Early manifestations of mental illness in children and adolescents “Methodical recommendations for pediatricians, neurologists, medical psychologists. If the child has a mental disorder what to do Attitude to failure

Nervous system disorders can be varied.
Most often these are:
affective-respiratory seizures;
speech disorders;
sleep disturbances;
awkwardness;
bouts of anger;
upbringing problems;
increased excitability.

Affective respiratory attacks:

Affective-respiratory seizures are acute holding of breath. May occur when a child screams or cries. From anger, resentment or pain (for example, when falling), the child begins to cry so bitterly that breathing is held, there is no air in the lungs, the child first turns red, then turns blue and immediately begins to breathe. At the moment of lack of air, short-term oxygen starvation of the brain is possible and the child loses consciousness. At this time, there may be convulsions.

All this lasts for several tens of seconds, after which the children become lethargic, sometimes drowsy. Similar attacks can occur in 2% of children under 2 years of age, rarely up to 4 years.
This is usually the case with very stubborn, wayward children who try to achieve their goal at any cost. Such states, as a rule, pass without a trace and serve as one of the manifestations of early childhood nervousness. During an attack, the child should be taken out into fresh air, turned face down so that the sunken tongue does not block the airway. You can spray your face with cold water, but do not give to drink, since the child does not swallow at this moment.

In order to avoid an attack, it is necessary to "switch" the child's attention to some other object, distract him and try to avoid conflict situations. It is necessary to have a unity of views of the whole family on the attitude to this problem, since the child very quickly learns to benefit from the situation for himself. In many cases, you need to consult a psychologist. Such seizures do not pose a particular danger, however, in all cases, a doctor's consultation is necessary to exclude epilepsy and cardiac arrhythmias. It should also be remembered that frequent seizures due to oxygen starvation of the brain can lead to neurological diseases.

Speech disorders:

If it seems to you that the child speaks little, find out from the speech therapist how he should speak at this age. The development of a child's speech depends on how much they talk to from the first days of life. At first, the newborn does not seem to react in any way to appeals to him. But several weeks pass, and the child listens to the sounds of speech, as if freezes. After a while, in response to your speech, he begins to utter sounds: "gu", "u". By 1.5-2 months, he walks well, and by 3 months he walks for a long time, drawn out, melodiously, calms down when you start talking, then he walks again, smiles. By 6-8 months, chains of sounds appear: "ba-ba-ba", "ma-ma-ma", by 9-12 months - words. By the age of one, a child usually knows 6-10 words.

By the age of 15 months, she begins to consciously address her parents and other family members: "mom", "dad", "baba". By the age of 18 months, he is copying intonation well, following instructions (“take and bring, put”, etc.). By the age of 2, she can speak short two-word sentences ("mom, am"). After 2 years, sentences are formed, and a 3-year-old child already speaks in phrases, sings songs, reads short rhymes. True, speech is still indistinct, not always clear to others. However, this is not always the case. If the child speaks little, it is necessary to find out if he has a hearing impairment or damage from the nervous system. If a child hears well, it is necessary to constantly talk to him, to teach him to use not gestures, but words.

A baby surrounded by a “wall of silence” lacks stimuli to develop speech. If the child's speech is unclear, you should contact a speech therapist to check if he has a short frenum of the tongue. The pathology of the hard palate (cleft) also leads to a violation of sound pronunciation, even after surgical correction. If there are no abnormalities on the part of the hearing organ, the oral cavity, it is necessary to consult a neurologist in order to exclude a delay in psycho-speech development as a consequence of damage to the nervous system.

It should also be remembered about the hereditary features of the development of speech. There is a natural difference in the development of the speech of children: someone starts speaking earlier, someone later. The more you talk to your child, the sooner he learns to speak himself. Most speech disorders are a consequence of hearing pathology.

Sleep disorders in a child:

Like adults, children have different sleep needs. Newborns sleep 12 to 20 hours a day, older children - all night. However, some can only sleep 4-5 hours and do not sleep during the day. In most cases, these are hereditary features, but the child's mode of life also makes its own changes. Children who are not very active during the day do not sleep well at night, as well as overly active children who do not have time to calm down in the evening.

Children with asthma, eczema, allergies, food intolerances also sleep poorly at night. Much depends on how you put your baby to bed. In some families, it is customary to rock the baby in their arms, in others - to put it in a crib. The advantage of the latter method is that the parents can be alone for a while.

About half of children under 5 wake up at night, which is the norm. Another thing is that at the same time parents do not get enough sleep. Therefore, they can get up to the child one by one or sleep longer in the morning.

Sleep disorders include:
nightmares;
night fears;
sleepwalking (sleepwalking).

Nightmares very unpleasant for the child. They arise due to breathing disorders: with asthma, allergies, enlarged tonsils, nasal congestion, due to mental reasons (scary movies, etc.), painful sensations or injuries suffered, as well as in hot and stuffy rooms. It usually happens between 8 and 9 years old. A child dreams that someone presses him, persecutes him, etc. In the morning he remembers what he dreamed about. These disorders occur during REM sleep.

Night terrors. The child wakes up at night and screams for several minutes without recognizing those around him. He is not easy to calm down, he is scared, he has a rapid heartbeat, wide pupils, rapid breathing, and distorted features. Most often, nighttime fears are noted between 4 and 7 years. After a few minutes, the child calms down and falls asleep, in the morning he does not remember anything. Night terrors arise in the phase of less deep sleep.

Sleepwalking (sleepwalking, somnambulism) appears in shallow sleep or waking up from shallow sleep: Children get out of bed, walk around the room, may talk, go to the toilet or urinate in the room, then return to their pastel or other and go to bed. In the morning they don't remember about it. Sometimes sleepwalking is combined with night fears. It should be remembered that tired children sleep soundly. Therefore, the physical and mental activity of the child during the day: outdoor games, singing, reading poetry, counting counters - contributes to sound sleep.

By the age of 3, children sleep much less during the day or even refuse to sleep during the day. Laying the child in the evening after the bath, bedtime story helps to consolidate the regime, and the child goes to bed calmly. You can leave a dim night light or light in the hallway if your baby is afraid of the dark. The child can take a favorite toy or book into the crib. Sometimes quiet music or "white noise" helps (the work of any household appliances, quiet conversations between adults). You should not rock the child in your arms, as he wakes up as soon as he is put in the crib. Better to sit next to me and sing a lullaby. The bedroom should be cozy and warm.

If a child cries for fear of being alone, teach him to do so gradually. After putting the child to bed, go out for a few minutes and come back again. Gradually increase your absence. The child will know that you are somewhere nearby and will return to him.

With nightmares and night fears, you need to calm the child down, put him to bed. Mild sedatives may be given as needed on the recommendation of a physician. It is important that the child does not watch movies in the evening, fairy tales that can scare him. When sleepwalking, you need to calmly lay the child down, not wake him up. It is necessary to examine him with a doctor and, if necessary, carry out treatment. Remember to keep your child safe: close windows and doors to prevent them from falling on the stairs and falling through the window.

Sleep disturbances are common in infants and young children. However, regular bedding at the same time allows you to develop a certain regimen. In case of sleep disorders, it is necessary to consult a doctor and use appropriate medications.

Awkwardness:

All young children are a little awkward, as their nervous systems do not keep pace with the development of muscles and bones. Starting to eat on his own, the child stains clothes, scatters food, learning to dress - he fights with buttons, fasteners, locks. Often falls, bruises, bruises and bumps appear on the head, arms and legs. At 3 years old, it is still difficult for a child to build a tower of cubes, preschoolers draw poorly, write, often break dishes, do not know how to estimate distances, so they throw and catch the ball awkwardly.

Many children cannot tell the right side from the left side. More often they are overly excitable, impulsive, and cannot concentrate for a long time. Some begin to walk late (after a year and a half). It will take some time for them to make up this gap. In some children, motor coordination suffers "inherited". Other children are emotionally disturbed.

Children with any disabilities: coordinating, emotional, manipulative - feel different from everyone else. Awkwardness sometimes results from injuries, especially to the head. Premature babies are also somewhat different from their peers. In many cases, as the child grows, initially imperceptible disorders such as minimal cerebral insufficiency appear. A child's awkwardness complicates parenting problems. Failure to complete a task can cause anger, resentment, a tendency towards solitude, shyness, and self-doubt in the child, especially if peers begin to laugh at him.

Severe neurological disorders are often overlooked, and the child is assessed as “normal but intolerable,” which leads to punishments, reprimands, even greater behavioral disturbances and pathological character formation. The child begins to avoid school, finds any reason not to go to lessons, where he is scolded, ridiculed. Parents must first of all understand that not everything is normal with the child. If you notice that your child is especially awkward, contact a neurologist, psychologist to identify and clarify the nature of the violations as early as possible.

Every tenth child has minor violations, so it is important to show maximum patience and attention in order to carry out the appropriate correction. Success requires mutual understanding, patience, not punishment, ridicule and reprimand. If minimal brain damage is detected, do not be discouraged, there are many ways to treat and correct such disorders.

Attacks of anger:

Attacks of anger often occur in children between the ages of one and a half to 4 years. The most difficult time is 2 to 3 years. This is a critical age for self-affirmation. By age 4, seizures are much more rare. At the age of 2-3 years, about 20% of children are angry every day for one reason or another.

The main reason for anger is dissatisfaction with the fact that the child cannot express his desires the way he wants. Children at this age understand very well everything that is happening around them, and passionately wish that everything was the way they want. If this does not happen, anger turns into bouts of anger, which cause a lot of anxiety for parents, especially in public places. Sometimes you even have to spank the baby.

To avoid this unpleasant situation, always analyze your actions before you go somewhere with your child. Children usually get naughty if they are hungry. Have some fruit or cookies with you at all times. If the child wants to sleep, try to get home by bedtime, or go after the child is awake and in a good mood. Sometimes it is possible to "switch" the child's attention to something unusual and interesting in the environment.

Attacks of envy of a sister or brother can be prevented by giving your child the maximum attention and tenderness, and not scolding him. Try to stay calm and not react to your child's antics. Do not think about what others will say. Many of them also have children and know how difficult it can be with them. Sometimes in anger, the child cries and can cause an affective-respiratory attack, but, fortunately, this is rare. Always remain calm and consistent.

Take the crying baby in your arms and hug it tightly so that it cannot escape. Move all nearby objects that he can grab and throw. If the child does not want to move, leave him and walk, but do not let him out of sight. Usually, children are always running after leaving parents. Despite the difficulties, do not let your child win, otherwise it will be even more difficult each time. In case of anger attacks in a child after 5 years of age, it is necessary to consult him with a psychologist.

