All diseases that are associated with irreversible pathologies of brain structures in children in the process of postembryonic and embryonic development and resulting in various mental problems and intellectual underdevelopment are combined into the general term mental retardation or dementia in children. According to the WHO decision, a set of diseases of this type is defined as mental retardation, which is assigned the ICD code 10-F70-F79.
In America, by law, any type of neurocognitive disability is called intellectual disability - that is, intellectual disability; the definition of “mental retardation” or “dementia” is practically no longer used in Western modern psychiatry.
Causes of dementia in children
In child psychiatry, the causes of dementia in children are usually divided into postnatal (during childbirth, during the newborn and the first few years of life), antenatal (pathogenic factors that affect the fetus during pregnancy) and hereditary (chromosomal disorders and gene abnormalities, which account for them). accounts for about 80% of pathology).
The causes of hereditary dementia in a child are usually justified by disturbances in the set of chromosomes or their pathologies. Let's define only the most common ones:
- 13th chromosome – Patau disease;
- Chromosome 21 – Down's disease;
- Abnormalities in chromosome 4p – Wolf-Hirschhorn disease;
- Fragile chromosome disorder – Rett disease in girls and X-linked disease in boys;
- Disruption of chromosome 15p – Prader-Willi disease, chromosome 9p – Alfie disease;
- Pathologies of chromosome 5p – oligophrenia in cry-the-cat syndrome.
All these are pronounced types of symptoms of dementia in children, when developmental disorders of various brain structures are a consequence of chromosome defects.
The most common causes of dementia in children, which are associated with heredity, are caused by metabolic disorders : a violation of the metabolic process of the amino acid phenylalanine (phenylpyruvic oligophrenia), iodine deficiency (neonatal thyrotoxicosis), lack of a lysosomal enzyme (neuronal lipofuscin ceroid), lack of arginine-digesting enzyme (hyperargininemia) and etc.
Antenatal causes of dementia in a child include:
- placental insufficiency (delayed development of the fetus in the womb);
- intrauterine chronic fetal hypoxia (lack of oxygen);
- rubella during pregnancy (leads to rubeolar dementia in the child);
- maternal diseases (toxoplasma, syphilis, cytomegalovirus, herpes virus);
- teratogenic effect on the fetus of ethanol (alcohol), as well as some medications taken during pregnancy (aspirin, antibiotics, isotretinoin, warfarin, etc.);
- toxic effects of mercury vapor, lead, phenol, pesticides;
- premature birth, preeclampsia;
- high level of ionizing radiation.
Postnatal causes of dementia include acute asphyxia during childbirth or traumatic brain injury ( head injury during childbirth when using a vacuum extractor or applying forceps). At the same time, disruption of brain function and further dementia in children can occur due to immune incompatibility of the Rh blood of the mother and child.
Oligophrenia in a child at an early age can appear as a result of viral-bacterial brain damage Neisseria meningitidis, Listeria coli, Escherichia coli, St. Pneumonia, with encephalitis or meningitis.
Diagnostics
When the first signs of dementia appear, the child should be shown to a qualified neurologist, who will assess the neuropsychic state of the young patient and take a history of his illness.
Upon referral from a neurologist, the child will have to undergo testing in a psychologist’s office, as well as laboratory and instrumental examination.
Psychological testing
To identify mental retardation, the following types of psychological tests are used:
- Eysenck test - shows the mental age and intelligence quotient (IQ) of the patient.
- Stanford-Binet Intelligence Scale - assesses the mental development of children aged 6 to 16 years.
- The Wechsler test assesses the intelligence of children aged 2.5 to 7.5 years.
- Benton's visual retention test - identifies organic brain damage and its severity.
Laboratory research
If dementia is suspected, the child is prescribed a laboratory blood test for glucose, thyroid hormones, vitamin B12, syphilis, ALT and AST.
A general blood test can detect the presence of infectious processes in the body, and a biochemical screening can be used to assess the functional state of the kidneys and the level of electrolytes in the blood.
The doctor may order genetic testing to detect Down syndrome, DiGeorge syndrome, Lejeune syndrome (cry of the cat), and fragile X chromosome.
Instrumental examination
- Magnetic resonance imaging (MRI) provides valuable information about malformations of the central nervous system, structural changes in the brain and various organic disorders.
- A computed tomography (CT) scan involves examining the physical structure of the brain using X-rays. Allows you to identify the presence of scars and injured areas in the brain, which may be the cause of the child’s mental disability.
- An electroencephalogram (EEG) allows you to assess the functional state of brain structures during wakefulness, sleep, active mental or physical work.
