Psychopharmacotherapy of mental retardation is entering a new era characterized by improved diagnostics, understanding of its pathogenetic mechanisms, and expanding therapeutic capabilities.
Research and treatment of children and adults with mental retardation should be comprehensive and take into account how a given individual learns, works, and how his relationships with other people develop. Treatment options include a wide range of interventions: individual, group, family, behavioral, physical, occupational and other therapies. Psychopharmacotherapy is one of the components of treatment.
The use of psychotropic drugs in mentally retarded persons requires special attention to legal and ethical aspects. In the 1970s, the international community proclaimed the rights of mentally handicapped persons to receive adequate medical care. These rights were set out in the “Declaration of the Rights of Persons with Disabilities”. The declaration proclaimed "the right to adequate medical care" and "the same civil rights as other people." According to the Declaration, “persons with disabilities should be provided with qualified legal assistance if it is necessary to protect these persons”.
The proclamation of the right of mentally retarded persons to adequate medical care implied close control over possible excesses when using restrictive measures, including in connection with the use of psychotropic drugs to suppress unwanted activity. Courts are generally guided by the provision that measures of physical or chemical restraint should be applied to a person only when “violent behavior, injury or suicide attempt occurs or is seriously threatened”. In addition, courts usually require “an individual assessment of the potential and nature of violent behavior, the likely effect of drugs on a given individual, and the possibility of less restrictive alternatives” in order to confirm that the “least restrictive alternative” has been implemented. Thus, when deciding on the use of psychotropic drugs in mentally retarded persons, one should carefully weigh the possible risks and the perceived benefits of such prescription. The protection of the interests of the mentally retarded patient is carried out through the attraction of an "alternative opinion" (if the anamnestic data indicate the absence of criticism and the patient's preferences) or through the so-called "substituted opinion" (if there is some information about the individual's preferences in the present or the past).
In the past two decades, the doctrine of the "least restrictive alternative" has become relevant in connection with research data on the use of psychotropic drugs in mentally retarded patients. It turned out that psychotropic drugs are prescribed by 30-50% of patients placed in psychiatric institutions, 20-35% of adult patients and 2-7% of children with mental retardation observed on an outpatient basis. It has been found that psychotropic drugs are more often prescribed to elderly patients, to persons who are subjected to more severe restrictive measures, as well as to patients with social, behavioral problems and sleep disorders. Gender, level of intelligence, nature of behavioral disorders did not affect the frequency of use of psychotropic drugs in mentally retarded persons. It should be noted that although 90% of mentally retarded persons live outside psychiatric institutions, systematic studies of this contingent of patients are extremely rare.
Psychotropic drugs and mental retardation
Since psychotropic drugs, and often a combination of drugs, are often prescribed to people with mental retardation for long-term behavior control, it is imperative to consider the short-term and long-term effects of these drugs in order to choose the safest ones. First of all, this concerns antipsychotics, which are especially often used in this category of patients and often cause serious side effects, including irreversible tardive dyskinesia. Although antipsychotics allow you to control inappropriate behavior by suppressing behavioral activity in general, they are also able to selectively inhibit stereotypes and auto-aggressive actions. Opioid antagonists and serotonin reuptake inhibitors are also used to reduce auto-aggressive effects and stereotypy. Normotimics - lithium salts, valproic acid (depakin), carbamazepine (finlepsin) - are useful in correcting cyclic affective disturbances and outbursts of rage. Beta-blockers such as propranolol (anaprilin) are effective in treating aggression and destructive behavior. Psychostimulants - methylphenidate (Ritalin), dextramphetamine (Dexedrine), pemoline (Zilert) - and alpha2-adrenergic agonists, such as clonidine (clonidine) and guanfacine (estulic), have a beneficial effect in the treatment of people with mental retardation with hyperactivity disorder ...
Combined treatment with antipsychotics, anticonvulsants, antidepressants and normotimics is fraught with problems associated with pharmacokinetic and pharmacodynamic interactions. Therefore, before prescribing a combination of drugs, the doctor should inquire about the possibility of drug interactions in reference books or other sources of information. It should be emphasized that often patients take unnecessary drugs for a long time, the abolition of which does not adversely affect their condition, but avoids the side effects of these drugs.
Antipsychotics. Many psychotropic drugs have been used to suppress destructive actions, but none of them was as effective as antipsychotics. The effectiveness of neuroleptics can be explained by the role of hyperactivity of the dopaminergic systems of the brain in the pathogenesis of autoaggressive actions. Clinical trials of chlorpromazine (aminazine), thioridazine (sonapax), risperidone (rispolepta) have demonstrated the ability of all these drugs to inhibit destructive actions. Open-label trials of fluphenazine (moditen) and haloperiaol have also demonstrated their effectiveness in correcting auto-aggressive (self-damaging) and aggressive actions. However, aggressiveness may not respond as well as self-damaging actions to antipsychotic treatment. Perhaps, in autoaggressive actions, internal, neurobiological factors are more important, while aggressiveness is more dependent on external factors.
The main danger with the use of antipsychotics is the relatively high incidence of extrapyramidal side effects. According to various studies, approximately one or two thirds of patients with mental retardation show signs of tardive dyskinesia - chronic, sometimes irreversible orofacial dyskinesia, usually associated with prolonged use of antipsychotics. At the same time, it has been shown that in a significant part (in some studies - in a third) of patients with mental retardation, violent movements resembling tardive dyskinesia occur in the absence of neuroleptic therapy. This indicates that this category of patients is characterized by a high predisposition to the development of tardive dyskinesia. The likelihood of developing tardive dyskinesia depends on the duration of treatment, the dose of the neuroleptic, and the patient's age. This problem is especially relevant due to the fact that approximately 33% of children and adults with mental retardation take antipsychotics. Parkinsonism and other early extrapyramidal side effects (tremor, acute dystonia, akathisia) are detected in about a third of patients taking antipsychotics. Akathisia is characterized by internal discomfort that forces the patient to be in constant motion. It occurs in about 15% of patients taking antipsychotics. The use of antipsychotics carries the risk of neuroleptic malignant syndrome (NMS), which is rare but can be fatal. Risk factors for NMS - male sex, the use of high-potential antipsychotics. According to a recent study, the mortality rate among mentally retarded persons with the development of NMS is 21%. In cases where patients with mental retardation are prescribed antipsychotics, a dynamic assessment of possible extrapyramidal disorders is required before treatment and during treatment using special scales: Abnormal Involuntary Movement Scale (AIMS), Dyskinesia Identification System Condensed User Scale - DISCUS, Acathisia Scale - AS Atypical antipsychotics such as clozapine and olanzapine are less likely to cause extrapyramidal side effects, but their efficacy in mentally retarded individuals should be confirmed in controlled clinical trials. although clozapine is an effective antipsychotic, it can induce agranulocytosis and epileptic seizures.Olanzapine, sertindole, quetiapine and ziprasidone are new atypical antipsychotics that will undoubtedly be used in the future to treat mentally retarded patients because dreams than traditional antipsychotics.
At the same time, an alternative to antipsychotics has recently appeared in the form of selective serotonin reuptake inhibitors and normotimics, but their use requires a clearer identification of the structure of mental disorders. These drugs can reduce the need for antipsychotics in the treatment of self-harm and aggressiveness.
Normotimics. The normotimic agents include lithium preparations, carbamazepine (finlepsin), valproic acid (depakin). Severe aggressiveness and self-damaging actions are successfully treatable with lithium even in the absence of affective disorders. The use of lithium led to a decrease in aggressive and auto-aggressive actions, both according to the data of clinical impression and the results of rating scales, in almost all clinical trials. Other normotimal agents (carbamazepine, valproic acid) can also suppress self-harm and aggressiveness in people with mental retardation, but their effectiveness needs to be tested in clinical trials.
Beta-blockers. Propranolol (anaprilin), a beta-adrenergic receptor blocker, can reduce aggressive behavior associated with increased adrenergic tone. By preventing the activation of adrenergic receptors by norepinephrine, propranolol reduces the chronotropic, inotropic and vasodilatory effects of this neurotransmitter. Inhibition of the physiological manifestations of stress can in itself weaken aggressiveness. Since in patients with Down's syndrome the level of propranolol in the blood was higher than usual, the bioavailability of the drug in these patients for certain reasons may be increased. Although the ability of propranolol to successfully suppress impulsive outbursts in some mentally retarded individuals has been reported, this effect of propranolol needs to be confirmed in controlled trials.
