Characteristics of children with moderate and severe mental retardation
Ilyashenko Ekaterina Alexandrovna
Characteristics of children with moderate and severe mental retardation
Mentally retarded is a child who has a persistent impairment of cognitive activity due to organic damage to the brain (S. Ya. Rubinstein. Psychology of a mentally retarded schoolchild .)
Mental retardation is a delay or incomplete development of the psyche that is detected before the age of 3 years. The priority task in working with mentally retarded children is their social development as a whole, and not just systematic education.
The expected result of all professional efforts with the systematic help of parents is the socialization of a mentally retarded child .
Children with moderate mental retardation (F-71)
mentally retarded people identified in the population . Moderate mental retardation is an average degree of mental underdevelopment. Its etiology can be either hereditary defects or the consequences of organic brain damage. It is characterized mainly by unformed cognitive processes. Their coordination, accuracy and pace of movements are impaired. Movements are slow and clumsy, which interferes with the formation of a complex mechanism of running and jumping. Severe defects in motor underdevelopment can prevent the formation of self-care skills that require fine movements of the fingers: when lacing shoes, fastening buttons, tying ribbons. Most delayed individuals require constant assistance with many household chores, and some require supervision. Everyone has an attention disorder. It is difficult to attract, is unstable and distractible. Extremely weak active attention prevents the achievement of the goal. Children with moderate mental retardation have a very limited supply of information and ideas.
They have difficulty operating with existing ideas. Their thinking is concrete, inconsistent, and slow-moving. The formation of abstract concepts is either inaccessible or sharply limited to the most elementary generalizations. They can be taught to group clothes, animals, etc. They can only make distinctions on specific objects. It is impossible to compose a coherent story based on the plot of the most elementary picture. The speech of such children is impaired . They slowly, with a delay of 3-5 years, develop understanding and use of speech, and its final formation is limited. Speech development usually corresponds to the degree of mental retardation . At the same time, the child understands the interlocutor’s speech very limitedly, satisfactorily capturing intonations, gestures and facial movements. In rare cases, the child’s speech is a stream of meaningless cliches pronounced in previously heard intonation (echolalic speech)
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The origin of this disorder is associated with predominant lesions of the frontal lobe of the cerebral cortex or with hydrocephalus (Simpson etc., 1925)
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In 20% of moderately mentally retarded children, speech does not appear at all, which is associated with damage to the speech areas of the cerebral cortex.
Children with severe mental retardation (F-72)
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Having mastered only self-care skills and simple labor operations, these children are often sent to boarding institutions of the Ministry of Social Protection of the Population. The reasons are mainly organic. Combined with severe motor disorders. Similar to mild mental retardation .
Possible development of communication skills. The photo shows the directions of correctional work with children of this category.
Features of mental development of mentally retarded children
Mental retardation is a persistently pronounced decrease in the cognitive activity of a child, resulting from organic damage to the central nervous system (primarily the cerebral cortex) in the prenatal, intranatal or early postnatal period. Clinical studies have established that with mental retardation, the leading symptom is diffuse damage to the cerebral cortex.
Neurodynamic processes in the cerebral cortex may also be disrupted. Diffuse damage to the cortex can also be combined with individual local deeper damage to the cortex. The degree of damage to the central nervous system can vary in severity, location, and time of onset. The diversity and different depths of damage determine the variety of impairments in the cognitive activity of children with mental retardation.
The science of oligophrenopedagogy deals with the problems of studying, upbringing, teaching, as well as social and labor adaptation of children with intellectual disabilities . The term denoting science is associated with the outdated name for this category of children - oligophrenics, where oligo means small, and fren means mind. The term was coined by Kraepelin and was widely used throughout the 20th century, but is now considered obsolete as it was considered offensive to this category of people. The term mental retardation implies some possibility of development for this category of children and corresponds to the English term “mental retardation”.
The causes of mental retardation can be both exogenous and endogenous.
Among exogenous causes, the greatest influence belongs to infections of the prenatal period: rubella, influenza, toxoplasmosis, syphilis. Mother's use of alcohol and drugs during pregnancy can also cause the birth of a mentally retarded child. Mental trauma suffered by the mother during pregnancy can sometimes cause mental retardation in the child, especially if these traumas are very intense. Physical injuries that can occur as a result of an accident or beating of a pregnant woman, and in some other cases, also pose a certain danger.
Birth trauma is also an aggravating circumstance for the occurrence of various developmental anomalies, including mental retardation (rapid birth with the umbilical cord entwining the child’s neck, prolonged labor with asphyxia, forceps birth, in which, according to some data, only 25% of children develop normally, hemorrhages in the ventricles of the brain, etc.).
Among the causes of mental retardation in the early postnatal period are neuroinfections of various etiologies, influenza, and intracranial injuries.
Endogenous causes include those caused by pathological heredity or gene mutations that occurred during the life of one of the parents .
Science knows more than 450 hereditary diseases accompanied by mental retardation. These include well-known diseases, such as, for example, Down syndrome and little-known to the general public Carpenter syndrome, Cornelia de Lange syndrome, Rubinstein-Taybi syndrome, Coffin-Lowry syndrome, leprechaunism, Seckel syndrome, etc. It has been established that when mentally retarded people marry and give birth to offspring, the number of children with the same developmental disorder is approximately 60% if both parents are sick and about 30% if one of them is mentally retarded.
Among the factors that cause mutations are: radiation exposure, chronic alcoholism of parents, their use of drugs and toxic substances. A significant factor contributing to the birth of a defective child is also the age of the mother. For example, it is known that in the case of a mother under 30 years of age, one child with Down syndrome is born per 1000 children; in the case when the mother’s age exceeds 40 years, this combination is 1 in 40.
According to the depth of the defect, mental retardation, in accordance with the International Classification of Diseases of the latest, 10th revision (ICD-10), is divided into four degrees:
- mild mental retardation;
- moderate mental retardation;
- severe mental retardation;
- profound mental retardation.
With mild , the intelligence quotient (IQ) ranges from 50 to 69 units (in adults, the mental age is 9 to 12 years). People with mild mental retardation acquire speech skills with some delay, but most of them are able to use speech for everyday purposes and maintain a conversation. Achieve complete independence in personal care, practical and household skills. The main difficulties are observed in the area of school performance; they cannot master the general education curriculum. However, many adults are able to work while maintaining good social relationships and making a meaningful contribution to the well-being of the family.
