Psychomotor disinhibition syndrome. Perceptual disorders
Hyperdynamic syndrome or motor disinhibition syndrome, manifests itself primarily in the form of excessive motor mobility, restlessness, and fussiness.
In this case, the so-called fine motor skills suffer; the child’s movements are not precise, sweeping, and somewhat angular. Very often the coordination of movements and their purposefulness are impaired. Such children are usually incompetent. Along with this, self-care skills suffer; it is difficult for them to go to the toilet, brush their teeth, and wash themselves. The simple procedure of washing your face and brushing your teeth in the morning can easily turn into a morning bath.
Hyperdynamic syndrome. A hyperactive child has sloppy writing with blots and clumsy drawings. Hyperdynamic syndrome in children is always combined with unstable attention and lack of concentration. They are characterized by increased distractibility during any activity. All this is often combined with increased fatigue and early exhaustion. Motor disinhibition syndrome is typical for children of preschool and early school age.
In kindergartens, hyperactive children are called fidgets. They are constantly on the move, like clockwork ones running around on the playground, changing toys in the game at great speed, trying to take part in several games at the same time. It is very difficult to attract the attention of such an “enthusiastic” child. It is very difficult to put a hyperactive child to rest during the day, and if this is possible, the sleep is not long and the child wakes up wet from sweat. It is characterized by increased sweating. Vessels often appear on the forehead and temples, and some blueness can be seen under the eyes.
Hyperactive children do not sit still, even in elementary school. Their attention constantly switches from one activity to another. Such children often stand up during lessons and walk around the class. It is extremely difficult for them to stay in one place, much less sit through the entire lesson at their desk. A hyperactive child is characterized by a situation in which he falls into the category of hooligans with pedagogical neglect precisely because of increased fatigue and exhaustion. By the end of the lesson, such a child can literally jump at his desk, often changing his position and attracting the attention of other children.
The described behavior of hyperactive children is often accompanied by other “extra” movements, when movements are repeated several times, like tics.
If you notice behavior similar to that described in your child, do not delay a visit to a child psychiatrist. In most cases, hyperactivity in children can be eliminated.
3.Basic principles of treatment of mental disorders in children.
Understanding the uniqueness of the clinical picture of mental disorders in children, its atypicality, variability, and connection with age-related somatic and mental characteristics allows us to formulate general principles of their treatment, but cannot predetermine all therapy - in full and to the smallest detail. Therapy is always individual, it depends on the time of its start, effectiveness, and the reaction of the child’s personality both to the disease and to the intervention itself
The choice of therapy for psychosomatic disorders in children should be based on some fundamental principles that guide the search for the most appropriate methods and means. They offer the following principles, which can be used not only by a doctor, but also by a special psychologist during therapeutic interventions in children and adolescents with mental disorders [Kagan V. E., 1996]
Systematic principle. Complex, combination therapy for mental disorders is advisable, i.e. the need for combined, simultaneous, parallel effects on the biological and mental components of the disease. Analysis of failures shows that they arise when influencing individual structures, without affecting what makes the disease a disease - systemic functional connections. For example, when conducting hypnotherapy, given the fundamental uniformity of this method, which reduces anxiety, when working with girls it is more appropriate to activate them (for example, “the heart beats confidently, evenly, strongly”), and when working with boys it is more correct to prefer somatic relaxation (for example, “the heart it works smoother, calmer, reminds us less of itself").
The principle of a therapy clinic. The same disease in the same child at different stages of treatment represents different aspects of pathogenetic mechanisms. An example would be the therapy of neurosis, when the successful use of psychotherapy for phobias and other disorders of a psychogenic nature leads to the fact that residual organic neurosis-like symptoms come to the fore, which are not amenable to psychotherapy, but require the use of medications. The principle of the “therapy clinic” dictates not only the correction tactics, but also determines the means and methods of these tactics.
The principle of individualization. The position that it is not the disease that should be treated, but the patient, must be clarified; it is necessary to treat a certain disease in a certain patient. The principle of individualization is one of the fundamental, but also the most difficult to implement. It equally concerns the choice of drug therapy, and the choice of ways and methods of psychological correction, and psychotherapy. The child is unique as an individual (organism) and as an individual (personality), and even more so as a unity of the individual and the individual.
The principle of mediation. No treatment is free from the effects of psychic mediation. There are several types of it:
Mediation by the child’s own attitudes - fear of treatment, prejudices about the “shamefulness” of the disease and seeking help;
Mediation by parents’ attitudes, when their opinions or feelings directly affect the action of certain therapeutic interventions;
Mediation by the specialist’s attitudes - the effects of using certain means and methods depend on the specialist’s attitude towards them (a doctor or psychologist who believes in a particular method of therapy gets a better effect from his clients than a specialist who doubts this method);
Mediation of psychotherapeutic techniques by the external characteristics of medications) and methods of their administration (implementation) - injections are perceived as a potent drug, and the same drug in tablets is perceived as weaker. Hypnosis in a specially equipped room is perceived by the child as a magical healing agent, and rational therapy in an ordinary office seems like a routine conversation.
The principle of relationships. Any treatment is not an impact on the disease or the patient, but a process of relationship between the specialist and the child (and his family). In this system of relationships there are conscious and unconscious goals, expectations, motivations of all participants in the healing process. At the same time, it is fundamentally important not to reduce the relationship solely to what the psychologist (doctor) and the patient can say about them - the motivation for the relationship is too often not realized. The patient may passionately desire healing, but unconsciously identify the specialist with the unloved parent. A psychologist (doctor) may strive to help a patient, but have unconscious associations of the child with some unpleasant person. Both, and especially the combination of such transference and countertransference, can essentially deprive the relationship of the specialist and the patient of meaning.
The principle of environment. The environment (animate and inanimate) is included in the system of therapeutic relationships and is their essential element. First of all, this concerns the environment of a medical, correctional institution, sanatorium: the emotional atmosphere, comfort and convenience for staff and patients. Unfortunately, the impersonal environment in institutions is often dissonant with the spirit of therapy.