Opioid receptor antagonists. Naltrexone and naloxone, opioid receptor antagonists that block the effects of endogenous opioids, are used in the treatment of auto-aggressive effects. Unlike naltrexone, naloxone comes in parenteral form and has a shorter T1 / 2. Although early open-label studies of opioid antagonists showed a decrease in auto-aggressive effects, in subsequent controlled trials, their effectiveness did not exceed that of placebo. The possibility of developing dysphoria and the negative results of controlled studies do not allow this class of drugs to be considered a means of choice for autoaggressive actions. But, as clinical experience shows, in some cases, these funds can be useful.
Serotonin reuptake inhibitors. The similarity of auto-aggressive actions with stereotypes may explain the positive reaction of some patients to serotonin reuptake inhibitors such as clomipramine (anafranil), fluoxetine (Prozac), fluvoxamine (fevarin), sertraline (zoloft), paroxetine (paxil), citalopram (cipramilopram). Self-harm, aggression, stereotypes, behavioral rituals can be reduced under the influence of fluoxetine, especially if they develop against the background of comorbid compulsive actions. Similar results (a decrease in auto-aggressive, ritual actions and perseverations) were obtained with the use of clomipramine. Double-blind trials will determine if these agents are helpful in all patients with auto-aggressive activities, or if they only help in the presence of comorbid compulsive / perseverative activities. Since these agents are capable of inducing arousal, their use can be limited only to the treatment of this syndrome.
Mental retardation and affective disorders
Recent advances in the diagnosis of depression and dysthymia in mentally retarded individuals allow these conditions to be treated with more specific means. However, the response to antidepressants in the mentally retarded is variable. Dysphoria, hyperactivity, and behavioral changes are common with antidepressants. In a retrospective review of the response to tricyclic antidepressants in mentally retarded adults, only 30% of patients showed a significant positive effect, and symptoms such as agitation, aggression, self-damaging actions, hyperactivity, irascibility remained largely unchanged.
More predictable was the response to normotimic drugs in cyclic affective disorders in patients with mental retardation. Although lithium is known to interfere with sodium transport in nerve and muscle cells and affect the metabolism of catecholamines, its mechanism of action on affective functions remains unclear. When treating with lithium preparations, you should regularly monitor the level of this ion in the blood, conduct a clinical blood test and study the function of the thyroid gland. One placebo-controlled study and several open-label studies of the efficacy of lithium for bipolar disorder in people with mental retardation have shown encouraging results. Side effects of lithium medications include gastrointestinal upset, eczema, and tremors.
Valproic acid (depakin) and divalproex sodium (depakote) have anticonvulsant and normotimal effects, which may be associated with the effect of the drug on the level of GABA in the brain. Although cases of toxic effects of valproic acid on the liver have been described, they were usually observed in early childhood, in the first six months of treatment. However, liver function should be monitored before starting and regularly during treatment. It has been shown that the positive effect of valproic acid on affective disorders, aggressiveness and self-harming actions in mentally retarded persons is manifested in 80% of cases. Carbamazepine (finlepsin), another anticonvulsant used as a normotimal agent, may also be useful in the treatment of affective disorders in mentally retarded individuals. Since aplastic anemia and agranulocytosis may develop when taking carbamazepine, a clinical blood test should be monitored before prescribing the drug and during treatment. Patients should be warned of early signs of intoxication and hematological complications such as fever, sore throat, rashes, oral ulcers, bleeding, petechial hemorrhages, or purpura. Despite the antiepileptic activity, carbamazepine should be prescribed with caution in patients with polymorphic seizures, including atypical absences, since the drug can provoke generalized tonic-clonic seizures in these patients. The response to carbamazepine in mentally retarded individuals with mood disorders is not as predictable as the response to lithium and valproic acid preparations.
Mental retardation and anxiety disorders
Buspirone (buspar) is an anxiolytic agent that differs in pharmacological properties from benzodiazepines, barbiturates and other sedative and hypnotic drugs. Preclinical studies show that buspirone has a high affinity for serotonin 5-HT1D receptors and a moderate affinity for dopamine D2 receptors in the brain. The latter effect may explain the appearance of restless legs syndrome, which sometimes occurs soon after the initiation of drug treatment. Other side effects include dizziness, nausea, headache, irritability, agitation. The effectiveness of buspirone in treating anxiety in mentally retarded individuals has not been tested in controlled trials. However, it has been shown to be useful in auto-aggressive actions.
Mental retardation and stereotypes
Fluoxetiv is a selective serotonin reuptake inhibitor that is effective in depression and obsessive-compulsive disorder. Since fluoxetine metabolites inhibit the activity of CYP2D6, the combination with drugs that are metabolized by this enzyme (for example, tricyclic antidepressants) can lead to side effects. Studies have shown that the stable concentration of imipramine and desipramine in the blood after the addition of fluoxetine increases by 2-10 times. Moreover, since fluoxetine has a long half-life, this effect may appear within 3 weeks of withdrawal. When taking fluoxetine, the following side effects are possible: anxiety (10-15%), insomnia (10-15%), changes in appetite and weight (9%), induction of mania or hypomania (1%), epileptic seizures (0.2%) ... In addition, asthenia, anxiety, increased sweating, gastrointestinal disturbances including anorexia, nausea, diarrhea, and dizziness are possible.
Other selective serotonin reuptake inhibitors — sertraline, fluvoxamine, paroxetine, and the non-selective inhibitor clomipramine — may be helpful in treating stereotypy, especially when there is a compulsive component. Clomipramine is a dibenzazepine tricyclic antidepressant with a specific antiobsessive effect. Clomipramine has been shown to be effective in the treatment of violent outbursts and compulsive ritualized activities in adults with autism. Although other serotonin reuptake inhibitors are also likely to have beneficial effects on stereotypy in mentally retarded patients, controlled studies are needed to confirm their effectiveness.
Mental retardation and attention deficit hyperactivity disorder
Although it has long been known that nearly 20% of children with mental retardation develop attention deficit hyperactivity disorder, only in the last two decades have attempts been made to treat it.
Psychostimulants. Methylphenidate (Ritalin), a mild central nervous system stimulant, selectively reduces manifestations of hyperactivity and attention deficit in people with mental retardation. Methylphenidate is a short-acting drug. The peak of its activity occurs in children after 1.3-8.2 hours (on average after 4.7 hours) when taking a sustained-release drug or after 0.3-4.4 hours (on average after 1.9 hours) with taking a standard drug. Psychostimulants have a positive effect in patients with mild to moderate mental retardation. Moreover, their effectiveness is higher in patients with impulsivity, attention deficit, behavioral disorder, impaired coordination of movements, perinatal complications. Due to the stimulating effect, the drug is contraindicated in cases of severe anxiety, mental stress, agitation. In addition, it is relatively contraindicated in patients with glaucoma, tics, and those with a family history of Tourette's syndrome. Methylphenidate may slow down the metabolism of coumarin anticoagulants, anticonvulsants (such as phenobarbital, phenytoin, or primidone), as well as phenylbutazone and tricyclic antidepressants. Therefore, the dose of these drugs, if prescribed together with methylphenidate, must be reduced. The most common adverse reactions with methylphenidate are anxiety and insomnia, both of which are dose dependent. Other side effects include allergic reactions, anorexia, nausea, dizziness, palpitations, headache, dyskinesia, tachycardia, angina pectoris, irregular heart rhythms, abdominal pain, and long-term weight loss.
Dextramphetamine sulfate (d-amphetamine, dexedrine) is the dextrorotatory isomer of d, 1-amphetamine sulfate. The peripheral effect of amphetamines is characterized by an increase in systolic and diastolic blood pressure, a weak bronchodilatory effect, and stimulation of the respiratory center. When taken orally, the concentration of dextramphetamine in the blood reaches a peak after 2 hours. The half-elimination period is approximately 10 hours. Drugs that increase acidity reduce the absorption of dextramphetamine, and drugs that reduce acidity increase it. Clinical trials have shown that dextramphetamine reduces the manifestations of DVH in children with mental retardation.
