Today, the term "mental retardation", applied to children's mental illness, is used mainly in medicine. In pedagogical practice, to determine this state, it is customary to use the corresponding concept of "intellectual insufficiency". This primarily applies to children whose condition is in an intermediate stage between the manifestations of oligophrenia and the intellectual norm. The broader meaning of this concept refers to mental retardation (MPD).
The boundaries of this state do not have a clear definition and depend on the requirements of the surrounding society. Borderline intellectual disability is considered a fairly common form of mental pathology in childhood and usually manifests itself in older groups of kindergarten or in the process of studying in elementary school.
What is this
Borderline intellectual deficiency is a phenomenon characterized by a slow pace of mental development, personal immaturity and minor cognitive impairment. When creating conditions for special training and education, this pathological process most often tends to compensate and reverse development. However, here it is necessary to distinguish between cases of persistent intellectual impairment and cases adjacent to the norm.
Etiology
The conditions and reasons for the appearance of various forms of intellectual disabilities are ambiguous. In the pathogenesis of these conditions, there may be biological factors (pathologies of pregnancy and childbirth, infection, intoxication, metabolic and trophic disorders, craniocerebral injuries, and other causes) that cause disturbances in the development of brain mechanisms or provoke cerebral damage.
Besides, the social factors leading to intellectual insufficiency are also known. These may be unfavorable conditions of upbringing, insufficient amount of information conveyed, pedagogical neglect, etc. Far from last is the genetic predisposition that affects the formation of various types of intellectual impairment.
Pathogenesis
In the pathogenesis of intellectual disability in preschoolers with borderline manifestations, underdevelopment of the frontal lobes and damage to their connections with other parts of the brain are of great importance. In addition, this pathology is causeddamage to the parietal, temporal and occipital cortex and a delay in the formation of the adrenergic substance of the brain.
Characteristics of intellectual deficiency
A generally accepted Russian classification of intellectual disabilities does not exist today. However, in modern medicine, the developments of well-known psychiatrists and psychoneurologists are widely used. So, for example, G. E. Sukhareva, based on the etiopathogenetic principle, identifies forms of intellectual impairment in children with mental retardation by type of origin:
- Constitutional.
- Somatogenic.
- Psychogenic.
- Cerebral Organic.
In this interpretation, the proposed options differ in the features of the structure and the specifics of the ratio of the components of the anomaly in question: the type and nature of the disorder.
I. F. Markovskaya distinguishes two variants of intellectual delay, which are characterized by a ratio of organic immaturity and damage to the central nervous system.
According to her interpretation, the underdevelopment of the emotional sphere is due to types of organic infantilism. Encephalopathic manifestations are represented by mild cerebrasthenic and neurosis-like disorders. The main features of violations of higher mental functions are manifested in dynamics and are due to their insufficient maturity and increased exhaustion.
According to the second option, the activity of the central nervous system of preschool children with intellectual disabilities is dominated by featuresdamage: pronounced encephalopathic disorders, manifested in the form of cerebrasthenic, neurosis-like, psychopathic, subclinical epileptiform and apathetic-asthenic syndromes. As a rule, in the pathogenesis there are neurodynamic disorders and manifestations of deficiency of cortical functions.
However, the most widely used classification developed by V. V. Kovalev, according to which four groups are distinguished:
- Dysontogenetic forms of borderline intellectual deficiency. These may be manifestations of mental infantilism: the immaturity of the personality with a predominant lag in the development of the emotional-volitional sphere, combined with various neuropathic conditions. In addition, this disorder may be a variant of early childhood autism syndrome. Children with intellectual disabilities should include developmental delays in some components of mental activity: speech, motor skills, reading, counting and writing.
- Encephalopathic forms in some cerebrosthenic and psychoorganic conditions and cerebral palsy.
- Intelligence disorders caused by defects in analyzers and sense organs.
- Intellectual deficiency caused by unfavorable upbringing conditions and lack of information.
International classification
Currently, to assess intellectual insufficiency, it is customary to use the international system for determining the intelligence quotient (from the English IQ -intelligence quotient). According to this method, with the help of certain tests, the level of intelligence of the subject is determined relative to the level of the average person of the same age.
The underdevelopment indicator is subdivided into the following forms:
- Borderline intellectual deficiency is characterized by an IQ level in the range of 80-90.
- Easy when IQ is between 50-69.
- Moderate, where IQ is 35-49.
- Severe, in which the IQ level is in the range of 20-34.
- Deep - IQ below 20.
Problems of adaptation in society
Normally developing children, thanks to family and social interactions and influences, spontaneously adapt to the social environment. However, in the presence of intellectual insufficiency, the features of the child's adaptation in society are such moments as:
- Inability to independently analyze the surrounding social environment.
- Rejection by peers due to speech or physical disabilities.
- Rejection and misunderstanding by society.
- Lack of conditions necessary for full-fledged rehabilitation in the family and public institutions.
- The inability of parents to provide a properly organized approach to raising a child with an intellectual pathology. As a result, dependent forms of behavior are fixed in such children, which makes it difficult not only for his adaptation in society, but also for interaction with loved ones.
The purpose of working withchildren with intellectual disabilities is a versatile education of the individual. The child must become socially adapted to the conditions of interaction with the environment.