The principle of humanism. Therapy cannot be satisfactory if its means and methods ignore the interests of the child’s personality and its development. No therapeutic goal justifies means that encroach on the child’s personal uniqueness, his right to “be himself,” his sense of self-worth and intimacy - physical and psychological.
The formulated principles acquire effective force if they are actually embodied in the activities of all personnel of the institutions where the child is located.
TICKET No. 19
Among psychomotor disorders Psychomotor disinhibition syndrome occupies a large place in young children. It is most often observed with early organic brain damage. The nature and degree of its severity may vary. Children are disinhibited, constantly on the move, breaking objects, tearing, scratching everything that comes to hand. When tired and before bedtime, motor restlessness usually increases. Psychomotor disinhibition of organic origin is often accompanied by a tendency to rhythmic stereotypes. In some children, against the background of psychomotor disinhibition, poverty of spontaneous activity predominates, in others there is a constant need for changes in actions.
Psychomotor disinhibition usually combined with frequent mood swings towards irritable-gloomy, with increased affective excitability. New distractibility, sleep disturbances, and a number of pathological habits are also noted. Children bite their nails and suck their fingers for a long time and persistently; sometimes pathological attractions are observed (elements of sadism, masturbation, etc.).
Peculiar psychomotor agitation syndrome can also manifest itself in mental illnesses in children, in particular schizophrenia. Psychomotor agitation in schizophrenia is called catatonic. This is an empty, absurd, unmotivated motor excitation, which is accompanied by pretentious stereotypical hand movements, incoherent speech, negativity reactions, echolalia (echo-like repetition of audible words), echopraxia (echo-like repetition of visible movements). A child in a state of such excitement usually does not react to the environment and commits a number of impulsive actions. Schizophrenia is characterized by the replacement of such excitation with more or less prolonged episodes of freezing and stupor.
State of psychomotor agitation may be the equivalent of a seizure. In these cases, psychomotor agitation occurs suddenly, paroxysmally, against the background of depressed consciousness, sometimes accompanied by individual muscle twitching. After the attack, the child does not remember what happened. In some cases, for example, in deep cerebrasthenic conditions, a syndrome of motor retardation occurs.
Perceptual disorders- disturbance of sensations and perception. Many symptoms and syndromes of neuropsychiatric diseases in children are associated with impaired perception. Perceptual disorders may occur in children with early organic brain damage. They are especially pronounced in cerebral palsy, which is characterized by specific sensory disorders (visual, auditory, kinesthetic), as well as disruption of the joint activity of various analyzers. This in turn leads to underdevelopment of Gnostic functions, in particular, optical-spatial gnosis. Young children with cerebral palsy have difficulty distinguishing the shape, size of objects, and their spatial location. In the future, more clear spatiotemporal disturbances may be revealed.
Perceptual disorders are also typical for children with mental retardation, and the severity of the disorders corresponds to the degree of decline in intelligence.
Symptoms of perceptual disorders in young children may manifest themselves in the occurrence of false perceptions (illusions and hallucinations).
Mechanisms of motor disinhibition and specific types of correctional work
Adaptation disorders, manifested in the form motor disinhibition, according to experts, have a variety of reasons: organic, mental, social. However, most authors dealing with the problems of the so-called attention deficit hyperactivity disorder regard it primarily as a result of certain problems of an organic, neurological nature. Motor disinhibition as a disordered behavior has many similarities with other types of deviant development, but at the moment there are criteria for identifying a group of disorders in which hyperactivity is the main problem.
Data on the prevalence of such behavioral disorders vary widely (from 2% to 20% in the pediatric population). It is well known that girls have such problems 4-5 times less often than boys.
Although the hypothesis of the identity of hyperkinetic syndrome and minimal cerebral dysfunction is often criticized, the causes of the disease (or condition) are usually considered to be complications throughout the perinatal period, diseases of the nervous system during the first year of life, as well as injuries and diseases that occurred during the first three years child's life. Subsequently, the majority of children with similar behavior problems are diagnosed with “mild brain dysfunction” or “minimal brain dysfunction” (Z. Trzhesoglava, 1986; T.N. Osipenko, 1996; A.O. Drobinskaya 1999; N.N. Zavadenko , 2000; B.R. Yaremenko, A.B. Yaremenko, 2002; I.P. Bryazgunov, E.V. Kasatikova, 2003).
For the first time, detailed clinical descriptions of functional brain failure appeared in the literature in the 30s and 40s of the last century. The concept of “minimal brain damage” was formulated, which came to mean “non-progressive residual conditions resulting from early local lesions of the central nervous system during the pathology of pregnancy and childbirth (pre- and perinatal), as well as traumatic brain injuries or neuroinfections. Later, the term “minimal brain dysfunction” became widespread, which began to be used “... in relation to a group of conditions that are different in their causes and mechanisms of development (etiology and pathogenesis), accompanied by behavioral disorders and learning difficulties not associated with severe impairments of intellectual development” ( N.N. Zavadenko, 2000). Further comprehensive study of minimal brain dysfunctions showed that they are difficult to consider as a single clinical form. In this regard, for the latest revision of the international classification of diseases ICD-10, diagnostic criteria were developed for a number of conditions previously classified as minimal brain dysfunctions. In relation to problems of motor disinhibition, these are headings P90-P98: “Behavioral and emotional disorders of childhood and adolescence”; rubric P90: “Hyperkinetic disorders” (Yu.V. Popov, V.D. Vid, 1997).
The positive effect of psychostimulants in the drug treatment of children with such disorders is explained by the hypothesis that children with hyperkinetic syndrome, from the point of view of brain activation, are “underexcited”, and therefore excite and stimulate themselves with their hyperactivity in order to compensate for this sensory deficiency. Lowe et al. found insufficient activity of metabolic processes in the anterior regions of the brain in children with signs of disinhibition.
In addition, the period from 4 to 10 years of age is considered the period of the so-called psychomotor reaction (V.V. Kovalev, 1995). It is during this age period that more mature subordination relationships are established between hierarchically subordinate structures of the motor analyzer. And violations of these, “... still unstable subordination relationships, are an important mechanism for the occurrence of disorders of the psychomotor level of response” (cited by V.V. Kovalev, 1995).