Alpha-adrenergic receptor agonists. Clonidine (clonidine) and guanfacine (estulic) are α-adrenergic receptor agonists, which are successfully used in the treatment of hyperactivity. Clonidine, an imidazoline derivative, stimulates α-adrenergic receptors in the brainstem, decreasing the activity of the sympathetic system, reducing peripheral resistance, renal vascular resistance, heart rate and blood pressure. Clonidine acts quickly: after taking the drug inside, blood pressure decreases after 30-60 minutes. The concentration of the drug in the blood reaches a peak after 2-4 hours. With prolonged use, tolerance to the drug develops. A sudden withdrawal of clonidine can lead to irritability, agitation, headache, tremors, which are accompanied by a rapid rise in blood pressure, an increase in the level of catecholamines in the blood. Since clonidine can provoke the development of bradycardia and atrioventricular blockade, caution should be exercised when prescribing the drug to patients taking digitalis drugs, calcium antagonists, beta-blockers that suppress the function of the sinus node or conduction through the atrioventricular node. The most common side effects of clonidine include dry mouth (40%), drowsiness (33%), dizziness (16%), constipation (10%), weakness (10%), sedation (10%).
Guanfacine (estulic) is another alpha2-adrenergic receptor agonist that also lowers peripheral vascular resistance and heart rate. Guanfacine is effective in reducing the manifestations of DVH in children and may specifically improve prefrontal brain function. Like clonidine, guanfacine enhances the sedative effect of phenothiazines, barbiturates, and benzodiazepines. In most cases, the side effects caused by guanfacine are mild. These include dry mouth, drowsiness, asthenia, dizziness, constipation, and impotence. When choosing a drug for the treatment of DVH in children with mental retardation, the presence of tics does not affect so often, in this category of patients it is more difficult to recognize them later than in normally developing children. However, if a patient with mental retardation has tics or a family history of Tourette's syndrome, alpha2-adrenoceptor agonists should be considered the drugs of choice for the treatment of ADHD.
- Exercise therapy) for children with mental retardation - ( video)
- Recommendations to parents regarding the labor education of children with mental retardation - ( video)
- Is the child given a disability group for mental retardation? - ( video)
- Life expectancy of children and adults with oligophrenia
The site provides background information for informational purposes only. Diagnosis and treatment of diseases must be carried out under the supervision of a specialist. All drugs have contraindications. A specialist consultation is required!
Treatment and correction of mental retardation ( how to treat oligophrenia?)
Treatment and correction mental retardation ( oligophrenia) - a complex process that requires a lot of attention, effort and time. However, with the right approach, certain positive results can be achieved within a few months after the start of treatment.Is it possible to cure mental retardation ( remove the diagnosis of mental retardation)?
Oligophrenia is incurable. This is due to the fact that when exposed to causal ( disease-provoking) factors damage to certain parts of the brain occurs. As you know, the nervous system ( especially its central section, that is, the brain and spinal cord) develop in the prenatal period. After birth, the cells of the nervous system practically do not divide, that is, the ability of the brain to regenerate ( recovery from damage) is practically minimal. Once damaged neurons ( nerve cells) will never be restored, as a result of which the once developed mental retardation will remain in the child until the end of his life.At the same time, children with a mild form of the disease respond well to therapeutic and corrective measures, as a result of which they can receive a minimum education, learn self-service skills and even get a simple job.
It is also worth noting that in some cases, the goal of treatment is not to cure mental retardation as such, but to eliminate its cause, which will prevent the progression of the disease. Such treatment should be carried out immediately after identifying the risk factor ( for example, when examining the mother before, during or after childbirth), since the longer the causal factor will affect the baby's body, the deeper the disorders of thinking he may develop in the future.
Treatment for the cause of mental retardation can be:
- With congenital infections- for syphilis, cytomegalovirus infection, rubella and other infections, antiviral and antibacterial drugs can be prescribed.
- With diabetes mellitus in the mother.
- With metabolic disorders- for example, with phenylketonuria ( metabolic disorders of the amino acid phenylalanine in the body) Avoiding foods containing phenylalanine from the diet can help solve the problem.
- With hydrocephalus- Surgical operation immediately after the detection of pathology can prevent the development of mental retardation.
Finger gymnastics for the development of fine motor skills
One of the disorders that occur in mental retardation is a violation of fine motor skills of the fingers. At the same time, it is difficult for children to perform precise, targeted movements ( such as holding a pen or pencil, tying shoelaces, etc.). Finger gymnastics, the purpose of which is to develop fine motor skills in children, will help to correct this deficiency. The mechanism of action of the method lies in the fact that frequently performed finger movements are "memorized" by the child's nervous system, as a result of which in the future ( after repeated workouts) the child can perform them more accurately, while spending less effort.Finger gymnastics can include:
- Exercise 1 (finger counting). Suitable for children with mild mental retardation who are learning to count. First you need to fold your hand into a fist, and then straighten 1 finger at a time and count them ( aloud). Then you need to bend your fingers back, also counting them.
- Exercise 2. First, the child should spread the fingers of both palms and place them in front of each other so that only the pads of the fingers touch each other. Then he needs to bring his palms together ( so that they also touch), and then return to the original position.
- Exercise 3. During this exercise, the child should fold his hands into the lock, while first the thumb of one hand should be on top, and then the thumb of the other hand.
- Exercise 4. First, the child should spread the fingers of the hand, and then bring them together so that the tips of all five fingers are gathered at one point. The exercise can be repeated many times.
- Exercise 5. During this exercise, the child needs to clench his hands into fists, and then straighten his fingers and spread them, repeating these steps several times.
Medicines ( drugs, tablets) with mental retardation ( nootropics, vitamins, antipsychotics)
The goal of drug treatment for oligophrenia is to improve metabolism at the level of the brain, as well as to stimulate the development of nerve cells. In addition, drugs can be prescribed to relieve certain symptoms of the disease, which may be expressed differently in different children. In any case, the treatment regimen must be selected for each child individually, taking into account the severity of the underlying disease, its clinical form and other features.Medication for mental retardation
Group of drugs | Representatives | The mechanism of therapeutic action |
Nootropics and drugs that improve cerebral circulation | Piracetam | Improves metabolism at the neuronal level ( nerve cells) of the brain, increasing the rate of oxygen utilization by them. This can contribute to patient education and mental development. |
Phenibut |
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Vinpocetine |
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Glycine |
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Aminalon |
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Pantogam |
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Cerebrolysin |
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Oxybral |
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Vitamins | Vitamin B1 | Essential for the normal development and functioning of the central nervous system. |
Vitamin B6 | It is necessary for the normal transmission of nerve impulses in the central nervous system. With its lack, such a sign of mental retardation as retardation of thinking can progress. |
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Vitamin B12 | With a lack of this vitamin in the body, accelerated death of nerve cells can be observed ( including at the level of the brain), which can contribute to the progression of mental retardation. |
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Vitamin E | Protects the central nervous system and other tissues from damage by various harmful factors ( in particular with a lack of oxygen, with intoxication, with irradiation). |
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Vitamin A | With its lack, the work of the visual analyzer may be disrupted. |
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Antipsychotics | Sonapax | They inhibit the activity of the brain, making it possible to eliminate such manifestations of oligophrenia as aggressiveness and pronounced psychomotor agitation. |
Haloperidol |
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Neuleptil |
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Tranquilizers | Tazepam | They also inhibit the activity of the central nervous system, helping to eliminate aggressiveness, as well as anxiety, increased excitability and mobility. |
Nosepam |
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Adaptol |
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Antidepressants | Trittico | They are prescribed when the child's psychoemotional state is suppressed, which persists for a long time ( more than 3 - 6 months in a row). It is important to note that the persistence of such a state for a long time significantly reduces the child's ability to learn in the future. |
Amitriptyline |
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Paxil |
It should be noted that the dosage, frequency and duration of use of each of the listed drugs is also determined by the attending physician, depending on many factors ( in particular, on the general condition of the patient, the predominance of certain symptoms, the effectiveness of the treatment being carried out, possible side effects, and so on).