With moderate mental retardation, the IQ is in the range of 35-49 (in adults, the mental age is 6-9 years). There is a pronounced lag in the development of self-care and motor skills, but in most cases, persons belonging to this category are amenable to training and over time achieve a certain level of independence, having mastered the skills necessary for self-care and adequate communication, master the ability to read and understand simple texts, basics of writing and counting. However, adults with moderate mental retardation, as a rule, are not able to lead a completely independent lifestyle. To live and work outside of specialized institutions, they need more or less support from relatives or persons replacing them.
Severe mental retardation in its clinical picture is in many ways similar to a moderate degree, but differs from it in a lower intelligence quotient, which ranges from 20 to 34 units (mental age in adults 3–6 years) and the presence of a pronounced degree of motor impairment. This degree of mental retardation, as a rule, entails a constant need for support and excludes the possibility of studying in any type of educational institution.
With severe mental retardation, the IQ is below 20 (in adults the psychological age is less than three years), which means very limited ability to understand and follow even the simplest instructions. Most of these patients are immobile or have severely limited movements, suffer from urinary and fecal incontinence; at best, only the simplest forms of non-verbal communication are possible with them. They are unable to take care of their basic needs and require constant help and supervision.
In addition to the presented typology, which is based on a psychometric study of intelligence and determines the possibility of further social and labor rehabilitation of mentally retarded people, there is another typology. It provides for the division of mental retardation, depending on the depth of the defect, into three degrees: debility, imbecility and idiocy.
Debility is the mildest degree of mental retardation. (IQ - 50-69 conventional units), i.e. corresponds to a mild degree of mental retardation according to ICD-10. Reduced intelligence and peculiarities of the emotional-volitional sphere do not allow children with such a degree of mental retardation to master the general education school curriculum. Mental retardation to the extent of debility is often combined with impaired phonemic hearing, which entails general underdevelopment of speech. Therefore, such children often have defective pronunciation, agrammatism and other speech development disorders. Due to the underdevelopment of the analytical-synthetic function of higher nervous activity, as well as the frequent occurrence of organic lesions in the parietal-occipital lobes of the left hemisphere, mastering counting and other mathematical operations also presents great difficulties.
Therefore, studying and mastering educational material in any subject of the school curriculum for children with retardation is extremely difficult. For example, while mastering written and spoken language, the concept of number and counting skills, they experience significant difficulties in understanding the connections between sound and letter, set and its numerical expression. The lack of ability to establish adequate cause-and-effect relationships leads to serious difficulties in solving even simple arithmetic problems.
Somatic disorders, general physical weakness, disorders of fine motor skills, characteristic of the majority of children with mental retardation in the degree of debility, as well as the characteristics of the emotional-volitional sphere, the system of incentive motives, character and behavior, significantly limit the range of their subsequent professional and labor activities. However, upon graduating from a auxiliary school, persons with debility become independent citizens, i.e. bear responsibility for their actions, master professions that do not require high qualifications, and have the right to be owners of housing and other real estate. Children with mild mental retardation make up approximately 75-80% of all mentally retarded children.
Imbecility is a more severe degree of mental retardation compared to debility. (IQ from 20 to 50). According to ICD-10, it corresponds to moderate and severe degrees. Children in this category have certain capabilities for mastering speech and mastering certain simple work skills. However, their vocabulary is extremely poor. They understand other people's speech, facial expressions and gestures only within the limits of their everyday life.
The presence of gross defects in perception, memory, thinking, motor skills and the emotional-volitional sphere makes some of these children practically uneducable even in a auxiliary school. Legally, these children, as well as children with idiocy, are incompetent, and they are placed under the guardianship of their parents or persons replacing them. At the same time, for the relatively safe part of children belonging to this category, defectologists have developed a special program that provides for mastering the skills of writing, reading, counting, as well as simple work skills. Their number is approximately 15% of cases of mental retardation.
Idiocy is the most severe degree of mental retardation. (IQ less than 20 units). Corresponds to a profound degree of mental retardation according to ICD-10. Children with idiocy have practically no speech, they do not recognize those around them, their facial expressions are meaningless, and almost nothing attracts attention. There is a sharp decrease in all types of sensitivity. If they begin to walk, it is very late, and their movements are poorly coordinated. They do not react to other people's facial expressions and gestures.
They are untidy in natural activities and incapable of self-care. Sometimes stereotypical movements are observed - pendulum-like swinging of the head or body from side to side. In the mildest cases, the ability to laugh and cry is noted. Sometimes they can understand someone else’s everyday speech or facial expressions and gestures addressed to them. In the case when an expressive form of speech develops, the active vocabulary is limited to several dozen words. Children diagnosed with idiocy cannot be taught and are incompetent.
In cases where parents cannot create favorable conditions for such a child at home, the children, with the consent of the parents, are placed in special institutions - orphanages for severely mentally retarded children. Upon reaching the age of 18, they are transferred to special boarding schools for psychochronic patients. Recently, it has become possible to partially rehabilitate such children in regional rehabilitation centers operating as a day hospital. The total number of such children is approximately 5% of all mentally retarded.
The development of a mentally retarded child from the first days of life differs significantly from the development of normal children. In many children with a congenital form of mental retardation, the development of erect standing is delayed, i.e. They begin to hold their heads, sit, stand, and walk much later than their normally developing peers. This delay can be quite significant and affect not only the first, but also the second year of the child’s life.
Almost all mentally retarded children of infancy experience a lack or significant decrease in interest in the environment, general inertia with loudness, restlessness, irritability and motor disinhibition. In the future, they do not develop interest in toys suspended above the crib or in the hands of an adult. There is no timely transition to communication with adults based on joint activities with toys, and gestural communication with adults, characteristic of a normally developing child in the pre-speech period, does not occur.
A mentally retarded child at an early age has significant deviations in mental and speech development. Speech, as a rule, does not appear in a timely manner. Object-manipulative activity does not develop due to the lack of interest in the objects surrounding the child and the insufficient development of the ability to hold them in the hand. But, at the same time, the development trends of such a child are the same as those of a normally developing peer. With the correct organization of the life of a mentally retarded child, which involves the earliest possible start of special correction classes, many developmental defects can be corrected and prevented.
