Mental retardation. Errors in diagnosis. Mental retardation (oligophrenia) - symptoms and signs. Diagnosis and differential diagnosis Mental retardation symptoms

Mental retardation in children, the symptoms of which begin to appear around the age of 3.5 years, can be caused by various reasons. The factors causing the pathology of intellectual development are varied, but most often they are:

Organic brain damage during childbirth.
Cerebral palsy.
Genetic metabolic disorders.
Down syndrome (translocation or trisomy 21 pairs of chromosomes).
Neuroinfection resulting in extensive damage to neurons (neurosyphilis, tuberculous meningitis, viral encephalitis).
Intoxication with heavy metals and other foreign substances, especially at an early age.
Hydrocephalus.
Endocrinopathies (dysfunction of the thyroid gland).
Rubivirus infection during pregnancy (rubella).
Comatose states caused by prolonged brain hypoxia.

With microcephaly, a malformation of intrauterine development, the volume of the brain is reduced, and, accordingly, the number of neurons and connections between them is reduced. Hydrocephalus is swelling of the brain accompanied by increased pressure inside the skull. Hydrostatic pressure damages neurons and can also lead to mental retardation. In some cases, past infections of the central nervous system affect the child’s mental abilities.

Signs

Signs of mental retardation in children include a weak ability to learn, as well as the absence or weakening of the child’s reaction to the words of the parents, decreased memory, and logical thinking. The construction of connections between events in life is disrupted.

The perception of information is difficult, which is associated with a violation of the processes of memorization, short-term and long-term memory. Speech, behavioral and hygiene skills are underdeveloped. By school age, it is extremely difficult to master reading, counting, and writing skills.

There is a lag in mental development, the course of which can progress, regress or be stable. The emotional sphere in young patients, as a rule, is not affected; children are able to experience both negative and positive emotions. The ability to self-care depends on the degree of intellectual disability of the individual child. There are several degrees of mental impairment.

Mild mental retardation

Mild mental retardation (ICD-10 code F70). Such children are characterized by preserved learning ability, but reduced memory potential compared to healthy children. A child with mild mental retardation may misjudge other people's actions and feelings, making the illness similar to Asperger's syndrome.

Children experience problems in social skills (communication, playing with other children) and feel inferior; they are dependent on their parents. The correct approach of the teacher in teaching such a child will improve the prognosis of the disease. Mild mental retardation, the symptoms of which do not interfere with self-care learning, can be corrected in type 8 special schools.

As a result, growing children, upon reaching adulthood, are capable of working and mastering the simplest skills of housekeeping and writing. They have access to physical labor and monotonous work without the need to make decisions. Upon reaching their 18th birthday, the state provides such patients with housing.

Moderate mental retardation

Moderate mental retardation (F71 according to ICD-10) is characterized by less independence from the help of other people than with a mild degree. However, social skills, with appropriate adjustments, are also instilled, although children remain dependent on parents and guardians.

In adulthood, they are capable of work, mainly physical, which does not require complex coordination of actions. Signs of mental retardation in adult patients: some inhibition of thought processes, slowness in movements, lack of critical thinking.

Severe degree of retardation

In severe cases (ICD code: F72), the patient’s speech is limited to a couple of dozen words to express his own needs. There are also motor disturbances, and the gait is uncoordinated. The process of memorizing surrounding objects is difficult and requires repeated repetition. The skills of counting visible objects are instilled. Upon reaching adulthood, people are not able to fully take responsibility for themselves and need care provided by psychoneurological boarding schools.

Profound mental disability (F73) may manifest as severe motor impairment. Patients are lagging behind in physical development, their speech is not formed. Children often suffer from enuresis. In adulthood, the care of such patients is provided by psychoneurological boarding schools.

Diagnostics

Mental retardation, the symptoms of which are similar to those of other psycho-intellectual diseases, requires differential diagnosis with diseases such as:

Asperger's syndrome;
sociopedagogical neglect (Mowgli syndrome) and intense psychotrauma;
hepatic encephalopathy.

How to determine mental retardation in a child? Neuropsychiatric doctors use various methods to test a child’s intellectual abilities: assessment of everyday skills, social adaptation. Anamnesis of pregnancy (maternal rubella), previous neuroinfections, and traumatic brain injuries is studied.

A test for mental retardation (IQ) is performed, which determines the intelligence quotient in points. An assessment is made of the child’s perception of artistic images in pictures, learning ability, incl. to counting and speech, the state of the child’s mental development. The degree of coordination of movements is analyzed.

Mild mental retardation in children is a congenital or acquired in early childhood condition of mental retardation or underdevelopment, the central defect of which is a decrease in intellectual functions.

Causes of mild mental retardation in children

The cause of any mental retardation is damage to the brain. The most severe structural defects manifest themselves in underdevelopment of the brain.

The main reasons causing the development of mental retardation in children can be grouped into the following groups:

Heredity (gene and chromosomal diseases). This group includes: various syndromes (for example, Down, Turner); forms associated with hereditary metabolic disorders, neurological diseases;
Exposure to harmful factors during intrauterine development: intrauterine infections (for example, rubella, toxoplasmosis, etc.), intoxication (alcohol intake, substances toxic to the fetus), hemolytic disease of the fetus, etc.;
Factors that were exposed during childbirth or at an early age (birth injuries, oxygen deprivation, trauma, infections);
Pedagogical neglect, which arises against the background of full-fledged brain function, but in the absence of full-fledged education and socialization;
The presence of several causes at once, mixed conditions.

Mental retardation in children under 3 years of age, symptoms andpsychological characteristics of children with mental retardation

The diagnosis of mental retardation in children can be officially made no earlier than 7 years of age. However, it is important to understand that there are symptoms of mild mental retardation in children, which can be used to suspect its presence in early childhood, up to 3 years.

