Mental retardation (MDD)
– reduced intellectual functioning, limitation of adaptive perception, when certain mental functions (thinking, attention and memory) lag behind in development from established psychological norms for a certain age. The number of people with mental retardation is 15-16% in the pediatric population.
Mentally retarded people score low on intelligence (IQ) tests, but the impact on functioning in daily life depends on the severity of the disease and associated impairments. Symptoms of mental retardation in children include insufficient development of speech and motor skills, thinking and memory, regulation and self-regulation of behavior. About 85% of children with mild developmental delays usually learn to speak and become independent with timely intervention.
General information
Mental retardation in children can be caused by a large number of reasons (including pronounced congenital syndromes), and the symptoms of mental retardation manifest themselves not only in a decrease in cognitive abilities, but also in other physical and mental abnormalities.
Mental retardation is characterized by a violation of the intellectual and emotional-volitional spheres. This condition is accompanied by learning difficulties. We are talking primarily about the psychological and pedagogical category, but it can also be based on organic disorders.
Mental changes in mentally retarded children are stable and do not progress, so psychosomatic complications are unlikely. The diagnosis is made for preschool children at the age of 4-5 years or during schooling. The main difficulty for such patients is the lack of opportunity to fully adapt to society.
Causes of mental retardation
Mental retardation in preschool children is a consequence of many different factors that ultimately lead to a defect in the neurobiological and functional development of the brain. Biological and social factors should be highlighted.
The most common causes of mental retardation in children
are:
· Embryonic development disorders: rubella, treponema, toxoplasma, cytomegalovirus, listeria, herpes infection, HIV. No less dangerous are placental dysfunction, alcohol, drug use, and smoking. Phenol poisoning, pesticides, lead and increased levels of radiation leave their mark.
· Perinatal problems: prematurity, hypoxia, intracranial hemorrhage, metabolic disorders in newborns, meningitis, severe brain injury, encephalitis.
· Severe somatic diseases of the child: rickets, neuroinfections, influenza. Epilepsy can also be a cause.
In some cases, the cause of mental retardation is heredity. This disease is diagnosed in some families from generation to generation. Congenital mental retardation is almost inevitable in many genetic diseases, for example: Patau, Edwards, Cornelia de Lange, Down syndrome.
Delayed development of a child of a secondary nature develops against the background of visual or hearing impairment. The cause may be a speech defect, as well as a severe deficit in communication and sensory information.
Mental retardation or dementia can be caused by abnormal brain development:
· insufficient brain size (microcephaly);
· complete or partial absence of the cerebral hemispheres (hydranencephaly);
· underdevelopment of the brain (lissencephaly);
Cerebellar hypoplasia (pontocerebellar hypoplasia).
Often the pathogenesis of mental development disorders lies in metabolic disorders or enzyme production (phenylketonuria). Postpartum mental retardation in children can also be caused by the destruction of red blood cells - hemolytic disease of the newborn. It occurs as a result of Rh conflict during pregnancy and leads to serious dysfunction of the cortex and subcortical neural nodes of the brain.
Among the social factors, one should highlight the influence of hypo- or hyperprotection, lack of opportunity to communicate with other people (for example, due to disability), authoritarian upbringing (unquestioning submission). Environmental factors, as a rule, cause mental retardation mainly in the presence of a primary organic basis for dysfunction.
Factors in the formation of the socio-psychological climate
Self-education is the necessary spontaneous desire of a person or organization to change the internal database and knowledge base. To organize self-education, it is necessary to use the manager’s working time. Organizing self-education consists of setting goals, determining priorities (main directions), choosing a method and ensuring regularity of work on oneself.
An important task in developing the problem of ZPR is to understand its cause-and-effect relationships. The concepts of “factor” and “cause” are ambiguous. No isolated factor by itself can be the cause. Any change in state is determined by “internal moments” - the attitude of the organism (individual) to the pathogenic factor (G.E. Sukhareva).
Not every negative experience should be qualified as a factor that forms mental retardation, since the degree of significance of the factor depends on the intrapsychic characteristics of the child’s personality and his family.
After analyzing the multiplicity of approaches to studying the causes of mental retardation, the complexity of the mechanism of its formation becomes obvious. 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, we can identify the following most important groups of reasons that can cause PPD:
1) biological reasons that prevent normal and timely maturation of the brain;
2) a general lack of communication with others, causing a delay in the child’s assimilation of social experience;
3) lack of full-fledged, age-appropriate activities that give the child the opportunity to effectively “appropriate” social experience and timely formation of internal mental actions;
4) social deprivation, which prevents timely mental development.