Perceptual actions in mentally retarded children begin to form after 3 years. Based on the interest in toys that had emerged by this time, the simplest ideas about their properties and relationships emerged: color, shape, size. However, only half of mentally retarded children by the age of 6-7 years reach the level of development of perception characteristic of a normally developing three-year-old child.
Visual-effective thinking is closely related to the process of perception and is an important aspect of sensory knowledge of the world. Mentally retarded preschoolers are characterized by a lag in the timing and pace of their development. Even by the age of 6, not all mentally retarded children can independently assemble a nesting doll, a pyramid, or perform other tasks that require moving, using, or changing an object. Unlike normal children, mentally retarded children, without special training, have almost no visual and effective thinking with age. And they practically do not have visual-figurative
Elementary verbal-logical thinking in mentally retarded preschoolers appears late, develops slowly and has a qualitative originality.
Play normally arises on the basis of objective activity that has developed in a certain way. In a mentally retarded child, such activity does not develop at the beginning of the preschool period, and therefore it is completely natural that play activity does not appear at this age. Actions with objects remain at the level of manipulation, interest in toys turns out to be short-term and unstable, stimulated only by their appearance.
Even after the age of five, genuine play does not arise. Without special training, the leading activity of a mentally retarded child of preschool age is not play, but object-based activity. Without special training, a mentally retarded child does not develop speech through play. There is no planning and fixing speech, and even conjugate speech.
Productive activity in mentally retarded preschoolers practically does not occur outside of specially organized training: constructive skills do not appear, object drawing does not appear. If children attend a regular kindergarten, then a drawing may appear, but it will be imitative, fragmentary, and will be a graphic stamp that does not reflect the real object. Mentally retarded children of this age practically do not use color in their drawings unless they are specifically taught to do so.
Elements of work activity (primarily self-service skills) in mentally retarded children begin to form under the influence of the demands of others. This process requires significant effort on the part of parents and educators. Therefore, many families follow the path of least resistance: the parents themselves undress and dress the child, wash them, and feed them. Such children find themselves completely helpless in the absence of their parents. But there are other families where parents try to set feasible goals for the child and show persistence in achieving them.
In this case, children master the simplest self-service skills. However, the nature of even the developed skill in mentally retarded children is unique. Children's movements associated with self-care are uncertain, unclear, often slow or, conversely, fussy, and not focused enough. There is a strong discrepancy between the movements of both hands. In some cases, even older preschoolers do not understand the sequence and logic of all the actions included in the skill. The nature of each individual movement also suffers.
Speech development in mentally retarded preschool children differs significantly from the norm. Delays in speech development occur in them from infancy and continue to accumulate in early childhood. Since such children have no need for communication, objective activity is not formed, and interest in the environment is reduced, speech does not appear in a timely manner. In addition, there is immaturity of phonemic perception and insufficient development of the articulatory apparatus. Many mentally retarded children begin to speak only after 3 years. And their first phrases appear by the age of 6. However, from the point of view of speech development, mentally retarded preschoolers represent a very heterogeneous group.
Among them there are children who have no speech at all, and children with formally well-developed speech. In the second case, the level of speech development is not a diagnostic indicator, since children poorly understand speech addressed to them and cannot answer questions related to understanding what is being said. The speech of such children is imitative in nature and is based, first of all, on good memory capabilities. In the overwhelming majority of mentally retarded children, speech by the end of the preschool period is characterized by a large number of phonetic and grammatical distortions; one of the characteristic features is a violation of the agreement of the numeral with the noun.
The situational meaning of the word is preserved for a long time, i.e. even a familiar word is not perceived outside of a familiar situation. In many cases, echolalic speech is observed. Thus, the speech of this category of children is so poorly developed that it cannot perform its most important function - communicative. In general, without special preschool education and upbringing, mentally retarded children reach school age with significant speech impairments.
The personality of a mentally retarded child is also formed with large deviations both in terms and rates of development, and qualitatively. By the beginning of preschool age, when a normal 3-year-old child begins to realize his “I,” a mentally retarded child still does not have any personal manifestations; his behavior is involuntary. The first glimpses of self-awareness appear after 4 years, when the child develops some interest in the environment and develops elementary actions with objects.
The first manifestations of one’s “I” are usually associated with a child’s negative emotional reaction in response to remarks or reproach from adults. The systematic experience of failure leads to the formation of pathological personality traits - refusal of all activities, passivity, isolation, aggressiveness, or, conversely, ingratiation with an adult or stronger. Either obsequiousness or negativism and bitterness appears.
When communicating with peers without developmental anomalies, mentally retarded children find themselves rejected because they do not understand the game situation and are limited in the means of communication. The desire to assert oneself, characteristic of older preschoolers, takes on pathological forms in them. On the one hand, they become embittered and can behave cruelly towards weaker ones. On the other hand, the developing inferiority complex makes them even more rejected among their peers. In general, momentary desires and impulsive actions prevail in the behavior of mentally retarded preschoolers.
Mentally retarded children who have reached the age of 7 can enter special schools, which are called correctional schools, since education in such a school has a correctional focus. It is built taking into account the intellectual capabilities of this category of children and involves teaching them the basics of science in the 4th-5th grade of a public school. Targeted educational work and intensive vocational training are carried out with children. By the end of school, mentally retarded children master one of the working professions that do not require abstract thinking skills. This, for example, is the profession of a seamstress, bookbinder, carpenter, shoemaker, plasterer, etc.
The population of students in correctional schools is very heterogeneous. These are mainly children with mild or moderate mental retardation with various combinations of damage to the cerebral cortex and disorders of neurodynamic processes. According to the classification of M.S. Pevzner, there are five forms of mental retardation (mental retardation according to the previously used designation of the defect).
In the uncomplicated form, the child is characterized by the balance of the basic nervous processes. Deviations in cognitive activity are not accompanied by gross disturbances of the analyzers. The emotional-volitional sphere is relatively preserved. A child is capable of purposeful activity if the task is understandable and accessible to him. In a familiar situation, his behavior does not have sharp deviations.
In mental retardation, which is characterized by instability of the emotional - volitional sphere such as excitability or inhibition, the deviations inherent in the child are also clearly manifested in changes in behavior (such as increased excitability or inhibition) and decreased performance.