Tasks of massage for mental retardation
Neck and head massage is part of a comprehensive treatment for mentally retarded children. At the same time, full body massage can stimulate the development of the musculoskeletal system, improve the patient's general well-being, and improve his mood.The tasks of massage for oligophrenia are:
- Improving blood microcirculation in massaged tissues, which will improve the delivery of oxygen and nutrients to the nerve cells of the brain.
- Improving the outflow of lymph, which will improve the process of removing toxins and metabolic by-products from the brain tissue.
- Improvement of microcirculation in muscles, which helps to increase their tone.
- Stimulation of nerve endings in the area of the fingers and palms, which can contribute to the development of fine motor skills in the hands.
- Creation of positive emotions that have a beneficial effect on the general condition of the patient.
Effects of music on children with mental retardation
Playing music or just listening to it has a positive effect on the course of mental retardation. That is why almost all children with mild to moderate disease are advised to include music in their correction programs. At the same time, it should be noted that with a more severe degree of mental retardation, children do not perceive music, do not understand its meaning ( for them it's just a set of sounds), and therefore they will not be able to achieve a positive effect.Music lessons allow:
- Develop the child's speech apparatus (while singing songs). In particular, the pronunciation of individual letters, syllables and words is improved in children.
- Develop a child's hearing. In the process of listening to music or singing, the patient learns to distinguish sounds by their tonality.
- Develop intellectual ability. To sing a song, a child needs to perform several consecutive actions at once ( draw air in the chest before the next verse, wait for a suitable melody, choose the right voice volume and singing speed). All this stimulates the thought processes that are disturbed in children with mental retardation.
- Develop cognitive activity. In the process of listening to music, a child can learn new musical instruments, evaluate and remember the nature of their sound, and then learn ( to define) them by sound alone.
- Teach a child to play musical instruments. This is possible only with a mild form of mental retardation.
Education of persons with mental retardation
Despite the mental retardation, almost all patients with mental retardation ( except deep form) can lend themselves to a certain amount of learning. At the same time, the general education programs of regular schools may not be suitable for all children. It is extremely important to choose the right place and type of training, which will allow the child to develop their abilities to the maximum. Regular and correctional schools, boarding schools and classes for schoolchildren with mental retardation ( PMPK recommendations)
In order for a child to develop as intensively as possible, you need to choose the right educational institution to send him to.Education of mentally retarded children can be carried out:
- In general education schools. This method is suitable for children with mild mental retardation. In some cases, mentally retarded children can successfully complete the first 1 - 2 grades of school, while there will be no noticeable differences between them and ordinary children. At the same time, it is worth noting that as the school curriculum grows older and heavier, children will begin to lag behind their peers in academic performance, which can cause certain difficulties ( low mood, fear of failure, and so on).
- In correctional schools or boarding schools for mentally retarded persons. A special school for children with mental retardation has both its pros and cons. On the one hand, the education of a child in a boarding school allows him to pay much more attention from the teachers than when he attended a regular school. In the boarding school, teachers and educators are trained to work with such children, as a result of which it is easier to establish contact with them, find an individual approach to teaching them, and so on. The main disadvantage of such training is the social isolation of a sick child, who practically does not communicate with normal ( healthy) children. Moreover, during their stay in the boarding school, children are constantly monitored and carefully cared for, to which they get used. After graduating from the boarding school, they may simply be unprepared for life in society, as a result of which they will need constant care for the rest of their lives.
- In special correctional schools or classes. Some mainstream schools have classes for mentally retarded children in which they are taught a simplified school curriculum. This allows children to receive the necessary minimum knowledge, as well as stay among "normal" peers, which contributes to their introduction into society in the future. This teaching method is suitable only for patients with a mild degree of mental retardation.
During the PMPC examination, the child may be asked:
- What's his name?
- How old is he?
- Where does he live?
- How many people are in his family ( may be asked to briefly talk about each family member)?
- Are there pets at home?
- What kind of games does the child like?
- What dishes does he prefer for breakfast, lunch or dinner?
- Does the child know how to sing ( at the same time, they may be asked to sing a song or tell a short rhyme)?
FGOS OVZ ( federal state educational standard
The Federal State Educational Standard is a generally recognized standard of education that all educational institutions of the country must adhere to ( for preschoolers, schoolchildren, students and so on). This standard regulates the work of an educational institution, material, technical and other equipment of an educational institution ( what kind of personnel and in what quantity should work in it), as well as monitoring of training, the availability of training programs, and so on.FGOS HVZ is a federal state educational standard for students with disabilities. It regulates the educational process for children and adolescents with various physical or mental disabilities, including mentally retarded patients.
Adapted basic general education programs ( AOOP) for preschoolers and schoolchildren with mental retardation
These programs are part of the Federal State Educational Standard of HVZ and represent the best method of teaching people with mental retardation in preschool institutions and schools.The main objectives of AOOP for children with mental retardation are:
- Creation of conditions for the education of mentally retarded children in general education schools, as well as in special boarding schools.
- Creation of similar educational programs for children with mental retardation, which could master these programs.
- Creation of educational programs for mentally retarded children to receive preschool and general education.
- Development of special programs for children with various degrees of mental retardation.
- Organization of the educational process, taking into account the behavioral and mental characteristics of children with various degrees of mental retardation.
- Quality control of educational programs.
- Control of the assimilation of information by students.
- To maximize the mental abilities of each individual child with mental retardation.
- Teach mentally retarded children self-care ( if possible), simple work, and other necessary skills.
- Teach children to behave correctly in society and interact with it.
- Develop students' interest in learning.
- Eliminate or smooth out the deficiencies and defects that a mentally retarded child may have.
- To teach the parents of a mentally retarded child to behave properly with him, and so on.
Work programs for children with intellectual disabilities
Based on the main general education programs ( regulating the general principles of teaching mentally retarded children) work programs are being developed for children with various degrees and forms of mental retardation. The advantage of this approach is that the work program maximally takes into account the individual characteristics of the child, his ability to learn, perceive new information and communicate in society.For example, a work program for children with mild mental retardation may include teaching self-care, reading, writing, mathematics, and so on. At the same time, children with a severe form of the disease are unable to read, write and count in principle, as a result of which their work programs will include only general self-care skills, learning to control emotions and other simple activities.
Correctional exercises for mental retardation
Correctional classes are selected for each child individually, depending on the mental disorders, behavior, thinking and so on. These classes can be taught in special schools ( professionals) or at home.The goals of remedial training are:
- Teaching the child basic school skills- reading, writing, simple counting.
- Teaching children to behave in society- for this, group lessons are used.
- Development of speech- especially in children who have impaired pronunciation of sounds or have other similar defects.
- Teach a child to self-serve- at the same time, the teacher should focus on the dangers and risks that may lie in wait for the child in everyday life ( for example, the child must learn that there is no need to grab onto hot or sharp objects as it will hurt afterwards).
- Develop attention and perseverance- especially important for children with impaired ability to concentrate.
- Teaching a child to control their emotions- especially if he has fits of anger or rage.
- Develop fine motor skills of the hands- if it is violated.
- Develop memory- memorize words, phrases, sentences or even poems.
CIPRs for children with mental retardation
SIPD is a special individual development program, selected for each particular mentally retarded child separately. The tasks of this program are similar to those in correctional classes and adapted programs, however, when developing the SIPR, not only the degree of oligophrenia and its form are taken into account, but also all the features of the disease that the child has, the degree of their severity, and so on.To develop SIPR, a child must undergo a full examination by many specialists ( at a psychiatrist, psychologist, neurologist, speech therapist and so on). During the examination, doctors will identify dysfunctions of various organs ( for example, memory impairment, fine hand motor impairment, impaired concentration) and evaluate their severity. On the basis of the data obtained, the SIPR will be drawn up, designed to correct, first of all, those violations that are most pronounced in the child.
So, for example, if a child with oligophrenia has impaired speech, hearing and concentration, but there are no movement disorders, it makes no sense to assign him many hours of classes to improve fine motor skills of the hands. In this case, classes with a speech therapist should come to the fore ( to improve pronunciation of sounds and words), classes to increase the ability to concentrate, and so on. At the same time, there is no point in wasting time teaching a child with a deep form of mental retardation to read or write, since he will not master these skills anyway.