Mild mental retardation in children, signs:

The child lags behind in motor development: he begins to hold his head up, sit down, stand up, and walk late. The baby's grasping reflex may be impaired, and at 1-1.5 years the child still does not hold objects (toys, spoon and fork);
Speech is absent or appears very late; the child has difficulty constructing phrases and coherent speech. At 2-3 years old, the baby poorly understands speech addressed to him and cannot follow basic instructions;
Mild mental retardation in children is characterized by an imbalance in the processes of nervous excitation and inhibition; This is expressed in excessive impulsiveness, lack of restraint, excitability, irritability or, conversely, lethargy and slowness;
The child shows no interest in the world around him and seems withdrawn; His emotional-volitional sphere is “impoverished”;
There is no story game. The games are primitive in content, the toys may not be of interest to the child or he may not use them for their intended purpose.

Diagnosis of mild mental retardation in children

The diagnosis of mental retardation is based on the establishment of a mental defect, the main place in which is occupied by the underdevelopment of intellectual and higher mental functions, as well as the absence of signs of progression of underdevelopment.

In order to determine the severity of a mental defect and its leading link, special psychological methods for assessing intelligence are used. Neuropsychological diagnostics are also carried out, which helps not only to determine the level of development of higher mental functions of a child with mental retardation, but also to see his current and potential capabilities (those strengths that can be relied upon in the correction and treatment of mental retardation).

Mild mental retardation must be distinguished from diagnoses caused by mental illness (for example, schizophrenia) and severe pedagogical neglect.

Features of mental development and thinking in children with mental retardation

Any child with mental retardation is different from another with the same diagnosis, due to the fact that each has its own characteristics of brain function, immaturity or deficiency of its structures and sections, as well as intact links.

L.S. Vygotsky believed that the primary defect of mental retardation is inertia, stiffness of the main nervous processes, as well as weakness of orienting activity, which underlies the child’s reduced activity and lack of interest in the world around him. A secondary defect is underdevelopment of higher mental functions. In turn, when a child finds himself in conditions of an inadequate teaching and educational environment, opportunities arise for the development of a tertiary level defect, namely, behavioral disorders and characteristics of the emotional-volitional sphere.
In addition, the following features can be highlighted:

Most authors prove that cognitive disorders in such children consist of difficulties in forming concepts and generalizations, difficulty in abstract thinking;
A child with mental retardation is poorly taught; it is difficult for him to perceive any new information;
As the child grows up, all of the above is accompanied by a poverty of outlook and superficiality of thinking.

Treatment and correction of children with mild mental retardation. Features of teaching children with mental retardation

Correction of children with mild mental retardation is carried out based on the leading defect (associated with impairment of various analyzers, frontal insufficiency, psychopathic behavior, etc.) and in several areas:

Neurocorrectional assistance. A well-structured program, taking into account the neuropsychological characteristics of the child, his strengths and “resource” sides, can help in the development of:

motor and coordination skills, fine motor skills;
development of stable interhemispheric connections, increasing the speed of processing sensory information;
visual-motor coordination, hand-eye communication, strengthening of the eye muscles and tracking eye movements (which is important, in particular, for the development of writing and reading skills);
expansion of visual fields, formation of spatial perception, development of thinking functions, which is necessary for mastering mathematics, the ability to build logical and grammatical structures, and coherent speech;
development of self-regulation, volition, attention, reduction of exhaustion;
creating opportunities to “inhibit” unwanted behavior;
improving the perception of non-speech noises, speech itself, the ability to distinguish tempo-rhythmic patterns: that is, auditory perception;

Specialized training program in kindergarten and school. Children with mild mental retardation are capable of mastering special programs based on concrete visual learning, which is carried out at a slow pace, as well as the ability to master simple work skills.
Additionally, you may need the help of a speech pathologist (development of social skills, self-care, thinking), speech therapist, or neurologist.

Prognosis of a child with mild mental retardation

The prognosis of children with mild mental retardation depends on the degree of damage or immaturity of the brain, and on the type of leading defect.

How does a child with mental retardation develop? How do psychiatrists diagnose this? What signs of mental retardation may people with varying degrees exhibit? A psychiatrist describes in detail the story of a patient with mental retardation in a popular book about various mental disorders.

He always smiled. Even when he was in pain, when he was sad, the smile did not leave his face. Sometimes it was a scared smile, sometimes it was a guilty smile. Strange, but the same guilt was in the smile when his stomach hurt, and we sent him to surgery with appendicitis. It was as if he was asking her for forgiveness for wasting our time. Although it is unlikely that he fully understood what this word “time” means.

He did not have a flat bridge of the nose or slanted eyes, and there were no other special signs of a chromosomal disease in him. Yes, it was intrauterine. He was born in the seventh month of pregnancy, and for almost two months doctors fought for his life.

There is another form of intellectual development disorders - pedagogical neglect. It occurs against the background of full-fledged biological capabilities of the brain, but lack of sufficient education and socialization. Such manifestations can occur in dysfunctional families leading a marginal, asocial lifestyle.

In our case study, the patient had near-moderate mental retardation, which was aggravated by his injury. He had no external manifestations of the disorder, except for the prevailing smile on his face. Most likely, this is due to unspecified adverse effects during fetal development or genetic disorders that do not affect the functions of other organs and systems.

When exposed to additional harmful factors, for example, traumatic brain injuries, the degree of intellectual defect may worsen. There may be an improvement - with good care and education, patients with mild mental retardation are adapted to lead a full social life: they start families, work and are practically indistinguishable from other people. Severe and profound mental retardation, unfortunately, is difficult to correct, and such patients need help and care from other people.