In oligophrenia with dysfunction of the analyzers, diffuse damage to the cerebral hemispheres of the cerebral cortex is combined with deeper local disorders. These children additionally have local defects in speech, hearing, vision, and musculoskeletal system.
With oligophrenia with psychopathic behavior, the child experiences a sharp disturbance in the emotional-volitional sphere. These children are characterized by a decrease in criticality towards themselves and the people around them, underdevelopment of personal components, and disinhibition of drives.
In oligophrenia with severe frontal insufficiency, disturbances in cognitive activity are combined with personality changes of the frontal type. These children are lethargic, lacking initiative, and helpless. Their speech is verbose, meaningless, and imitative. Children are not capable of mental stress, focus, activity, and have little regard for the situation.
All children suffering from mental retardation are characterized by persistent impairment of all mental activity. Moreover, they not only lag behind the norm in development, but also have deep qualitative originality in both personal manifestations and intellectual capabilities. Therefore, in no case can they be equated with normally developing young children.
However, mentally retarded children who are classified as trainable can develop. Impaired mental functions can be compensated to some extent by the development of positive personality traits. To carry out such work, it is necessary to have a good knowledge of the characteristics and capabilities of this category of children. And therefore, such work is most effective when it is carried out by a specially trained teacher in the conditions of correctional and developmental education in a special school.
In Ukraine, teaching mentally retarded children in special correctional schools involves taking into account the characteristics and shortcomings of their psychophysical development, imparting to them a certain range of knowledge, developing practical skills, nurturing positive personality traits, and opens up the prospect of an independent working life and integration into society.
In the case when a mentally retarded child attends a regular secondary school, he needs not only the creation of learning conditions adequate to his capabilities, but also the implementation of special events aimed at correcting possible personality deviations. Additional efforts will also be required for the task of his further social adaptation.
Children with severe mental retardation.
Severe mental retardation is usually detected and diagnosed early, before one year of age, or in the first years of a child's life. The depth of damage to the central nervous system in this case is such that it manifests itself not only at the cognitive, but also at the motor, as well as psychophysical level.
The psychomotor development of children with severe mental retardation from the first days of life is characterized by a significant lag from the norm: they begin to hold their head up, sit, stand, walk very late, and also experience great difficulty in switching movements, changing postures and actions.
Motor impairment manifests itself differently in different groups of children. With mental retardation with a predominance of inhibition, motor underdevelopment manifests itself in poverty, monotony of movements, a sharp slowness of their pace, lethargy, and awkwardness.
In children with a predominance of the excitation process, on the contrary, increased mobility is noted, but their movements are unfocused and disorderly, children find it difficult to reproduce sequential actions when necessary. Therefore, such a child cannot take care of himself. Subtle, differentiated movements are especially difficult for such children: they have difficulty learning to lace their shoes, tie their shoelaces, and fasten buttons on their own. They often do not measure up the effort when handling objects - they either drop them or squeeze them so tightly that they sometimes destroy them.
In children with severe intellectual impairment, all aspects of the psyche are grossly impaired: perception, attention, memory, speech, thinking, emotional-volitional sphere. They are characterized by a superficial global perception. Children do not analyze the perceived material, do not compare and contrast it with other objects. At the same time, children usually perceive and distinguish everyday, familiar objects quite well, but when it is necessary to perceive and distinguish from others a new object that has unfamiliar properties, the child fails to cope with the task. He most likely either refuses to complete the task or easily solves it incorrectly.
The attention of children with severe mental retardation is always impaired to one degree or another. It is difficult to attract, it is weakly stable, children are easily distracted. Voluntary attention is practically not developed. It is possible to attract attention only with the help of bright new objects, but even in this case, long-term concentration is impossible. At the same time, when favorable conditions are created for the development of attention: frequent changes in types of activities, with dosed presentation of the material, most children are quite actively involved in the educational process, follow the teacher’s instructions, and switch from one type of feasible activity to another.
Logical and mechanical memory in children with severe intellectual disabilities are not developed. At the same time, there are cases of hypertrophied mechanical memory. Such children are able to memorize large amounts of material and reproduce it without realizing the meaning of their own statements.
The most dramatic underdevelopment of these children is manifested in the peculiarities of their thinking . Transfer of acquired knowledge and skills, application of them in slightly changed conditions, independent analysis of the situation, choice of solutions to simple life problems - all these are almost insurmountable difficulties for abnormal children of this category. If children who have not undergone special training are asked to tell the contents of a simple plot picture, then at best they name individual objects. They cannot arrange the pictures in order or create a story based on them.
The deficiencies in thinking are especially evident when teaching them to read and write. Some children can learn to read, but most of them are unable to comprehend text. Children do not notice mistakes made when trying to retell what they read. When reproducing the texts they listen to, children often add facts from their own experience to their stories, without distinguishing new information from existing information. Often the content of the story is conveyed in such a way that the child himself becomes the main character.
Children with severe mental retardation master ordinal counting and perform arithmetic operations using visual means, but abstract counting, even within the first ten, is usually inaccessible to them. When solving problems, they have difficulty retaining the condition in memory and cannot establish the necessary semantic connections.
Severe intellectual impairments are closely related to profound underdevelopment of speech . The appearance of speech is usually very late. For many children, speech appears only by the age of 6-7 years. The degree of speech damage usually corresponds to the level of general mental underdevelopment. However, there are cases of their divergence in one direction or another. Sometimes the good mechanical memory inherent in some deeply mentally retarded children leads to the phenomenon of seemingly rich speech. However, such speech is not comprehended by the child himself; it has a “parrot” character, preserving not only previously heard phrases and speech cliches, but also intonation. Other children do not speak. Such a defect has a sharply negative effect on mental activity and reduces the child’s cognitive capabilities.
At primary school age, deeply mentally retarded children still poorly understand other people's speech, catching only tone, intonation and individual supporting words associated mainly with their immediate needs. In the future, understanding of addressed speech develops, passive vocabulary grows, but understanding rarely goes beyond the personal experience of children.
Independent speech appears in the form of individual words and short phrases. It is characterized by insufficient modulation, severe tongue-tiedness, violation of the structure of words, and agrammatisms. The lack of speech is partially compensated by gestures, inarticulate sounds, and words of autonomous speech that are incomprehensible to others.