Parenting problems in children:

Education problems are very diverse. The causes of the problems that arise can be attacks of anger, refusal to eat, sleep disturbances, excessive excitability, and sometimes attacks of aggression, when a child can harm himself and others by biting and fighting. The behavior of parents in such situations depends on their culture, upbringing, social status. Parents' behavior is particularly influenced by their own childhood experiences.

Some parents are very strict with the child and do not allow any indulgences, others are more gentle and loyal. From a medical point of view, there are no uniform approaches to education. The main thing is that the parents do not humiliate or insult the child. Children who are accustomed to the daily routine and constantly know what to do next, as a rule, do not cause trouble in education, even if they are overly excitable.

Parents seek help when they cannot cope with the child and their parenting methods do not work. There are no ideal children, but the behavior of parents in matters of upbringing largely determines the fate of the child. Sometimes upbringing (or, better to say, lack of it) is contrary to all norms of behavior in society. In upbringing, it is necessary to take into account the characteristics of the child. Some children are calm, timid from birth, while others, on the contrary, are mobile and assertive.

Restless children do not sleep well, are prone to nightmares, and get tired quickly. If they are constantly under pain of punishment, see strained relations between parents, then they try to attract attention in any way, including bad behavior. In many ways, parenting is the result of parenting behavior. A child who was not given sweets begins to be capricious, but if he does not achieve his goal, he will draw conclusions for himself.

Sometimes a child's bad behavior manifests itself in certain situations: if he is hungry, thirsty or tired. Then it is very easy to establish the cause and normalize the situation. If the child misbehaves, you need to patiently and easily explain his mistakes and repeat this in appropriate situations. Children respond to empathetic, considerate attitudes, especially praise, even if they may not always deserve it. An agitated child can be allowed to "throw out energy" in the game, in sports activities, so that he calms down.

You can't let the child do everything. If it says "No!" - this should be a sure "no", the law for all family members. It is very bad when one of the parents forbids, and the other, on the contrary, allows. Always react intelligently to your child's antics. It is better to praise good behavior than punish disobedience. You can even promise a reward for something good, and you should definitely keep your promise. However, the reward should not be the daily stimulus for the child's behavior.

A daily routine and a consistent attitude towards the child can prevent many difficulties. If you do not cope with the problems of raising your child, contact a neurologist or psychiatrist to identify possible (hidden) deviations from the nervous system.

Increased excitability:

This term is not always used correctly. Often an energetic, agile child is called excitable. However, children suffering from increased excitability are not only mobile, but also restless, they cannot concentrate attention, make many unnecessary movements when performing any work, do not study well, cannot complete the work they have begun, their mood changes quickly.

These children often have fits of anger when they throw objects on the floor, they often suffer from poor coordination, awkwardness. Such phenomena occur in 1-2% of children, 5 times more often in boys than in girls. Correction of such behavior must be carried out as early as possible: as adults, overly excitable children can commit antisocial acts. The reasons for increased excitability are not fully understood. Great importance is attached to hereditary factors and the impact of the social environment. The influence of allergies (eczema, asthma) and other diseases, as well as deviations during pregnancy and childbirth, is not excluded.

If the child is very excitable, it is necessary to carefully consider the regimen of his day. Find out what interests the child and use these interests to teach him concentration, perseverance, and improve coordination and motor activity of his hands. It can be drawing, coloring, construction, certain games, sports activities, etc. Do not leave the child to himself, but give freedom at certain times.

The main role in correcting the behavior of an excitable child belongs to the parents. The child trusts you, and with you he feels protected. If necessary, you can seek help from a neurologist, psychologist, allergist.

Mental health is a very vulnerable topic. Clinical manifestations depend on the age of the child and the influence of some factors. Often, due to fear for the upcoming changes in their own disposition of life, parents do not want to notice some problems with the psyche of their child.

Many are afraid to catch the sidelong glances of neighbors on themselves, to feel the pity of friends, to change the usual order of life. But the child has the right to qualified, timely help from a doctor, which will help alleviate his condition, and in the early stages of some diseases heal one or another spectrum.

One of the most complex mental illnesses is children's. This disease is understood as an acute condition of a baby or already a teenager, which manifests itself in his incorrect perception of reality, his inability to distinguish the present from the fictional, the inability for them to really understand what is happening.

Features of childhood psychoses

And children are not diagnosed as often as adults and. Mental disorders are of different types and forms, but no matter how the disorder manifests itself, whatever the symptoms of the disease are, psychosis significantly complicates the life of the child and his parents, prevents him from thinking correctly, controlling actions, and building adequate parallels with respect to established social norms.

Children's psychotic deviations are characterized by:

Childhood psychosis has different forms and manifestations, therefore it is difficult to diagnose and treat.

Why are children prone to mental health problems?

Multiple causes contribute to the development of mental disorders in toddlers. Psychiatrists identify whole groups of factors:

• genetic;
• biological;
• sociopsychic;
• psychological.

The most important provoking factor is a genetic predisposition to. Other reasons include:

• problems with intelligence (and (others like) with it);
• incompatibility of the temperament of the baby and the parent;
• family discord;
• conflicts between parents;
• events that left psychological trauma;
• drugs that can cause a psychotic state;
• high fever, which can cause or;

To date, all possible causes are not fully understood, but studies have confirmed that children with schizophrenia almost always have signs of organic brain disorders, and patients with autism are often diagnosed with the presence, which is due to hereditary causes or trauma during childbirth.

Psychoses in young children can occur due to the divorce of parents.

At-risk groups

Thus, children are at risk:

• one of the parents has or has a mental disorder;
• who are brought up in a family where conflicts constantly arise between parents;
• have undergone;
• have suffered psychological trauma;
• in whom blood relatives have mental illness, and the closer the degree of relationship, the greater the risk of the disease.

Varieties of psychotic abnormalities among children

Diseases of the child's psyche are divided according to some criteria. Depending on age, there are:

• early psychosis;
• late psychosis.

The first type includes patients from infancy (up to a year), preschool (from 2 to 6 years) and early school age (from 6-8). The second type includes pre-adolescent (8-11) and adolescent (12-15) patients.

Depending on the cause of the development of the disease, psychosis can be:

• exogenous- disorders caused by external factors;
• - violations provoked by the internal characteristics of the body.

Depending on the type of course, psychosis can be:

• that have arisen as a result of prolonged psychotraumas;
• - that have arisen instantly and unexpectedly.

A type of psychotic disorder is. Depending on the nature of the course and symptoms of affect disorders, there are:

Symptoms depending on the form of failure

Different symptoms of mental illness are justified by different forms of the disease. Common symptoms of the disease are:

• - the baby sees, hears, feels what is not really there;
• - a person sees the existing situation in his wrong interpretation;
• passivity, not initiative;
• aggressiveness, rudeness;
• compulsion syndrome.
• deviations associated with thinking.

Psychogenic shock often occurs in children and adolescents. Reactive psychosis occurs as a result of psychological trauma.

This form of psychosis has signs and symptoms that distinguish it from other mental spectrum disorders in children:

• the reason for it is a deep emotional shock;
• reversibility - symptoms weaken by the preceding time;
• symptoms depend on the nature of the injury.

Early age

At an early age, mental health impairment manifests itself in. The kid does not smile, in any way does not show joy on his face. Up to a year, the disorder is revealed in the absence of humming, babbling, clapping hands. The crumb does not react to objects, people, parents.

Age crises, during which children are most susceptible to mental disorders from 3 to 4 years, from 5 to 7, from 12 to 18 years.

Early mental disorders are manifested in:

• frustrations;
• capriciousness, disobedience;
• increased fatigue;
• irritation;
• lack of communication;
• lack of emotional contact.

Later ages up to adolescence

Mental problems in a 5-year-old child should worry the parents if the baby loses the skills already acquired, communicates little, does not want to play role-playing games, and does not monitor his appearance.

At the age of 7, the child becomes unstable in the psyche, he has a violation of appetite, unnecessary fears appear, efficiency decreases, and rapid overwork appears.

At the age of 12-18, parents need to pay attention to a teenager if he has:

• sudden mood swings;
• melancholy;
• aggressiveness, conflict;
• , inconsistency;
• a combination of the incompatible: irritability with acute shyness, sensitivity with callousness, the desire for complete independence with the desire to be always close to mom;
• schizoid;
• rejection of the accepted rules;
• a penchant for philosophy and extreme positions;
• intolerance to guardianship.

More painful signs of psychosis in older children are manifested in:

Diagnostic criteria and methods

Despite the proposed list of signs of psychosis, no parent can surely and accurately diagnose it on their own. First of all, parents should show their child to a psychotherapist. But even after the first appointment with a professional, it is too early to talk about mental personality disorders. A small patient should be examined by the following doctors:

• neuropathologist;
• speech therapist;
• psychiatrist;
• a doctor who specializes in developmental diseases.

Sometimes the patient is admitted to the hospital for examination and the necessary procedures and tests.

Providing professional assistance

Short-term seizures of psychosis in a child disappear immediately after the disappearance of their cause. More severe diseases require long-term therapy, often in an inpatient hospital setting. Specialists for the treatment of childhood psychosis use the same drugs as for adults, only in the right doses.

Treatment of psychoses and psychotic spectrum disorders in children involves:

If the parents were able to identify the failure of the psycho in their child in time, then to improve the condition, several consultations with a psychiatrist, psychologist are usually enough. But there are cases that require long-term treatment and stay under the supervision of doctors.

Psychological failure in a child, which is associated with his physical condition, is cured immediately after the disappearance of the underlying disease. If the disease was provoked by an experienced stressful situation, then even after the condition improves, the baby requires special treatment and consultations from a psychotherapist.

In extreme cases, with manifestations of strong aggression, the baby can be prescribed. But for the treatment of children, the use of heavy psychotropic drugs is used only in extreme cases.

In most cases, childhood psychoses do not return to adulthood in the absence of provoking situations. Parents of recovering children should fully comply with the daily regimen, do not forget about daily walks, balanced nutrition and, if necessary, take care of taking medications in a timely manner.

The kid cannot be left unattended. At the slightest disturbance in his mental state, it is necessary to seek help from a specialist who will help to cope with the problem that has arisen.

To treat and avoid consequences for the psyche of the child in the future, it is necessary to follow all the recommendations of specialists.

Every parent with concerns about their child's mental health should remember:

Love and care is what any person needs, all the more small and defenseless.

Both psychological, biological and sociopsychological factors are on the list of what can be a mental disorder at an early age. And how the disease manifests itself directly depends on its nature and the degree of exposure to the stimulus. A mental disorder in a minor patient can be caused by a genetic predisposition.