Treatment and correction of mental retardation ( how to treat oligophrenia?)

Rehabilitation and socialization of children with mental retardation - ( video)

The site provides reference information for informational purposes only. Diagnosis and treatment of diseases must be carried out under the supervision of a specialist. All drugs have contraindications. Consultation with a specialist is required!

Features of a child and adolescent with mental retardation ( manifestations, symptoms, signs)

For children with mental retardation ( oligophrenia) characterized by similar manifestations and signs ( disorders of attention, memory, thinking, behavior, etc.). At the same time, the severity of these disorders directly depends on the degree of mental retardation.

For mentally retarded children it is typical:

thinking disorder;
impaired concentration;
cognitive impairment;

speech disorders;
communication problems;
visual impairment;
hearing impairment;
sensory development disorders;
memory impairment;
movement disorders ( motor disorders);
mental disorders;
behavioral disorders;
disturbances of the emotional-volitional sphere.

Disorders of mental development and thinking, intellectual impairments ( main violation)

Impaired mental development is the main symptom of mental retardation. This manifests itself in the inability to think normally, make the right decisions, draw conclusions from the information received, and so on.

Impairments of mental development and thinking in oligophrenia are characterized by:

Impaired perception of information. In mild cases of illness, perception of information ( visual, written or verbal) occurs much more slowly than normal. Also, the child needs more time to “comprehend” the data received. With moderate oligophrenia, this phenomenon is even more pronounced. Even if a child can perceive any information, he cannot analyze it, as a result of which his ability to act independently is limited. In severe mental retardation, damage to sensory organs is often observed ( eye, ear). Such children cannot perceive certain information at all. If these sense organs work, the data perceived by the child is not analyzed by him. He may not distinguish colors, not recognize objects by their outlines, not distinguish between the voices of loved ones and strangers, and so on.
Inability to generalize. Children cannot identify connections between similar objects, cannot draw conclusions from the data received, or highlight small details in any general flow of information. With a mild form of the disease, this is only slightly expressed, while with moderate mental retardation, children have difficulty learning to arrange clothes into groups, identify animals among a set of pictures, and so on. In severe forms of the disease, the ability to somehow connect objects or associate them with each other may be completely absent.
Violation of abstract thinking. Children understand everything they hear or see literally. They do not have a sense of humor and cannot understand the meaning of popular expressions, proverbs or sarcasm.
Violation of the sequence of thinking. This is most pronounced when trying to complete any task consisting of several stages ( for example, take a cup out of the cupboard, place it on the table and pour water from a jug into it). For a child with severe mental retardation, this task will be impossible ( he can take a cup, put it in its place, approach the jug several times and pick it up, but he will not be able to connect these objects). However, in moderate to mild forms of the disease, intensive and regular training sessions can promote the development of sequential thinking, which will allow children to perform simple and even more complex tasks.
Slow thinking. To answer the simplest question ( for example, how old is he), a child with a mild form of the disease may think about the answer for several tens of seconds, but ultimately usually gives the correct answer. With moderate mental retardation, the child will also think about the question for a very long time, but the answer may be meaningless and unrelated to the question. In severe cases of the disease, you may not receive a response from the child at all.
Inability to think critically. Children are not aware of their actions and cannot assess the importance of their actions and their possible consequences.

Cognitive disorders

Children with mild mental retardation are characterized by a decrease in interest in the objects, things and events around them. They do not strive to learn something new, and when learning they quickly forget what they have received ( read, heard) information. At the same time, properly conducted classes and special training programs allow them to learn simple professions. With moderate and severe mental retardation, children can solve simple problems, but they remember new information extremely difficult and only if they are taught for a long time. They themselves do not show any initiative to learn something new.

Impaired concentration

All children with mental retardation experience a decrease in the ability to concentrate, which is caused by impaired brain activity.

With a mild degree of mental retardation, it is difficult for a child to sit still and do the same thing for a long time ( for example, they cannot read a book for several minutes at a time, and after reading they cannot retell what the book was about). At the same time, an absolutely opposite phenomenon may be observed - when studying any subject ( situations) the child excessively concentrates attention on its smallest details, without appreciating the subject ( situation) generally.

With moderate mental retardation, it is extremely difficult to attract the child’s attention. If this can be done, after a few seconds the child is distracted again, switching to another activity. In severe forms of the disease, it is not possible to attract the patient’s attention at all ( Only in exceptional cases can a child react to any bright objects or loud, unusual sounds).

Speech impairment/underdevelopment and communication problems

Speech disorders may be associated with functional underdevelopment of the brain ( which is typical for a mild form of the disease). At the same time, with moderate and profound oligophrenia, organic damage to the speech apparatus may be observed, which will also create certain problems in communication.

Speech impairment in children with mental retardation is characterized by:

Mute. In mild forms of the disease, complete muteness is relatively rare, usually in the absence of the necessary correctional programs and activities. With imbecility ( moderately severe oligophrenia) muteness may be associated with damage to the speech apparatus or hearing impairment ( if a child is deaf, he will also not be able to learn words and pronounce them). With severe mental retardation, children usually cannot speak. Instead of words, they utter incomprehensible sounds. Even if they manage to learn a few words, they are not able to use them correctly.
Dyslalia. It is characterized by a speech disorder consisting of incorrect pronunciation of sounds. At the same time, children may not pronounce some sounds at all.
Stuttering. Characteristic of oligophrenia of mild to moderate severity.
Lack of expressive speech. In mild forms of the disease, this deficiency can be eliminated through exercise, while in more severe forms this cannot be done.
Impaired speech volume control. This can occur with hearing impairment. Normally, when a person speaks and hears his speech, he automatically controls its volume. If an oligophrenic does not hear the words he speaks, his speech will be too loud.
Difficulties in constructing long phrases. Having started to say one thing, a child can immediately switch to another phenomenon or object, as a result of which his speech will be meaningless and incomprehensible to others.