From the above classification it is clear that three of the four groups of causes of mental retardation have a pronounced socio-psychological character. A child’s mental retardation can be caused by either a single unfavorable factor or a combination of factors that develop during the interaction process.
The interdependence of the social and biological causes of mental retardation is considered as the basic basis for the study. A systematic approach helps to overcome the disunity that still exists to one degree or another in medical and psychological research that isolates any one of the many aspects of the problem.
Classification
The classification of a person's intellectual indicators is based on the measurement of IQ. Depending on the amount of missing cognitive abilities, three degrees of oligophrenia are distinguished, which are applied regardless of the etiology of the disease:
· Mild (CIE 10-F70).
The level of intellectual development (CI) ranges from 50-69. Patients have minimal sensorimotor slowing. At preschool age they can develop communication skills, acquire some knowledge, and at a later age – professional skills.
· Medium degree (F71-F72).
They can understand other people’s speech, and at the age of 5-6 years they formulate short phrases. Thinking is limited, primitive. It takes a lot of effort to teach reading, writing, arithmetic and self-care skills.
· Severe (F73).
Thinking in this form is almost completely blocked (IQ below 20), all actions are limited to reflexes. Such children cannot learn (except for some development of motor skills) and require constant care.
The etiopathogenetic classification of ZPR includes four types of the disease. Constitutional genesis is characterized by a slowdown in the maturation of the central nervous system, which is accompanied by psychophysical and mental infantilism. This type of mental retardation, as somatogenic, is caused by long-term and severe somatic disorders of children at an early age (chronic dyspepsia, bronchial asthma, heart or kidney failure, etc.), which leads to disruption of the development and maturation of the central nervous system.
Mental retardation of psychogenic origin is associated with unfavorable social conditions (abuse, neglect). Due to attention deficit, impulsivity and mental instability are formed. With increased care, the child develops egocentrism and lack of initiative.
For mental retardation of cerebral-organic origin, organic damage to the brain is noted. This type of disease occurs most often. Disorders affect certain areas of the psyche or manifest themselves in different areas. It is characterized by immaturity of cognitive activity or the emotional-volitional sphere.
“It looks like it doesn’t look like it”
The game teaches children to carefully examine objects and identify their common and distinctive features.
Necessary equipment: a couple of similar toys, for example: a tractor and a car, a doll and a tumbler.
◈ How to play: invite your child to compete to see who can find similar toys faster. Find them together and ask the child to first say how they are similar (for example: the bunny and the bear have fluffy legs, ears, tails, eyes, etc.), and then how they differ from each other (the bear is big, the ears are small, brown ; bunny - small, white, long ears).
◈ Let’s complicate it: take two pairs of toys that are more similar to each other - a large and a small ball, two cars of different brands, etc.
◈ We consolidate: you can play the game “Eagle Eye” on the road, in a store, at the dacha - who will find the most similarities and differences in clothes, vegetables, trees, etc. For example, compare the leaves of poplar, birch, maple, larch. The one who finds the most similarities and differences among them will win. And if you “don’t notice” something, but the child does, he will get real pleasure from the game. Don’t be afraid to play along with your little “I want to know it all” sometimes!
Characteristics of children with mental retardation
Complications of PVD vary depending on the specific cause. Children with Down syndrome have a higher incidence of cardiovascular complications than other patients. Mental retardation in a mild form allows a person to integrate and work normally. People with more severe delays may have poor physical functioning and need care throughout their lives.
Perception
Children with mental retardation perform perception and observation of objects, events, and situations in an insufficiently differentiated form. It is difficult for them to separate the characteristics of certain objects, as well as to make comparisons and understand the relationships that exist between objects.
Memory quality
The quality of memory is significantly reduced due to weak thinking. This prevents children with developmental delays from separating the essential from the non-essential, that is, connecting isolated elements with each other and using random and auxiliary associations.
These children have difficulty learning and remembering, making it difficult to transfer lessons learned to new situations. For this reason, organized events should take into account learning tools that help improve memory efficiency.
Speech skills
The speech of children with developmental delays develops with a delay. Vocabulary is small. They have limited understanding of the meaning of words and little generalization due to difficulties in language development, as well as difficulties in the function that regulates thinking and critical judgment.