Often doctors define the disorder as a consequence of:

• limited intellectual abilities,
• brain damage
• problems within the family,
• regular conflicts with loved ones and peers.

Emotional trauma can lead to serious mental illness. For example, there is a deterioration in the psycho-emotional state of the child as a result of an event that caused a shock.

Symptoms

Juvenile patients are prone to the same mental disorders as adults. But, the disease manifests itself, as a rule, in different ways. So, in adults, the most common manifestation of the disorder is a state of sadness, depression. Children, in turn, often show the first signs of aggression, irritability.

How a child's illness begins and progresses depends on the type of acute or chronic disorder:

• Hyperactivity is a major symptom of attention deficit disorder. Violation can be identified by three key symptoms: inability to concentrate, excessive activity, including emotional, impulsive, sometimes aggressive behavior.
• The signs and severity of symptoms of autistic mental disorders are variable. However, in all cases, the violation affects the ability of the minor patient to communicate and interact with others.
• A child's reluctance to eat, excessive attention to changes in weight indicate eating disorders. They interfere with daily life and harm your health.
• If the child is prone to loss of connection with reality, memory lapses, inability to navigate in time and space, this may be a symptom of schizophrenia.

It is easier to treat the disease when it starts. And in order to identify the problem in time, it is also important to pay attention to:

• Changes in the child's mood. If for a long time children are in a state of sadness or anxiety, you need to take action.
• Excessive emotionality. An increased acuteness of an emotion, such as fear, is an alarming symptom. Emotionality without a valid reason can also provoke disturbances in heart rhythm and breathing.
• Atypical behavioral responses. A signal of a mental disorder may be a desire to harm yourself or others, frequent fights.

Diagnosis of mental disorder in a child

The basis for the diagnosis is the combination of symptoms and the degree to which the disorder affects the child's daily activities. If necessary, related specialists help diagnose the disease and its type:

• psychologists,
• social workers,
• behavioral doctor, etc.

Working with a minor patient takes place on an individual basis using an approved symptomatology database. Analyzes are prescribed primarily in the diagnosis of eating disorders. The clinical picture, history of diseases and injuries, including psychological ones, preceding the disorder are studied without fail. There are no precise and rigorous methods for defining a mental disorder.

Complications

What a mental disorder is dangerous depends on its nature. In most cases, the consequences are expressed in violation of:

• ability to communicate,
• intellectual activity,
• correct reaction to situations.

Often mental disorders in children are accompanied by suicidal tendencies.

Treatment

What can you do

In order to cure a mental disorder in a minor patient, the participation of doctors, parents, and teachers - all people with whom the child comes into contact is necessary. Depending on the type of disease, it can be treated with psychotherapeutic methods or with the use of drug therapy. The success of treatment directly depends on the specific diagnosis. Some diseases are incurable.

The task of parents is to consult a doctor in time and give detailed information about the symptoms. It is necessary to describe the most significant discrepancies between the current state and behavior of the child with the previous ones. The specialist will tell the parents what to do with the disorder and how to provide first aid during home treatment if the situation worsens. For the period of therapy, the task of the parents is to provide the most comfortable environment and the complete absence of stressful situations.

What the doctor does

As part of psychotherapy, the psychologist talks with the patient, helping him independently assess the depth of his feelings and understand his condition, behavior, and emotions. The goal is to develop the correct response to acute situations and freely overcome the problem. Drug treatment involves taking:

• stimulants,
• antidepressants,
• sedatives,
• stabilizing and antipsychotic agents.

Prophylaxis

Psychologists remind parents that the family environment and upbringing are of great importance when it comes to the psychological and nervous stability of children. For example, divorce or regular fights between parents can provoke violations. Mental disorder can be prevented by providing ongoing support to your child, allowing them to share their experiences without hesitation or fear.

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Arm yourself with the knowledge and read a helpful informative article about mental disorder in children. After all, to be parents means to study everything that will help maintain the level of health in the family at the level of "36.6".

Find out what can cause an ailment, how to recognize it in a timely manner. Find information about what are the signs that can identify ailment. And what tests will help identify the disease and make the correct diagnosis.

In this article, you will read all about the methods of treating a disease such as mental disorder in children. Clarify what effective first aid should be. How to treat: choose medicines or alternative methods?

You will also learn what the danger of untimely treatment of a mental disorder in children can be, and why it is so important to avoid the consequences. Everything about how to prevent mental disorder in children and prevent complications.

And caring parents will find on the pages of the service complete information about the symptoms of mental illness in children. What is the difference between the signs of the disease in children at 1, 2 and 3 years old from the manifestations of the disease in children at 4, 5, 6 and 7 years old? What is the best treatment for mental disorder in children?

Take care of the health of loved ones and be in good shape!

Department of Health of the Tyumen Region

State medical institution of the Tyumen region

"Tyumen Regional Clinical Psychiatric Hospital"

State educational institution of higher professional education "Tyumen Medical Academy"

Early manifestations of mental illness

in children and adolescents

medical psychologists

Tyumen - 2010

Early manifestations of mental illness in children and adolescents: guidelines. Tyumen. 2010.

E.V. Rodyashin chief physician of the GLPU TO TOKPB

Raeva T.V. head Department of Psychiatry, Dr. med. Sciences of the State Educational Institution of Higher Professional Education "Tyumen Medical Academy"

Fomushkina M.G. Chief freelance child psychiatrist of the Tyumen Region Health Department

The guidelines provide a brief description of the early manifestations of major mental disorders and mental development disorders in childhood and adolescence. The manual can be used by pediatricians, neurologists, clinical psychologists and other specialists in "childhood medicine" to establish preliminary diagnoses of mental disorders, since the establishment of the final diagnosis is within the competence of the psychiatrist.

Introduction

Neuropathy

Hyperkinetic disorders

Pathological habitual actions

Childhood fears

Pathological fantasies

Organ neuroses: stuttering, tics, enuresis, encopresis

Neurotic sleep disorders

Neurotic Appetite Disorders (Anorexia)

Mental underdevelopment

Mental infantilism

Violation of school skills

Decreased mood background (depression)

Departures and vagrancy

Painful attitude towards an imaginary physical disability

Anorexia nervosa

Early Childhood Autism Syndrome

Conclusion

Bibliography

Appendix

Scheme of pathopsychological examination of the child

Diagnostics of the presence of fears in children

Introduction

The mental health status of children and adolescents is essential to ensure and support the sustainable development of any society. At the present stage, the effectiveness of the provision of psychiatric care to the child population is determined by the timeliness of identifying mental disorders. The earlier children with mental disorders are identified and receive appropriate comprehensive medical, psychological and pedagogical assistance, the higher the likelihood of good school adaptation and the lower the risk of maladaptive behavior.

Analysis of the incidence of mental disorders in children and adolescents living on the territory of the Tyumen region (excluding the autonomous okrugs) over the past five years has shown that the early diagnosis of this pathology is not well organized. In addition, in our society there is still a fear, both of direct contact to a psychiatric service, and of possible condemnation of others, leading to active avoidance of parents from consulting their child by a psychiatrist, even when it is indisputable necessity. Late diagnosis of mental disorders in the child population and untimely initiation of treatment lead to a rapid progression of mental illness, early disability of patients. It is necessary to increase the level of knowledge of pediatricians, neurologists, medical psychologists in the field of the main clinical manifestations of mental illness in children and adolescents, since when any deviations in the health (somatic or mental) of a child appear, his legal representatives turn to these specialists for help. ...

An important task of the psychiatric service is the active prevention of neuropsychiatric disorders in children. It should start from the perinatal period. Identification of risk factors when taking anamnesis in a pregnant woman and her relatives is very important for determining the likelihood of neuropsychiatric disorders in newborns (hereditary burden of both somatic and neuropsychiatric diseases in families, the age of a man and a woman at the time of conception, the presence of them bad habits, especially during pregnancy, etc.). Intrauterine fetal infections are manifested in the postnatal period by perinatal encephalopathy of hypoxic-ischemic genesis with varying degrees of damage to the central nervous system. As a result of this process, attention deficit disorder and hyperactivity disorder can occur.

Throughout the child's life, there are so-called "critical periods of age-related vulnerability", during which the structural, physiological and mental balance in the body is disturbed. It is during such periods, when exposed to any negative agent, that the risk of mental disorders in children increases, as well as, in the presence of mental illness, its more severe course. The first critical period is the first weeks of intrauterine life, the second critical period is the first 6 months after birth, then, from 2 to 4 years, from 7 to 8 years, from 12 to 15 years. Toxicosis and other harmful effects on the fetus in the first critical period are often the cause of severe congenital malformations, including severe cerebral dysplasias. Mental illnesses, such as schizophrenia, epilepsy, occurring at the age of 2 to 4 years, are characterized by a malignant course with a rapid disintegration of the psyche. The preference is noted for the development of specific age-related psychopathological conditions at a certain age of the child.

Early manifestations of mental illness in children and adolescents

Neuropathy

Neuropathy is a syndrome of congenital childhood "nervousness" that occurs before the age of three. The first manifestations of this syndrome can be diagnosed already in infancy in the form of somatovegetative disorders: sleep inversion (sleepiness during the day and frequent awakenings and anxiety at night), frequent regurgitation, temperature fluctuations to subfebrile, hyperhidrosis. Frequent and prolonged crying, increased moodiness and tearfulness are noted with any change in the situation, change in the regime, conditions of care, the placement of the child in a child care institution. A fairly common symptom is the so-called "rolling", when a reaction of discontent arises to a psychogenic stimulus, associated with resentment and accompanied by a cry, which leads to an affective-respiratory attack: at the height of exhalation, tonic tension of the muscles of the larynx occurs, breathing stops, the face turns pale, then acrocyanosis is manifested. The duration of this state is several tens of seconds, ends with a deep breath.

Children with neuropathy often have an increased tendency to allergic reactions, infectious and colds. With the preservation of neuropathic manifestations in preschool age under the influence of adverse situational influences, infections, injuries, etc. various monosymptomatic neurotic and neurosis-like disorders easily arise: nocturnal enuresis, encopresis, tics, stuttering, night fears, neurotic appetite disorders (anorexia), pathological habitual actions. The syndrome of neuropathy is relatively often included in the structure of residual organic neuropsychiatric disorders resulting from intrauterine and perinatal organic lesions of the brain, accompanied by neurological symptoms, increased intracranial pressure and, often, delayed psychomotor and speech development.

Hyperkinetic disorders.