Visual impairment

In mild and moderate forms of the disease, the visual analyzer is usually developed normally. At the same time, due to impaired thought processes, the child may not distinguish between certain colors ( for example, if he is asked to choose yellow pictures among pictures of other colors, he will distinguish yellow from the rest, but it will be difficult for him to complete the task).

Severe visual impairments can be observed in cases of deep mental retardation, which is often combined with defects in the development of the visual analyzer. In this case, the child may not distinguish colors, see objects distorted, or be completely blind.

It is also worth noting that visual impairment ( strabismus, blindness and so on) may be associated with an underlying disease that causes mental retardation ( for example, with hereditary Bardet-Biedl syndrome, in which children may be born blind).

Are there hallucinations in mental retardation?

Hallucinations are non-existent images, images, sounds or sensations that the patient sees, hears or feels. To him they seem realistic and believable, although in reality they are not.

The development of hallucinations is not typical for the classic course of mental retardation. At the same time, when oligophrenia is combined with schizophrenia, signs characteristic of the latter disease may appear, including hallucinations. Also, this symptom can be observed during psychosis, with severe mental or physical fatigue and with the use of any toxic substances ( alcoholic drinks, drugs) even in minimal quantities. The latter phenomenon is due to the inadequate development of the central nervous system and the brain in particular, as a result of which even an insignificant amount of alcohol can cause visual hallucinations and other mental disorders in the patient.

Hearing impairment ( deaf children with mental retardation)

Hearing disorders can be observed with any degree of mental retardation. The reason for this may be organic damage to the hearing aid ( for example, with congenital developmental anomalies, which is typical for children with severe mental retardation). Also, damage to the auditory analyzer can be observed with hemolytic disease of the newborn, with some genetic syndromes, and so on.

The development and learning of a deaf, mentally retarded child proceeds even more slowly, since he cannot perceive the speech of the people around him. With complete deafness, children, as a rule, cannot speak ( without hearing speech, they cannot repeat it), as a result of which, even with a mild form of the disease, they express their emotions and feelings only with a kind of mooing and screaming. With partial deafness or deafness in one ear, children can learn to speak, but during a conversation they may pronounce words incorrectly or speak too loudly, which is also associated with the inferiority of the auditory analyzer.

Sensory developmental disorders

Sensory development is the child’s ability to perceive the world around him using various senses ( primarily sight and touch). It has been scientifically proven that the majority of mentally retarded children are characterized by impairments of these functions of varying degrees of severity.

Sensory developmental disorders may manifest themselves as:

Slow visual perception. To evaluate an object seen ( understand what it is, why it is needed, and so on), a mentally retarded child needs several times more time than a normal person.
Narrowness of visual perception. Normally, older children can simultaneously perceive ( notice) up to 12 items. At the same time, patients with oligophrenia can perceive no more than 4–6 objects at the same time.
Violation of color perception. Children may not be able to distinguish between colors or shades of the same color.
Impaired sense of touch. If you close your child's eyes and give him a familiar object ( for example, his personal cup), he can easily recognize her. At the same time, if you give the same cup, but made of wood or other material, the child will not always be able to accurately answer what he has in his hands.

Memory disorders

In a healthy person, after several repetitions of the same material, certain connections are formed between the nerve cells of the brain ( synapses), which allows him to remember the information received for a long time. With mild mental retardation, the rate of formation of these synapses is impaired ( slows down), as a result of which the child must repeat certain information much longer ( more times) to remember it. At the same time, when you stop studying, the memorized data is quickly forgotten or may be distorted ( the child incorrectly retells information read or heard).

With moderate oligophrenia, the listed disorders are more pronounced. The child has difficulty remembering the information received, and when reproducing it, he may become confused about dates and other data. At the same time, with deep oligophrenia, the patient’s memory is extremely poorly developed. He can recognize the faces of those closest to him, can respond to his name or ( rarely) learn a few words, although he does not understand their meaning.

Movement disorders ( motor disorders)

Impairments in motor skills and voluntary movements are observed in almost 100% of children with mental retardation. At the same time, the severity of movement disorders also depends on the degree of the disease.

Motor disorders in mentally retarded children can manifest themselves:

Slow and clumsy movements. When trying to take an object from the table, the child may move his hand towards it very slowly, awkwardly. Such children also move very slowly, they can often stumble, their legs can get tangled, and so on.
Motor restlessness. This is another type of movement disorder in which the child does not sit still, constantly moves around, and performs simple movements with his arms and legs. At the same time, his movements are uncoordinated and senseless, abrupt and sweeping. During a conversation, such children may accompany their speech with excessively expressed gestures and facial expressions.
Impaired coordination of movements. Children with mild and moderate forms of the disease take a long time to learn to walk, pick up objects, and maintain balance in a standing position ( For some of them, these skills may not appear until adolescence.).
Inability to perform complex movements. Children with mental retardation experience significant difficulty if they need to perform two consecutive but different movements ( for example, throw a ball up and hit it with your hand). The transition from one movement to another is slower for them, as a result of which the ball thrown up will fall, and the child will not “have time” to hit it.
Impaired fine motor skills. Precise movements that require increased concentration of attention are extremely difficult for oligophrenics. For a child with a moderate form of the disease, tying his shoelaces can be a difficult and sometimes even impossible task ( he will take hold of the laces, twirl them in his hands, try to do something with them, but the final goal will never be achieved).