Literacy teaching method ( reading) children with mental retardation
With a mild form of the disease, the child can learn to read, understand the meaning of the text read, or even partially retell it. With a moderate form of mental retardation, children can also learn to read words and sentences, but their reading of the text is meaningless ( they read, but do not understand what). They are also unable to retell what they have read. With a severe and deep form of mental retardation, the child cannot read.Learning to read mentally retarded children allows:
- Teach your child to recognize letters, words and sentences.
- Learn expressive reading ( with intonation).
- Learn to understand the meaning of the read text.
- Develop speech ( while reading aloud).
- Create prerequisites for learning to write.
Learning to write
Only children with a mild degree of illness can learn to write. With moderately severe mental retardation, children may try to pick up a pen, write letters or words, but they will not be able to write something meaningful.It is imperative that the child learns to read at least to a minimum before starting the training. After that, he should be taught to draw simple geometric shapes ( circles, rectangles, squares, straight lines and so on). When he masters this, you can move on to writing letters and memorizing them. Then you can start writing words and sentences.
It is worth noting that for a mentally retarded child, the difficulty lies not only in mastering writing, but also in understanding the meaning of what is written. At the same time, some children have a pronounced violation of fine motor skills of the hands, which prevents them from mastering writing. In this case, it is recommended to combine the teaching of grammar and corrective exercises that allow developing motor activity in the fingers.
Math for children with mental retardation
Teaching math to children with mild mental retardation contributes to the development of thinking and social behavior. At the same time, it should be noted that the mathematical abilities of children with imbecility ( moderate degree of mental retardation) are quite limited - they can perform simple mathematical operations ( add, subtract), however, it is not able to solve more complex problems. Children with severe and deep mental retardation do not understand mathematics in principle.Children with mild mental retardation can:
- Count natural numbers.
- Learn the concepts of "fraction", "proportion", "area" and others.
- Master the basic units of measurement of mass, length, speed and learn how to apply them in everyday life.
- Learn how to shop, calculate the cost of several items at once and the amount of change required.
- Learn to use measuring and counting devices ( ruler, compasses, calculator, abacus, clock, scales).
Pictograms for children with mental retardation
Pictograms are a kind of schematic pictures that depict certain objects or actions. Pictograms allow you to establish contact with a mentally retarded child and teach him in cases where it is impossible to communicate with him through speech ( for example, if he is deaf, and also if he does not understand the words of others).The essence of the pictogram technique is to associate a certain image in a child ( picture) with some specific action. For example, a picture of a toilet bowl can be associated with the desire to go to the toilet. At the same time, a picture of a bath or shower can be associated with water treatments. In the future, these pictures can be fixed on the doors of the corresponding rooms, as a result of which the child will better navigate in the house ( wanting to go to the toilet, he will independently find the door into which he needs to enter for this).
On the other hand, you can use pictograms to communicate with your child. So, for example, in the kitchen you can keep pictures with the image of a cup ( jug) with water, plates of food, fruits and vegetables. When a child is thirsty, he can point to water, while pointing to a picture of food will help others to understand that the child is hungry.
The above were only some examples of the use of pictograms, however, using this technique, you can teach a mentally retarded child a wide variety of activities ( brush your teeth in the morning, make and make your own bed, fold things, and so on). However, it should be noted that this technique will be as effective as possible in case of mild oligophrenia and only partially effective in case of a moderate degree of the disease. At the same time, children with a severe and deep degree of mental retardation practically do not lend themselves to learning with the help of pictograms ( due to the complete lack of associative thinking).
Extracurricular activities of children with mental retardation
Extracurricular activities are activities that are not in the classroom ( like all lessons), and in a different setting and according to a different plan ( in the form of games, competitions, travel and so on). Changing the method of presenting information to mentally retarded children allows them to stimulate the development of intelligence and cognitive activity, which has a beneficial effect on the course of the disease.The goals of extracurricular activities can be:
- adaptation of the child in society;
- application of the acquired skills and knowledge in practice;
- development of speech;
- physical ( sports) child development;
- development of logical thinking;
- developing the ability to navigate in unfamiliar terrain;
- psycho-emotional development of the child;
- the acquisition of new experiences by the child;
- development of creative abilities ( for example, when hiking, playing in the park, in the forest, etc.).
Homeschooling children with mental retardation
Teaching mentally retarded children can be done at home. Both parents themselves and specialists ( speech therapist, psychiatrist, teachers who know how to work with these children, and so on).On the one hand, such a teaching methodology has its advantages, since the child is paid much more attention in this case than when teaching in groups ( classes). At the same time, the child in the learning process does not contact peers, does not acquire the skills of communication and behavior necessary for him, as a result of which in the future it will be much more difficult for him to integrate into society and become a part of it. Therefore, it is not recommended to practice teaching mentally retarded children exclusively at home. It is best to combine both methods when the child visits an educational institution in the afternoon, and in the afternoon the parents study with him at home.
Rehabilitation and socialization of children with mental retardation
If the diagnosis of mental retardation is confirmed, it is extremely important to start working with the child in a timely manner, which in case of mild forms of the disease will allow him to get along in society and become a full member of it. At the same time, special attention should be paid to the development of mental, mental, emotional and other functions that are impaired in children with mental retardation. Classes with a psychologist ( psychocorrection)
The primary task of a psychologist when working with a mentally retarded child is to establish friendly, trusting relationships with him. After that, in the process of communicating with the child, the doctor identifies certain mental and psychological disorders that prevail in this particular patient ( for example, instability of the emotional sphere, frequent tearfulness, aggressive behavior, unexplained joy, difficulties in communicating with others, and the like). Having established the main violations, the doctor tries to help the child get rid of them, thereby speeding up the learning process and improving the quality of his life.Psychocorrection can include:
- psychological education of the child;
- help in realizing your "I";
- social education ( teaching the rules and norms of behavior in society);
- assistance in experiencing psycho-emotional trauma;
- creation of favorable ( friendly) family environment;
- improving communication skills;
- teaching the child to control emotions;
- teaching skills to overcome difficult life situations and problems.
Speech therapy classes ( with a speech therapist)
Violations and underdevelopment of speech can be observed in children with varying degrees of mental retardation. To correct them, classes with a speech therapist are prescribed, who will help children develop speech abilities.Classes with a speech therapist allow you to:
- Teach children to pronounce sounds and words correctly. For this, the speech therapist uses various exercises, during which children have to repeat many times those sounds and letters that they pronounce the worst.
- Teach your child to build sentences correctly. This is also achieved through activities during which the speech therapist communicates with the child orally or in writing.
- Improve your child's performance in school. Underdevelopment of speech can be the reason for poor performance in many subjects.
- Stimulate the overall development of the child. Learning to speak and pronounce words correctly, the child simultaneously memorizes new information.
- Improve the position of the child in society. If a student learns to speak correctly and correctly, it will be easier for him to communicate with classmates and make friends.
- Develop the child's ability to concentrate. During classes, the speech therapist may allow the child to read aloud longer and longer texts, which will require a longer concentration of attention.
- Expand the child's vocabulary.
- Improve your understanding of speaking and writing.
- Develop the abstract thinking and imagination of the child. To do this, the doctor can have the child read aloud books with fairy tales or fictional stories, and then discuss the plot with him.
Didactic games for children with mental retardation
During observations of mentally retarded children, it was noted that they are reluctant to study any new information, but they can play all kinds of games with great pleasure. Based on this, a didactic methodology was developed ( teaching) games, during which the teacher in a playful way brings certain information to the child. The main advantage of this method is that the child, without realizing it, develops mentally, psychically and physically, learns to communicate with other people and acquires certain skills that he will need in later life.For educational purposes, you can use:
- Picture games- children are offered a set of pictures and asked to choose from them animals, cars, birds, and so on.
- Number Games- if the child already knows how to count, on various objects ( on cubes, books or toys) you can stick numbers from 1 to 10 and mix them, and then ask the child to arrange them in order.
- Animal Sound Games- the child is shown a series of pictures with images of animals and asked to demonstrate what sounds each of them makes.
- Games to help develop fine motor skills- you can draw letters on small cubes, and then ask the child to assemble any word from them ( the name of the animal, bird, city and so on).