Hyperkinetic disorders (hyperdynamic syndrome) or psychomotor disinhibition syndrome occurs mainly at the age of 3 to 7 years and is manifested by excessive mobility, restlessness, fussiness, incoherence, leading to impaired adaptation, instability of attention, distraction. This syndrome occurs several times more often in boys than in girls.

The first signs of the syndrome appear in preschool age, but before entering school, they can sometimes be difficult to recognize due to the various variants of the norm. At the same time, the behavior of children is characterized by the desire for constant movements, they run, jump, then sit down for a short time, then jump up, touch and grab objects that fall into the field of view, ask many questions, often not listening to the answers to them. Due to increased motor activity and general excitability, children easily come into conflicts with their peers, often violate the regime of children's institutions, poorly master the school curriculum. Hyperdynamic syndrome up to 90% occurs with the consequences of early organic brain damage (pathology of intrauterine development, birth trauma, asphyxia at birth, prematurity, meningoencephalitis in the first years of life), is accompanied by diffuse neurological symptoms and, in some cases, a lag in intellectual development.

Pathological habitual actions.

The most common pathological habitual actions in children are thumb sucking, nail biting, masturbation, pulling or plucking hair, rhythmic head and torso rocking. Common features of pathological habits are an arbitrary nature, the ability to stop them for a while by an effort of will, the child's understanding (starting from the end of preschool age) as negative and even harmful habits in the absence, in most cases, of the desire to overcome them and even active resistance to adults' attempts to eliminate them.

Thumb sucking or tongue sucking as a pathological habit occurs mainly in young and preschool children. Thumb sucking is most common. Long-term presence of this pathological habit can lead to deformation of the bite.

Yakation is an arbitrary rhythmic stereotypical rocking of the body or head, observed mainly before falling asleep or upon awakening in young children. As a rule, swinging is accompanied by a feeling of pleasure, and attempts by others to prevent it cause discontent and crying.

Nail biting (onychophagia) is most common during puberty. Often, in this case, not only the protruding parts of the nails are bitten off, but partially adjacent areas of the skin, which leads to local inflammation.

Masturbation (masturbation) consists in irritating the genitals with hands, squeezing the legs, rubbing against various objects. In young children, this habit is the result of fixation of playful manipulation of body parts and is often not accompanied by sexual arousal. With neuropathy, masturbation occurs due to increased general excitability. From the age of 8-9 years, irritation of the genitals can be accompanied by sexual arousal with a pronounced autonomic reaction in the form of facial hyperemia, increased sweating, tachycardia. Finally, at puberty, masturbation begins to be accompanied by representations of an erotic nature. Sexual arousal and orgasm contribute to the consolidation of a pathological habit.

Trichotillomania is the urge to pull the hair out of the scalp and eyebrows, often accompanied by a feeling of pleasure. It is observed mainly in girls of school age. Pulling hair sometimes leads to local baldness.

Childhood fears.

The relative ease of the occurrence of fears is a characteristic feature of childhood. Fears under the influence of various external, situational influences arise the easier, the younger the child. In young children, fear can be triggered by any new object that suddenly appears. In this regard, an important, although not always easy task is to distinguish between "normal", psychological fears from fears of a pathological nature. Signs of pathological fears are considered to be their causelessness or a clear discrepancy between the severity of fears, the intensity of the effect that caused them, the duration of the existence of fears, a violation of the general condition of the child (sleep, appetite, physical well-being) and the behavior of the child under the influence of fears.

All fears can be divided into three main groups: obsessive fears; fears with overvalued content; fears of a delusional nature. Obsessive fears in children are distinguished by the concreteness of the content, more or less clear connection with the content of the traumatic situation. Most often these are fears of infection, pollution, sharp objects (needles), enclosed spaces, transport, fear of death, fear of oral answers at school, fear of speech in stuttering, etc. Obsessive fears are perceived by children as "superfluous", alien, they fight with them.

Children do not regard fears of overvalued content as alien, painful, convinced of their existence, do not try to overcome them. Among these fears in children of preschool and primary school age, fears of darkness, loneliness, animals (dogs), fear of school, fear of failure, punishment for violation of discipline, fear of a strict teacher prevail. Fear of school can be the reason for persistent refusals to attend it and the phenomenon of school maladjustment.

Fears of delusional content are distinguished by the experience of a latent threat both from people and animals, and from inanimate objects and phenomena, accompanied by constant anxiety, alertness, fearfulness, and suspicion of others. Young children are afraid of loneliness, shadows, noise, water, a variety of everyday objects (water taps, electric lamps), strangers, characters from children's books, fairy tales. The child treats all these objects and phenomena as hostile, threatening his well-being. Children hide from real or imaginary objects. Delusional fears arise outside the traumatic situation.

Pathological daydreaming.

The emergence of pathological fantasizing in children and adolescents is associated with the presence of painfully altered creative imagination (fantasizing). In contrast to the mobile, rapidly changing fantasies of a healthy child closely related to reality, pathological fantasies are persistent, often divorced from reality, bizarre in content, often accompanied by violations of behavior, adaptation and manifest in various forms. The earliest form of pathological daydreaming is game reincarnation. A child temporarily, sometimes for a long time (from several hours to several days), transforms into an animal (wolf, hare, horse, dog), a character from a fairy tale, an invented fantastic creature, an inanimate object. The child's behavior imitates the appearance and actions of the given object.

Another form of pathological play activity is represented by monotonous stereotyped manipulations with objects that have no play value: bottles, pots, nuts, ropes, etc. Such "games" are accompanied by embrace, difficulty in switching, discontent and irritation of the child when trying to tear him away from this activity.

In older preschool and primary school children, pathological fantasies usually take the form of figurative fantasies. Children vividly represent animals, little people, children, with whom they mentally play, endow them with names or nicknames, travel with them, getting to unfamiliar countries, beautiful cities, to other planets. Boys' fantasies are often associated with military themes: scenes of battles, troops are presented. Warriors in colorful clothes of the ancient Romans, in the armor of medieval knights. Sometimes (mainly in prepubertal and pubertal age) fantasies have a sadistic content: natural disasters, fires, scenes of violence, executions, torture, murder, etc. are presented.

Pathological fantasizing in adolescents can take the form of self-incrimination and slander. Most often, these are detective-adventure self-incriminations of teenage boys who talk about their alleged participation in robberies, armed attacks, car thefts, and belonging to spy organizations. To prove the truth of all these stories, adolescents write in a modified handwriting and put notes to relatives and friends, allegedly from the leaders of gangs, which contain all kinds of demands, threats, obscene expressions. Teenage girls have slanderous rapes. Both with self-incrimination and slander, adolescents at times almost believe in the reality of their fantasies. This circumstance, as well as the brilliance and emotionality of messages about fictional events, often convince others of their truthfulness, in connection with which, investigations begin, appeals to the police, etc. Pathological daydreaming is observed in various mental illnesses.

Organ neuroses(systemic neuroses). Organ neuroses include neurotic stuttering, neurotic tics, neurotic enuresis, and encopresis.

Neurotic stuttering... Stuttering is a violation of the rhythm, tempo and fluency of speech associated with muscle cramps involved in the speech act. The causes of neurotic stuttering can be both acute and subacute mental trauma (fear, sudden anxiety, separation from parents, a change in the usual life stereotype, for example, placing a child in a preschool child care institution), and long-term psycho-traumatic situations (conflict relationships in the family, improper upbringing). Contributing internal factors are family history of speech pathology, primarily stuttering. A number of external factors also play an important role in the origin of stuttering, especially the unfavorable "speech climate" in the form of information overload, attempts to speed up the child's speech development, a sharp change in the requirements for his speech activity, bilingualism in the family, and excessive parental demands on the child's speech. As a rule, increased stuttering occurs in conditions of emotional stress, excitement, increased responsibility, and, if necessary, come into contact with strangers. At the same time, in the usual home environment, when talking with friends, stuttering may become less noticeable. Neurotic stuttering is almost always combined with other neurotic disorders: fears, mood swings, sleep disorders, tics, enuresis, which often precede the onset of stuttering.

Neurotic tics. Various automatic habitual elementary movements are called neurotic tics: blinking, wrinkling of the forehead, licking of the lips, twitching of the head, shoulders, coughing, "humming", etc.). In the etiology of neurotic tics, the role of causal factors is played by long-term traumatic situations, acute mental trauma accompanied by fright, local irritation (conjunctiva, respiratory tract, skin, etc.), causing a protective reflex motor reaction, as well as imitation of tics in someone from others. Tics usually arise in the form of a direct or somewhat delayed in time from the action of the psycho-traumatic factor of a neurotic reaction. More often, such a reaction is recorded, there is a tendency to the occurrence of tics of a different localization, other neurotic manifestations join: instability of mood, tearfulness, irritability, episodic fears, sleep disturbances, asthenic symptoms.

Neurotic enuresis. The term "enuresis" refers to the state of unconscious passing of urine, mainly during a night's sleep. To neurotic enuresis are those cases in the occurrence of which a causal role belongs to psychogenic factors. Enuresis, as a pathological condition, is spoken of when urinary incontinence in children from the age of 4 years old, since at an earlier age it can be physiological, associated with age-related immaturity of the mechanisms of urination regulation and the lack of a strong skill to retain urine.

Depending on the time of occurrence of enuresis, it is divided into "primary" and "secondary". In primary enuresis, urinary incontinence is noted from early childhood without intervals of the formed skill of neatness, characterized by the ability not to retain urine, not only during wakefulness, but also during sleep. Primary enuresis (dysontogenetic), in the genesis of which, the delay in the maturation of urinary regulation systems often has a family-hereditary character. Secondary enuresis occurs after a more or less long - at least 1 year period of having the skill of neatness. Neurotic enuresis is always secondary. The clinic of neurotic enuresis is distinguished by a pronounced dependence on the situation and environment in which the child is, from various influences on his emotional sphere. Urinary incontinence, as a rule, sharply increases with an exacerbation of a traumatic situation, for example, in the event of a parental breakup, after another scandal, due to physical punishment, etc. On the other hand, the temporary withdrawal of a child from a traumatic situation is often accompanied by a noticeable decrease or cessation of enuresis. Due to the fact that the emergence of neurotic enuresis is facilitated by such character traits as inhibition, timidity, anxiety, fearfulness, impressionability, self-doubt, low self-esteem, children with neurotic enuresis relatively early, already in preschool and primary school age, begin to painfully experience their disadvantage, they are ashamed of it, they have a feeling of inferiority, as well as anxious expectation of a new loss of urine. The latter often leads to sleep disturbance and disturbing night sleep, which, however, does not ensure timely awakening of the child when the urge to urinate occurs during sleep. Neurotic enuresis is never the only neurotic disorder, it is always combined with other neurotic manifestations, such as emotional lability, irritability, tearfulness, moodiness, tics, fears, sleep disturbances, etc.

