International magazine
The development of a child with intellectual disabilities from the first days of life differs from the norm. In many children, the appearance of erect standing is delayed, i.e. They begin to hold their head up, sit, stand, and walk much later. This delay is sometimes quite significant, extending into the second year of life [1].
Let us consider the developmental features of a child with intellectual disabilities in the following age periods: infant, early, preschool and school age.
Infancy. All children with intellectual disabilities have a reduced reaction to external stimuli, indifference, and general pathological inertia (which does not exclude loudness, anxiety, irritability, etc.). They do not have a need for emotional communication with adults; as a rule, there is no “revival complex,” while a normally developing child, in response to an adult’s voice or smile, throws up his arms and legs, smiles, and hums quietly [2].
In the future, children with intellectual disabilities do not develop interest in toys hung above the crib or in the hands of an adult. There is no timely transition to communication with adults based on joint actions with toys, and a new form of communication—gesture—does not arise. Children in the first year of life do not differentiate between “their” and “strangers” adults, although with normal development this is observed already in the first half of life [3].
Children with intellectual disabilities do not have active grasping, they do not develop visual-motor coordination and perception of the properties of objects (large and small objects; normally developing children grasp differently, depending on the shape), as well as the selection of objects from a number of others [4].
In these children, the prerequisites for speech development are not formed in a timely manner: objective perception and objective actions, emotional communication with adults and, in particular, pre-speech means of communication (facial expressions, pointing gestures).
The developmental influence of an adult, in many cases, is not carried out, and the zone of proximal development does not expand. The sensitive period for the formation of many physical capabilities and mental processes has been missed [5].
Early age (from 1 year to 3 years). For many children with intellectual disabilities, learning to walk is delayed for a long time, sometimes until the end of early childhood. When moving, instability, clumsiness of gait, slowness or impulsiveness of movements are observed [6].
With the development of walking, a new stage in development begins, and the rapid development of objective actions begins.
Not every child’s action with an object is an objective action. An object action is only an action when an object is used in accordance with its functional purpose. So, for example, if a child picks up a spoon and knocks on the table with it, this is not an objective action, but manipulation with an object, since the function of the spoon is different; objective, the action will be when the child uses a spoon to eat [7].
Development of subject activity.
In young children with intellectual disabilities, object-based activity is not developed. Some of them show no interest in objects, including toys. They do not pick up toys at all or manipulate them. They do not only have an orientation like “What can you do with this?”, but also a simpler orientation like “What is this?” In other cases, children of the third year of life begin to manipulate objects, which are interspersed with inappropriate actions [8].
Inappropriate actions are those actions that contradict the logic of using an object and come into conflict with the role of the object in the objective world. For example, when a child first puts a cap on the stem of a pyramid and then tries to string rings; knocks the doll on the table; trying to fit a large car into a small garage, etc. - this means he is committing inappropriate actions. In this case, there is no cognitive-orienting activity and these actions do not contribute to the development of the child. The presence of inappropriate actions is a characteristic feature of a child with intellectual disabilities [9].
Other types of children’s activities do not develop independently either—playing, drawing, the beginnings of work activity, which, with normal intelligence, develop by the end of the third year of life [10].
Development of speech and communication.
Children with intellectual disabilities at an early age do not have the necessary prerequisites for the formation of speech: actions with objects, emotional communication with adults, readiness of the articulatory apparatus and phonemic hearing. For most children with intellectual disabilities, the first words in active speech appear after two years. The phrase, as a rule, does not appear until the age of three [11].
The main thing is that the speech of a young child with intellectual disabilities cannot serve either as a means of communication or as a means of conveying social experience to the child. She also cannot assume the function of regulating his actions [8].
Preschool age. Preschoolers with intellectual disabilities do not develop play, work, productive activities, as well as communication as they should at this age. This is due to the immaturity or insufficient development of mental processes: attention, perception, memory, thinking.
Thus, the leading play activity for preschool children is at the initial stage of development by the end of preschool age. In children, only object-based play and procedural actions are observed. They are characterized by repeated, stereotypical repetition of the same actions, carried out without emotional reactions, without the use of speech (L.B. Baryaeva, A.P. Zarin, N.D. Sokolova, O.P. Gavrilushkina) [9] .
Children with intellectual disabilities master self-care skills at a later date than their typically developing peers.
Without special training, they do not develop productive activities - drawing, modeling, appliqué, design.