Exercise and physiotherapy exercises ( Exercise therapy) for children with mental retardation
The goal of exercise therapy ( physiotherapy exercises) is the general strengthening of the body, as well as the correction of physical defects that may be present in a mentally retarded child. The physical activity program should be selected individually or by combining children with similar problems into groups of 3 - 5 people, which will allow the instructor to pay enough attention to each of them.The goals of exercise therapy for oligophrenia can be:
- The development of fine motor skills of the hands. Since this disorder is more common in mentally retarded children, exercises to correct it should be included in every exercise program. Among the exercises, one can note clenching and unclenching the hands into fists, spreading and bringing the fingers together, touching each other with fingertips, alternately flexing and unbending each finger separately, and so on.
- Correction of spinal deformities. This disorder occurs in children with severe mental retardation. To correct it, exercises are used that develop the muscles of the back and abdomen, the joints of the spine, water procedures, exercises on the horizontal bar and others.
- Correction of movement disorders. If the child has paresis ( in which he weakly moves his arms or legs), exercises should be aimed at developing the affected limbs ( flexion and extension of arms and legs, rotational movements by them, and so on).
- Development of coordination of movements. To do this, you can perform exercises such as jumping on one leg, long jump ( after the jump, the child must maintain balance and remain on his feet), throwing the ball.
- Development of mental functions. To do this, you can perform exercises consisting of several consecutive parts ( for example, put your hands on your belt, then sit down, stretch your arms forward, and then do the same in reverse order).
For sports activities, mentally retarded children are recommended:
- Swimming. This helps them learn to solve complex sequential problems ( come to the pool, change, wash, swim, wash and dress again), and also forms a normal attitude towards water and water procedures.
- Skiing. They develop physical activity and the ability to coordinate the movements of the arms and legs.
- Biking. Promotes the development of balance, concentration and the ability to quickly switch from one task to another.
- Travels ( tourism). A change of environment stimulates the development of cognitive activity of a mentally retarded patient. At the same time, when traveling, physical development and strengthening of the body occurs.
Recommendations to parents regarding the labor education of children with mental retardation
Labor education of a mentally retarded child is one of the key points in the treatment of this pathology. After all, it depends on the ability to self-service and to work whether a person can live independently or whether he will need the care of strangers throughout his life. Labor education of a child should be carried out not only by teachers at school, but also by parents at home.The development of work activity in a child with mental retardation may include:
- Self-service training- the child needs to be taught how to dress independently, observe the rules of personal hygiene, take care of his appearance, eat and so on.
- Learning to do work- from an early age, children can independently lay out things, sweep the street, vacuum, feed pets or clean up after them.
- Teamwork training- if the parents are going to do some simple work ( for example, picking mushrooms or apples, watering the garden), the child should be taken with you, explaining and clearly demonstrating to him all the nuances of the work performed, as well as actively cooperating with him ( for example, instructing him to bring water while watering the garden).
- Versatile training- parents should teach the child a variety of types of work ( even if at first he does not succeed in doing any work).
- A child's awareness of the benefits of their work- parents should explain to the child that after watering the garden, vegetables and fruits will grow on it, which the baby can then eat.
Prognosis for mental retardation
The prognosis for this pathology directly depends on the severity of the disease, as well as on the correctness and timeliness of the treatment and corrective measures taken. So, for example, if you regularly and intensively deal with a child who is diagnosed with a moderate degree of mental retardation, he can learn to speak, read, communicate with peers, and so on. At the same time, the absence of any training sessions can provoke a deterioration in the patient's condition, as a result of which even a mild degree of oligophrenia can progress to moderate or even severe. Is the child given a disability group for mental retardation?
Since the ability for self-care and full life of a mentally retarded child is impaired, he can get a group of disabilities, which will allow him to enjoy certain advantages in society. At the same time, one or another group of disabilities is exposed depending on the degree of mental retardation and the general condition of the patient.Children with mental retardation may be assigned:
- 3 group of disabilities. It is issued to children with a mild degree of mental retardation, who can serve themselves independently, are amenable to learning and can attend regular schools, but require increased attention from the family, others and teachers.
- 2 group of disabilities. Issued to children with a moderate degree of mental retardation who are forced to attend special correctional schools. They do not lend themselves well to training, do not get along well in society, have little control over their actions and cannot be held responsible for some of them, and therefore often need constant care, as well as the creation of special conditions for living.
- 1 group of disabilities. Issued to children with severe and profound mental retardation who are practically unable to learn or self-serve, and therefore need continuous care and guardianship.
Life expectancy of children and adults with oligophrenia
In the absence of other diseases and developmental defects, the life expectancy of mentally retarded people directly depends on the ability to self-care or on the care of them from others.Healthy ( physically) people with a mild degree of mental retardation can take care of themselves, are easy to learn and can even get a job, earning money to feed themselves. In this regard, their average life expectancy and causes of death practically do not differ from those among healthy people. The same can be said for patients with mild oligophrenia, who, however, are also amenable to learning.
At the same time, patients with severe forms of the disease live much less than ordinary people. First of all, this can be associated with multiple defects and congenital malformations, which can lead to the death of children during the first years of life. Another cause of premature death can be the inability of a person to critically assess their actions and the environment. In this case, patients can be in dangerously close proximity to fire, working electrical appliances or poisons, fall into the pool ( while not being able to swim), get hit by a car ( accidentally running out onto the road) etc. That is why the duration and quality of their life directly depend on the attention from others.
There are contraindications. Before use, you must consult a specialist.Treatment standards for mental retardation in children
Protocols for the treatment of mental retardation in children
Mental retardation in children
Profile: pediatric.
Stage: hospital.
Duration of treatment: 30 days.
ICD codes:
F70 Mild mental retardation
F71 Moderate mental retardation
F72 Severe mental retardation.
Definition: Mental retardation (mental underdevelopment) is used abroad to denote the various forms of intellectual impairment, regardless of the nature of the disease in which it occurs.
Classification:
1.mild mental retardation;
2. moderate mental retardation;
3. severe mental retardation;
4. deep mental retardation;
5. unspecified mental retardation;
6. other types of mental retardation.
Risk factors:
1.the state of health of the parents and working conditions by the beginning of pregnancy;
2.the presence of preeclampsia, the diseases suffered by the mother, the medications taken during pregnancy, the course of labor (duration, the application of forceps, asphyxia), the condition of the newborn after childbirth (jaundice, convulsions, flinching);
3. the timeliness of the main stages of motor and mental development;
4. hereditary factor.
Receipt: planned.
Indications for hospitalization:
1. mental retardation in the form of pronounced emotional-volitional disorders and motor skills (delay in the formation of stato-motor acts, lack of motor-adaptive movements, weak interest in others, toys, speech);
2. diagnostics of the delay level;
3. solution of social issues.
The required scope of examination before planned hospitalization:
1. consultation: neurologist, psychologist, geneticist, endocrinologist, psychiatrist.
Diagnostic criteria:
1.the presence of a biological inferiority of the brain, established on the basis of anamnesis, mental, neurological and somatic status;
2. the characteristic structure of diffuse dementia with a mandatory deficiency in conceptual thinking and personality underdevelopment;
3. the lack of progress of the state with a positive, albeit to varying degrees, retarded dynamics of mental development.
List of main diagnostic measures:
1. Biochemical blood test for phenylketonuria, histidinemia, homocystinuria, galactosemia, fructosuria;
2. Consultation with a neurologist;
3. Complete blood count (6 parameters);
4. General urine analysis;
5. Determination of total protein;
6. Definition of ALT, AST;
7. Determination of bilirubin;
9. Study of feces for eggs, worms.
List of additional diagnostic measures:
1. Neuropsychological testing;
2. Chromasome analysis (karyotyping);
3. Consultation of a geneticist;
4. Consultation of a psychiatrist;
5. Consultation of an endocrinologist;
6. Consultation with a psychologist;
7. Consultation with a speech therapist;
8. Blood test for intrauterine infections (toxoplasmosis, herpes, cytomegalovirus);
9. Microreaction.
Treatment tactics:
Medication and correctional educational activities.
Drug treatment:
1. Psychomotor stimulants (tonic effect on the cortex, reticular formation without interfering with the metabolism of nerve cells: adaptol 300 mg in a tablet, regardless of food intake, a course from several days to 2-3 months, from 0.5 to 1 tablet X 3 times a day depending on age.