It is necessary to distinguish neurotic enuresis from neurosis-like. Neurosis-like enuresis occurs in connection with the transferred cerebral-organic or general somatic diseases, is characterized by a greater monotony of the course, the absence of a clear dependence on changes in the situation with a pronounced dependence on somatic diseases, a frequent combination with cerebrasthenic, psychoorganic manifestations, focal neurological and diencephalic-vegetative disorders EEG changes and signs of hydrocephalus on the X-ray of the skull. In neurosis-like enuresis, the personality response to urinary incontinence is often absent until puberty. Children do not pay attention to their defect for a long time, they are not ashamed of it, despite the natural inconvenience.

Neurotic enuresis should also be distinguished from urinary incontinence as one of the forms of passive protest reactions in preschool children. In the latter case, urinary incontinence is noted only during the daytime and occurs mainly in a traumatic situation, for example, in a nursery or kindergarten in case of unwillingness to attend them, in the presence of an unwanted person, etc. In addition, manifestations of protesting behavior, dissatisfaction with the situation, and negativism reactions are observed.

Neurotic encopresis... Encopresis is the involuntary discharge of feces that occurs in the absence of abnormalities and diseases of the lower intestine or the sphincter of the anal opening. The disease occurs about 10 times less often than enuresis. The cause of encopresis is in most cases chronic traumatic situations in the family, excessively strict requirements of the parents to the child. Contributing factors of the "soil" can be neuropathic conditions and residual-organic cerebral insufficiency.

The clinic of neurotic encopresis is characterized by the fact that a child, who had previously had the skills of neatness, periodically in the daytime has a small amount of feces on the linen; more often parents complain that the child only “slightly stains his pants”; in rare cases, more abundant bowel movements are found. As a rule, the child does not feel the urge to defecate, at first does not notice the presence of bowel movements, and only after a while does he feel an unpleasant odor. In most cases, children painfully experience their lack, are ashamed of it, try to hide dirty linen from their parents. A peculiar reaction of the personality to encopresis may be the child's excessive desire for cleanliness and accuracy. In most cases, encopresis is combined with a low mood background, irritability, and tearfulness.

Neurotic sleep disorders.

The physiologically required duration of sleep varies significantly with age from 16-18 hours per day in a child of the first year of life to 10-11 hours at the age of 7-10 years and 8-9 hours in adolescents 14-16 years old. In addition, with age, there is a shift in sleep towards predominantly nighttime, in connection with which most of the children over 7 years old do not feel like sleeping during the daytime.

To establish the presence of a sleep disorder, it is not so much its duration that matters as the depth, determined by the speed of awakening under the influence of external stimuli, as well as the duration of the period of falling asleep. In young children, various traumatic factors that affect the child in the evening hours, shortly before bedtime, are often the direct cause of the onset of sleep disorders: parental quarrels at this time, various adult messages frightening the child about any incidents and accidents, watching movies on television, etc.

The clinic of neurotic sleep disorders is characterized by sleep disturbance, sleep depth disorders with nocturnal awakenings, night fears, as well as sleepwalking and sleep-speaking. Sleep disturbance is expressed in a slow transition from wakefulness to sleep. Falling asleep can last up to 1-2 hours and is often combined with various fears and fears (fear of the dark, fear of suffocating in sleep, etc.), pathological habitual actions (thumb sucking, hair curling, masturbation), obsessive actions such as elementary rituals ( repeated wishes of good night, putting certain toys to bed and certain actions with them, etc.). Sleepwalking and sleeping-talk are common manifestations of neurotic sleep disorders. As a rule, in this case, they are associated with the content of dreams, reflect individual traumatic experiences.

Nocturnal awakenings of neurotic origin, in contrast to epileptic ones, are devoid of sudden onset and cessation, are much longer, and are not accompanied by a distinct change in consciousness.

Neurotic appetite disorders (anorexia).

This group of neurotic disorders is widespread and includes various eating disorders in children associated with primary loss of appetite. A variety of traumatic moments play a role in the etiology of anorexia: separation of the child from the mother, placement in a child care facility, uneven educational approach, physical punishment, insufficient attention to the child. The immediate reason for the onset of primary neurotic anorexia is often the mother's attempt to force-feed the child when he refuses to eat, overfeeding, the accidental coincidence of feeding with some unpleasant impression (a sharp cry, fright, an adult quarrel, etc.). The most important contributing intrinsic factor is the neuropathic state (congenital or acquired), which is characterized by sharply increased autonomic excitability and instability of autonomic regulation. In addition, somatic weakness plays a role. From external factors, the excessive anxiety of parents regarding the nutritional status of the child and the process of his feeding, the use of persuasion, stories and other distractions from eating, as well as improper upbringing with the satisfaction of all the whims and whims of the child, leading to his excessive pampering, matters.

The clinical manifestations of anorexia are fairly similar. The child has no desire to eat any food, or he shows great selectivity in food, refusing many common foods. As a rule, he reluctantly sits down at the table, eats very slowly, “rolls” food in his mouth for a long time. Due to the increased gag reflex, vomiting often occurs during meals. Eating food causes a low mood, moodiness, tearfulness in a child. The course of a neurotic reaction can be short-lived, not exceeding 2-3 weeks. At the same time, in children with neuropathic conditions, as well as spoiled in conditions of improper upbringing, neurotic anorexia can acquire a protracted course with a long persistent refusal to eat. In these cases, a decrease in body weight is possible.

Mental underdevelopment.

Signs of mental retardation appear as early as 2-3 years of life, phrasal speech is absent for a long time, the skills of neatness and self-service are slowly developed. Children are not inquisitive, have little interest in the surrounding objects, games are monotonous, there is no liveliness in the game.

At preschool age, attention is drawn to the weak development of self-service skills, phrasal speech is characterized by the poverty of the vocabulary, the absence of detailed phrases, the impossibility of a coherent description of plot pictures, there is an insufficient supply of everyday information. Contact with peers is accompanied by a misunderstanding of their interests, the meaning and rules of games, poor development and undifferentiated higher emotions (sympathy, pity, etc.).

At primary school age, it is noted that it is impossible to understand and master the curriculum of primary grades of a mass school, the lack of basic everyday knowledge (home address, profession of parents, seasons, days of the week, etc.), inability to understand the figurative meaning of proverbs. Kindergarten and school educators can help diagnose this mental disorder.

Mental infantilism.

Mental infantilism is a delayed development of the child's mental functions with a predominant lag in the emotional-volitional sphere (personal immaturity). Emotional-volitional immaturity is expressed in lack of independence, increased suggestibility, the desire for pleasure as the main motivation for behavior, the predominance of play interests at school age, carelessness, immaturity of a sense of duty and responsibility, a weak ability to subordinate one's behavior to the requirements of the team, school, inability to restrain direct manifestations of feelings , inability to volitional tension, to overcome difficulties.

Immaturity of psychomotor skills is also characteristic, manifested in the insufficiency of fine movements of the hands, difficulty in developing motor school (drawing, writing) and work skills. The listed psychomotor disorders are based on the relative predominance of the activity of the extrapyramidal system over the pyramidal system due to its immaturity. Intellectual deficiency is noted: the predominance of a specific-shaped type of thinking, increased fatigue of attention, a slight decrease in memory.

The socio-pedagogical consequences of mental infantilism are insufficient "school maturity", lack of interest in learning, and poor performance at school.

School Skills Disorders.

Disorders of school skills are typical for children of primary school age (6-8 years old). Violations in the development of the reading skill (dyslexia) is manifested in the lack of recognition of letters, difficulty or impossibility of correlating the image of letters to the corresponding sounds, replacing some sounds with others when reading. In addition, there is a slow or accelerated reading pace, rearrangement of letters, swallowing of syllables, incorrect placement of stress during reading.

A disorder in the formation of writing skills (dysgraphia) is expressed in violations of the correlation of the sounds of oral speech with their writing, gross disorders of independent writing under dictation and in presentation: the replacement of letters corresponding to sounds similar in pronunciation, omission of letters and syllables, their rearrangement, dismemberment of words and continuous writing two or more words, replacing graphically similar letters, mirroring letters, fuzzy writing letters, slipping off a line.

Violation of the formation of the skill of counting (dyscalculia) manifests itself in special difficulties in the formation of the concept of number and understanding the structure of numbers. Particular difficulties are caused by digital operations associated with the transition over a dozen. The spelling of multi-digit numbers is difficult. Mirror spelling of numbers and numerical combinations is often noted (21 instead of 12). Often there are violations of the understanding of spatial relationships (children confuse the right and left sides), the mutual arrangement of objects (in front, behind, above, below, etc.).

Decreased mood background - depression.

In children of early and preschool age, depressive states are manifested in the form of somatovegetative and motor disorders. The most atypical manifestations of depressive conditions in young children (up to 3 years old), they occur during prolonged separation of the child from the mother and are expressed by general lethargy, crying attacks, motor restlessness, refusal to play activities, disturbances in the rhythm of sleep and wakefulness, loss of appetite, weight loss, a tendency to colds and infectious diseases.

In preschool age, in addition to sleep and appetite disorders, enuresis, encopresis, depressive disorders in psychomotor systems are observed: children have a suffering expression on their faces, walk with their heads down, dragging their legs, without moving their hands, speak in a low voice, there may be discomfort or pain in different parts of the body ... In children of primary school age, behavioral changes come to the fore in depressive states: passivity, lethargy, withdrawal, indifference, loss of interest in toys, learning difficulties due to impaired attention, slow assimilation of educational material. Some children, especially boys, are dominated by irritability, resentment, a tendency to aggression, as well as leaving school and home. In some cases, there may be a resumption of pathological habits characteristic of a younger age: sucking fingers, biting nails, pulling hair, masturbation.

In prepubertal age, a more distinct depressive affect appears in the form of a suppressed, melancholy mood, a kind of feeling of inferiority, ideas of self-deprecation and self-blame. Children say: “I am incapable. I am the weakest among the guys in the class. " For the first time, suicidal thoughts arise (“Why should I live like this?”, “Who needs me like that?”). At puberty, depression is manifested by its characteristic triad of symptoms: depressed mood, intellectual and motor retardation. A large place is occupied by somatovegetative manifestations: sleep disorders, decreased appetite. constipation, complaints of headaches, pains in various parts of the body.