During training, children's vocabulary is enriched: they master the names of various household items, animals, vegetables, and master the names of actions related to educational or everyday situations. However, as a rule, they associate a word only with a certain object in a certain situation.
For the socialization of children with severe mental retardation, a certain level of development of the communicative function of speech is necessary. However, such children often turn out to be incapable of dialogue. The adult always starts the conversation. Children are silent for a long time before answering, or, having said one word, they immediately fall silent. Others, on the contrary, talk a lot, but their speech consists of borrowed phrases and speech cliches and rarely corresponds to the situation.
The regulatory function of speech is also not developed in these children. Oral instructions from an adult, consisting of several orders following each other, are practically not perceived by children of primary school age. Only step-by-step execution of instructions is possible, as well as actions associated with the actions of the teacher or by demonstration.
In mentally retarded children suffering from severe intellectual disabilities, the emotional-volitional sphere . They are characterized by immediate impulsive reactions to external impressions. Most of them are easily suggestible. But at the same time, these children stubbornly resist everything new and unknown. They like to do things that are familiar to them, take walks in a certain place, and put their things in a certain way.
When severely mentally retarded children are praised, they express their joy vigorously. When reprimanded, they often get offended and can be hot-tempered and aggressive. However, emotional reactions may manifest differently depending on the type of nervous system. Thus, some children are characterized by sluggish, inhibited, stereotypical emotional reactions. For others, on the contrary, the reactions are excessively violent, their strength does not correspond to the reasons that caused them, and sometimes they are inadequate. At the same time, the emotions of these children are not diverse and differentiated.
The study of the personal characteristics of children with severe intellectual disabilities showed the possibility of a certain growth in their self-awareness. By the age of 15-16, they may have developed the ability to critically evaluate their own successes in certain types of educational activities.
The above-described features of various aspects of the psyche of children with severe intellectual disabilities are characteristic of the entire category of these children as a whole and are their common features. However, severe mental retardation is always a consequence of significant damage to the central nervous system, which is often combined with deeper damage to individual areas of the brain. This leads to a complication of the overall picture of the mental development of a child with severe intellectual disabilities.
Questions and tasks for self-control:
1. What developmental disorder is called mental retardation? Name its main features.
2. Name the causes of mental retardation. What role do genetic factors play in the development of mental retardation?
3. What is the name of the science that deals with the education and upbringing of mentally retarded children?
4. How, in accordance with ICD-10, are the degrees of mental retardation determined?
5. Observe how the child’s cognitive sphere changes from mild to severe mental retardation.
6. Compare the degrees of mental retardation according to ICD-10 and according to the previously used classification. What developmental disorders are called debility, imbecility, idiocy?
7. What are the characteristic features of the mental development of a mentally retarded young child?
8. What are the characteristic features of the mental development of a mentally retarded child of preschool age?
9. What clinical forms of mental retardation are distinguished in accordance with the classification of M.S. Pevzner?
10. Describe the role of a special school in solving the problem of social adaptation of the mentally retarded.
11. Describe the system of assistance to mentally retarded children in Ukraine.
12. Decipher the concept of “correction”, “compensation”, “adaptation” in relation to mentally retarded children.
Article:
PSYCHOLOGICAL AND PEDAGOGICAL CHARACTERISTICS OF MENTAL RETARDATION.
Issues related to the study of mental retardation are among the most important in defectology. They are dealt with not only by oligophrenopedagogues, but also by specialists in related sciences: psychologists, neuropathologists, psychiatrists, embryologists, geneticists, etc. Attention to the problems of mental retardation is caused by the fact that the number of people with this type of anomaly is not decreasing. This is evidenced by statistical data from all countries of the world. This circumstance makes it paramount to create conditions for maximum correction of developmental disorders in children. In our country, educational work with mentally retarded children is carried out in special preschool and school institutions of the education and health care systems. Children with deep damage to the central nervous system are in orphanages for social protection, where educational work is also carried out with them according to a special program.
In order for the entire pedagogical process to be more effective, it is necessary to properly staff special institutions. Therefore, the task of making the most accurate differential diagnosis arises, but before solving this problem, it is important to know which yetis should be considered mentally retarded, what is unique about their cognitive activity, emotional-volitional sphere and behavior.
Research by scientists (L. S. Vygotsky, A. R. Luria, K. S. Lebedinskaya, V. I. Lubovsky, M. S. Pevzner, G. E. Sukhareva, etc.) gives grounds to classify only those as mental retardation conditions in which there is a persistent, irreversible impairment of primarily cognitive activity caused by organic damage to the cerebral cortex. It is these signs (persistence, irreversibility of the defect and its organic origin) that should be primarily taken into account when diagnosing mental retardation.
Mental retardation is not just a “small amount of intelligence”, it is qualitative changes in the entire psyche, the entire personality as a whole, which are the result of organic damage to the central nervous system. This is a developmental atypia in which not only the intellect suffers, but also emotions, will, behavior, and physical development. This diffuse nature of the pathological development of mentally retarded children follows from the characteristics of their higher nervous activity.
Research by A. R. Luria, V. I. Lubovsky, A. I. Meshcheryakov, M. S. Pevzner and others showed that mentally retarded people have quite severe changes in conditioned reflex activity, an imbalance in the processes of excitation and inhibition, and also disturbances in the interaction of signaling systems. All this is the physiological basis for the abnormal mental development of the child, including cognitive processes, emotions, will, and personality as a whole.
The features of the psyche of the mentally retarded have been studied quite fully (L. V. Zankov, V. G. Petrova, B. I. Pinsky, S. Ya. Rubinshtein, I. M. Solovyov, Zh. I. Shif, etc.) <…> .
The mentally retarded are characterized by underdevelopment of cognitive interests (N.G. Morozova), which is expressed in the fact that they have less need for knowledge than their normal peers.