Thus, if in preschool age hyperexcitability, motor disinhibition, motor clumsiness, absent-mindedness, increased fatigue, infantilism, and impulsivity prevail among children with signs of minimal brain dysfunction, then among schoolchildren the difficulties of organizing their behavior and academic difficulties come to the fore.
However, as our research and consulting experience show, children with similar behavior problems also have a variety of emotional and affective characteristics. Moreover, in children with behavioral problems of the type of motor disinhibition, usually classified by most authors as a single “hyperactivity syndrome,” often fundamentally different features of the development of the affective sphere as a whole are found that are opposite in sign.
Specifics of our research is that the problems of motor disinhibition were considered not only from the point of view of the characteristics and differences in neurological status, but also affective status. And the analysis of behavioral problems and characteristics of the child was based on identifying not only the causes, but also the psychological mechanisms underlying them.
In our opinion, an analysis of the affective status of children with behavioral problems based on the type of motor disinhibition can be carried out from the point of view of the model of basic affective regulation proposed in the school of K.S. Lebedinskaya - O.S. Nikolskaya (1990, 2000). In accordance with this model, the mechanisms of formation of the child’s affective-emotional sphere can be assessed by the degree of formation of the four levels of the basic affective regulation system (BA levels), each of which can be in a state of increased sensitivity or increased endurance (hypo- or hyperfunctioning).
Working hypothesis was that motor disinhibition itself, which is so identical in its manifestation in most children, can have a different “nature”. Moreover, the latter is determined not only by problems of neurological status, but also by the peculiarities of the tonic support of the child’s vital activity - the level of the child’s mental activity and the parameters of his performance, that is, first of all, it depends on the specific functioning of the levels of basic affective regulation.
Materials and research methods
The analyzed group included 119 children aged 4.5-7.5 years, whose parents complained about motor and speech disinhibition, uncontrollability children, which significantly complicates their adaptation in preschool and school educational institutions. Often children came with existing diagnoses, such as attention deficit hyperactivity disorder, hyperexcitability syndrome, and minimal brain dysfunction.
It should be noted that children whose symptoms of motor disinhibition were part of some more “general” psychological syndrome (total underdevelopment, distorted development, including Asperger’s syndrome, etc.) were not included in the analyzed group.
In accordance with the objectives of the study, a diagnostic block of methods was developed, which included:
1. Detailed and specifically oriented collection of psychological history, where the following was assessed:
features of early psychomotor development;
features of early emotional development, including the nature of interaction in the mother-child dyad (the mother’s main worries and worries regarding her interaction with the child in the first year of life were analyzed);
the presence of indirect signs of neurological distress.
2. Analysis of the features of the operational characteristics of the child’s activity,
3. Assessment of the level of mental tone (for these purposes, together with Candidate of Medical Sciences O.Yu. Chirkova, a special thematic questionnaire for parents was developed and tested).
4. Study of the characteristics of the formation of various levels of voluntary regulation of activity:
simple movements;
motor programs;
voluntary possession of mental functions;
maintaining the activity algorithm;
voluntary regulation of emotional expression.
5. Study of the developmental features of various aspects of the cognitive sphere.
6. Analysis of the child’s emotional and affective characteristics. It should be emphasized that special attention was paid to assessing the general level of mental activity and mental tone of the child.
7. In addition, the type of assistance required by the child when working with certain tasks was necessarily assessed. The following types of assistance were used:
stimulating;
assistance that “tonicizes” the child and his activities;
organizing assistance (that is, constructing an algorithm of activity “instead” of the child, programming this activity and monitoring it by an adult).
Indicators of the level of general mental activity of the child, pace of activity, and other performance parameters were correlated with an assessment of the child’s emotional and affective characteristics. For this purpose, an integral assessment of the profile of bipolar disorder as a whole was carried out, and the states of individual levels of basic affective regulation were also assessed according to O.S. Nikolskaya. In this case, it was assessed which of the BAP levels (1-4) was in a state of increased sensitivity or increased endurance (hypo-or hyperfunctioning).
Research results and discussion
The study revealed significant differences between the manifestations of the developmental features under study. These results made it possible to divide the 119 examined children into three groups:
We assigned 70 children to the first group (20 girls, 50 boys);
the second group consisted of 36 children (15 girls and 21 boys, respectively);
13 children made up the third group.
Specific to children, which we classify as first group, there was a history of indirect or explicit (objectified in medical documents) signs of neurological distress, usually quite pronounced. In the early stages, this was primarily manifested in changes in muscle tone: muscle hypertonicity or muscle dystonia - uneven muscle tone - were much more common. Quite often, already in the early stages of development, a child was diagnosed with perinatal encephalopathy (PEP). Indirect signs of neurological ill-being were manifested during this period by profuse regurgitation, sleep disturbances (sometimes inversion of the sleep-wake regime), and shrill, “heart-rending” screams. Increased muscle tone in the lower extremities - sometimes even the inability to relax the leg muscles - led to the fact that, having risen to his feet early, the child stood “until he dropped.” Sometimes the child began to walk early, and the walking itself was more like an unstoppable run. Children, as a rule, did not accept any “solid” complementary foods well (sometimes until the age of 3-3.5 years they had difficulty accepting solid food).
In mothers' stories about their worries (in 62 out of 70 cases), the most common memory was that the child was very difficult to calm down, he screamed a lot, was in her arms all the time, required rocking, and the constant presence of the mother.
Specific to this type of development was the presence of a significant number of signs of neurological distress in the anamnesis, changes (usually acceleration and, less often, disruption of the sequence) of early motor development. All this, based on the totality of signs, can be qualified as minimal brain dysfunctions, the consequence of which was the insufficient formation of the voluntary (regulatory) component of activity as a whole (N.Ya. Semago, M.M. Semago, 2000).
Thus, the motor disinhibition observed in children of the first group can essentially be considered “primary” and only intensifies in its manifestations when the child is tired.