Children fear for their health and life, become anxious, are fixed on somatic disorders, fearfully ask their parents if their hearts can stop, if they will suffocate in a dream, etc. In connection with persistent somatic complaints (somatized, "masked" depression), children undergo numerous functional and laboratory examinations, examinations of narrow specialists to identify any somatic disease. The survey results are negative. At this age, against the background of a lowered mood, adolescents develop an interest in alcohol and drugs, they join companies of juvenile delinquents, are prone to suicidal attempts and self-harm. Depression in children develops in severe traumatic situations, in schizophrenia.

Departures and vagrancy.

Departures and vagrancy are expressed in repeated leaving home or school, boarding school or other childcare institution, followed by vagrancy, often for many days. Mostly observed in boys. In children and adolescents, leaving can be associated with the experience of resentment, infringed pride, representing a reaction of passive protest, or with fear of punishment or anxiety about any offense. With mental infantilism, there are mainly dropouts from school and absenteeism due to the fear of difficulties associated with school. Escapes in adolescents with hysterical traits are associated with the desire to attract the attention of relatives, to arouse pity and sympathy (demonstrative escapes). Another type of motivation for initial withdrawal is "sensory thirst", i.e. the need for new, ever-changing experiences; and the desire for entertainment.

Departures can be "unmotivated", impulsive, with an irresistible urge to run away. They are called dromomania. Children and adolescents run away together or in a small group, they can go to other cities, spend the night in entrances, in attics, basements, as a rule, they do not return home on their own. They are brought by police officers, relatives, strangers. Children do not experience fatigue, hunger, thirst for a long time, which indicates that they have pathology of drives. Leaving and vagrancy disrupt the social adaptation of children, reduce school performance, and lead to various forms of antisocial behavior (hooliganism, theft, alcoholism, substance abuse, drug addiction, early sexual intercourse).

Painful attitude to an imaginary physical disability (body dysmorphic disorder).

The painful idea of ​​an imaginary or unreasonably exaggerated physical disability in 80% of cases occurs at puberty, more often occurs in adolescent girls. The very ideas of physical disability can be expressed in the form of thoughts about facial defects (long, ugly nose, large mouth, thick lips, protruding ears), physique (excessive fullness or thinness, narrow shoulders and short stature in boys), insufficient sexual development (small, "Curved" penis) or excessive sexual development (large mammary glands in girls).

A special type of dysmorphophobic experiences is the lack of certain functions: fear of not holding intestinal gases in the presence of strangers, fear of bad breath or sweat odor, etc. The experiences described above affect the behavior of adolescents who begin to avoid crowded places, friends and acquaintances, try to walk only after dark, change their clothes and hairstyle. More sthenic adolescents are trying to develop and use various self-medication methods, special physical exercises for a long time, persistently turn to cosmetologists, surgeons and other specialists with the requirement of plastic surgery, special treatment, for example, growth hormones, drugs that reduce appetite. Adolescents often look at themselves in the mirror (“mirror symptom”) and also refuse to be photographed. Episodic, transient dysmorphophobic experiences associated with a bias towards real minor physical disabilities are normal in puberty. But if they have a pronounced, persistent, often absurd, pretentious character, determine behavior, disrupt the social adaptation of a teenager, and are based on a low background of mood, then these are already painful experiences that require the help of a psychotherapist or psychiatrist.

Anorexia nervosa.

Anorexia nervosa is characterized by a deliberate, extremely persistent drive for qualitative and / or quantitative food abstinence and weight loss. It is much more common in adolescent girls and young women, much less often in boys and children. The leading symptom is the conviction of being overweight and the desire to correct this physical "deficiency". At the first stages of the state, the appetite persists for a long time, and abstinence from food is intermittently interrupted by bouts of overeating (bulimia nervosa). Then the fixed habitual nature of overeating alternates with vomiting, leading to somatic complications. Teenagers tend to eat alone, try to get rid of it imperceptibly, carefully study the calorie content of foods.

Weight loss occurs in various additional ways: grueling exercise; taking laxatives, enemas; regular artificial induction of vomiting. The feeling of constant hunger can lead to hypercompensatory forms of behavior: feeding the younger brothers and sisters, an increased interest in cooking various foods, as well as the appearance of irritability, increased excitability, and a decrease in the background mood. Signs of somatoendocrine disorders gradually appear and grow: the disappearance of subcutaneous fat, oligo-, then amenorrhea, dystrophic changes in the internal organs, hair loss, changes in blood biochemical parameters.

Early Childhood Autism Syndrome.

The syndrome of early childhood autism is a group of syndromes of different origins (intrauterine and perinatal organic brain damage - infectious, traumatic, toxic, mixed; hereditary-constitutional) observed in children of early, preschool and primary school age within the framework of different nosological forms. The syndrome of early childhood autism manifests itself most clearly from 2 to 5 years, although some of its signs are noted at an earlier age. So, already in infants, there is a lack of a "revitalization complex" characteristic of healthy children upon contact with a mother, they do not have a smile at the sight of their parents, sometimes there is a lack of an orienting response to external stimuli, which can be mistaken for a defect in the sense organs. In children, sleep disorders (intermittent sleep, difficulty falling asleep), persistent appetite disorders with its decrease and special selectivity, and lack of hunger are noted. There is a fear of novelty. Any change in the usual environment, for example, in connection with the rearrangement of furniture, the appearance of a new thing, a new toy, often causes dissatisfaction or even a violent protest with crying. A similar reaction occurs when changing the order or timing of feeding, walking, washing, and other aspects of the daily routine.

The behavior of children with this syndrome is monotonous. They can spend hours performing the same actions, vaguely reminiscent of a game: pouring water into dishes and pouring out of it, sorting out pieces of paper, matchboxes, cans, strings, arrange them in a certain order, not allowing anyone to put them away. These manipulations, as well as an increased interest in certain objects that usually do not have a game purpose, are an expression of a special obsession, in the origin of which the role of impulse pathology is obvious. Children with autism actively seek loneliness, feeling better when left alone. Psychomotor disorders are typical, manifested in general motor failure, awkward gait, stereotypes in movements, shaking, rotating the hands, jumping, rotating around its axis, walking and running on tiptoes. As a rule, there is a significant delay in the formation of elementary self-service skills (independent eating, washing, dressing, etc.).

The child's facial expressions are poor, not expressive, characterized by an "empty, expressionless look", as well as a look, as it were, by or "through" the interlocutor. In speech, there are echolalia (repetition of the heard word), pretentious words, neologisms, drawn intonation, the use of pronouns and verbs in the 2nd and 3rd person in relation to themselves. In some children, there is a complete refusal to communicate. The level of intelligence development is different: normal, exceeding the average norm, there may be a lag in mental development. The syndromes of early childhood autism have different nosological affiliations. Some scientists attribute them to the manifestation of the schizophrenic process, others - to the consequences of early organic brain damage, atypical forms of mental retardation.

Conclusion

The establishment of a clinical diagnosis in child psychiatry is based not only on complaints from parents, guardians and the children themselves, collecting an anamnesis of the patient's life, but also on observing the child's behavior and analyzing his appearance. When talking with the parents (other legal representatives) of the child, it is necessary to pay attention to the facial expression, facial expressions of the patient, his reaction to your examination, the desire to communicate, the productivity of contact, the ability to comprehend what he heard, follow the instructions given, the volume of vocabulary, the purity of pronunciation of sounds, the development of fine motor skills , excessive mobility or lethargy, slowness, awkwardness in movements, reaction to the mother, toys, children present, the desire to communicate with them, the ability to dress, eat, develop tidiness skills, etc. If signs of a mental disorder in a child or adolescent are detected, the parent or guardian should be advised to seek advice from a child psychotherapist, child psychiatrist, or psychiatrists at regional hospitals in rural areas.

Child psychotherapists and child psychiatrists serving the child and adolescent population of Tyumen work in the outpatient department of the Tyumen Regional Clinical Psychiatric Hospital, Tyumen, st. Herzen, d. 74. Telephone registration of child psychotherapists: 50-66-17; telephone of the registration of child psychiatrists: 50-66-35; helpline: 50-66-43.

Bibliography

1. Bukhanovsky A.O., Kutyavin Yu.A., Litvan M.E. General psychopathology. - Publishing house "Phoenix", 1998.
2. V.V. Kovalev Child psychiatry. - M .: Medicine, 1979.
3. V.V. Kovalev Semiotics and diagnosis of mental illness in children and adolescents. - M .: Medicine, 1985.
4. Levchenko I.Yu. Pathopsychology: Theory and Practice: Textbook. - M .: Academy, 2000.
5. Problems of diagnostics, therapy and instrumental research in child psychiatry / Scientific materials of the All-Russian conference. -Volgograd, 2007.
6. Eidemiller E.G. Child psychiatry. SPb .: Peter, 2005.

APPENDIX

1. Scheme of pathopsychological examination of a child according to

Contact (speech, gesture, mimicry):

- does not come into contact;

- shows speech negativism;

- formal contact (purely external);

- does not come into contact immediately, with great difficulty;

- does not show interest in contact;

- selective contact;

- easily and quickly establishes contact, shows interest in it, willingly obeys.

Emotional-volitional sphere:

active / passive;

active / inert;

cheerful / sluggish;

motor disinhibition;

aggressiveness;

spoiledness;

mood swings;

conflicts;

Hearing condition(norm, hearing loss, deafness).

Vision state(norm, myopia, farsightedness, strabismus, optic nerve atrophy, low vision, blindness).

Motor skills:

1) leading hand (right, left);

2) the development of the manipulative function of the hands:

- there is no grabbing;

- sharply limited (cannot manipulate, but there is grabbing);

- limited;

- insufficient, fine motor skills;

- safe;

3) consistency of hand actions:

- missing;

- norm (N);

4) tremor. Hyperkinesis. Impaired coordination of movements

Attention (duration of concentration, resilience, switching):

- the child concentrates poorly, has difficulty keeping attention on the object (low concentration and instability of attention);

- attention is not stable enough, superficial;

- quickly depleted, requires switching to another type of activity;

- poor switching of attention;

- attention is quite stable. The duration of concentration and attention switching is satisfactory.

Reaction to approval:

- adequate (rejoices in approval, waits for it);

- inadequate (does not react to approval, is indifferent to it). Reaction to remark:

- adequate (corrects behavior in accordance with the remark);

Adequate (offended);

- there is no reaction to the remark;

- negative reaction (doing it out of spite).

Attitude towards failure:

- evaluates failure (notices the incorrectness of his actions, corrects mistakes);

- there is no assessment of failure;

- negative emotional reaction to failure or own mistake.

Efficiency:

- extremely low;

- reduced;

- sufficient.

Nature of activity:

- lack of motivation for activity;

- works formally;

- the activity is unstable;

- the activity is stable, works with interest.