With deep mental retardation, movements develop very slowly and weakly ( Children can begin to walk only by the age of 10–15 years.). In extremely severe cases, movement in the limbs may be completely absent.

Disorders of mental functions and behavior

Mental disorders can manifest themselves in children with any degree of illness, which is caused by impaired functioning of the cerebral cortex and a disturbed, incorrect perception of themselves and the world around them.

Children with mental retardation may experience:

Psychomotor agitation. In this case, the child is active and can pronounce various incomprehensible sounds and words ( if he knows them), move from side to side, and so on. Moreover, all his movements and actions are devoid of any meaning, disordered, chaotic.
Impulsive actions. Being in a state of relative rest ( for example, lying on the sofa), the child may suddenly stand up, go to the window, walk around the room, or perform some similar aimless action, and then return to the previous activity ( lie back on the sofa).
Stereotypical movements. During training, the child learns certain movements ( for example, waving your hand in greeting), after which he repeats them constantly, even without obvious need ( for example, when he is indoors, when he sees an animal, bird or any inanimate object).
Repeating the actions of others. At an older age, children with mild mental retardation may begin to repeat movements and actions they have just seen ( provided that they are trained in these actions). So, for example, seeing a person pouring water into a cup, the patient can immediately take the cup and also start pouring water for himself. At the same time, due to the inferiority of thinking, he can simply imitate these movements ( at the same time, without having a jug of water in his hands) or even take a jug and start pouring water on the floor.
Repeating the words of others. If a child has a certain vocabulary, when he hears a word he knows, he can immediately repeat it. At the same time, children do not repeat unfamiliar or too long words ( instead they may utter incoherent sounds).
Complete immobility. Sometimes a child may lie absolutely motionless for several hours, after which he may also suddenly begin to perform any actions.

Violations of the emotional-volitional sphere

All children with mental retardation are characterized by a violation of motivation of varying degrees of severity, as well as a disturbance of the psycho-emotional state. This makes it much more difficult for them to stay in society, and in cases of moderate, severe and profound mental retardation, it makes it impossible for them to be independent ( without the supervision of another person) accommodation.

Children with mental retardation may experience:

Weakening motivation. The child does not show initiative for any actions, does not strive to learn new things, to get to know the world around him and himself. They do not have any “own” goals or aspirations. Everything they do is done only according to what their loved ones or people around them tell them. At the same time, they can do absolutely everything that is told to them, since they are not aware of their actions ( cannot evaluate them critically).
Easy suggestibility. Absolutely all people with mental retardation are easily influenced by others ( because they cannot distinguish between lies, jokes or sarcasm). If such a child goes to school, classmates may bully him, forcing him to do abnormal things. This can significantly traumatize the child’s psyche, leading to the development of deeper mental disorders.
Slow development of the emotional sphere. Children begin to feel something only by the age of 3–4 years or even later.
Limited feelings and emotions. Children with severe illness may experience only primitive feelings ( fear, sadness, joy), while in a deep form of oligophrenia they may also be absent. At the same time, patients with mild or moderate mental retardation may experience many more feelings and emotions ( can empathize, feel sorry for someone, and so on).
Chaotic emergence of emotions. Feelings and emotions of oligophrenics can arise and change suddenly, without any apparent reason ( The child just laughed, 10 seconds later he is already crying or behaving aggressively, and a minute later he is laughing again).
"Superficial" feelings. Some children very quickly experience any of life's joys, burdens and hardships, forgetting about them within a few hours or days.
"Intense" feelings. The other extreme in mentally retarded children is excessive distress over even the most minor problems ( for example, if a mug drops on the floor, a child may cry for several hours or even days because of this).

Is aggression characteristic of mental retardation?

Aggression and inappropriate, hostile behavior are most often observed in patients with severe mental retardation. Most of the time they can behave aggressively towards others, as well as towards themselves ( may beat themselves, scratch, bite, and even cause severe bodily harm to themselves). In this regard, their separate residence ( without constant supervision) impossible.

Children with severe illness also often have angry outbursts. They can be aggressive towards others, but they rarely injure themselves. Often their aggressive attitude can change to the completely opposite ( they become calm, quiet, friendly), however, any word, sound or image can again provoke an outbreak of aggression or even rage in them.

With moderate mental retardation, children can also be aggressive towards others. A child may shout at the “offender,” cry, or gesticulate threateningly with his hands, but this aggression extremely rarely turns into an open form ( when a child seeks to cause physical harm to someone). Outbursts of anger can be replaced by other emotions within a few minutes or hours, but in some cases the child may remain in a bad mood for a long time ( several days, weeks or even months).

In mild forms of oligophrenia, aggressive behavior is extremely rare and is usually associated with some negative emotions, experiences or events. In this case, a loved one can quickly calm the child down ( To do this, you can distract him with something fun, interesting), causing his anger to change to joy or another feeling.

Is physical development impaired in children with mental retardation?

Mental retardation itself especially mild form) does not lead to retardation in physical development. The child may be relatively tall, his muscles may be quite developed, and his musculoskeletal system may be no less strong than that of normal children ( however, only with regular physical activity and training). At the same time, with severe and profound oligophrenia, it is quite difficult to force a child to do physical exercises, and therefore such children may lag behind their peers not only in mental, but also in physical development ( even if they were born physically healthy). Also, physical underdevelopment can be observed in cases where the cause of mental retardation affected the child after his birth ( for example, severe head trauma within the first 3 years of life).

At the same time, it is worth noting that physical underdevelopment and developmental anomalies may be associated with the cause of mental retardation itself. So, for example, with mental retardation caused by alcoholism or drug addiction of the mother, a child may be born with various congenital anomalies, physical deformities, underdevelopment of certain parts of the body, and so on. The same is typical for oligophrenia caused by various intoxications, some genetic syndromes, injuries and exposure of the fetus to radiation in the early stages of intrauterine development, maternal diabetes, and so on.