Children second group demonstrated a deficiency in the regulation of their own activity already at the most elementary levels - the level of performing simple motor tests according to a model (up to the age of 5.5 years) and the level of performing simple motor programs according to a model (for older children). It is quite obvious that hierarchically higher and later developing levels of behavior regulation in general turned out to be clearly deficient in children of this group.
For the children we classified in the second group (36 cases), the following developmental features were specific.
The picture of early development of children did not reveal signs of pronounced neurological ill-being, and from the point of view of timing and pace, early psychomotor and emotional development generally corresponded to average normative indicators. However, somewhat more often than the population average, changes occurred not in the timing, but in the sequence of motor development itself. Doctors identified problems associated with minor disturbances of autonomic regulation, minor eating disorders, and sleep disorders. Children in this group were sick more often, including dysbacteriosis and variants of allergic manifestations more often than the population average in the first year of life.
The mothers of most of these children (27 out of 36) recalled their anxieties about relationships with children in the first year of life as uncertainty in their actions. Often they did not know how to calm the child down, how to feed or swaddle him correctly. Some mothers recalled that they often fed the baby not in their arms, but in the crib, simply supporting the bottle. Mothers were afraid to spoil their children and did not teach them to “handle” them. In some cases, such behavior was dictated by the grandparents, less often by the child’s father (“You can’t pamper, teach him to be rocked, to be handled”).
When examining children in this group, the first thing that caught our attention was a decreased background mood and, most often, low indicators of general mental activity. Children often needed encouragement and a kind of “toning” from an adult. This type of help was the most effective for the child.
The development of the regulatory sphere of these children (in accordance with age) turned out to be sufficient. These children before fatigue sets in(this is of fundamental importance) they coped well with special tests for the level of regulatory maturity and maintained the algorithm of activity. But the ability to regulate emotional expression was most often insufficient. (Although it should be noted that before the age of 7-8 years, healthy children may demonstrate difficulties regulating emotions even in expert situations).
Thus, in general, we can talk about a sufficient level of voluntary regulation of children classified as the second group. At the same time, the level of voluntary regulation of the emotional state was often insufficiently formed, which shows a clear relationship between the formation of the regulation of emotions and emotional expression and the specifics of the formation of the actual affective regulation of behavior.
As for the features of the formation of leveled affective regulation, according to the results of an integral assessment of the child’s behavior and the parents’ responses, a distortion of the proportions of the system was usually observed, as a rule, due to the hyperfunction of the 3rd level of affective regulation, and in severe cases - of the 2nd and 4th levels .
From the standpoint of analyzing affective status, it was often necessary to talk about insufficient affective tonization, already starting from the 2nd level of affective regulation (that is, its hypofunction) and, as a consequence, about a change in the proportions in tonization of the 3rd and 4th levels.
In this case, especially with the onset of fatigue, the affective tonization necessary for solving behavioral problems can be compensatory manifested in the growth of protective mechanisms of the 2nd level of affective regulation.
This kind of “toning” is specific to the hypofunction of the second level of affective regulation (the level of affective stereotypes), and the “unjustified fearlessness” and playing “at risk” that appears in situations of fatigue characterize the features of the third level of affective regulation - the level of affective expansion.
Perhaps, precisely due to the fact that in children with early childhood autism (3rd group of RDA according to O.S. Nikolskaya) there is a “breakdown” of the entire system of affective regulation or a gross distortion of the interaction of this particular level, such children quite often, especially in early and preschool age, ADHD is mistakenly diagnosed.
The emergence of stereotypical motor reactions in children, manifesting themselves as motor disinhibition, in this case has fundamentally different mental mechanisms.
Thus, for children of the second group, various manifestations of motor and speech disinhibition indicate not hyperactivity, but a decrease in mental tone against the background of fatigue and a compensatory need to activate and “tonicize various levels of affective regulation” through motor activity - jumping, stupid running, even elements stereotypical movements.
That is, for this category of children, motor disinhibition is a compensatory reaction to mental exhaustion; The motor excitation occurring in children of this group can be considered compensatory or reactive.
In the future, such behavior problems lead to developmental deviation towards disharmony of the extrapunitive type (in accordance with our typology (2005), diagnosis code: A11 -x).
Analysis of the condition of children of the first and second groups allows us to conclude that there are significant differences between them in terms of parameters:
specifics of early psychomotor development;
subjective difficulties of mothers and their style of interaction with the child;
level of mental tone and mental activity;
level of maturity of regulatory functions;
features of the development of the cognitive sphere (in most children by subgroup);
the type of assistance needed (organizing for children of the first group and stimulating for children of the second group).
Based on the characteristics of the pace of activity, the following patterns were identified:
in children of the first group, as a rule, the pace of activity was uneven or accelerated due to impulsiveness;
in children of the second group, the pace of activity before the onset of fatigue may not have been slowed down, but after the onset of fatigue most often became uneven, slowed down, or, less often, accelerated, which negatively affected the results of the child’s activity and criticality;
There were no significant differences between children in terms of performance - the latter was most often insufficient in children of both groups.
At the same time, a profile of basic affective regulation specific to each group of children was identified:
increasing endurance at individual levels (hyperfunction) for children of the first group;
increasing their sensitivity (hypofunction) for children of the second group.
We consider such differences in the affective status of children of the first and second groups as the leading mechanisms of the identified behavioral characteristics in both cases.
This understanding of the fundamentally different mechanisms of behavioral maladaptation makes it possible to develop specific, fundamentally different approaches and methods of psychological correction for the two variants of behavioral problems discussed.
The children we assigned to third group(13 people) demonstrated both signs of neurological distress and quite pronounced regulatory immaturity, as well as a low level of mental tone, uneven tempo characteristics of activity, and problems of insufficient development of the cognitive sphere. Apparently, the symptoms of motor disinhibition in these children were only one of the manifestations of the lack of formation of both the regulatory and cognitive components of mental functions - in our typology of deviant development (M.M. Semago, N.Ya. Semago, 2005) such a condition is defined as “Partial immaturity of mixed type” (diagnosis code: NZZ's). For these children (6 people), the indicators of the level of mental tone were inconsistent (which may also indicate possible neurodynamic characteristics of these children), and the integral assessment of the level of mental tone was difficult.