Learning ability, use of help (during the survey):

- there is no learning ability. Help does not use;

- there is no transfer of the shown method of action to similar tasks;

- learning ability is low. Help is underutilized. Knowledge transfer is difficult;

- we teach the child. Uses the help of an adult (moves from a lower way of completing tasks to a higher one). Carries out the transfer of the received method of action to a similar task (N).

Activity development level:

1) expression of interest in toys, selectivity of interest:

- persistence of playful interest (whether it takes a long time to engage in one toy or moves from one to the other): does not show interest in toys (it does not work with toys. It doesn’t join a joint game with adults. Doesn’t organize independent play);

- shows a superficial, not very persistent interest in toys;

- shows a persistent selective interest in toys;

- performs inappropriate actions with objects (ridiculous, not dictated by the logic of the game or the quality of the object of the action);

- uses toys adequately (uses the object in accordance with its intended purpose);

3) the nature of actions with toys:

- nonspecific manipulations (with all objects acts the same, stereotypically - taps, pulls in the mouth, sucks, throws);

- specific manipulations - takes into account only the physical properties of objects;

- objective actions - uses objects in accordance with their functional purpose;

- procedural actions;

- a chain of game actions;

- game with plot elements;

- a role-playing game.

Stock of general ideas:

- low, limited;

- slightly reduced;

- corresponds to age (N).

Knowledge of body parts and face (visual orientation).

Visual perception:

color perception:

- no idea about the color;

- matches colors;

- distinguishes colors (highlights by word);

- recognizes and names the primary colors (N - at 3 years old);

size perception:

- no idea about the size;

- correlates items by size; - differentiates objects by size (selection by word);

- names the size (N - at 3 years old);

form perception:

- no idea about the form;

- correlates objects in shape;

- distinguishes between geometric shapes (highlights by word); names (planar and volumetric) geometric shapes (N - at 3 years).

Folding nesting dolls (three-piece– from 3 to 4 years old; four-part– from 4 to 5 years; six-part– from 5 years old):

- ways to complete the task:

- action by force;

- enumeration of options;

- targeted tests (N - up to 5 years);

- trying on;

Inclusion in a row (six-piece matryoshka– from 5 years old):

- actions are inadequate / adequate;

- ways to complete the task:

- excluding size;

- targeted tests (N - up to 6 years);

- visual correlation (from the age of 6 is required).

Folding the pyramid (up to 4 years old - 4 rings; from 4 years old - 5-6 rings):

- actions are inadequate / adequate;

- excluding the size of the rings;

- taking into account the size of the rings:

- trying on;

- visual correlation (N - mandatory from 6 years old).

Insert Cubes(tests, enumeration of options, fitting, visual correlation).

Mailbox (from 3 years old):

- action by force (permissible in N up to 3.5 years);

- enumeration of options;

- trying on;

- visual correlation (N is mandatory from 6 years old).

Paired pictures (from 2 years old; choice from two, four, six pictures).

Construction:

1) design from building material (by imitation, by model, by presentation);

2) folding figures from sticks (by imitation, by model, by presentation).

Perception of spatial relationships:

1) orientation in the sides of one's own body and mirroring;

2) differentiation of spatial concepts (above - below, further - closer, to the right - to the left, in front - to the back, in the center);

3) a holistic image of an object (folding of cut pictures from 2-3-4-5-6 parts; vertical, horizontal, diagonal, broken line cut);

4) understanding and use of logical and grammatical constructions (N from 6 years old).

Temporary views:

- parts of the day (N from 3 years old);

- seasons (N from 4 years old);

- days of the week (N from 5 years old);

- understanding and use of logical and grammatical constructions (N from 6 years old).

Quantitative representations:

— ordinal counting (verbally and counting items);

- determination of the number of items;

- allocation of the required quantity from the set;

- correlation of items by quantity;

- the concept of "a lot" - "little", "more" - "less", "equally";

- counting operations.

Memory:

1) mechanical memory (within N, reduced);

2) mediated (verbal-logical) memory (N, decreased). Thinking:

- the level of development of thinking:

- visual and effective;

- visual and figurative;

- elements of abstract logical thinking.

1. Diagnostics of the presence of fears in children.

To diagnose the presence of fears, a conversation is held with the child with a discussion of the following issues: Tell me, please, are you afraid or not afraid:

1. When are you alone?
2. Get sick?
3. Die?
4. Any children?
5. Some of the educators?
6. That they will punish you?
7. Babu Yaga, Kashchei the Immortal, Barmaley, Snake Gorynych?
8. Terrible dreams?
9. Darkness?
10. Wolf, bear, dogs, spiders, snakes?
11. Cars, trains, planes?
12. Storms, thunderstorms, hurricanes, floods?
13. When is it very high?
14. In a small, cramped room, toilet?
15. Water?
16. Fire, fire?
17. Wars?
18. Doctors (other than dentists)?
19. Blood?
20. Injections?
21. Pain?
22. Unexpected sharp sounds (when suddenly something falls, knocks)?

Processing of the methodology "Diagnostics of the presence of fears in children"

On the basis of the received answers to the listed questions, it is concluded that children have fears. The presence of a large number of various fears in a child is an important indicator of a preneurotic state. Such children should be referred to the “risk” group and special (corrective) work should be carried out with them (it is advisable to consult them with a psychotherapist or psychiatrist).

Fears in children can be divided into several groups: medical(pain, injections, doctors, diseases); physical damage(unexpected sounds, transport, fire, fire, elements, war); of death(his); animals and fairytale characters; nightmares and darkness; socially mediated(people, children, punishment, lateness, loneliness); "Spatial fears"(height, water, confined spaces). In order to make an unmistakable conclusion about the emotional characteristics of a child, it is necessary to take into account the characteristics of the entire life of the child as a whole.

In some cases, it is advisable to use a test that allows you to diagnose a child's anxiety at the age of four to seven years in relation to a number of typical life situations of communication with other people. The authors of the test consider anxiety as a type of emotional state, the purpose of which is to ensure the safety of the subject at the personal level. An increased level of anxiety may indicate insufficient emotional adaptation of the child to certain social situations.

In childhood, a variety of diseases can manifest themselves - neuroses, schizophrenia, epilepsy, exogenous brain damage. Although the main signs of these diseases, most important for diagnosis, appear at any age, the symptoms in children are somewhat different from those observed in adults. At the same time, there are a number of disorders specific to childhood, although some of them may persist throughout a person's life. These disorders reflect disturbances in the natural course of development of the body, they are relatively stable, significant fluctuations in the state of the child (remission) are usually not observed, as well as a sharp increase in symptoms. As development progresses, some of the anomalies can be compensated for or disappear altogether. Most of the disorders described below are more common in boys.

Childhood autism

Childhood autism (Kanner's syndrome) occurs with a frequency of 0.02-0.05%. In boys, it is observed 3-5 times more often than in girls. Although developmental abnormalities can be detected as early as infancy, the disease is usually diagnosed at the age of 2 to 5 years, when social skills are formed. The classic description of this disorder [Kanner L., 1943] includes extreme isolation, a desire for loneliness, difficulties in emotional communication with others, inappropriate use of gestures, intonation and facial expressions when expressing emotions, deviations in the development of speech with a tendency to repetition, echolalia, incorrect use of pronouns ("you" instead of "I"), monotonous repetition of noise and words, decreased spontaneous activity, stereotypy, mannerism. These disorders are combined with excellent mechanical memory and an obsessive desire to maintain everything unchanged, fear of changes, the desire to achieve completion in any action, the preference for communication with objects of communication with people. The danger is the tendency of these patients to self-harm (biting, pulling out hair, hitting the head). In older school age, epileptic seizures are often associated. Concomitant mental retardation is observed in 2/3 of patients. It is noted that often the disorder occurs after intrauterine infection (rubella). These facts testify in favor of the organic nature of the disease. A similar syndrome, but without intellectual disabilities, was described by H. Asperger (1944), who considered it as a hereditary disease (concordance in identical twins in up to 35%). Di This disorder has to be differentiated from oligophrenia and childhood schizophrenia. The prognosis depends on the severity of the organic defect. Most patients show some improvement in behavior with age. For treatment, special training methods, psychotherapy, small doses of haloperidol are used.

Childhood hyperkinetic disorder

Hyperkinetic Conduct Disorder (hyperdynamic syndrome) is a relatively common developmental disorder (3 to 8% of all children). The ratio of boys and girls is 5: 1. Characterized by extreme activity, mobility, impaired attention, which prevents regular studies and the assimilation of school material. The business that has been started, as a rule, is not completed; with good mental abilities, children quickly cease to be interested in the task, lose and forget things, get involved in fights, cannot sit at the TV screen, constantly pester others with questions, push, pinch and tug on parents and peers. It is assumed that the disorder is based on minimal cerebral dysfunction, but clear signs of psychoorganic syndrome are almost never noted. In most cases, behavior normalizes at the age of 12-20 years, however, to prevent the formation of persistent psychopathic asocial traits, treatment should be started as early as possible. Therapy is based on persistent, structured parenting (strict supervision by parents and caregivers, regular sports). In addition to psychotherapy, psychotropic drugs are also used. Nootropic drugs are widely used - piracetam, pantogam, phenibut, encephabol. In most patients, there is a paradoxical improvement in behavior against the background of the use of psychostimulants (sydnocarb, caffeine, phenamine derivatives, stimulating antidepressants - imipramine and sydnophen). With the use of phenamine derivatives, a temporary growth retardation and a decrease in body weight are occasionally observed, the formation of dependence is possible.

Isolated delays in skill formation

Often, children have an isolated delay in the development of a skill: speech, reading, writing or counting, motor functions. In contrast to oligophrenias, which are characterized by a uniform lag in the development of all mental functions, with the above disorders, a significant improvement in the condition and a smoothing of the existing lag are usually observed as they grow older, although some disorders can remain in adults. Pedagogical methods are used for correction.

ICD-10 includes several rare syndromes, presumably organic in nature, occurring in childhood and accompanied by an isolated disorder of certain skills.

Landau-Kleffner syndrome manifests itself as a catastrophic impairment of pronunciation and understanding of speech at the age of 3-7 years after a period of normal development. The majority of patients develop epileptiform seizures, almost all of them have abnormalities on the EEG with mono- or bilateral temporal lobe pathological epiactivity. Recovery is observed in 1/3 of cases.

Rett syndrome occurs only in girls. It manifests itself as a loss of manual skills and speech, combined with head growth retardation, enuresis, encopresis and attacks of shortness of breath, sometimes epileptic seizures. The disease occurs at the age of 7-24 months against the background of relatively favorable development. At a later age, ataxia, scoliosis and kyphoscoliosis join. The disease leads to severe disability.

