortical functions, first of all, disorders of the emotional sphere are observed, often with disinhibited trains, severe disturbances in purposeful activity and the personality as a whole.

Damage leads to the phenomena of isolation of individual systems, the collapse of complex hierarchical relationships, often with a gross regression of intelligence and behavior.

Dementia is characterized by a partial disturbance of mental functions. This means that some of them are damaged more, while others are less. The complication of cognitive activity is predetermined not so much by violations of thinking, but by gross disorders of purposefulness, attention, memory, perception, emotions, as well as an extremely low intensity of striving for achievements. With dementia, neurodynamic processes are significantly affected, as a result of which inertia of thinking, rapid exhaustion, and disorganization of mental activity as a whole are observed.