Further, based on an understanding of the psychological mechanisms underlying such types of deviant development, based on the idea of general and specific patterns of development, we substantiated the need for an adequate direction of correctional work with children of the studied categories, taking into account the understanding of the mechanisms of adaptation disorders.
Corrective work
Technologies of correctional and developmental work for children with problems in the formation of a voluntary component of activity are described in our previous articles, which outline the principles and sequence of work on the formation of a voluntary component of activity (N.Ya. Semago, M.M. Semago 2000, 2005).
Technologies of correctional and developmental work for children with a reduced level of mental tone are presented for the first time.
Since such behavioral problems, from our point of view, are caused by a reduced level of mental tone and mental activity in general (increased sensitivity of the 1st and 2nd levels of basic affective regulation), signs of disinhibition in this case act as compensatory mechanisms, “tonic” , increasing the overall level of mental tone of the child. They can be considered as an increase in protective mechanisms of the 2nd level of affective regulation. Consequently, correctional technologies in this case should be focused, first of all, on the harmonization of the affective regulation system. Speaking about the methodological foundations for constructing correctional programs, it is necessary to generally rely on the theory of K.S. Lebedinskaya - O.S. Nikolskaya (1990, 2000) about the structure and mechanisms of basic affective regulation (toning) in normal and pathological conditions (4-level model of the structure of the affective sphere).
The proposed correctional and developmental approaches are based on two main principles: the principle of toning and “rhythmizing” the child’s environment (including through distant sensory systems: vision, hearing) and the actual methods aimed at increasing the level of mental toning, for example, the bodily method -oriented therapy and related techniques adapted to work with children.
Depending on the degree of insufficiency of mental tone and the age of the child (the younger the child, the greater importance is attached to contact, bodily methods that are more natural for the child), the volume of the necessary rhythmic organization of the environment and the actual tactile rhythmic influences were developed, increasing the child’s tone due to direct contact with him - bodily and tactile, leading, in turn, to an increase in overall mental tone.
We included the following as distant methods of rhythmic organization of the environment:
Establishing a clear, repeating routine (rhythm) of the child’s life with affective reinforcement (pleasure). The very rhythm and events of the day should be experienced by the child together with the mother, giving pleasure to both.
Selection of adequate rhythmically organized musical and poetic works that are presented to the child in a situation before the onset of obvious fatigue, thereby preventing, to a certain extent, compensatory chaotic movements that arise (with the goal of autotonizing the child, but destructive in their behavioral manifestations). These same problems were often solved in the family by drawing by the child to one tune or another. In this case, multimodal tonization methods (rhythm of movement, changes in color, musical accompaniment) were connected to tonization mechanisms specific to the second level. In the activities of specialists from educational institutions (PPMS centers), such work can be carried out within the framework of art therapy.
Actually, a system of tactile toning, accompanied by specific intonationally designed “chants” (similar to folklore refrains).
Playing simple folklore games and ball games that have a stereotypical, repetitive nature.
Distant tonization methods also include methods of mental tonization using the mechanisms of the first level of affective tonization: creating sensory comfort and searching for the optimal intensity of certain influences, which fit well into this type of psychotherapy as “landscape therapy”, the specific organization of the “living” environment: comfort, safety , sensory comfort. This kind of “distant” tonization can be carried out both by a specialist when working with children, and at home in the family when implementing a system of branch therapy.
If such methods for organizing the correct behavior of a child and increasing his mental tone are not enough, special techniques of tactile toning are used directly for the tasks of normalizing behavior. These techniques are, first of all, taught to the child’s mother (the person replacing her). An appropriate technology for training the mother (branch therapy) and an appropriate sequence of the tonic work techniques themselves were developed. This correctional program was called “Increasing mental tone (PGP program).”
The system of work to increase the level of mental tone of the child had to be carried out by the mother daily, for 5-10 minutes according to a certain scheme and in a certain sequence. The work scheme included mandatory consideration of the basic laws of development (primarily cephalocaudal, proximo-distal laws, the law of the main axis), adherence to the principle of sufficiency of influence.
The toning techniques themselves were variations of stroking, patting, tapping of varying frequencies and strengths (certainly pleasant for the child), performed first from the top of the head to the shoulders, then from the shoulders to the arms and from the chest to the tips of the legs. All these “touches” of the mother were necessarily accompanied by sentences and “conspiracies” corresponding to the rhythm of the touches. To solve these problems, mothers were familiarized with a sufficient amount of folklore materials (songs, sentences, chants, etc.). It should be noted that the effect of this type of “conversational” communication with children (in a certain rhythm and intonation pattern) is noted by psychologists and other specialists working with children with early childhood autism of the O.S. group. Nikolskaya.
Our observations have shown that for older children (7-8 years old), tactile influences themselves are not adequate either to age or to the patterns of dyadic mother-child relationships. In this case, a fairly effective technology of work, in addition to the rhythmically organized and predictable life of the child, which makes it possible to increase his mental tone, is his inclusion in the so-called folklore group.
Involving the mother in working with the child also had a strictly tactical task. As preliminary studies have shown (Semago N.Ya., 2004), it was the mothers of children with insufficient mental tone who found themselves untenable in their parental position in the first year of the child’s life. Hence, one of our assumptions was that the low level of mental tone of the child may be a consequence, among other things, of insufficient tactile, bodily, and rhythmic maternal behavior. In this regard, it is precisely such full-fledged maternal behavior at a child’s early age that is one of the main factors in the formation of a harmonious system of affective regulation in children.
Another direction of our work to harmonize the affective sphere and increase the level of the child’s mental tone is a specially selected range of games (having a large volume of motor component), with the help of which the child could also receive affective saturation and, thereby, increase his tonic mental resource. These included games that had a repetitive stereotypical nature (from infant games such as “We drove, we drove, bang into the hole,” “Ladushki,” etc. to a number of ritual folklore games and stereotypical games with a ball, which have a high affective charge for the child ).