Fluctuations in alpha, theta and delta waves indicate acquired dementia syndrome and delayed psychomotor development in a child.
Symptoms of dementia in children
Dementia refers to significant age-appropriate limitations in cognitive and intellectual abilities and adaptive behavior that begin in children and last a lifetime. And the stages of dementia in a child depend on the level of mental limitation:
- The first or mild stage of dementia (debility);
- Second or moderate stage (mild imbecility);
- Third or severe stage (severe imbecility);
- Fourth or deep stage (idiocy).
Distinctive signs of mild dementia in children are:
- retardation in physical development;
- level of intelligence development (IQ) 51–68 points;
- difficulties with logical and abstract thinking;
- instability of attention and poor memory;
- great suggestibility, which often leads to absolute dependence on the influence of others;
- mild behavioral disorders and emotional instability;
- Difficulty in performing targeted actions.
Doctors note that the first symptoms of mild neurocognitive deviation can most often be identified only after the child begins schooling - at 7–10 years old, when it is difficult for him to master the school curriculum. According to statistics from English psychiatrists, approximately 88% of children with mild dementia are only slightly slower in learning new skills and information.
With moderate dementia, IQ is in the range of 36–48 points, and with severe dementia, it is at the level of 21–35 – that is, the ability to think independently is minimal (in the first situation) or completely absent. These children may not eat or sleep well and become easily irritated and tired. Developmental retardation can be clearly traced at an early age: these children begin to crawl, sit, talk and walk later than others. Although, despite all the difficulties, a child with imbecility can learn a minimum vocabulary. There are also problems with mastering basic self-care activities, with poor memorization and fine motor skills.
Dementia is a non-progressive condition, that is, it does not progress, but the signs of oligophrenia in children with severe and moderate stages become more distinct to those around them with age. This is expressed in an absolute inability to adapt and control one’s behavior, which often manifests itself as behavioral deviations in the form of attacks of psychomotor agitation, in some cases to affective disorders that resemble psychosis with elements of aggression and seizure epilepsy.
About 7–18% of children with dementia have behavioral problems, which pose a major challenge to the adults who care for them. But during dementia, which is caused by congenital hypothyroidism, the child is usually apathetic and lethargic, his movements are slow, and there is probably an absolute absence of speech and hearing. That is, in each individual case, the appearance of certain signs is determined by both the pathogenesis and the level of brain damage.
The characteristics of children with fourth-degree dementia are characterized by a lack of mental abilities and speech (at a deep stage, the IQ level is less than 19 points). Profound dementia in children is almost always detected at the time of birth or shortly after it. Many of these children have serious disorders of the nervous system and are unable to perceive speech, respond to external stimuli, express and experience emotions (no conscious facial expressions), recognize parents, touch objects, coordinate movements, smell, taste, and even in some cases pain. A common symptom is repeated mechanical repetition of one movement or, conversely, a state of absolute immobility.
It should be noted that certain symptoms of oligophrenia (Apert disease, Crouzon disease, Down disease, etc.) are characterized by some typical external symptoms , including disruption of the general innervation of muscles (with convulsions or paresis) and the conductivity of the ocular motor nerves (with nystagmus or strabismus), craniofacial anomalies. And from the endocrine and cardiovascular systems there can be many nonspecific symptoms.
Symptoms of the disease
Congenital dementia is characterized by the following symptoms:
- Mental underdevelopment with obvious signs of intellectual disability.
- Slow pace of physical, mental and mental development.
- Lack of dynamics of intellectual state.
- Marked immaturity of brain structures.
Worth seeing: Amaurotic Idiocy
It is quite difficult to make an accurate diagnosis of the disease on your own, so you need to urgently contact a qualified psychotherapist. The diagnosis is made based on symptoms, as well as after conducting an appropriate examination of the child.
One of the main symptoms of dementia is a slow rate of mental and physical development.
Symptoms of dementia in adults
During the asthenic form of oligophrenia, the following signs appear:
- Fatigue, weakness;
- Emotional instability;
- Impaired consciousness, attention;
- Mental imbalance.
For atonic dementia:
- Unreasonable and unstable behavior.
During sthenic dementia:
- Imbalance, hot temper;
- Impaired mental reaction;
- Inappropriate behavior.
Dysphoric stage:
- Unreasonable mood swings;
- Aggressive behavior.
Moreover, absolutely all people who are diagnosed with “moronism” have a mental disorder. Of course, this factor will affect the social adaptation in society of both children and adults. Patients with debilitation have difficulty building relationships with other people, learning, and can only work in the simplest jobs.