Disorders of some physiological functions in children

Enuresis, encopresis, eating inedible (peak), stuttering can occur as independent disorders or (more often) are symptoms of childhood neuroses and organic brain damage. Often, several of these disorders or their combination with tics can be observed in the same child at different age periods.

Stuttering occurs quite often in children. It is indicated that transient stuttering occurs in 4%, and persistent stuttering occurs in 1% of children, more often in boys (in various works, the sex ratio is estimated from 2: 1 to 10: 1). Stuttering usually occurs between the ages of 4 and 5, with normal mental development. In 17% of patients, there is a hereditary burden of stuttering. There are neurotic variants of stuttering with psychogenic onset (after fright, against the background of severe intra-family conflicts) and organically determined (dysontogenetic) variants. The prognosis for neurotic stuttering is much more favorable; after puberty, the disappearance of symptoms or smoothing is noted in 90% of patients. Neurotic stuttering is closely related to traumatic events and personal characteristics of patients (anxious and suspicious traits prevail). Characterized by an increase in symptoms in a situation of great responsibility, a difficult experience of their illness. Quite often, this type of stuttering is accompanied by other symptoms of neurosis (logoneurosis): sleep disturbances, tearfulness, irritability, fatigue, fear of public speaking (logophobia). The prolonged existence of symptoms can lead to pathological personality development with an increase in asthenic and pseudoschizoid features. An organically conditioned (dysontogenetic) variant of stuttering gradually develops regardless of traumatic situations, psychological worries about the existing speech defect are less pronounced. Other signs of organic pathology are often observed (diffuse neurological symptoms, changes in the EEG). Stuttering itself has a more stereotypical, monotonous character, reminiscent of teak-like hyperkinesis. An increase in symptoms is associated more with additional exogenous harm (trauma, infection, intoxication) than with psychoemotional stress. Stuttering treatment should be done in collaboration with a speech therapist. In the neurotic variant, speech therapy sessions should be preceded by relaxing psychotherapy ("silence mode", family psychotherapy, hypnosis, auto-training and other suggestions, group psychotherapy). In the treatment of organic variants, great importance is attached to the appointment of nootropics and muscle relaxants (mydocalms).

Enuresis at various stages of development, it is noted in 12% of boys and 7% of girls. The diagnosis of enuresis is made in children over 4 years of age; in adults, this disorder is rarely observed (up to 18 years of age, enuresis persists only in 1% of boys, and is not observed in girls). Some researchers note the participation of hereditary factors in the occurrence of this pathology. It is proposed to distinguish primary (dysontogenetic) enuresis, which is manifested by the fact that the normal rhythm of urination is not established from infancy, and secondary (neurotic) enuresis, which occurs in children against the background of psychotraumas after several years of normal urination regulation. The latter variant of enuresis proceeds more favorably and by the end of puberty in most cases disappears. Neurotic (secondary) enuresis, as a rule, is accompanied by other symptoms of neurosis - fears, timidity. These patients often sharply emotionally react to the existing disorder, additional mental trauma provoke an increase in symptoms. Primary (dysontogenetic) enuresis is often combined with mild neurological symptoms and signs of dysontogenesis (spina bifida, prognathia, epicanthus, etc.); partial mental infantilism is often observed. A calmer attitude towards one's defect, a strict periodicity, not associated with a momentary psychological situation, are noted. Urination during nocturnal epileptic seizures should be distinguished from inorganic enuresis. For differential diagnosis, EEG is examined. Some authors consider primary enuresis as a sign that predisposes to the onset of epilepsy [Sprecher BL, 1975]. For the treatment of neurotic (secondary) enuresis, sedative psychotherapy, hypnosis and auto-training are used. Patients with enuresis are advised to reduce fluid intake before bedtime, as well as eat foods that promote water retention in the body (salty and sweet foods).

Tricyclic antidepressants (imipramine, amitriptyline) for enuresis in children have a good effect in most cases. Bedwetting often goes away without special treatment.

Tiki

Tiki occur in 4.5% of boys and 2.6% of girls, usually at the age of 7 years and older, usually do not progress and in some patients completely disappear upon reaching maturity. Anxiety, fear, attention of others, the use of psychostimulants increase tics and can provoke them in an adult who has recovered from tics. There is often a connection between tics and obsessive-compulsive disorder in children. You should always carefully differentiate tics from other movement disorders (hyperkinesis), which are often a symptom of severe progressive nervous diseases (parkinsonism, Huntinggon's chorea, Wilson's disease, Lesch-Nychen syndrome, chorea minor, etc.). Unlike hyperkinesis, tics can be suppressed by an effort of will. The children themselves treat them as a bad habit. Family therapy, hypnosuggestion and autogenous training are used to treat neurotic tics. It is recommended to involve the child in physical activity that is interesting for him (for example, playing sports). If psychotherapy is unsuccessful, mild antipsychotics (sonapax, ethaperazine, halotteridol in small doses) are prescribed.

A serious illness manifested by chronic tics isGilles de la Tourette's syndrome . The disease begins in childhood (usually between 2 and 10 years); in boys 3-4 times more often than in girls. First, tics appear in the form of blinking, head twitching, grimaces. A few years later, in adolescence, vocal and complex motor tics join, often changing localization, sometimes having an aggressive or sexual component. Coprolalia (swear words) is observed in 1/3 of cases. Patients are characterized by a combination of impulsivity and obsessions, a decrease in the ability to concentrate. The disease is hereditary. There is an accumulation among the relatives of sick patients with chronic tics and obsessive compulsive disorder. There is a high concordance in identical twins (50-90%), in fraternal twins - about 10%. Treatment is based on the use of antipsychotics (haloperidol, pimozide) and clonidine in minimal doses. The presence of profuse obsessions also requires the appointment of antidepressants (fluoxetine, clomipramine). Pharmacotherapy allows you to control the condition of patients, but does not cure the disease. Sometimes the effectiveness of drug treatments diminishes over time.

Features of the manifestation of the main mental illness in children

Schizophrenia with a debut in childhood differs from typical variants of the disease in a more malignant course, a significant predominance of negative symptoms over productive disorders. Early onset of the disease is more common in boys (sex ratio is 3.5: 1). In children, it is very rare to see such typical manifestations of schizophrenia as delusions of exposure and pseudo-hallucinations. Disorders of the motor sphere and behavior predominate: catatonic and hebephrenic symptoms, disinhibition of drives or, conversely, passivity and indifference. All symptoms are characterized by simplicity and stereotype. Attention is drawn to the monotonous nature of the games, their stereotypes and schematism. Often, children pick up special items for games (wires, plugs, shoes), and neglect toys. Sometimes there is a surprising one-sidedness of interests (see the clinical case illustrating body dysmorphomania, in section 5.3).

Although typical signs of a schizophrenic defect (lack of initiative, autism, indifferent or hostile attitude towards parents) can be observed in almost all patients, they are often combined with a kind of mental retardation, reminiscent of oligophrenia. E. Kraepelin (1913) singled out as an independent formpfropfschizophrenia, combining the features of oligophrenia and schizophrenia with a predominance of hebephrenic symptoms. Occasionally, forms of the disease are noted in which mental development preceding the manifestation of schizophrenia occurs, on the contrary, at an accelerated pace: children begin to read and count early, are interested in books that do not correspond to their age. In particular, it has been noticed that the paranoid form of schizophrenia is often preceded by premature intellectual development.

At puberty, frequent signs of the onset of schizophrenia are dysmorphomanic syndrome and symptoms of depersonalization. The slow progression of symptoms, the absence of obvious hallucinations and delusions may resemble neurosis. However, unlike neuroses, such symptomatology does not in any way depend on the existing stressful situations, it develops autochthonously. Rituals and senestopathies are early added to the symptoms typical of neuroses (fears, obsessions).

Affective insanity does not occur in early childhood. Distinct affective seizures can be observed in children at least 12-14 years old. It is quite rare for children to complain of feelings of boredom. More often, depression is manifested by somatovegetative disorders, sleep and appetite disorders, and constipation. Depression can be evidenced by persistent lethargy, slowness, discomfort in the body, moodiness, tearfulness, refusal to play and communicate with peers, a feeling of worthlessness. Hypomanic states are more noticeable to those around them. They are manifested by unexpected activity, talkativeness, restlessness, disobedience, decreased attention, inability to measure actions with one's own strengths and capabilities. In adolescents, more often than in adult patients, there is a continual course of the disease with a constant change in affective phases.

Outlined pictures are rarely seen in young children. neurosis. More often, there are short-term neurotic reactions due to fright, unpleasant for the child, the prohibition on the part of the parents. The likelihood of such reactions is higher in children with residual organic deficiency. It is not always possible to clearly identify the typical adult variants of neuroses (neurasthenia, hysteria, obsessive-phobic neurosis) in children. Attention is drawn to incompleteness, rudimentary symptoms, the predominance of somatovegetative and movement disorders (enuresis, stuttering, tics). G.E. Sukhareva (1955) emphasized that the regularity is that the younger the child, the more monotonous and monotonous the symptoms of neurosis.

A fairly common manifestation of childhood neuroses is a variety of fears. In early childhood, this is a fear of animals, fairy-tale characters, movie characters, in preschool and primary school age - fear of darkness, loneliness, separation from parents, death of parents, anxious expectation of the upcoming school, in adolescents - hypochondriacal and dysmorphophobic thoughts, sometimes fear of death ... Phobias more often occur in children with anxious and suspicious character and increased impressionability, suggestibility, fearfulness. The emergence of fears is facilitated by hyperprotection on the part of the parents, which consists in constant anxious fears for the child. Unlike obsessions in adults, children's phobias are not accompanied by a consciousness of alienation and pain. As a rule, there is no purposeful drive to get rid of fears. Obsessive thoughts, memories, obsessive counting are not typical for children. Abundant ideatorial, emotionally uncolored obsessions, accompanied by rituals and isolation, require differential diagnosis with schizophrenia.

Detailed pictures of hysterical neurosis in children are also not observed. More often you can see affect-respiratory seizures with loud crying, at the height of which respiratory arrest and cyanosis develop. Psychogenic selective mutism is sometimes noted. The reason for such reactions may be the prohibition of the parents. In contrast to hysteria in adults, children's hysterical psychogenic reactions occur in boys and girls with the same frequency.

The basic principles of treatment of mental disorders in childhood do not differ significantly from those used in adults. Leading in the treatment of endogenous diseases is psychopharmacotherapy. In the treatment of neuroses, psychotropic drugs are combined with psychotherapy.

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