Clinical picture
Manifestations of intellectual disability are a variety of clinical and psychophysiological conditions, depending on a number of factors. Such violations manifest themselves in the form of weak curiosity and slow learning. Such children have practically no susceptibility to the new. At the same time, primary violations are observed from the first days of a child's life:
- no response to external stimuli;
- late interest in the outside world;
- the behavior of such a baby is dominated by lethargy and drowsiness, but this does not exclude loudness and anxiety;
- the baby does not know how to distinguish between his own and strangers;
- does not show keen interest in interacting with adults;
- does not show interest in toys hung over crib and does not respond to toys in adult hands.
In children of the first year of life with various forms of intellectual impairment, the grasping reflex is absent for a long time. Only by the age of two or three do they experience some shift in mastering the skills of manipulation, however, intellectual deficiency manifests itself in behavior and play activities.
Children cannot take care of themselves for a long time, do not show a keen interest in anything and do not show curiosity. Rarely occurringinterest quickly fades. In the course of games, such a child is limited to elementary manipulation, has little contact with surrounding peers, and moves little.
At senior preschool age, he is characterized by a lack of interest in intellectual pursuits. In games with peers, such children are not independent and do not show initiative, while copying the surrounding children.
In communication with peers never have the status of a leader. These children are much more willing to play with younger children, and tend to be overly active and disorganized in the game.
Intellectual disorders come to the fore at school age: they are especially noticeable in educational areas of activity and behavior. The perception of new information is slow, and the educational material is absorbed in a narrow volume. Students with intellectual disabilities are unable to identify the main or common thing in a picture or text and do not understand the connections between parts. They do not perceive the logic of events, and when retelling the plot or describing the picture, the reproduction is meaningless.
Most of the children in this category are characterized by local disorders, expressed by difficulties in perceiving such concepts as "right - left", "above - below", and mastering school skills. Some children with similar pathologies do not distinguish between the right and left sides even by the age of nine, often unable to find their class. Many of them have difficulty telling the time on the clock, days of the week, months and seasons.
Very often such children suffer from phonetic-phonemicunderdevelopment of speech and are not able to correctly reproduce the lexical and grammatical structure of the sentence. They are characterized by poor vocabulary, so they have difficulty expressing their decisions and actions. Questions are usually answered impulsively, without thinking about the answer. In the development of children with intellectual disabilities, there is a violation of the function of attention, frequent distractibility and rapid exhaustion.
Teaching children with intellectual disabilities
In children with intellectual disabilities, the mechanisms responsible for concentration of attention suffer during the learning process. Some of them often experience a decrease in RAM, memorization and reproduction of the information received. Unlike normally developing children, who have a learning motive for memorization, children with intellectual disabilities can remember the information presented mainly in a playful way.
Not all children with manifestations of this pathology may have changes in thinking: some of them are able to think at the level of abstract and generalized categories, while others do not have these abilities. However, as such students develop, they acquire the ability to purposefully think, solve similar examples, form generic names, and the like. In general, children with intellectual disabilities studying in a public school may show a high level of practical solutions to the issue, but low verbal and logical abilities prevent such childrenexpress yourself fully.
In the speech of children with intellectual disabilities, there are practically no prepositions expressing spatio-temporal relationships. When writing, they do not hold the line well, often make mistakes, skipping or not adding letters and syllables. Sometimes they begin to give letters a mirror image and confuse characters that are similar in spelling (for example, “n” and “p”), when transferring a word, they begin to write it first and do not separate sentences with dots.
When reading, such children experience errors similar to those encountered in writing: they read incomprehensibly and hastily, distorting words and skipping individual syllables. They do not always correctly understand the measures of length, weight and time, they cannot build lexical and grammatical structures that reflect spatial relationships.
Difficulties in mental arithmetic or in moving to the next ten should be attributed to the characteristics of children with intellectual disabilities. They may confuse numbers that are close in spelling (for example, 6 and 9 or 35 and 53). Such children often cannot choose the correct arithmetic operation correctly (they subtract instead of adding), weakly keep the terms of the problem in mind and make mistakes when writing down the answer.
Diagnosis
To conduct a differentiated diagnosis and determine a child's borderline intellectual disability or oligophrenia, a whole complex of clinical, psychological and pedagogical examinations is needed. Some cases require long-term follow-up.
Differences between intellectual disability and mental retardationlie in the fact that the second group of children has a pronounced inertia and stiffness of thinking. However, children in the first group are more intelligent, able to perform well on non-verbal tests and are happy to accept help.
Boundary conditions correction
Correction of borderline intellectual insufficiency is carried out with the help of pedagogical influence. In the Russian Federation, there are special schools and correction classes for children with mental retardation. The education and upbringing of children with intellectual disabilities in such institutions is carried out according to the program of ordinary schools, but for a longer period according to specially developed methods. With deeper intellectual defects, training with a permanent stay in specialized boarding schools can be recommended.
Treatment and prevention
Medicinal therapy is used as a rehabilitation treatment. The use of certain treatment regimens depends on the clinical manifestations and severity of the pathology. The most commonly used nootropic drugs. Children with symptoms of intellectual disability are recommended to be treated twice a year in a psycho-neurological dispensary.
The main prevention of such conditions is the timely prevention of pregnancy and childbirth pathologies, neuroinfections and head injuries.