As research data show, in mentally retarded people, at all stages of the cognition process, there are elements of underdevelopment, and in some cases, atypical development of mental functions. As a result, these children receive incomplete and sometimes distorted ideas about the environment; their experience is extremely poor. It is known that with mental underdevelopment, even the first stage of cognition—perception—is defective. Often the perception of mentally retarded people suffers due to decreased hearing, vision, and underdevelopment of speech, but even in cases where the analyzers are intact, the perception of these children differs in a number of features, as indicated by research by psychologists (K. A. Veresotskaya, V. G. Petrova, Zh. I. Shif). The main disadvantage is a violation of the generality of perception; its slow pace is noted in comparison with normal children. Mentally retarded people need much more time to perceive the material offered to them (picture, text, etc.). The slowness of perception is further aggravated by the fact that, due to mental underdevelopment, they have difficulty identifying the main thing and do not understand the internal connections between parts, characters, etc. Therefore, their perception is also less differentiated. These features during learning are manifested in a slow pace of recognition, as well as in the fact that students often confuse graphically similar letters, numbers, objects, similar-sounding sounds, words, etc.
A narrow scope of perception is also noted. Mentally retarded people pick out individual parts in an observed object or in a listened text, sometimes without seeing or hearing the material that is important for general understanding. In addition, a violation of the selectivity of perception is characteristic.
All noted shortcomings of perception occur against the background of insufficient activity of this process, as a result of which the possibility of further understanding of the material is reduced. Their perceptions need to be guided. Thus, when children are presented with a picture depicting absurd situations (the absurdity of what is depicted is clear to them), there are no pronounced emotional manifestations similar to those observed in children with normal intelligence. This is explained not only by the differences in their emotional reactions, but also by the passivity of the perception process. They do not know how to peer, they do not know how to independently examine, having seen one absurdity, they do not move on to look for the rest, they need constant encouragement. In educational activities, this leads to the fact that children, without stimulating questions from the teacher, cannot complete a task that is understandable to them.
The mentally retarded are characterized by difficulties in perceiving space and time, which prevents them from orienting themselves in their surroundings. Often, even at the age of 8-9, these children do not distinguish between the right and left sides, cannot find their classroom, cafeteria, toilet, etc. in the school premises. They make mistakes when determining the time on the clock, days of the week, seasons, etc. n. Much later than their peers with normal intelligence, mentally retarded people begin to distinguish colors. It is especially difficult for them to distinguish shades of color. Thus, according to Zh.I. Shif, in 14% of cases, pupils of the auxiliary school matched a dark blue color to a dark blue sample and vice versa. This was not observed among secondary school students.
Perception is inextricably linked with thinking. If a student has perceived only the external aspects of the educational material and has not grasped the main thing, the internal dependencies, then understanding, mastering and completing the task will be difficult. Thinking is the main tool of cognition. It occurs in the form of such operations as analysis, synthesis, comparison, generalization, abstraction, and concretization. As studies show (V. G. Petrova, B. I. Pinsky, I. M. Solovyov, N. M. Stadnenko, Zh. I. Shif, etc.), all these operations in mentally retarded people are not sufficiently formed and have peculiar features .
Thus, they analyze objects haphazardly, skip a number of important properties, isolating only the most noticeable parts. As a result of such analysis, they find it difficult to determine connections between parts of the subject. Usually only such visual properties of objects as size and color are established. When analyzing objects, the general properties of objects are distinguished, and not their individual characteristics. Due to the imperfection of the analysis, the synthesis of objects is difficult. By identifying their individual parts in objects, they do not establish connections between them, and therefore find it difficult to form an idea of the object as a whole.
The specific features of thinking in the mentally retarded are clearly manifested in the comparison operation, during which it is necessary to conduct a comparative analysis and synthesis. Unable to identify the main thing in objects and phenomena, they make comparisons based on unimportant characteristics, and often on incomparable ones. It is difficult to establish differences in similar objects and common features in different ones. It is especially difficult for them to establish similarities. So, comparing a pen and a pencil, they are about.
A distinctive feature of the thinking of mentally retarded people is uncriticality and the inability to independently evaluate their work. They often do not notice their mistakes. This is especially pronounced in mentally ill children, in children with damage to the frontal parts of the brain and in imbeciles. As a rule, they do not understand their failures and are satisfied with themselves and their work. All mentally retarded children are characterized by reduced activity of thought processes and a weak regulatory role of thinking. Mentally retarded people usually begin to do work without listening to the instructions, without understanding the purpose of the task, without an internal plan of action, and with weak self-control.
The characteristics of children’s perception and comprehension of educational material are inextricably linked with the characteristics of their memory. The basic processes of memory - memorization, preservation and reproduction - have specific features in mentally retarded people, since they are formed under conditions of abnormal development. They better remember external, sometimes random, visually perceived signs. It is more difficult for them to recognize and remember internal logical connections. In the mentally retarded, voluntary memorization is formed later than in their normal peers, while the advantage of intentional memorization in the mentally retarded is not as pronounced as in schoolchildren with normal intelligence. As noted by L.V. Zankov and V.G. Petrova, the weakness of the memory of mentally retarded people is manifested in difficulties not so much in obtaining and storing information, but in reproducing it, and this is their main difference from children with normal intelligence. Reproduction is a very complex process, requiring great volitional activity and focus. Due to a lack of understanding of the logic of events, the reproduction of mentally retarded people is unsystematic. Immaturity of perception and inability to use memorization and recollection techniques lead mentally retarded people to errors in reproduction. The greatest difficulties are caused by the reproduction of verbal material. Indirect semantic memory is poorly developed in mentally retarded people.
It is also necessary to point out such a feature of memory as episodic forgetfulness. It is associated with overwork of the nervous system due to its general weakness. Mentally retarded people more often than their normal peers experience a state of protective inhibition.
Children with mental retardation also have difficulties in reproducing images of perception - ideas. Undifferentiation, fragmentation, similarity of images and other disturbances of ideas negatively affect the development of cognitive activity of the mentally retarded.
In order for children to learn more successfully and be creative, a sufficiently developed imagination is necessary. In mentally retarded people it is fragmented, inaccurate and sketchy. Since their life experience is poor and their mental operations are imperfect, the formation of imagination proceeds on an unfavorable basis.
Along with the indicated features of mental processes, mentally retarded people have deficiencies in the development of speech activity, the physiological basis of which is a violation of the interaction between the first and second signaling systems.
According to experts (M. F. Gnezdilov, V. G. Petrova, etc.), all aspects of speech suffer in mentally retarded people: phonetic, lexical, grammatical. Difficulties in sound-letter analysis and synthesis, perception and understanding of speech are noted. As a result, various types of writing disorders, difficulties in mastering reading techniques, and a reduced need for verbal communication are observed.