Currently, monitoring of a number of children included in such correctional work continues. Work continues to analyze the criteria for the effectiveness of correctional work. Among the positive changes obtained as a result of carrying out this comprehensive program with children of different ages, the following can be highlighted:
in most cases, there is a significant decrease in the number of complaints about motor disinhibition of children both from parents and from specialists of the educational institutions in which they are located;
the periods of active performance of the child and the overall productivity of his activities increase;
The relationship in the mother-child dyad and mutual understanding between mother and child are significantly improved;
As a result of involving mothers in working with their own children, most of them acquired the ability to “read” and more sensitively assess the emotional and physical well-being of the child.
Emphasizing that classes to “tonicize” the child’s mental sphere in this case were combined with elements of psychotherapeutic work, it should be noted that without such a context, no correctional program can be effective. But in this case, work to increase the child’s mental tone was the main “system-forming” element of correctional work.
References
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Zavadenko N.N. How to understand a child with hyperactivity and attention deficit disorder. - M.: Shkola-Press, 2000. (Therapeutic pedagogy and psychology. Appendix to the journal “Defectology”. Issue 5).
Zavadenko N.N., Petrukhin A.S., Solovyov, O.I. Minimal brain dysfunction in children. Cerebrolysin induces minimal brain dysfunction. - M.: EBEVE, 1997.
Kovalev V.V. Childhood psychiatry. - M.: Medicine, 1995.
Machinskaya R.I., Krupskaya E.V. EEG analysis of the functional state of deep regulatory structures of the brain in hyperactive children 7-8 years old // Human Physiology. - 2001. - T. 27 - No. 3.
Osipenko T.N. Psychoneurological development of preschool children. - M.: Medicine, 1996.
Popov Yu.V., Vid V.D. Modern clinical psychiatry. - M.: Expert Bureau-M, 1997.
Semago N.Ya., Semago M.M. Problem children: basics of diagnostic and correctional work of a psychologist. - M.: ARKTI, 2000. (Bibliography of practicing psychologists).
Semago N.Ya. New approaches to the psychological assessment of children with motor disinhibition // Issues of mental health of children and adolescents. - 2004. - No. 4.
Semago N.Ya., Semago M.M. Organization and content of the activities of a special education psychologist. - M, ARKTI, 2005. (Library of a practicing psychologist).
Tzhesoglava 3. Mild brain dysfunction in childhood. - M.: Medicine, 1986.
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This deviation (which is primarily of a neurological nature) is characterized by high impulsiveness, mobility, restlessness, distractibility, and decreased self-control. A hyperactive child cannot sit still and constantly twirls something in his hands. At the same time, in contrast to productive activity, focus is low. The child does not accept the task set by an adult well, jumps from one activity to another, although he can do something he loves for a long time, without stopping or being distracted. With hyperactivity, tics and obsessive movements are frequent (but not obligatory). The cause of hyperactivity may be increased intracranial pressure (hydrocephalus) or organic brain damage. In many cases, it is not possible to establish a physiological cause for hyperactivity. If hyperactivity is suspected, consultation with a neurologist is recommended.
G. Asthenia
This is a state of nervous exhaustion, weakness. In this state, both physical and mental fatigue sharply increases in the child, and performance decreases. With asthenia, memory and attention deteriorate. Tearfulness, moodiness, and irritability appear. Asthenia occurs as a result of illnesses (both nervous and general), overwork, lack of vitamins, and lifestyle disorders (lack of sleep, nutrition, walking). Long-term stress also leads to asthenia. Some children have a predisposition to mild asthenia - the so-called asthenic type, characterized by a general weakening of the nervous system and high sensitivity (sensitivity). By the end of the school year, most schoolchildren experience more or less pronounced asthenic conditions due to the fatigue that has accumulated over the year. For severe signs of asthenia, consultation with a neurologist is recommended.
D. Decreased motivation
This is one of the common causes of school difficulties. It can be local (that is, relate only to some - then a specific type of activity) or general (relating to any activity). A local decrease in motivation is most significant when it relates to educational activities. A decrease in educational motivation, as a rule, is reflected in the child’s behavior during a psychological examination, especially when tasks similar to academic ones are offered. A general decrease in motivation is most characteristic of depression. It is also possible with deep asthenia and with some other mental disorders.
III.4. Correlating complaints with mental development features
In this subsection, we will dwell on the question of what the psychological causes of some of the most widespread complaints with which primary schoolchildren are brought to a consulting psychologist may be. Knowing this will help to analyze survey materials in a more targeted manner.
A. The child does not study well
This is perhaps the most common complaint in primary school age. Often, in the initial complaint, parents and teachers do not note any other difficulties: poor performance overshadows everything else for them. Only in the final conversation, when the consultant describes the psychological characteristics of the child, other problems emerge (communication disorders, emotional distress, etc.). One of the following reasons (or a combination of several of them) may be behind this complaint:
Impaired mental function(learning disabilities). In our experience, when a complaint is made about poor academic performance, in approximately half of the cases one or another degree of deviation in the development of cognitive processes is detected. It should be borne in mind that even in a normal sample, learning disabilities are quite common (occurring in approximately 20-25% of primary schoolchildren). In relatively rare cases, academic failure is explained by deeper impairments in intellectual development ( mental retardation).
Chronic failure . If parents or a teacher report that a child is failing in almost all subjects, then the examination almost always reveals signs of chronic failure. Rare exceptions are cases of mental retardation, particularly profound mental retardation, infantilism, or a sharp decrease in motivation, leading to negative assessments being of little significance for the child. Sometimes the psychological syndrome of chronic failure is the only cause of academic failure, but more often it appears in combination with other deviations: learning disabilities, asthenia, and a mild decrease in educational motivation. A more localized disorder that causes symptoms similar to chronic failure is school anxiety .
Retirement from activities rarely leads to particularly profound underachievement, however, this psychological syndrome also reduces educational achievements. Sometimes this syndrome can be suspected by the very nature of the complaint, when it is not so much the low academic performance that is emphasized as the child’s passivity.
Verbalism– one of the common reasons for the pronounced unevenness of a child’s achievements. As a rule, children with verbalism read well and are able to answer questions comprehensively and “smoothly,” but they have problems with subjects that require a higher level of intellectual development. Most often they relate to mathematics, and primarily to problem solving, while examples aimed at formally performing arithmetic operations do not cause difficulties.