Thinking
Thinking is formed in conditions of incomplete sensory perception, lack of language development, and limited practical activity. For this reason, mental functions develop slowly and have special characteristics.
Emotional sphere
The personal-volitional sphere is characterized by its immaturity, caused by insufficient development of cognitive activity, therefore children with mental retardation are limited in expressing their impressions, feelings and emotions. They can either react intensely to a minor motive, or show themselves weakly to serious life events.
Inadequate, superficial relationships of feelings, characteristic of children with mental retardation, as well as the inability to suppress their desires. They move from one mood to another, in some cases without motivating reasons. They are characterized by elements of infantilism and impulsiveness, as well as difficulties in prohibitions.
Children with mental retardation have difficulty concentrating on any activity, they show anxiety and are poorly motivated. When not treated properly, they react to disappointments at school with rebellious, aggressive behavior or great withdrawal. Their development outside of school or at a later stage is largely determined by how they relate to their environment and the people around them.
If a child with mental retardation finds understanding, sympathy, help and respect, then full development is possible within the limits of his abilities. But when sick children become victims of ridicule, rejection, and intolerance, this leads to serious changes in behavior and various decompensations.
Diagnostics
The differential diagnosis of mental retardation should be made by personnel trained in the use of standardized psychometric methods. In early childhood, the first signs of mental retardation rarely appear and can be clearly expressed only after 4-5 years.
Today, the diagnosis of mental retardation is carried out by collecting anamnesis (obstetric data on the course of pregnancy and information on diseases of relatives), a general psychological and psychometric assessment of the patient. This makes it possible to assess the somatic state, establish the presence of not only physical (visually defined) signs of mental retardation, determine the level of intellectual development and compliance with their standards, as well as observe mental behavior and reactions.
To accurately determine the specific form of ZPR, you may need:
· general, biochemical and serological blood test;
· blood for syphilis and other infections;
· Analysis of urine.
Genetic testing is performed to identify congenital causes of the disease.
Instrumental diagnosis of developmental delay includes:
· encephalogram;
· computed tomography;
MRI of the brain.
Differential diagnosis is necessary. Despite some characteristic physical defects, many neurological disorders (paresis, convulsions, trophic and reflex disorders, epileptiform convulsions) are observed in other neuropsychiatric pathologies.
Even when the fact of inhibition and inadequacy is obvious, a thorough professional assessment of the mental abilities of children is necessary in order to distinguish a mild form of mental retardation from emotional-behavioral (psychiatric) disorders.
Correction of mental retardation
Treatment begins with timely identification of the problem. Depending on the degree of mental dysfunction, the child will be asked to complete standard school work designed for children of a similar age. Correction of mental retardation is carried out through educational intervention optimized depending on the degree of mental retardation. Children must be integrated into social, educational and cultural life with the rest of the population.
If the cause of mental retardation is hypothyroidism, Rh conflict, phenylketonuria, etiological treatment of mental retardation with the help of hormonal drugs, blood transfusion to the child, or a special diet without protein is possible. In most cases, there is no etiological treatment.
Patients with intellectual disabilities are treated with symptomatic therapy. Drugs are prescribed to reduce the intensity of psychotic disorders: antipsychotics, as well as medications to stabilize mood (which helps to correct behavior).
Reduce anxiety levels, stop crises and improve sleep with the help of psychoactive substances with tranquilizers. The negative consequences of their use are expressed in muscle weakness, increased drowsiness, impaired coordination of movements and speech, and decreased visual acuity. Long-term use of these drugs can compromise attention and memory, even leading to the development of anterograde amnesia.
One of the main roles in the correction of intellectual disability is given to cognitive-behavioral therapy, i.e., medical correctional pedagogy. To raise children with mental retardation in specialized schools and boarding schools, specially developed methods of adapting children to society are used.
Rehabilitation of patients with mental retardation, especially with genetically determined forms of mental pathology, consists not so much of their treatment as of teaching programs and instilling basic household and, if possible, simple social skills. Experts say that mild mental retardation in children can be corrected, and despite the disability, such patients can perform simple work and take care of themselves.
"We decorate the Christmas tree"
Necessary equipment: New Year's toys.
◈ How to play: are you decorating a Christmas tree? Play with your baby. Invite him to choose from 4-6 balls exactly the same (in color, size, design) as the one in your hands. Or choose the same cracker as yours, or a serpentine of the same color. Or maybe you have New Year's houses or bunnies - take your pick. Change roles, make mistakes, let the child correct you.