As a result of long-term observations, it was noticed that the more severe the degree of oligophrenia, the higher the likelihood that the child will have certain physical anomalies in the development of the skull, chest, spine, oral cavity, external genitalia, and so on.

Signs of mental retardation in newborns

Identifying mental retardation in a newborn can be extremely difficult. The fact is that this disease is characterized by delayed mental development of the child ( compared to other children). However, this development begins only a certain time after birth, as a result of which the child must live at least several months to be diagnosed. When, during routine examinations, the doctor reveals any developmental delays, then it will be possible to talk about one or another degree of mental retardation.

At the same time, it is worth noting that the identification of certain predisposing factors and symptoms may lead the doctor to think about the child’s possible mental retardation at the very first examination ( immediately after birth).

An increased likelihood of oligophrenia may be indicated by:

Predisposing factors in the mother– alcoholism, drug use, the presence of chromosomal syndromes in close relatives ( for example, in other children), diabetes mellitus and so on.
Presence of signs of mental retardation in the mother or father– people with a mild form of the disease can start families and have children, but they are at risk of having ( their children) mental retardation is increased.
Newborn skull deformities– with microcephaly ( reduction in skull size) or with congenital hydrocephalus ( an increase in the size of the skull as a result of the accumulation of large amounts of fluid in it) the probability of a child having mental retardation is close to 100%.
Congenital malformations– defects of the limbs, face, mouth, chest or other parts of the body can also accompany severe or profound forms of mental retardation.

Diagnosis of mental retardation

Diagnosis of mental retardation, determination of its degree and clinical form is a complex and lengthy process that requires a comprehensive examination of the child and various diagnostic tests.

Which doctor diagnoses and treats mental retardation?

Since mental retardation is characterized by a predominant disturbance of the mental processes and psycho-emotional state of the patient, the diagnosis of this pathology and treatment of children with mental retardation should be addressed psychiatrist ( sign up) . It is he who can assess the extent of the disease, prescribe treatment and monitor its effectiveness, as well as determine whether a person poses a danger to others, select optimal correction programs, and so on.

At the same time, it is worth noting that in almost 100% of cases, oligophrenics have not only mental, but also other disorders ( neurological, sensory organ damage, etc.). In this regard, a psychiatrist never treats a sick child on his own, but constantly refers him to consultations with specialists from other fields of medicine, who help him choose the most adequate treatment suitable for each specific case.

When diagnosing and treating a mentally retarded child, a psychiatrist may prescribe a consultation:

neurologist ( sign up) ;
speech pathologist ( sign up) ;
psychologist ( sign up) ;
psychotherapist ( sign up) ;
ophthalmologist ( ophthalmologist) (sign up) ;
otorhinolaryngologist ( ENT doctor) (sign up) ;
dermatologist ( sign up) ;
pediatric surgeon ( sign up) ;
neurosurgeon ( sign up) ;
endocrinologist ( sign up) ;
infectious disease specialist ( sign up) ;
chiropractor ( sign up) and other specialists.

Methods for examining a child with mental retardation

Anamnesis data is used to make a diagnosis ( the doctor asks the child’s parents about everything that may be related to the existing disease). After this, he examines the patient, trying to identify certain disorders characteristic of mentally retarded people.

When interviewing parents, the doctor may ask:

Were there any mentally retarded children in the family? If there were oligophrenics among your immediate relatives, the risk of the child having this disease is increased.
Did any of your immediate family suffer from chromosomal diseases? (Down syndrome, Bardet-Biedl, Klinefelter and so on)?
Did the mother ingest any toxins while carrying the baby? If the mother smoked, drank alcohol, or took psychotropic/narcotic drugs, she has an increased risk of having a child with mental retardation.
Was the mother exposed to radiation during pregnancy? This could also contribute to the development of mental retardation in the child.
Does the child's memory suffer? The doctor may ask the baby what he ate for breakfast, what book he was read at night, or something like that. Normal child ( able to speak) will easily answer these questions, while for an oligophrenic it will be difficult.
Does your child have aggressive outbursts? Aggressive, impulsive behavior ( during which the child can hit people around him, including parents) is typical for severe or profound mental retardation.
Is it typical for a child to have frequent and causeless mood swings? This may also indicate the presence of mental retardation, although it is also observed in a number of other mental disorders.
Does the child have congenital malformations? If yes, which ones and how many of them?

After the interview, the doctor begins to examine the patient, which allows him to assess general development and identify any deviations characteristic of mental retardation.

The child's examination includes:

Speech assessment. By the age of 1 year, children should speak at least a few words, and by the age of two years they should be able to communicate more or less. Speech impairment is one of the main signs of oligophrenia. To assess speech, the doctor can ask the child simple questions - how old is he, what grade of school he is in, what are the names of his parents, and so on.
Hearing assessment. The doctor may call the child's name in a whisper, assessing his reaction to this.
Vision assessment. To do this, the doctor can place a bright object in front of the child's eyes and move it from side to side. Normally, a child should follow a moving object.
Thinking speed assessment. To check this, the doctor can ask the child a simple question ( for example, what are his parents' names?). A mentally retarded child may answer this question late ( in a few tens of seconds).
Assessing the ability to concentrate. The doctor may give the child some bright object or picture, call him by name, or ask some question that requires a complex answer ( for example, what would the child like to eat for dinner?). For an oligophrenic it will be extremely difficult to answer this question, since his emotional-volitional sphere is disturbed.
Fine motor skills assessment. To assess this indicator, the doctor can give the child a felt-tip pen and ask him to draw something ( for example the sun). A healthy child can easily do this ( if you have reached the appropriate age). At the same time, with mental retardation, the child will not be able to complete the task assigned to him ( he can move a felt-tip pen along the paper, draw some lines, but the sun will not draw).
Assessment of abstract thinking. For older children, the doctor may ask them to tell what the child would do in some imaginary situation ( for example, if you could fly). A healthy child can “fantasize” many interesting things without any problems, while a mental retard will not be able to cope with the task due to a complete lack of abstract thinking.
Examination of the child. During the examination, the doctor tries to identify any defects or developmental anomalies, deformations of various parts of the body and other abnormalities that can be observed in severe forms of mental retardation.