In the cognitive sphere, attention disorders come to the fore: children’s attention is difficult to gather, they cannot concentrate on completing a task, they have increased distractibility and absent-mindedness. Preschoolers with intellectual disabilities are attracted to bright, colorful objects and toys, but they quickly lose interest in them [2].
At this age, memory impairments appear. It is especially difficult for them to remember instructions that determine the sequence of actions.
The leading form of thinking in preschoolers with intellectual disabilities is visual-effective thinking, although it does not reach the same level of development as in normally developing children. By the end of preschool age, children with intellectual problems who do not receive special correctional assistance “virtually lack the ability to solve visual-figurative problems” [10].
We can say that by the end of preschool childhood, children with intellectual development problems who have not undergone special training lack readiness for educational activities. Disturbances in mental development that are not corrected in a timely manner are aggravated, becoming more pronounced and vivid [11].
School age. The leading activity of school-age children is educational, which has a number of features for children with problems of intellectual development.
In physical development, children with intellectual disabilities lag behind their normally developing peers. It is quite difficult for schoolchildren with intellectual disabilities to maintain a working posture throughout the entire lesson; they get tired quickly. Children's performance in the classroom is reduced [12].
Attention in children with intellectual disabilities is characterized by a number of features: the difficulty of attracting it, the impossibility of long-term active concentration, quick and easy distractibility, instability, absent-mindedness, low volume (I.L. Baskakova, S.V. Liepin, M.P. Feofanov, etc. .). A student with an intellectual disability may pretend to be an attentive student in class, but at the same time not hear the teacher’s explanations at all. In order to combat this phenomenon (pseudo-attention), the teacher, during the explanation, should ask questions that reveal whether the students are following his train of thought, or offer to repeat what was just said [7].
Perception in children with intellectual disabilities is also characterized by a number of features. Their perception speed is noticeably reduced. In order to learn an object or phenomenon, schoolchildren with intellectual disabilities need more time compared to their normally developing peers (K.I. Veresotskaya). This feature is important to take into account in the educational process: the teacher’s speech should be slow so that students have time to understand it, it is necessary to give more time to look at objects, paintings, and illustrations [13].
Schoolchildren with intellectual disabilities have a reduced volume of perception, that is, the simultaneous perception of a group of objects. The narrowness of perception makes it difficult for students to master reading, calculations with multi-digit numbers, etc.
In children with insufficient intelligence, spatial perception and spatial orientation are significantly impaired, which makes it difficult for them to master such academic subjects as mathematics, geography, history, etc. [5].
The perception of paintings presents great difficulties for them (K.I. Veresotskaya, I.M. Solovyov, N.M. Stadnenko). They, as a rule, do not see connections between characters, do not understand cause-and-effect relationships, do not understand the emotional states of the characters depicted, do not see the plot, do not understand the depiction of movement, etc.
Children with intellectual disabilities have speech development disorders. In this case, all components of speech suffer: vocabulary, grammatical structure, sound pronunciation. By the time they start school, they have a limited vocabulary that consists mainly of nouns and verbs.
Impaired ability of thought processes - analysis, synthesis, abstraction, comparison. The thinking of children with intellectual disabilities is characterized by inertia and stiffness [14].
Classification of mental retardation according to the epigenetic principle. Causes of mental retardation
- 75% of cases of mental retardation are a delay of cerebral-organic origin, that is, it is based on insufficient functioning of the brain and its pathways (often the consequences of an unsuccessful pregnancy, problems during childbirth, etc.).
- ZPR of constitutional origin. The so-called harmonious infantilism, when psychophysically the child is somewhat behind his peers. This is due to hereditary reasons. A child may be more suggestible and emotional than his peers. In general, he looks younger (the difference with his real age is 1-1.5 years).
- ZPR of somatogenic origin. Here the delay is due to the weakening of the body, frequent, chronic somatic diseases of the child. The general tone of the child’s body and psyche is reduced. Often the situation is complicated by overprotection from the family.
- Mental retardation of psychogenic origin (this also includes pedagogical neglect). The reason is unfavorable psychosocial conditions. Previously, it was generally accepted that such a delay could only occur in children from disadvantaged families (unemployed, parasites, alcoholics, etc.). Nowadays, there are increasingly cases where, despite financial wealth, the type of upbringing in the family is inharmonious, in particular, the child does not develop the necessary level of self-regulation, awareness, self-care due to overprotection, inconsistency, educational insecurity, and anxiety of parents.
The difference between mental retardation and mental retardation
Differential diagnosis of these two conditions can be carried out from 5-5.5 years. That is, it turns out that up to 5 years of age, doctors (neurologists, psychiatrists) in practice write “CPR” in the conclusion, and then a diagnosis is made (remember that, according to the current international classification of diseases, CPR is not a medical diagnosis).