Mentally retarded children have more pronounced attention deficits than their normal peers: low stability, difficulties in distributing attention, slow switching ability. With oligophrenia, involuntary attention suffers greatly, but it is its voluntary side that is predominantly underdeveloped (I. L. Baskakova). This is due to the fact that mentally retarded children, when difficulties arise, do not try to overcome them. They usually quit their job in this case. However, if the work is interesting and feasible, it will maintain children's attention without requiring much stress from them. The weakness of voluntary attention is also manifested in the fact that during the learning process there is a frequent change of objects of attention, the inability to concentrate on any one object or one type of activity.
Mental retardation manifests itself not only in the immaturity of cognitive activity, but also in a violation of the emotional-volitional sphere, which has a number of features. There is underdevelopment of emotions, there are no shades of experiences. A characteristic feature is the instability of emotions. The state of joy without any particular reason is replaced by sadness, laughter by tears, etc. Their experiences are shallow and superficial. In some mentally retarded people, emotional reactions are not adequate to the source. There are cases of either increased emotional excitability or pronounced emotional decline (pathological emotional states - euphoria, dysphoria, apathy).
It is also necessary to take into account the state of the volitional sphere of the mentally retarded. The weakness of their own intentions, motives, and great suggestibility are the distinctive qualities of their volitional processes. As researchers note, mentally retarded children prefer the easy way in work, which does not require volitional efforts. That is why imitation and impulsive actions are often observed in their activities. Due to the unbearable demands made, some children develop negativism and stubbornness.
All these features of the mental processes of mentally retarded students influence the nature of their activities. The psychology of activity has been deeply studied by defectologists G. M. Dulnev, B. I. Pinsky and others. Noting the undeveloped skills of educational activity, one should first of all note the underdevelopment of the purposefulness of activity, as well as the difficulties of independent planning of one’s own activity. Mentally retarded people begin work without the necessary prior orientation in it and are not guided by the ultimate goal. As a result, in the course of work, they often move away from the correctly started execution of an action, slip into actions performed earlier, and carry them over unchanged, not taking into account the fact that they are dealing with a different task. This departure from the set goal is observed when difficulties arise, as well as in cases when the immediate motives of activity are leading (“just to get it done”). Mentally retarded people do not correlate the results obtained with the task that was set before them, and therefore cannot correctly evaluate its solution. Lack of criticism towards their work is also a feature of these children’s activities.
These are the most characteristic features of the course of cognitive and emotional-volitional processes of mentally retarded people.
Disturbances of higher nervous activity and underdevelopment of mental processes are the cause of a number of specific personality traits of mentally retarded people. Psychologists (A. D. Vinogradova, N. L. Kolomensky, Zh. I. Namazbaeva, etc.) point out that, unlike peers with normal intelligence, mentally retarded people are characterized by limited ideas about the world around them, primitive interests, needs and motives . All activities are reduced. These personality traits make it difficult to form healthy relationships with peers and adults.
All noted features of the mental activity of mentally retarded children are persistent, since they are the result of organic lesions at different stages of development (genetic, intrauterine, during childbirth, postnatal).
Although mental retardation is considered an irreversible phenomenon, this does not mean that it cannot be corrected. V.I. Lubovsky, M.S. Pevzner and others note positive dynamics in the development of mentally retarded children with properly organized medical and pedagogical influence in special (correctional) institutions.
DISTINCTION OF MENTAL RETARDATION FROM SIMILAR CONDITIONS. One of the most important tasks of psychological and pedagogical diagnostics is to distinguish mental retardation from similar conditions. Much credit for the development of these issues belongs to defectologists T. A. Vlasova, G. M. Dulnev, A. R. Luria, M. S. Pevzner, Zh. I. Shif and others. The problem of differential diagnosis in connection with acquisition institutions for mentally retarded children was the subject of discussion at the International Conference held in 1964 in Copenhagen. Even then, it was pointed out that only psychometric assessments were insufficient in diagnosing mental retardation, and tasks were set to develop research methods and criteria for distinguishing mental retardation from borderline, similar conditions.
What conditions cause the greatest difficulties in differential diagnosis?
As a rule, the reason for questioning the usefulness of the intellect of a school-age child is his underachievement, which is revealed in the learning process. Equating academic failure with mental retardation is a gross and dangerous theoretical and practical mistake.
In the works of teachers and psychologists Z. I. Kalmykova, N. A. Menchinskaya, A. M. Gelmont, L. S. Slavina and others, devoted to the study of the causes of academic failure, it is indicated that in most cases, academic failure is not caused by impairments in cognitive activity, but is caused by other reasons.
One of the most common reasons for academic failure is the unpreparedness of children for schooling, the lack of development of prerequisites for it and activity skills. Children are not accustomed to obeying requirements, do not know how to complete a task, or be attentive while completing a task. They are restless and unfocused in their work. In cases where a child ends up in a school, in a class with a low level of educational process (the didactic principles of the lesson are violated, the teacher’s pedagogical qualifications are low, the individual characteristics of students are ignored, etc.), his academic performance develops into pedagogical neglect.
Often the cause of academic failure is the child’s unfavorable living conditions in the family: lack of control and assistance in learning from parents, non-compliance with the daily routine, conflict situation in the family, etc. Particularly severe consequences are observed in cases where social and pedagogical disadvantage occurs in the early months and years of the child's life. If in early and preschool age children were deprived of emotionally positive contact with parents, other adults and children, when they had to stay in preschool boarding institutions for a long time, pedagogical neglect may occur, manifested in the fact that these children have a poor supply of general information and representations, limited vocabulary, do not know basic logical operations. These children have a lower stock of knowledge and ability to acquire new knowledge than their peers, so already in the 1st grade they are among the underachievers. <…>
Poor academic performance can also be associated with the asthenic state of the child caused by a long-term illness, as a result of which the child quickly gets tired, memory and attention are weakened, and behavior is disrupted. But all this is not permanent and is not based on organic disorders.
In all these cases, the creation of favorable living conditions, primarily a protective pedagogical regime, is required in order for underachievement to be overcome. It is necessary to establish the causes of academic failure (inability to learn, gaps in knowledge, negative attitude towards learning, conflict situations at school, in the family, etc.) and eliminate them, developing the child’s potential capabilities.