2. Drugs that stimulate mental development, improve brain metabolism - encephabol 0.25 mg tab.
3. Antidepressants - amitriptyline, L-dopa drugs.
4. Fortifying: multivitamins.
5. Preparations of calcium, phosphorus, iron, phytin, phosphrenic.
6. Sedative, neuroleptic drugs (dizepam tab. 2 mg. 5 mg, solution 10 mg / 2.0);
7. Anticonvulsants: phenobarbital 0.01 mg / year of life, valproic acid preparations 20-25 mg / kg / day, lamotrigine, carbamazepines (finlepsin).
The course of treatment is 1 month.
List of essential medicines:
1. Amitriptyline 25 mg, table 50 mg;
2. Disepam 10 mg / 2 ml amp .; 5 mg, 10 mg tablets;
3. Valproic acid 150 mg, 300 mg, 500 mg table.
List of additional medicines:
1. Preparations L-dopa 50 mg table;
2. Multivitamins;
3. Phenobarbital 50 mg, 100 mg table.
Criteria for transferring to the next stage of treatment:
1. stabilization and improvement of impaired functions;
2. rehabilitation;
3. supportive therapy;
4. supervision of a psychologist.
A great misfortune for a family is an inferior child. Can such a misfortune be prevented? Can it be mitigated? This is our conversation with the doctor of medical sciences, pediatrician Lev KORONEVSKY.
At the very origins
A child's congenital disease sometimes lurks at the very origins of his life, depends on the unfavorable conditions of intrauterine development. Such conditions are sometimes created due to serious illness of the mother. Gross violations of the activity of her cardiovascular system, severe chronic diseases of the kidneys and liver entail a delay in the delivery of oxygen to the fetus, and to this he is very sensitive.
A woman suffering from similar diseases should consult with a therapist and obstetrician-gynecologist and decide with them: is it possible for her to give birth, what measures to take to strengthen her own health.
Anomalies in fetal development, and later, as a consequence, mental retardation of a child can cause infectious diseases of a pregnant woman, and among them, first of all, toxoplasmosis.
If such a woman turns to a doctor in a timely manner and undergoes a course of treatment, she will be able to give birth to a healthy child. And if not? Toxoplasmas, like many viruses, most intensively act on young tissue, multiply intensively in it. They will fall on the fetus, and the child will subsequently have to suffer much more than his mother suffered.
It has been established that rubella, transferred by the mother in the first months of pregnancy, causes severe damage to the fetus. It is not indifferent for the unborn child if the mother is sick with epidemic hepatitis and flu.
Certain medications used by the mother unauthorized during pregnancy can also adversely affect the development of the fetus. Severe consequences for the mental development of a child often arise from attempts to terminate a pregnancy in various non-medical ways. Undoubtedly, alcohol has a harmful toxic effect on the development of the fetus.
Mental development can be affected by various diseases that a child suffers in early childhood. This is not only inflammation of the brain and its membranes, head bruises, but also chronic severe gastrointestinal infections.
The culprit is an extra chromosome
It is known that the hereditary properties of a person are transmitted from parents to children through his reproductive cells. The nucleus of each cell consists of special filamentous structures, the so-called chromosomes, in which the most elementary units of heredity - genes - are located.
The chromosomal set of human cells consists of 46 chromosomes, forming 23 pairs. This number of chromosomes is present in all cells of the body, with the exception of germ cells, where there are half the number of chromosomes - 23. In the female reproductive cell there are 22 non-sex chromosomes and one sex chromosome, the so-called X chromosome. Each male sperm cell has 22 nonsex chromosomes and, in addition, 50 percent of them have an X chromosome and 50 percent have a small, the so-called Y chromosome. When the female and male germ cells merge, the total number of chromosomes is restored. Fertilized eggs, consisting of 44 chromosomes and two X chromosomes, are future women, and eggs, consisting of 44 chromosomes and one sex X chromosome and one small Y chromosome, are future men.
In this process, worked out by nature with the greatest accuracy, disturbances may nevertheless occasionally occur. For still unknown reasons, during cell division, any pair of chromosomes may not separate, and germ cells arise, the nucleus of which contains extra chromosomes. After their fertilization, the fetus develops and a child is born, in whose body cells there are extra chromosomes. The presence of extra chromosomes entails diseases that are characterized by impaired physical and mental development. These types of chromosomal abnormalities include Down's disease.
More often, such children are born to older mothers. Sometimes the birth of a child is preceded by a long break in the onset of pregnancy - up to 10 years or more.
The prevention of mental retardation is not only the feasible elimination of the causes that give rise to it. Let's say that it was not possible to do this, the baby is sick. Do not consider that all is lost, do not surrender to trouble!
The child should be under constant supervision of a neurologist. Currently, there are a number of means, the skillful selection and combination of which can improve the condition of such a patient.
Timely treatment and proper upbringing make it possible to achieve great success in the development of the child, to prevent possible disability, to achieve, if not complete mental health, then the maximum approximation to it.
From early childhood, the characteristics of such children are manifested. External signs of physical underdevelopment: the child has a small head with a sloping back of the head, or, conversely, an increased head size, an elongated head.
The eye section may be beveled. The eye slits are narrow; the third eyelid seems to hang over them. The earlobe is often adherent, the teeth are of an irregular, ugly shape, the skin is dry, flaky, sharply shortened fingers on the hands, a crooked little toe, an irregular foot structure - widened spaces between the toes, especially between the big and the second.
None of these signs by itself is still indicative of a disease - after all, similar features are possible in perfectly healthy people. Only a combination of a number of signs of physical underdevelopment with mental retardation should be alarming and require special medical advice.
What to do?
The development of movements plays a huge role in the general and mental development of the child. In sick children, from the very first months of life, there is a lag in the development of movements - later they begin to hold their heads, stand, walk. Their movements are awkward, awkward. Along with general motor retardation, they sometimes have unnecessary movements - twitching of individual muscles of the face or trunk.
The delicate hand movements are especially impaired in such children. Therefore, such children do not serve themselves well. The ability to dress, wash, make the bed requires special long-term and patient training.
Correct upbringing is one of the most important conditions for overcoming these shortcomings. In some families, such children are overprotected and do everything for them, and this further hinders the development of their motor skills. Parents must have patience, endurance and actively fight the disease. It is necessary to teach the child literally all the little things: lace up shoes, button up buttons, put on a dress. It is useful for such a child to cut and paste pictures, sculpt according to the model suggested by adults, the simplest plasticine figures.
Daily special exercises for the fingers and hands are absolutely necessary: for example, clenching and unclenching the hand into a fist, being able to show only one finger, tapping alternately with two fingers on a smooth surface.
Human speech and thinking are closely related. The speech of mentally retarded children is often indistinct, the fluency and tempo are impaired, the vocabulary is poor, the phrase is constructed primitively, grammatically incorrect. Sometimes speech at first seems normal, even rich, but, observing more closely, one can notice that it consists, as it were, of ready-made, memorized expressions: the child does not understand the meaning of the words he utters. One of the most important ways to combat mental retardation is the development of speech.
Normally developing children, already at 4-5 years old, show a great interest in everything around them and usually ask countless questions, listening carefully to the answers. A retarded child is lethargic, passive, not inquisitive. It is necessary to stimulate and increase his activity in every possible way, to acquaint him with objects and phenomena of the surrounding reality, to ask questions first for the child, then, as it were, with him, gradually trying to make him become as "why" as his peers.
Play as a remedy
The main form of cognition for young children is play. A normally developing child, while playing, actively gets to know the properties of objects, acquires various skills.
A retarded child usually cannot play on their own. He does not even know how to use toys in a differentiated manner, showing interest only in their individual properties - color, sound. If he creates the simplest game situation, then his game usually turns out to be very monotonous. For example, a girl roaches, wraps or unfolds the doll for hours without adding any options to this activity.
Sick children show a tendency to monotonous, stereotyped actions. They have no initiative, they do not plan their game, and in a collective game they do not understand the general plan, rules, and the distribution of roles.
