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Diagnosis and correction of disturbances of development of the highest mental functions in children

Table of contents
Diagnosis and correction of disturbances of development of the highest mental functions in children
Methods of psychological correction
Methodical approaches to neuropsychological diagnosis and correction
Appendices and literature

Scientific and therapeutic center of prevention and treatment of psychoneurological disability

I.A. Skvortsov, G. A. Adashinskaya, I.V. Nefedova
THE MODIFIED TECHNIQUE OF NEUROPSYCHOLOGICAL DIAGNOSIS AND CORRECTION AT DISTURBANCES OF DEVELOPMENT OF THE HIGHEST MENTAL FUNCTIONS IN CHILDREN

The wide experience on rehabilitation and social adaptation of children with various inborn and hereditary diseases of a nervous system, including different forms of a children's cerebral palsy, the children's autism, speech arrests of development, mental retardation which is saved up for 10 flyings by the Scientific and therapeutic Center of prevention and treatment of psychoneurological disability under the leadership of I.A. Skvortsov is reflected in the manual.
The analysis of results of a large number of diagnostic testings formed the basis for development of adequate and objective methodical approaches for the differentiated step-by-step diagnosis of children, and also for search of more effective ways of correction of disturbances.
The grant is intended for neuropathologists, neuropsychiatrists, psychiatrists and medical psychologists improving skills in institutions of the Ministry of Health of the Russian Federation.

Introduction

Disturbance of psychoneurological development in children - one of actual medikosotsialny problems. Weight of functional defect in motive, speech, intellectual spheres, in perception of world around and skills of communication with it can vary from heavy disabling cerebral pathology to the minimum brain dysfunction complicating training of the child at school.
For 10 flyings of work of our Center the wide experience on rehabilitation and social adaptation of children with various inborn and hereditary diseases of a nervous system, including different forms of a children's cerebral palsy, children's autism, speech arrests of development, mental retardation is saved up. These disturbances can be connected with pre-natal or patrimonial injury of a brain, and also with some hereditary diseases which are followed by defeat of a nervous system and, as a result, - disturbance of psychoneurological development.
The analysis of results of a large number of diagnostic testings formed the basis for development of adequate and objective methodical approaches for the differentiated step-by-step diagnosis of children, and also for search of more effective ways of correction of disturbances.
STUBS psychological inspection of children with disturbances of psychoneurological development includes 3 main directions in STC:

  1. complex patopsikhologichesky research with definition of "a development profile" of children till 7 flyings,
  2. neuropsychological research with a localization assessment in a brain of disturbances of the highest mental functions,
  3. complex research of the interpersonal relations in a dyad "mother child".

Methods of psychological diagnosis in the Scientific and therapeutic center of prevention and treatment of psychoneurological disability

Definition of "development profile"

Efficiency of rehabilitation and perspective of training of children with abnormal development depend on many factors, but, first of all on early identification of aberrations. Early recognition of disturbances of psychoneurological development - guarantee of successful treatment and rehabilitation of such children. The special adapted "Psychological Inspection of Children of the First Seven Years of Life with Disturbances of Psychoneurological Development" card was developed for objective diagnosis and standardization of procedure of inspection in the Scientific and therapeutic center of prevention and treatment of psychoneurological disability (STC KICK). Results of inspection are presented in the form of a graphic "profile of the development" reflecting a condition of the psychoneurological status of the child in comparison with age norm on the following scales:

  1. Motility (large and small). Forming of movement skills, subject actions, assimilation of ways of use of various objects.
  2. Perception. Level of perception and processing of information on objects and the phenomena in total, their properties and parts is defined. Level of visual perception of children defines correctness of recognition of objects and images, level of selectivity of attention. Level of acoustical perception - understanding aurally words, texts, rhythmic structures.
  3. Self-service. Motor and intellectual skills on leaving for by itself, skills of neatness are estimated.
  4. Intelligence. Game. Assessment of a level of development and formation certain (figurative, logical) cogitative operations, space thinking, verbal intelligence. Determination of level of formation of game activity of the child.
  5. Speech (expressional and impressivny). Emergence at the child of understanding of the speech (the impressivny speech) turned to it, and also development of own speech activity directed to people around (the expressional speech): at the beginning of the early lepetny and syllabic speech, in the subsequent - forming and enrichment of a lexicon, assimilation of grammatical and stylistic structures, emergence of ability to express the thought, to understand and interpret foreign thought.
  6. Communication. Definition of degree of formation and an originality of communicative behavior of the child, extent of assimilation by the child of norms and rules of communication that is a necessary factor for early diagnosis of psychoemotional frustration.