The most difficult in diagnostic terms are children with mental retardation (MDD), who also turn out to be unsuccessful already in the first years of education. Currently, this category of children has been deeply and comprehensively studied both from the clinical and psychological-pedagogical sides. Here we do not dwell in detail on the etiology and main signs, but indicate only the most significant features of the mental activity of children with developmental delays for differential diagnosis.
Depending on the origin (cerebral, constitutional, somatogenic, psychogenic), and the time of exposure of the child’s body to harmful factors, mental retardation gives rise to different types of deviations in the emotional-volitional sphere and in cognitive activity.
Delays in mental development of cerebral origin due to chromosomal abnormalities, intrauterine lesions, and birth injuries are more common than other types and represent the greatest difficulty in distinguishing them from mental retardation.
Studies by defectologists (V.I. Lubovsky, K.S. Lebedinskaya, M.S. Pevzner, N.A. Tsypina, etc.) indicate that when mental development is delayed, there is uneven formation of mental functions, and is noted as damage, and underdevelopment of individual mental processes. In oligophrenia, the totality and hierarchy of the lesion are characteristic.
Scientists who studied mental processes and learning opportunities for children with mental retardation (T. V. Egorova, G. I. Zharenkova, V. I. Lubovsky, N. A. Nikashina, R. D. Triger, N. A. Tsypina, S. G. Shevchenko, U. V. Ulienkova, etc.), identified a number of specific features in their cognitive, personal, emotional-volitional sphere and behavior. The following main features of children with mental retardation are noted: increased exhaustion and, as a result, low performance, immaturity of emotions, weakness of will, psychopathic behavior, a limited supply of general information and ideas, poor vocabulary, difficulties in sound analysis, immaturity of intellectual activity skills. Game activity is also not fully formed. Perception is characterized by slowness. In thinking, a lack of verbal and logical operations is revealed. When a task is presented in a visually effective way, the quality of its implementation improves significantly. To assess the level of development of thinking during a psychological and pedagogical examination, it is necessary to compare the results of the child’s work with verbal, logical and visually effective material.
These children suffer from all types of memory and lack the ability to use aids for memorization. A longer period is required to receive and process sensory information. Attention is unstable.
In addition, there is a low skill of self-control, which is especially evident in the process of activity. By the beginning of school, these children, as a rule, have not formed the basic mental operations - analysis, synthesis, comparison, generalization; they do not know how to navigate the task, do not plan their activities, and do not retain the terms of the task. But, unlike the mentally retarded, they have higher learning ability, they use help better and are able to apply the shown method of action when performing similar tasks.
When examining reading, writing, and counting, they often reveal errors of the same type as the mentally retarded, but nevertheless they have qualitative differences. Thus, with poor reading technique, children with mental retardation always try to understand what they read, resorting, if necessary, to repeated reading. People with mental retardation have no desire to understand, so their retelling may be inconsistent and illogical. The letter notes unsatisfactory calligraphy skills, negligence, etc., which, according to experts, may be due to underdevelopment of motor skills and spatial perception. Sound analysis is difficult for children with mental retardation. In the mentally retarded, all these shortcomings are more severely expressed.
In mathematics, there are difficulties in mastering the composition of numbers, counting by passing through ten, in solving problems with indirect questions, etc., but the help here is more effective than for the mentally retarded. Taking this into account, when making differentiated diagnostics, it is necessary to conduct an examination of children in the form of a teaching experiment.
These are some of the characteristics of children with mental retardation, who are often referred to medical and pedagogical commissions.
An apparent similarity with mental retardation may also occur when the activity of the analyzers is disrupted. These disorders create certain difficulties in the cognitive activity of children, and in a school environment they give rise to poor performance. Therefore, distinguishing these disorders from mental retardation is an urgent task.
Even minor dysfunctions of the analyzers can lead to an incomplete and sometimes distorted reflection of the outside world, to an impoverished range of ideas, and inappropriate behavior if the compensatory capabilities of the central nervous system and special technical means (hearing aids, glasses, etc.) are not used. Thus, hearing loss can cause certain difficulties when a child is studying at school, especially when mastering literacy. Children with reduced vision do not see lines, confuse images that are similar in outline, etc. Inappropriate requirements quickly tire the child, make learning unsuccessful in normal school conditions, worsening his general condition.
Children with visual and hearing defects find themselves helpless in simple situations and give the impression of being mentally retarded. But if you offer a hearing-impaired person a task of a logical nature that does not require perfect hearing from him (classification, arranging pictures taking into account cause-and-effect relationships, etc.), and the visually impaired person is offered corresponding oral tasks, then they complete them. When distinguishing conditions caused by disturbances of analyzers from mental retardation, it is necessary to find out what primarily dominates the lag: mental retardation is the leading and primary defect, and decreased hearing and vision only accompany it, or the lag occurred as a result of dysfunction of the analyzers. It is important to consider the time of damage to the analyzer. The earlier the disease process occurs, the more severe the consequences. Depending on the diagnosis, the question of what special school the child needs will be decided.
In addition, it is very important to separate normal children with speech disorders from mentally retarded children, for whom speech disorders are one of the characteristic features.
There are different types of speech disorders that have varying degrees of severity depending on the strength and time of the lesion. These are children with normal intelligence, but who have difficulty mastering reading and writing, and some of them have general underdevelopment of speech. Even though the auditory analyzer is intact, these children suffer from phonemic hearing, which leads to difficulties in learning (they do not clearly perceive spoken speech, do not differentiate similar sounds, so sound-letter analysis is difficult, etc.). In case of severe impairment of phonemic hearing, underdevelopment of the entire speech function occurs. Pronunciation problems also affect literacy acquisition. All this should be taken into account when conducting a speech therapy examination.
The preservation of the intelligence of children with speech impairments is clearly visible when performing tasks that do not require speech (visual techniques with “non-speech” instructions). These children have a lively reaction and adequate behavior. This is what primarily distinguishes them from the mentally retarded.
All of the listed temporary difficulties in cognitive activity and disorders of the central nervous system, if the attention of the school and family is not promptly drawn to them, can lead to the so-called pedagogical neglect, which is most often identified with mental retardation.
The difficulty in determining mental retardation lies in the fact that, unlike other anomalies (deafness, blindness), for mental retardation there is no absolutely objective criterion, no scale by which it could be measured.