Area of manifestation of problems
Each part of the brain has its own task. The cerebral cortex is responsible for sleep, wakefulness, and the functioning of the senses. Subcortical structures control human behavior and reactions. The nature and symptoms of dementia depend on which part of the brain is damaged.
| Affected area | Disease |
| Bark |
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| Subcortical structures |
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| Cortical and subcortical areas |
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| Different parts of the brain |
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Memory
Problems with short-term memory are an early symptom of dementia. It becomes difficult to remember or understand information. A person remembers facts from many years ago, but may completely forget about the events of recent days. He has to rely on friends, family, and electronic devices to keep track of his activities.
Other symptoms of dementia associated with memory loss:
- often forgets where he put something;
- cannot remember why he entered the room;
- constantly forgets what he should do.
Simple tasks
An early sign of dementia may be an inability to perform simple tasks. A person has difficulty following clear instructions, such as cooking recipes. The patient is not aware of the procedure and does not remember them.
Daily Activities
When dementia sets in, it becomes difficult to do usual things: work on a computer, tune in the TV, and even make tea. The problem arises constantly, both at work and at home.
Over the years, the situation worsens under the influence of various factors.
Orientation in space and time
With the development of dementia, the sense of direction, the ability to navigate the area, and recognize signs deteriorate. If a person remembers them, he quickly forgets about them and gets lost. Because of this, his loved ones are forced to constantly monitor him and restrict his movements.
As the disease progresses, the sense of time disappears.
The patient cannot understand whether it is too late or early. Checking his watch, he forgets even the approximate time. It is difficult for the patient to comprehend the facts of the present and future. He lives in the past, so the events of the coming days are unreal for him.
Distance determination
Patients with dementia cease to correctly assess distances and understand street names. A person cannot calculate the distance to the desired point or choose a shorter and more convenient road.
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Speech and writing
Over time, it becomes more difficult for the patient to carry on a conversation. He forgets what he said, what he still has to say. It becomes difficult for a person to read. Written speech deteriorates - many errors appear, grammar and style are very poor. Handwriting becomes less legible.
Suspicion
When memory, thinking, and the ability to draw conclusions deteriorate. A person often gets confused, stops distinguishing faces, cannot find the right words, or communicate normally. He constantly forgets where he puts things, money, important documents, gets upset and accuses other people of stealing.
Apathy
In the early stages of dementia, the patient becomes lethargic. He is not interested in his previous hobbies or hobbies. He refuses fun activities and doesn’t want to go outside. If he used to love to travel, now he is satisfied with staying within four walls.
Closedness
The person avoids communication with family and friends. They seem too energetic and emotional to him. The patient may withdraw and not talk to loved ones, does not pay attention when others talk to him, and avoids crowded places.
Character change
People with dementia often experience mood swings and can move from irritability to depression, from fear to anxiety. They often tend to take risks and commit rash and inappropriate actions.
Diagnosis of dementia in a child
Complete information about the birth and pregnancy of the mother, collection of anamnesis (including family history), assessment of the general and physiological development of the child - this is the basis on which the diagnosis of dementia in children is based.
But child psychiatrists note that it is quite difficult to identify oligophrenia in children of preschool and early age (if, of course, this is an implicitly expressed sign): determining the level of mental abilities according to Wechsler for preschoolers (according to WAIS) is designed for children five years old or more, find out the level communication skills and adaptive behavior using a specially created rating scale is also quite difficult. All that remains is to test your ability to add cubes and vocabulary.
Therefore, determining mental development (in addition to severe idiocy and imbecility) can be complicated, but at the same time, a specialist needs to diagnose the symptoms (often nonspecific) as clearly as possible and determine the relationship of the clinical picture with the cause of mental retardation.
Blood tests sometimes help with this - biochemical, general, RW, AntiHSV-IgM, enzymes, CMV (cytomegalovirus) and toxoplasma, genetic research, urine analysis for amino acids , etc. And only instrumental examination of the brain - MRI, CT and encephalography - will be able to determine the presence of craniocerebral disorders.
The correct diagnosis of pathology of mental development can be ensured by a differential examination, since many diseases and conditions (schizophrenia, epilepsy, etc.) partially have similar neuropsychiatric symptoms.
In most countries around the world, the definition of dementia in children is made according to the American Psychiatric Association (APA) Statistical and Diagnostic Manual of mental disorders (DSM), and is based on three main factors: evidence that mental development limitations became apparent in adolescence or childhood, significant limitations in one or more areas of adaptive behavior and deficits in general mental abilities.
Symptoms of childhood dementia
Symptoms and signs of dementia in children and adolescents vary depending on the underlying cause of the disease and the severity of its progression.