The technique of an assessment of a level of development of the child was developed on the basis of the normative criteria defining at what age at the child these or those skills have to be created. As criteria of estimates on scales served age indicators of development of the main mental functions (motility, the speech, perception, self-service, game, verbal and constructive intelligence) at the healthy child of a certain age.
Comparison of data of development of mental functions of the sick child with normal indicators allows to establish extent of his lag (compliance) from age norm. Lag can be uniform and uneven (dissociated), on weight - expressed, average and easy. Against treatment and in process of the child's growing "the development profile" significantly changes. Our treatment allows to accelerate considerably development of the child that he could overtake for the healthy peers.
Against treatment STUBS the sick child develops in STC on a number of indicators quicker, than normal, and "the development profile" of the patient gradually approaches age norm (fig. 1). Now we together with employees of VNIIIMT developed the computer program "Psychological Inspection of Children of the First Seven Years of Life with Disturbances of Psychoneurological Development" considerably helping doctors, psychologists and teachers with drawing up "a development profile".

Figure 1. KICK "A development profile" of the child against treatment in STC
First name, middle initial, last name the child Ilya A. Prokhodil treatment during 8 courses. Data on the last 4 courses are provided.

  1. course - age of 2 g 10 months.
  2. course - age of 3 g 3 months.
  3. course - age of 3 g 8 months.
  4. course - age of 4 g 1 months.

Профиль развития ребенка
At receipt STUBS to 1 course could not go to STC. The expressed delay with development of small motility was noted. In the speech - a dysarthtia.
5 course (age of 2 g 10 months). Arrest of development of small motility. Difficulties in forming of skills of drawing and self-service. Speech and intellectual development corresponds to age. High rate of recovery and development of movement skills is noted.

  1. course (age of 4 g 1 months). Residual motor awkwardness. Speech and intellectual development high.

Neuropsychological inspection of children and computer ANT program

The main objective of psychological research - to isolate psychophysiological mechanisms and the reasons of the defects breaking process of adaptation and development of the child. In STC STUBS the original technique of the adapted neuropsychological mapping of bark of big cerebral hemispheres at children (E.G. Simernitskaya, I.A. Skvortsov, etc., 1988) in the subsequent improved and computerized is widely used.
It allows to reveal a factor (mechanism) of disturbance of these or those the highest mental functions (HMF) and, on the basis of the analysis of the revealed changes of VPF, to make the topical diagnosis (i.e. to define localization of preferential dysfunction in a cerebral cortex), and further - to plan ways and methods of recovery work.
Carrying out neuropsychological diagnosis allows:

  1. To receive the description and the analysis of a clinical picture of disturbances of mental activity of the child.
  2. To define a major factor (mechanism) which is a cause of infringement of these or those VPF.
  3. To define a zone (territory) of defeat of bark of cerebral hemispheres (the topical diagnosis).
  4. To isolate and carry out the analysis of safe highest mental functions.
  5. To receive recommendations about carrying out adequate correctional and recovery work.

A few years ago on the basis of a neuropsychological technique of research of children in STC STUBS the computer ANT (the adapted neuropsychological test) program in which put an opportunity to receive the schematic image of parencephalons with a comparative assessment of degree of manifestation of disturbances of VPF in frontal, parietal, occipital and temporal shares of both hemispheres is developed (see fig. 2). The computer option of ANT allows to estimate objectively dynamics of recovery of VPF at children against treatment.
адаптированный нейропсихологический тест)

Psychological analysis of the parent and children's relations

Efficiency of correctional and recovery work with children is closely connected with features of the child parent relations. For anybody not a secret that kind trusting relationships of children and their relatives allow to facilitate difficulties of correctional work and, on the contrary, the intense emotional background of the family relations can slow down process of rehabilitation and recovery of the child.
Therefore at revenues to treatment to STC STUBS diagnostic inspection there go not only children, but also at parents the psychoemotional status, features of personal structure is defined. The child's mother with psychoneurological disability - the most important participant of process of rehabilitation, social adaptation and training.
However, the heavy psychological load connected with an illness of the child quite often serves as the reason of disadaptation of mother, loss of belief in the future of the child by it, and in some cases leads to psychosomatic morbid conditions. At such mothers the adynamy, a febricula, heartaches, gastrointestinal frustration, disturbances of a menstrual cycle and other disturbances which need special medical assistance, psychotherapy, drug treatment can be observed.
Most successfully help mother's doctors, holding the leading, dominant position in a dyad - "mother child" as these mothers are distinguished by such lines as self-confidence, high motivation in achievement of the goal, activity, commitment, ability to stand for themselves, ability to control a situation. The contrast to them is made by the mothers conducted, holding the subordinated position in interaction with the child. These mothers are, as a rule, not self-assured, a mood background reduced, activity low, they have no confidence in receiving successful result of treatment, in the future the child.
Psychological research of a dyad "mother child" in each case allows to reveal timely problems in the parent and children's relations and to carry out their psychological and medical correction.



 
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