Lack of educational and cognitive motives . This reason for academic failure is rare at the beginning of schooling. However, by the second year of study, motivation decreases in many children. Of course, it is not the children who are to blame for this, but the adults who create an atmosphere of coercion and joylessness around studying. A general decrease in motivation is much less common than a local decrease in educational motives.
Asthenia . With asthenia, parents and teachers usually note a relatively recent decline in academic performance, which was previously good. Teachers also report that in the first (morning) lessons the child works better than in the last, and at the beginning of the lesson - better than at the end. As a rule, there are direct indications of increased fatigue.
B. The child is lazy
This is one of the very common complaints, and there can be a variety of reasons behind it. Let's look at some of them.
Excessive requirements . Often, parents and teachers consider a child lazy who studies quite normally, but, in fact, does not make any special efforts and therefore does not fully realize his potential at school. However, he may have some - then his hobby - for example, he likes to play football. It is then quite natural that he devotes only as much time to his studies as is necessary to remain at an average level, even if his abilities allow him to achieve much more. Any claims against such a child are inappropriate. He, like any person, has the right to choose his hobbies.
Decreased educational and cognitive motives . This problem was discussed in the previous subsection. It is often behind both complaints about poor performance and complaints about laziness.
Slow pace of activity . In these cases, the child works completely conscientiously and purposefully, but so slowly that it seems to others that he is too lazy to move or make any effort. In fact, the slowness of the pace of activity is of a physiological nature (the slow flow of nervous processes) and in no case can be considered “laziness.”
Asthenicity, decreased energy gives the most classic picture of “laziness”: a child likes to lie in bed for a long time, does nothing for hours (since he has no strength to do anything), lifts a finger and is already tired... It seems to adults that he could not get tired of such a trifling effort, but it turns out that he could.
Self-doubt, anxiety can also manifest itself as “laziness”: the child does not write a phrase because he is completely unsure of what and how to write. He begins to shirk any action if he is not sure that he will perform it well, and an anxious person almost never has such confidence.
Violation of relationship with teacher- another common reason for shirking schoolwork, perceived by adults as “laziness.” The child does not want to go to school, do homework, and is not interested in anything even remotely reminiscent of school.
Laziness in the truest sense of the word, that is, hedonism, when a child does only what pleases him and avoids everything else, is quite rare. When it is nevertheless observed, we can assume with a high degree of confidence that its root cause is ordinary spoilage.
B. The child is distracted
Complaints about inattention and childhood absent-mindedness are very common in advisory practice. Naturally, with such a complaint, it is necessary, first of all, to check the attention function using some special technique (in particular, the “Coding” test is convenient for this; see II.3. IN). Taking into account other data, this makes it possible to distinguish the main types of behavior, commonly referred to in everyday life as “inattention.”
Immaturity of the attention function- not only not the only, but also by no means the most common cause of complaints about inattention. If it really does occur, then it is necessary to find out whether the child has signs of organic brain damage, which serves as the most common basis for primary attention disorders. If such signs are present, consultation with a neurologist is advisable.
Lack of organization of actions– one of the most common problems hidden behind a complaint of inattention. Its essence is that the child does not know effective methods of self-organization, to put it simply, he does not know how to work. This inability is most clearly manifested in the “Complex Figure” technique (see II.3. A), it is also reflected in the “Pictogram” technique (II.2. B). In this case, the actual function of attention can be completely preserved, and in tasks that do not require complex organization and planning of one’s actions, the child’s “inattention” will not manifest itself.
Retirement from activities, in which the child is immersed in himself, in his fantasies and dreams, also creates the impression of inattention. At the same time, the child becomes distracted and absent-minded when the activity is boring for him, but he concentrates well and becomes especially attentive when faced with an interesting task. The tasks proposed by the consultant during the examination are, as a rule, new, entertaining and attractive for younger students. And often the teacher or parents, who complained about the child’s absent-mindedness and lack of concentration, note that “now with you he was surprisingly collected and attentive; This doesn’t usually happen.” Such selectivity of attention indicates the motivational reasons for its disconnection in certain areas of life.
Decreased learning motivation . In this case, “switching off” attention occurs according to the same mechanism as when leaving an activity, with the only difference being that it usually switches not to fantasies, but to some external factor.
Anxiety, which destroys any activity, is especially harmful to attention. Both anxiety “in its pure form” (acting as a monosymptom) and anxiety that is part of a more complex symptom complex (for example, with chronic failure) can lead to pronounced disturbances of attention.
Hyperactivity(motor disinhibition) inevitably disrupts the function of attention. These violations are very persistent and extend to a wide variety of activities.
Intellectualism often leads to everyday absent-mindedness: a child forgets his briefcase at school, loses the key to the apartment on the way home, etc. In reality, these are not violations of attention, but manifestations of high selectivity of memory (akin to “professor absent-mindedness”): the child is focused on solving intellectual problems and sincerely forgets about the “little things in life.”
D. The child is uncontrollable
Uncontrollability and disobedience of a child are the most common behavioral complaints. The following reasons may be behind it:
Adult mistake who do not know how to assess the age characteristics of children and take what they want as the norm, and the reality as a deviation. We are talking about cases when a child is obedient and controllable to exactly the same extent as most of his peers, but this seems insufficient to parents. For example, a father is concerned about the “uncontrollability” of his seven-year-old son: “It is impossible to teach him to brush his teeth every day, without reminders, to make his own bed, or to keep his shoes clean. I have to remind you every time. He is completely uncontrollable!” This kind of error is almost never found among teachers, since they have sufficient experience in observing children, but they are quite common among parents. They are typical for parents with an epileptoid personality type, who themselves are highly punctual and expect the same from their child.
Increased energy child. This is a variant of normal development that does not require correction, although the complaint of the parents (or teacher) is completely adequate: the child is indeed difficult to control. When a child sets goals for himself and, knowing firmly what he wants, knows how to achieve his own, then adults really have a hard time with him. However, in terms of prognosis, powerful activity with a high level of goal-directed behavior is a favorable development option (however, if the child is not “shut down” for excessive independence and a tendency to risky experiments).