In order to reliably separate MR from ZPR, it is necessary to conduct a diagnosis using the Wechsler children's test. There are other diagnostic tools that help to “measure” the degree and structure of mental retardation, but at the moment only according to Wechsler there is a clear gradation: with UL the child scores less than 69 points. In this case, it is optimal to conduct testing at the age of about 8 years. Both in practice and according to the test results, there is a “layer” of children who have a fairly severe developmental delay on a cerebral-organic basis, but nevertheless do not yet belong to the category of developmental disabilities.
Differences between MA and ZPR in practice:
- A child with ID has no cognitive interest;
- Does not transfer the learned material to another similar one;
- After a break in classes, it’s “like a blank slate,” that is, what has been covered is very poorly absorbed and is not updated;
- The difference between the current level of development and biological age is more than 2 years;
- Children with ID do not develop abstract thinking;
- A child with mental retardation shows better dynamics and also successfully copes with tasks from the “zone of proximal development” with the help of an adult;
- Presenting the material in a playful manner improves the results of a child with mental retardation, while with mental retardation the child slips from the task into the game;
- Visual activity in children with mental retardation is, as a rule, better developed.
Psychological classification of mental retardation, according to N.Ya. and N.N. Semago
This classification of mental retardation reflects not the causes, but the structure of the disorder.
In the group of child development disorders, the Semago couple distinguishes two fundamental categories:
- Arrested development;
- Partial (partial) immaturity of higher mental functions (and here there will be three options).
In essence, these will all be variants of the ZPR, but with a different structure. We'll look at the first category. It can be called “true ZPR”, because It is the representatives of this category that are characterized by a slower rate of mental maturation. Here the authors distinguish harmonious infantilism and disharmonious infantilism. As the name implies, harmonic means uniform, and disharmonious means the opposite.
Harmonic infantilism ZPR
As mentioned above, such a child looks 1-1.5 years younger than his age. Intellectual and emotional development corresponds to the age he appears to be. All spheres of the psyche are uniformly delayed, that is, the child matures later due to his constitution (the action of hereditary factors is possible). The emotional and cognitive spheres of the child correspond to the level characteristic of a younger age. A child with harmonious infantilism is more suggestible, naive, his emotions are more vivid and spontaneous, even for a schoolchild play motives in activities predominate. They quickly become fed up with intellectual activity, although they are often tireless in the game. They find it difficult to follow established rules of behavior (for example, at school).
No specific correction is required for this type of DPR. They should be sent to school as late as possible, ideally closer to 8 years of age. It is necessary to create a developmental and preventive environment, that is, to ensure that the child passes all normative levels of development and develops the necessary abilities for school, “mature.” Some children of this type need speech therapy. It is important to follow a daily routine, general strengthening moments, and supervision of a good pediatrician. To develop self-regulation, games with rules are suitable (any kind, it is important that the child learns to act according to the rules and learns to wait his turn). To develop coordination and improve performance, it is good to use motor neurocorrection. The prognosis is favorable. Such a child does not need a defectologist-oligophrenopedagogist.
Disharmonic infantilism (unevenly delayed type)
Such a child often also looks younger than his age. Chronic diseases (for example, allergies, visual impairment, diseases of the digestive and respiratory systems), and somatic weakness are typical. Also, the authors of the classification note that children with disharmonic infantilism often have a violation of interhemispheric interaction (left-handedness, unsettled choice of the dominant hand). At the same time, disharmony manifests itself in the fact that the intellectual sphere is ahead of the emotional-volitional sphere. Such children have weak voluntary self-regulation, they can be capricious, emotionally unstable, unbalanced, easily exhausted, and insufficiently critical of themselves. Self-esteem is often either overestimated or underestimated. Learning ability can be at a high level. Spatial representations as the basis of nonverbal intelligence can also develop ahead of schedule.
Correction for this type of mental retardation should include harmonization of the emotional sphere (art therapy, sand therapy, as well as family psychotherapy with an emphasis on child-parent relationships are well suited here), motor neurocorrection (improving neurodynamics, interhemispheric interaction, performance), development of programming functions and control – frontal lobes (as part of cognitive neurocorrection), observation and treatment by specialized doctors for somatic problems. The prognosis is favorable intellectually, but personally there are risks of developing accentuations, psychopathy, and deviant behavior.