If during the examination the doctor suspects that the child is mentally retarded, he can conduct a number of diagnostic tests to confirm the diagnosis.

What tests may be needed to diagnose mental retardation?

As mentioned earlier, to make a diagnosis it is not enough to simply identify mental retardation in a child, but you also need to determine its degree. For this, various diagnostic tests are used, as well as instrumental studies.

For mental retardation, the doctor may prescribe:

tests to determine the level of intelligence ( for example, Wechsler test);
tests to determine psychological age;
EEG ( electroencephalogram) (sign up);
MRI ( magnetic resonance imaging) (sign up).

Tests to determine iq and psychological age for mental retardation ( Wechsler test)

IQ ( intelligence quotient) is an indicator that allows you to numerically assess a person’s mental abilities. When diagnosing mental retardation, it is iq that is used to determine the degree of the disease.

Degree of mental retardation depending on iq

It is worth noting that healthy people should have an iq of at least 70 ( ideally more than 90).

To determine the level of iq, many methods have been proposed, the best of which is considered to be the test ( scale) Wechsler. The essence of this test is that the test taker is asked to solve several tasks ( build a series of numbers or letters, count something, find an extra or missing number/letter, perform certain actions with images, and so on). The more tasks the patient completes correctly, the higher his iq level will be.

In addition to determining iq, the doctor can also determine the psychological age of the patient ( There are also many different tests for this). Psychological age does not always correspond to biological age ( that is, the number of years that have passed since the birth of a person) and allows you to assess the degree of development of the child. The fact is that a person’s psychological maturation occurs as he learns, is introduced into society, and so on. If the child does not learn basic skills, concepts and rules of behavior in society ( what is typical for mentally retarded children), his psychological age will be below normal.

Psychological age of the patient depending on the degree of oligophrenia

Consequently, the thinking and behavior of a patient with severe mental retardation corresponds to those of a three-year-old child.

Basic diagnostic criteria for mental retardation

In order to confirm the diagnosis of mental retardation, you need to undergo a series of examinations from various specialists and pass a number of tests. At the same time, there are certain diagnostic criteria, the presence of which can be said with a high degree of probability that the child suffers from oligophrenia.

Diagnostic criteria for oligophrenia include:

Delayed psycho-emotional development and thought processes.
Decrease in iq level.
Discrepancy between biological age and psychological age ( the latter is significantly below normal).
Violation of the patient's adjustment in society.
Behavioral disorders.
The presence of a cause that led to the development of mental retardation ( not necessary).

The degree of expression of each of these criteria directly depends on the degree of mental retardation. It is also worth noting that it is not always possible to identify the cause of oligophrenia, as a result of which its absence is not a reason to doubt the diagnosis if all previous criteria are positive.

Does EEG show mental retardation?

EEG ( electroencephalography) is a special study that allows you to evaluate the activity of various parts of the patient’s brain. In some cases, this makes it possible to assess the severity of disturbances in thought processes in mental retardation.

The essence of the method is as follows. The patient comes to the doctor's office and, after a short conversation, lies down on the couch. Special electrodes are attached to his head, which will record electrical impulses emitted by brain cells. After installing the sensors, the doctor starts the recording device and leaves the room, leaving the patient alone. In this case, the patient is prohibited from standing up or speaking throughout the procedure ( unless the doctor asks for it).

During the study, the doctor can contact the patient via radio communication and ask him to perform certain actions ( raise your arm or leg, touch your finger to the tip of your nose, and so on). Also, in the room in which the patient is located, the lights may periodically turn on and off, or certain sounds and melodies may be heard. This is necessary in order to assess the reaction of individual areas of the cerebral cortex to external stimuli.

The entire procedure usually lasts no more than an hour, after which the doctor removes the electrodes and the patient can go home. Received data ( written on special paper) the doctor carefully examines, trying to identify any abnormalities characteristic of mentally retarded children.

Can MRI detect mental retardation?

MRI ( Magnetic resonance imaging) of the head does not allow one to determine mental retardation or assess the degree of its severity. At the same time, this study can be used to identify the causes of oligophrenia.

The study is carried out using a special apparatus ( magnetic resonance imaging scanner). The essence of the procedure is as follows. At the appointed time, the patient comes to the clinic where the study will be carried out. First, he lies down on a special sliding table of the tomograph so that his head is located in a strictly defined place. Next, the table moves to a special compartment of the device, where the research will be carried out. During the entire procedure ( which can last up to half an hour) the patient must lie absolutely still ( do not move your head, do not cough, do not sneeze). Any movement can distort the quality of the data obtained. After the procedure is completed, the patient can immediately go home.

The essence of the MRI method is that while the patient is in a special compartment of the machine, a strong electromagnetic field is created around his head. As a result, the tissues of various organs begin to emit a certain energy, which is recorded by special sensors. After processing the received data, the information is presented on the doctor’s monitor in the form of a detailed layer-by-layer image of the brain and all its structures, skull bones, blood vessels, and so on. Having examined the data obtained, the doctor can identify certain disorders that could cause mental retardation ( for example, lesions of the brain after injury, reduction in brain mass, reduction in the size of certain lobes of the brain, and so on).