The most common signs of childhood dementia are impaired attention, memory, speech, deviant behavior and fatigue.
Preschoolers (up to 7 years old)
The first sign of dementia in young children and preschoolers is the persistent loss of skills that were previously learned and easily practiced.
We can talk about mental retardation if the child:
- later than peers begins to walk and talk,
- forgets words, constructs sentences incorrectly,
- looks untidy, does not care about his appearance,
- feels indifference to the outside world,
- loses affection for loved ones.
The baby's movements become disinhibited, and high spirits prevail. With further development of the disease, the child’s movements become less differentiated and more uniform.
Junior schoolchildren (7-11 years old)
If in preschool age it is quite difficult to recognize mild dementia, then during school years the disease manifests itself more confidently:
- the student has difficulty learning new material,
- writes and reads slowly, cannot solve logic problems,
- does not understand the meaning of proverbs and sayings,
- cannot reproduce the content of the text just read,
- forgets words, has difficulty constructing sentences,
- reacts inappropriately to the words and actions of others,
- gets tired quickly, often feels apathy and lethargy.
Previously acquired skills and speech are retained for a long time, but memory works selectively . For example, a preschooler can name the days of the week and the sequence of seasons in order, but confuse the colors.
Boys and girls (11-18 years old)
What are the symptoms of dementia at 15? At this age, dementia can be recognized by the following signs:
- the child does not assimilate social and legal norms,
- does not take care of himself, looks untidy,
- loses interest in hobbies and previously loved activities,
- begins to obsessively collect unnecessary things,
- all his games become monotonous, with constantly repeating actions,
- does not remember information well, thinks superficially, and has problems doing homework.
Symptoms of dementia indirectly depend on the child’s temperament, his state of health, the presence of concomitant diseases, the social and everyday aspects of his life and some other factors.
About the symptoms of mental retardation in this video:
Dementia treatment
Almost all psychiatrists tell parents of children with dementia directly that mental retardation is not a disease, but a condition, and it is impossible to cure these children: there is no cure for mental retardation.
Therefore, the treatment of childhood dementia is, by and large, the rehabilitation of children diagnosed with mental retardation : with the help of the efforts of adults and teachers of specialized educational institutions, many children with mental retardation (with the exception of severe imbecility and idiocy) will be able to learn a lot. However, this requires more effort and will take longer.
Children with a mild degree of underdevelopment need positive motivation, support and attention, and children with a moderate form of dementia need to be helped to master the simplest skills of communicating with parents and other children, and teach them basic self-care. In special schools, rehabilitation is carried out using the methods of corrective therapeutic pedagogy, and most children with a moderate form of dementia receive initial skills in writing, counting, manual labor, drawing, and reading.
Etiological treatment can only be used in cases where mental retardation is associated with enzymopathies (phenylketonuria) or hereditary metabolic disorders.
The symptomatic treatment of dementia in children used by doctors - with the use of neuroleptics (antipsychotics) or tranquilizers (sedatives) - is aimed at improving mood, relieving obsessive-compulsive disorders and increased tension, and is also required for severe behavioral disorders with obvious aggressiveness or psychotic agitation.
But these drugs cause many side effects, and the constant use of antipsychotics has almost inevitable consequences in the form of involuntary muscle spasticity, rigidity of extrapyramidal movement disorders, and persistent disturbances in visual acuity and sleep. Amnesia may also develop and memory may deteriorate.
It is more appropriate to use B vitamins . For example, the drug Gamalate B6 (in the form of a solution for oral administration) - with vitamin B6, gamma-aminobutyric acid and magnesium glutamate hydrobromide, which has a sedative effect (stops the processes of excitation of the nervous system) and at the same time promotes improving memory and increasing concentration.
Traditional methods of treatment
Traditional methods of treating childhood mental retardation involve treatment with plants: infusion of the roots of medicinal valerian (it is forbidden to give alcoholic tincture to children). Ginseng root and ginkgo biloba plants are also used. Homeopathy is not used in the treatment of children with mental retardation.
Forecast
The prognosis of dementia in children is associated psychological problems and lifelong intellectual disability of various levels. In cases of profound dementia (idiocy) and severe stages (pronounced imbecility) - a disability that sometimes requires placement in special medical institutions.