Partial (partial) immaturity of the HMF (higher mental functions)
In the group of insufficient development (ID), according to Semago’s classification, two subgroups are distinguished: delayed development (“true” LD - harmonious and disharmonious infantilism) and partial immaturity of higher mental functions.
With harmonious and disharmonious infantilism, the psyche goes through all stages in the process of development, and functions mature. That is, by the age of 9-11, the child catches up with his peers.
In the case of a partially unformed HMF, the development of events is different. This is not just a tempo delay in the maturation of the psyche. Such a child is characterized by a different structure of the disorder. We can say that some parts of the psyche do not mature to normal levels. It turns out to be a kind of “mosaic” of mature and immature HMFs. Moreover, since all mental functions influence each other, after the age of 8-9 years this type of disorder can be classified as disharmonious (that is, we are talking about a distortion of personal development) or total underdevelopment (mental retardation, if the situation was borderline) .
In this case, the partial immaturity of the HMF is of cerebral-organic origin (that is, there is brain damage).
There are three types in this category:
Partial unformation of the HMF with a predominant unformation of the regulatory component.
Imagine a “classic” child with ADHD. Characteristic:
- Impulsiveness;
- Motor and often speech disinhibition;
- Difficulties of voluntariness in activity (when it’s interesting, it does it easily; and when it’s “necessary”, the volitional component cannot ensure concentration);
- The predominance of gaming interests over cognitive ones;
- With sufficiently strict control on the part of an adult, they are capable of performing cognitive tasks;
- There may be difficulty understanding complex speech patterns.
Correction:
- Neuropsychological correction for the formation of programming functions in activity, self-control, self-regulation;
- Psychological assistance to the child and family according to the situation;
- Observation by a pediatric neurologist and/or psychiatrist.
At the same time, the child is physically developed according to his age.
Prognosis: manifestations remain into adulthood, but in general, with early help, the prognosis is favorable. In the worst case, there are risks of personality disorders, secondary learning problems, deviant and antisocial behavior.
Partial immaturity of the HMF of the predominantly verbal and verbal-logical components.
This group includes the majority of so-called “speech” children who previously had the following diagnoses: “DDG”, “ONR”, “CHD”, “developmental dysphasia”, “alalia”.
This violation is characterized by:
- Low speech activity, specificity of speech;
- Sound pronunciation disorders;
- Difficulties in understanding grammar, logical-grammatical constructions;
- Motor clumsiness, dyspraxia;
- When tested, nonverbal intelligence exceeds verbal intelligence;
- In speech there can be semantic substitutions (means one thing, but says another word);
- Often – difficulties in forming spatio-temporal concepts;
- Anxiety, lack of self-confidence;
- Stuttering, tics, and enuresis may occur;
- There may be difficulties in interhemispheric interaction (left-handedness, unsettled choice of the dominant hand);
- Such children may be somatically weakened - allergies, diseases of the gastrointestinal tract, respiratory.
Correction:
- Speech pathologist-defectologist for a long term (several years, including primary school);
- Neuropsychological correction should include the formation of spatiotemporal concepts and the development of interhemispheric connections;
- If the correction begins late, a defectologist-oligophrenopedagogist (since thinking suffers a second time);
- If necessary, provide psychological assistance to the child and family.
Prognosis: with early and well-structured correction, quite favorable. In the worst case (if recommendations are not followed and activities are started late): the risk of developing emotional disturbances, learning problems, and perpetuating speech pathology. At school there is an increased risk of developing dyslexia and dysgraphia. Such children are often diagnosed with “neurosis-like syndrome” by a neurologist.
Partial immaturity of mixed type HMF.
This is the most difficult option in correctional and diagnostic terms, intermediate between mental retardation and mental retardation. These children are characterized by:
- Severe adaptation problems, low adaptive capabilities;
- Low activity, low performance;
- Against the background of fatigue - manifestations of impulsiveness;
- Insufficient formation of thinking operations;
- Underdevelopment of various forms of perception, including phonemic hearing;
- During the learning process, transfer to similar material is difficult;
- Difficulty concentrating and poor memory;
- Low self-esteem, increased level of anxiety;
- There may be protest forms of behavior;
- Lack of formation of spatial representations;
- Difficulties in understanding complex speech structures.
Correction:
- Increasing the level of general activity and tone (including exercise therapy);
- Classes with a defectologist-oligophrenopedagogue;
- Correctional school;
- Classes on the formation of the regulatory component of the psyche and spatial representations (neuropsychologist);
- If necessary, help from a psychologist to the child and family.
Prognosis: depending on the quality of correction, the social and family environment is very different.