Hyperactivity(motor disinhibition) also often causes complaints about the child’s uncontrollability. This diagnosis should be clearly distinguished from the diagnosis of “increased energy”. A child with hyperactivity is characterized by insufficient goal-directed behavior, while with increased energy, goal-directedness, on the contrary, is increased compared to the usual level. Unlike increased energy, hyperactivity is, of course, a developmental deviation that requires correction to the extent possible (unfortunately, the possibilities in this regard are quite limited).
Negative self-presentation– a psychological syndrome, the main manifestation of which is precisely uncontrollability, and deliberately. It serves as a means for the child to attract the attention of adults, which he is not able to achieve in other ways.
Social disorientation– another psychological syndrome, the central manifestation of which is uncontrollability. However, social disorientation leads to uncontrollability not due to the child’s conscious desire to break the rules, but due to their misunderstanding.
Spoiled, which is not a psychological deviation, also often leads to uncontrollability. It is common for children who are constantly surrounded by many overly caring adults (grandparents, etc.). Spoilage often occurs in a child from a single-parent family, on whom a single mother is overly withdrawn.
Almost all children are lively, restless, and often inattentive. But a person familiar with this problem can distinguish these babies by their eyes.
Children whom specialists diagnose with attention deficit hyperactive disorder are like a car without brakes, so they generally behave atypically in situations that are familiar to others. And their parents constantly hear comments from strangers.
It’s very difficult to hear all the time while riding on a trolleybus: “What kind of mother are you? How do you raise a child? Can’t he or she sit quietly for 15 minutes?” And these children often find it really difficult to travel in public transport,” explains the psychologist. Moreover, both ordinary citizens and teachers, even some doctors, do not understand this.
This diagnosis is being made more and more often
Such children, by their nature, are not just active from childhood, but overly active. In addition, they are too impulsive - they act under the influence of their desires and feelings, without having time to think about the consequences of their actions and the rules accepted in society.
“My six-year-old daughter, for example, cannot even sit down and eat calmly,” says the woman. She will just take a spoonful of borscht into her mouth and will already get up from her chair to have fun with something or become interested in what is happening outside the window. Then she returns to the plate. A moment later, she runs into another room because she remembered something. The child simply cannot concentrate on one thing and complete it.
Also, hyperactive children have difficulty concentrating for a long time on something that is of little interest to them, such as a school lesson or doing homework. And the reason is not a lack of discipline or education. This is one of the most common behavioral disorders. Moreover, such a diagnosis has recently been given to children more often.
This disorder has many names and synonyms - disinhibition in children, minimal brain dysfunction, psychomotor disinhibition syndrome, hyperkinetic disorder and others. In fact, ADHD is caused by the immaturity of certain areas of the brain that are responsible for the function of controlling behavior, namely the ability to temporarily “slow down” one’s desires and feelings in order to stop and think about the possible consequences of one’s actions, to coordinate them with socially accepted rules, desires and feelings of other people and then act appropriately to the situation.
In children with psychomotor disinhibition syndrome, this inhibitory, controlling and organizational function of the frontal lobe of the cerebral cortex is not developed according to age. As a result, their behavior is often problematic. Consequently, this affects relationships with parents, the ability to study successfully at school, and to be in a group of peers. In fact, the children themselves suffer from this because they feel they are different.
Psychomotor disinhibition syndrome must be diagnosed early
However, children with ADHD can be helped! Modern methods of psychological assistance and drug therapy, correctly applied in close cooperation with parents and teachers, can significantly reduce a child’s behavioral problems, help him fully develop and realize himself in society.
But if the family and the child are not provided with proper help, then with age the child’s problems can only grow and his full adult life and self-realization may be in jeopardy.
The first and most important step in helping a child is timely diagnosis of psychomotor disinhibition syndrome, as well as education of parents regarding the causes and manifestations of this disorder and effective ways to help.
At least 3% of school-age children are diagnosed with ADHD. In order for parents to turn to specialists in a timely manner, it is necessary to conduct educational campaigns on this problem. It is necessary to promote active socialization of children who live with this syndrome.
Emotional reactions are not age appropriate
If parents and professionals join forces, a child with ADHD can finally go to a regular school. But it is moms and dads who have to work hard for this result.
This is especially true in cases where the child is lagging behind in speech or mental development in general. If mom puts pots and solving only everyday problems first, there is no point in waiting for progress. After all, we are talking about hard, simply titanic work - every minute, every day.
Timely diagnosis of disinhibition in children gives the child a chance for a successful start in life, the interlocutor adds. To understand whether your child really has psychomotor disinhibition syndrome, check the boxes in the picture above that indicate the presence of the main symptoms of this behavioral disorder.
The fact is that the emotional reactions of these children do not correspond to their age. For example, if a healthy six to ten year old child was offended, then her reaction will be an appropriate image. But in children with ADHD, such “brakes” do not work. She reacts emotionally like much younger children. This is why the child cannot calm down for a long time. It's like a huge explosion of emotion.
By the way, in this case it is impossible to do without medication. Doctors usually prescribe herbs, homeopathic medicines, and psychotropic drugs. By the way, sedatives are contraindicated for children with ADHD.
Don't celebrate the negative
We advise parents who have a hyperactive child not to point out some negative trait in their children, but to look for something for which the child can be praised - some kind of talent, for example, a penchant for drawing or other creativity. In fact, despite behavioral problems, children with ADHD do show special abilities in certain areas, such as the arts.
Sometimes the mother noticed that the child was good at drawing. Mom encouraged the kids to be creative, constantly repeating: “You are so talented, you draw so well!” Ultimately, this had a positive effect on other aspects of the child’s development. Flowers, as you know, need to be watered constantly!
Therefore, do not give in to the persuasion of such “specialists” who promise to solve all the problems that the child has in 10 sessions.
Parents should know that the road to saving their child is long, but it will definitely lead to a positive ending. Moreover, the participation of the father is especially important. His attention is also very important for the child. Dad is usually tougher and more demanding, and this also has a positive effect.