Despite its safety, MRI has a number of contraindications. The main one is the presence of any metal objects in the patient’s body ( splinters, dentures, dental crowns and so on). The fact is that a magnetic resonance imaging scanner is a strong electromagnet. If a patient with metal objects in his body is placed in it, this can lead to very disastrous consequences ( up to damage to the patient’s internal organs and tissues).

Differential diagnosis ( differences) mental retardation and autism, dementia, mental retardation ( mental retardation, borderline mental retardation in preschool children)

Signs of mental retardation may be similar to those of a number of other mental illnesses. In order to correctly diagnose and prescribe adequate treatment, the doctor needs to know how these pathologies differ from each other.

Mental retardation should be differentiated ( differ):

From autism. Autism is a disease that occurs as a result of underdevelopment of certain brain structures. People with autism are withdrawn, do not like to communicate with others, and may outwardly resemble mentally retarded patients. At the same time, unlike oligophrenia, with autism there are no pronounced disturbances in thought processes. Moreover, people with autism can have very extensive knowledge in various fields of science. Another distinctive feature is the ability to concentrate. With oligophrenia, children cannot do the same thing for a long time ( they have increased distractibility), while autistic people can sit in the same place for hours, repeating the same action.
For dementia. Dementia is also characterized by impaired thought processes and the loss of all skills and abilities acquired throughout life. Unlike oligophrenia, dementia does not develop in early childhood. The main distinguishing feature is that with mental retardation, the child cannot acquire new knowledge and skills due to brain damage. With dementia, a previously healthy ( mentally and psychoemotionally) a person begins to lose the skills he already had and forget information that he once knew.
From ZPR ( mental retardation, borderline mental retardation). ZPR is characterized by insufficiently developed thinking, attention and the emotional-volitional sphere in preschool children ( up to 6 years inclusive). The reasons for this may be unfavorable circumstances in the family, lack of attention from parents, social isolation ( lack of communication with peers), psycho-emotional traumas and experiences in early childhood, and less often – minor organic lesions of the brain. At the same time, the child retains the ability to learn and receive new information, but his mental functions are less developed than those of his peers. An important diagnostic criterion is the fact that the mental retardation must be completely resolved by the time the child enters the first grade of school. If, after 7–8 years of life, the child still has signs of impaired thinking, they speak not of mental retardation, but of oligophrenia ( mental retardation).

Mental retardation in children with cerebral palsy

In 10–50% of children with cerebral palsy ( cerebral palsy) signs of mental retardation may be observed, and the incidence of mental retardation depends on the specific form of cerebral palsy.

The essence of cerebral palsy is a violation of the patient’s motor functions associated with damage to his brain in the prenatal period, during childbirth or immediately after birth. There can also be many reasons for the development of cerebral palsy ( injuries, intoxication, oxygen deprivation of the fetus, radiation, and so on), but all contribute to developmental impairment or damage ( destruction) certain areas of the brain.

It is worth noting that the same causative factors can lead to the development of oligophrenia. That is why identifying signs of mental retardation in patients with cerebral palsy is one of the primary tasks of a doctor.

When these two pathologies are combined, disturbances in the child’s mental, cognitive and psycho-emotional functions are more pronounced than with isolated mental retardation. Severe or profound mental retardation is most common, but even with moderate and mild degrees of the disease, patients cannot care for themselves ( due to motor dysfunction). This is why any child with cerebral palsy and mental retardation needs constant care from the moment of birth and throughout life. Such children are extremely difficult to teach, and the information they receive is quickly forgotten. Their emotions may be weakly expressed, however, with severe forms of mental retardation, unreasonable aggression towards others may occur.

Differential diagnosis of alalia and mental retardation ( mental retardation)

Alalia is a pathological condition in which a child has a speech disorder ( pronunciation of sounds, words, sentences). The cause of the disease is usually a lesion ( in case of birth trauma, as a result of intoxication, oxygen starvation, and so on) brain structure responsible for speech formation.

In medical practice, it is customary to distinguish two forms of alalia - motor ( when a person understands the speech of others, but cannot reproduce it) and sensory ( when a person does not understand the speech he heard). An important feature is the fact that with alalia the child’s hearing organ is not damaged ( that is, he normally hears the speech of others) and there are no mental disabilities ( that is, he is not mentally retarded). At the same time, speech impairment in mental retardation is associated with underdevelopment of the hearing organ ( deafness) or with the child’s inability to learn and reproduce the sounds and words he has heard.

Difference between mental retardation and schizophrenia

Schizophrenia is a mental illness characterized by impaired thinking and severe psycho-emotional disorders. If the disease manifests itself in childhood, it is referred to as childhood schizophrenia.

Childhood schizophrenia is characterized by a severe course, accompanied by delusions ( the child says incoherent words or sentences) and hallucinations ( the child sees or hears something that is not really there, which may cause him to panic, scream in fear, or be in an unreasonably good mood). The child may also have problems communicating with peers ( Children with schizophrenia are withdrawn and have poor contact with others), problems with sleep, concentration, and so on.

Many of these symptoms also occur in children with mental retardation ( especially in the atonic form of the disease), which significantly complicates differential diagnosis. In this case, signs such as delusions, hallucinations, perversion, or a complete lack of emotion may indicate schizophrenia.

It is worth noting that the onset of schizophrenia in early childhood disrupts the development of the central nervous system and the brain in particular, which can cause mental retardation. At the same time, mental retardation may be present in a child from birth ( however has not yet been diagnosed), and against its background ( at the age of 2 – 3 years) may develop schizophrenia.

Before use, you should consult a specialist.