Prevention
Prevention of dementia consists of a full examination of a woman during pregnancy planning (it is imperative to conduct a blood test for TORCH bacteria); you also need to consult with geneticists , especially when the family history of future parents has recorded cases of the birth of children with various signs of mental disability. Syphilis, cytomegaly, and congenital toxoplasmosis are subject to mandatory treatment before pregnancy. Pregnant women in the first trimester must definitely take folic acid and avoid infection (measles, rubella, etc.).
almost 7 million people in America suffer from mental retardation , of which more than 600 thousand are aged 7–25 years. In England, there are about 250 thousand adolescents and children with varying degrees of dementia. Childhood mental retardation affects 3–4% of the total population on Earth. 80–95% have a mild degree of pathology. From all that has been said above, it is quite logical to conclude that it is much easier to prevent the symptoms of dementia than to cure it, especially given the fact that this disease is not very treatable.
Degrees of the disease
There are several types of mental retardation: mild, moderate, severe and profound. Let's talk about them in a little more detail.
Mild mental retardation often implies debility. This word has mistakenly entered the stock of domestic citizens as a curse word, but in essence it only implies features of development.
Morons can study in the same class with other children and are almost no different from them, except for lethargy and lack of initiative. Such a child can achieve success if properly raised.
A moderate degree of mental retardation is called imbecility. Such children learn with difficulty and have a poor vocabulary (about three hundred words). They can study at home or in special schools and as a result gain basic knowledge. Imbeciles have quite good self-service skills.
A severe degree of retardation is called idiocy. Idiots are unable to think and speak adequately; they do not understand speech addressed to them at all. Such children cannot take care of themselves and therefore need constant help from their parents.
Such patients do not always distinguish “us” from “strangers”, and can only experience basic emotions: pleasure and displeasure. In the latter case, indignation is expressed by strong screaming and aggression.
Features of childhood dementia
Preschool age only forms a personality, which is characterized by many factors: developmental characteristics, temperament, individuality.
Only after the child goes to school can parents identify a developmental disorder. Such children practically do not master the program. It is not possible to attract the attention of oligophrenics and fix it on something. Difficulties arise with memorization and retelling—children suffering from ID are unable to retain received information in memory for a long time.
A “special” student usually does not understand the essence of the task and does not grasp the connections between things and phenomena. It is very easy to intimidate him in such a situation: you just have to shout, and the psychological trauma that follows the stress is inevitable.
Depending on the environment, such a child can develop into two completely different personality types:
- kind and sympathetic, ready to help at any moment, vulnerable and warm-hearted;
- embittered and aggressive, who, having no desires and feelings of their own, are subject to the negative influence of others.
A practicing psychotherapist shared the story of a boy who was doomed to mental illness while still in utero development. A dysfunctional mother carried a child in violation of all acceptable rules: she smoked, drank alcoholic beverages, and took psychotropic drugs. After the birth of the child, he was deprived of proper attention.
After some time, the visiting nurse noticed some mental underdevelopment of the baby: he could not hold his head up on his own and did not make any sounds. Thanks to the prompt and coordinated work of medical workers, the boy was saved. And at the moment it has practically adapted to modern living conditions.
A predisposition to mental illness or unacceptable behavior of a pregnant woman is a reason to warn her about the possible dementia of the unborn child.
However, a loving and caring mother who leads a healthy lifestyle and has absolutely no prerequisites for the occurrence of mental pathologies can also face the problem of dementia in her child.
Having noticed the first alarm bells, which are a definite reason for consultation, you must immediately contact a qualified specialist. This will give you the opportunity to deeply adapt your baby to society before the moment of his socialization.
Prevention and treatment
In order to prevent the development of mental retardation in the womb, pregnant women who have an unfavorable history (physiological indicators, predisposition) are recommended to undergo a more thorough examination. Doctors place women under special observation who suffered from viral diseases during pregnancy.
Birth injuries received by newborns, as well as infectious diseases they suffered at an early age, can lead to brain damage.
A child with mild mental retardation has the opportunity to develop and learn within the limits of his biological capabilities. This pathology is incurable, but its timely and competent correction will make it possible for such a person to become a full-fledged member of society, albeit with limited abilities. A special role in this case is played by the environment and perception. There is no doubt that such people require increased attention.
Mental retardation requires close contact with loved ones, teachers, doctors, and psychologists. The doctor selects specialized institutions for children with mental development problems taking into account the child’s capabilities and abilities. Additionally, the psychotherapist can prescribe medication support using pharmacological drugs. Medical and educational measures and labor training for the mentally retarded show good results.
It is always important to remember that any mental illness is not a death sentence. The main thing is to contact a specialist in time, who will help make your stay in society as comfortable and fruitful as possible for the patient.
In the case of mild oligophrenia, experts give a relatively favorable prognosis. This applies to cases not burdened with concomitant psychopathological and somatoneurological disorders. People with such deviations are quite capable of mastering certain types of professions, can adapt to independent living, and even create families.