◈ Fastening: what about New Year’s gifts? Let the child choose the same one from 10 candies as you have in your hands. Switch roles. Remember the New Year's poems along the way, there are many of them.
Prognosis and prevention
According to statistics, a quarter of mental development defects are associated with chromosomal abnormalities, so prevention is only possible for non-congenital pathologies.
Basic preventive measures:
· during the planned period of preparation for pregnancy, it is necessary to undergo a full examination for the presence of infections, eliminate all foci of inflammation and cure existing chronic diseases;
· check the condition of the thyroid gland and hormone levels;
· some types of mental retardation can be prevented through genetic counseling of future parents to identify disorders that are potentially dangerous for the normal development of the embryo and fetus;
· During pregnancy, women should regularly visit their doctor, take the necessary tests and undergo an ultrasound scan on time.
An important preventive measure for delaying the pace of development is the early detection of certain metabolic processes leading to mental retardation. If congenital hypothyroidism affecting a newborn is detected during the first month of life, the development of dysfunction can be prevented. If the problem is not identified and treated before the age of three months, then 20% of children with thyroid hormone deficiency will be mentally disabled.
"Plant mysteries"
The game helps to form voluntary attention and conceptual thinking.
Required equipment: forfeits.
◈ How do we play: is the whole family gathered together? Then let's play! The presenter (at first it will be an adult) points to each player in turn and says: “Flower, tree, fruit, flower...”.
◈ The player on whom the counting stops must quickly name the plant, in this case a flower (for example, chamomile or rose), etc.
◈ The answer is correct - the game continues. If the answer is incorrect or the name is repeated (delayed response is also considered a violation), then the player gives his forfeit to the presenter and is eliminated from the game.
◈ The game continues until one player remains. He and the presenter are playing out what each “fanta” should do - sing a song, dance, crow... That will be fun!
◈ Let's consolidate: this game can be played both at home and on the road (if you are not driving). Change the theme: fish, bird, animal or wood, glass, iron. Imagine!
◈ Let’s make it more complicated: a child can be the leader.
Mental retardation (MDD) - treatment at the RebenOK clinic in Moscow
The medical center employs experienced doctors who identify the causes of developmental delay and take effective measures to eliminate them. Pediatricians, child neurologists, psychologists, as well as speech pathologists and speech therapists take part in the work. Correction requires a long period and begins from preschool age.
Patients with mental retardation at the RebenOK clinic receive speech correction in individual speech therapy sessions. Medical care includes drug therapy, which is prescribed in accordance with cerebral-organic and somatic disorders. Massage, exercise therapy and physiotherapy are also prescribed.
ZPR is a diagnosis that can be treated. The main thing is to start taking action in time. Sign up for the RebenOK clinic in Moscow, where the best doctors work and use new treatment methods developed based on international protocols.
Literature:
1. Makarova O.A. Aspect analysis of mental retardation in domestic psychology // Concept magazine, 2013. URL: https://cyberleninka.ru/article/n/aspektnyy-analiz-zaderzhki-psihicheskogo-razvitiya-v-otechestvennoy-psihologii (access date: 02.09.2021)
2. Borisova P.V. Study of aggressive behavior of children with mental retardation of senior preschool age // Concept magazine, 2015. URL: https://cyberleninka.ru/article/n/issledovanie-agressivnogo-povedeniya-detey-s-zaderzhkoy-psihicheskogo-razvitiya- starshego-doshkolnogo-vozrasta (date of access: 02.09.2021)
3. Makarov I.V., Emelina D.A. Mental retardation in children (analytical review) // Review of Psychiatry and Medical Psychology No. 1, 2022. URL: https://psychiatr.ru/files/magazines/2018_04_scp_1276.pdf
4. Fillipova N.V., Barylnik Yu.B., Ismailova A.S.
Modern view of mental retardation // Medical Journal of Applied and Basic Research No. 10 (part 2), 2015. URL: https://applied-research.ru/ru/article/view?id=7480 (access date: 02.09 .2021) 5. Zotov A.G. On the issue of treating children with mental retardation // Regular issues of “RMZh”, No. 20. URL: https://www.rmj.ru/articles/pediatriya/K_voprosu_lecheniya_detey_s_zaderghkoy_psihicheskogo_razvitiya/ (access date: 09/02/2021)