All aspects of the child's personality develop in the game - thinking, will, imagination, emotions. That is why a family where a retarded child grows up should pay special attention to this side of his life. It is necessary to understand that this is not a matter of simple entertainment, but, in essence, of a medicine. Adults should play with the child and thus involve him in the game, teach him how to use toys, gradually moving from elementary games to more detailed, story-driven ones.
The earlier you start working with a child, the easier it is to achieve success in his mental development. Even markedly pronounced mental retardation can be well compensated.
The girl was under our supervision for many years. We ascertained a significant delay in the development of motor skills, speech, thinking in her at the age of three. The mother persistently and patiently worked with the child, doing all the exercises that we talked about. She managed to completely prepare the girl for admission to a special school, but even then she did not rely only on school activities. The daily patient work at home continued. Now the girl is 19 years old, she graduated from this school and has been working as a registrar for three years, quite coping with her duties.
As yet, medicine does not have the means to treat mental retardation. Educational interventions, combined with drugs, remain the main weapon in the fight against such injuries. In patient and loving hands, this weapon gains great power.
Description:
Mental retardation (dementia, mental retardation; Old Greek. Along with mental disability, there is always an underdevelopment of the emotional-volitional sphere, speech, motor skills and the whole personality as a whole. "
The term "mental retardation" was proposed by Emil Kraepelin.
Oligophrenia (dementia) as a syndrome of a congenital mental defect is distinguished from acquired dementia, or (German de - a prefix meaning lowering, lowering, moving down + German mens - mind, mind). Acquired dementia is a decrease in intelligence from the normal level (corresponding to age), and with oligophrenia, the intellect of an adult physically in its development never reaches the normal level.
"An accurate assessment of the prevalence of oligophrenia is difficult due to differences in diagnostic approaches, in the degree of society's tolerance for mental abnormalities, in the degree of access to medical care. In most industrialized countries, the incidence of oligophrenia reaches 1% of the population, but the vast majority (85%) of patients have mild Mental retardation The proportion of moderate, severe and profound mental retardation is 10, 4 and 1%, respectively. The ratio of men and women ranges from 1.5: 1 to 2: 1.
Mental retardation is not a progressive process, but a consequence of a past illness. The degree of mental disability is assessed quantitatively using the intelligence quotient on standard psychological tests.
Sometimes oligophrenic is defined as "... an individual incapable of independent social adaptation."
Symptoms:
General diagnostic instructions F7X.X:
& nbsp & nbsp & nbsp & nbsp * A. Mental retardation is a state of delayed or incomplete development of the psyche, which is primarily characterized by impaired abilities that manifest themselves during maturation and provide a general level of intelligence, that is, cognitive, speech, motor and special abilities.
& nbsp & nbsp & nbsp & nbsp * B. Retardation can develop with or without any other mental or physical disorder.
& nbsp & nbsp & nbsp & nbsp * C. Adaptive behavior is always impaired, but in protected social settings where support is provided, these impairments in patients with mild mental retardation may not be at all obvious.
& nbsp & nbsp & nbsp & nbsp * D. IQ measurements should be cross-culturally appropriate.
& nbsp & nbsp & nbsp & nbsp * E. The fourth character is used to determine the severity of behavioral disorders, if they are not caused by a concomitant (mental) disorder.
Indicators of behavioral disturbances:
& nbsp & nbsp & nbsp & nbsp * .0 - absence or weak severity of behavioral disorders
& nbsp & nbsp & nbsp & nbsp * .1 - with significant behavioral disorders requiring care and treatment
& nbsp & nbsp & nbsp & nbsp * .8 - with other behavioral disorders
& nbsp & nbsp & nbsp & nbsp * .9 - without indicating a violation of behavior.
Classification by E.I.Bogdanova (GUZ RKPND, Ryazan, 2010):
& nbsp & nbsp & nbsp & nbsp * .1 - Decrease in intelligence
& nbsp & nbsp & nbsp & nbsp * .2 - General systemic speech underdevelopment
& nbsp & nbsp & nbsp & nbsp * .3 - Disturbance of attention (instability, difficulty of distribution, switchability)
& nbsp & nbsp & nbsp & nbsp * .4 - Perception impairment (slowness, fragmentation, decrease in the volume of perception)
& nbsp & nbsp & nbsp & nbsp * .5 - Concreteness, non-critical thinking
& nbsp & nbsp & nbsp & nbsp * .6 - Low memory performance
& nbsp & nbsp & nbsp & nbsp * .7 - Underdevelopment of cognitive interests
& nbsp & nbsp & nbsp & nbsp * .8 - Violation of the emotional-volitional sphere (lack of differentiation, instability of emotions, their inadequacy)
Difficulties in diagnosing mental retardation may arise if it is necessary to differentiate from the early onset. Unlike oligophrenics, in patients with schizophrenia, developmental delay is partial, dissociated; along with this, a number of manifestations characteristic of the endogenous process are found in the clinical picture - autism, pathological fantasizing, catatonic symptoms.
Mental retardation is also distinguished from dementia - acquired dementia, in which, as a rule, elements of existing knowledge are revealed, a greater variety of emotional manifestations, a relatively rich vocabulary, and a retained tendency to abstract constructions.
Causes of occurrence:
& nbsp & nbsp & nbsp & nbsp * Genetic causes of mental retardation;
& nbsp & nbsp & nbsp & nbsp * Intrauterine damage to the fetus by neurotoxic factors of physical (ionizing radiation), chemical or infectious (cytomegalovirus, etc.) nature;
& nbsp & nbsp & nbsp & nbsp * Significant prematurity.
& nbsp & nbsp & nbsp & nbsp * Disorders during childbirth (asphyxia, birth trauma);
& nbsp & nbsp & nbsp & nbsp * Head trauma, brain hypoxia, infections with damage to the central nervous system.
& nbsp & nbsp & nbsp & nbsp * Pedagogical neglect in the first years of life in children from disadvantaged families.
& nbsp & nbsp & nbsp & nbsp * Mental retardation of unknown etiology.
Genetic causes of mental retardation.
Mental retardation is one of the main reasons for seeking genetic counseling. Genetic causes are responsible for up to half of cases of severe mental deficiency. The main types of genetic disorders leading to intellectual disability include:
& nbsp & nbsp & nbsp & nbsp * Chromosomal abnormalities that disrupt the dose balance of genes, such as aneuploidy, deletions, duplications.
& nbsp & nbsp & nbsp & nbsp & nbsp & nbsp & nbsp & nbsp Trisomy 21 (Down syndrome);
& nbsp & nbsp & nbsp & nbsp & nbsp & nbsp & nbsp & nbsp Partial deletion of the short arm of chromosome 4;
& nbsp & nbsp & nbsp & nbsp & nbsp & nbsp & nbsp & nbsp Microdeletion of a region of chromosome 7q11.23 (Williams syndrome), etc.
& nbsp & nbsp & nbsp & nbsp * Deregulation of imprinting due to deletions, homogeneous disomy of chromosomes or chromosome regions.
& nbsp & nbsp & nbsp & nbsp & nbsp & nbsp & nbsp & nbsp Angelman Syndrome;
& nbsp & nbsp & nbsp & nbsp & nbsp & nbsp & nbsp & nbsp Prader-Willi Syndrome.
& nbsp & nbsp & nbsp & nbsp * Dysfunction of individual genes. The number of genes, mutations in which cause one or another degree of mental retardation, more than 1000. These include, for example, the gene NLGN4, located on chromosome X, mutations in which are found in some patients with autism; the FMR1 gene linked to the X chromosome, the deregulation of the expression of which causes the fragile X syndrome; the MECP2 gene, also on chromosome X, mutations in which cause Rett syndrome in girls.
Treatment:
For treatment are prescribed:
Specific therapy is carried out for certain types of mental retardation with an established cause (congenital syphilis, etc.); with mental retardation associated with metabolic disorders (phenylketonuria, etc.), diet therapy is prescribed; with endocrinopathies, myxedema) - hormonal treatment. Medicines are also prescribed to correct affective lability and suppress perverted drives (neuleptil, phenazepam, sonapax). Of great importance for the compensation of an oligophrenic defect are therapeutic and educational measures, labor training and professional adaptation. In the rehabilitation and social adaptation of oligophrenics, along with health authorities, auxiliary schools, boarding schools, specialized vocational schools, workshops for the mentally retarded, etc. play a role.
