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Boundary intellectual insufficiency

Treat boundary intellectual insufficiency various on an etiology, a pathogeny and clinical features of a condition of easy intellectual insufficiency, intermediate between an oligophrenia and intellectual norm (the coefficient of intellectuality makes 70 — 90 points).
For the first time one of forms of boundary intellectual insufficiency — infantility was described last century E. Lasegue (1864) and P. Lorain (1871). Further A. V. Melnikova (1936), T. A. Vlasov, M. S. Pevzner (1967), I. A. Yurkov (1971) and some other researchers were studied by its clinical features, differential criteria and on the basis of the obtained data distinguished infantility simple, organic, endocrine. In the last 15 — 25 years especially much attention is paid to studying of boundary intellectual insufficiency, including a delay of mental development. G.E. Sukhareva (1965) described conditions of the detained rate of the intellectual development coming owing to influence of social factors; the intellectual frustration caused by somatopathies; disturbances of cognitive activity at harmonious and disgarmonichesky infantility. M. S. Pevzner and T. A. Vlasov (1967) is distinguished by two clinical forms: mental and psychophysical infantility (uncomplicated and complicated) and the secondary delay of mental development (DMD) caused by asthenic and tserebrastenichesky states. K. S. Lebedinskaya (1980) allocates constitutional, somatogenic, psychogenic and cerebral and organic ZPR. I. F. Merkovskaya (1982) describes two main options of a delay of mental development of cerebral and organic genesis: with dominance of an underdevelopment of the emotional and strong-willed sphere as organic infantility and with dominance of disturbance of the highest cognitive functions. F. M. Gayduk (1982) described severity of ZPR of a cerebral and organic origin.

Etiology.

From etiological factors of boundary intellectual insufficiency on the first place pathology of pregnancy and childbirth, incompatibility on a Rhesus factor and the AVO system, neuroinfections and craniocereberal injuries, chronic somatopathies, alcoholism of parents move forward. A certain part in development of boundary intellectual insufficiency is assigned to the unsuccessful social environment, and also hereditary mechanisms.

Pathogeny.

 In a pathogeny the PIN is of great importance an underdevelopment of frontal lobes and their bonds with other departments of a brain, and also defeat of parietal and temporal and occipital departments of bark, a delay of forming of adrenergic substance of a brain.

Classification.

The conventional classification of boundary intellectual insufficiency is still not developed. Now V. V. Kovalyov (1979) classification according to which are allocated is most widely applied: 1) dizontogenetichesky forms of boundary intellectual insufficiency: a) at simple mental infantility, at the complicated mental infantility in combination with psychoorganic, tserebrastenichesky, psychoendocrine syndromes and neuropathic states; b) intellectual insufficiency at lag in development of separate components of mental activity: speeches, readings, letters, accounts, motility; c) the distorted mental development with intellectual insufficiency (option of a syndrome of early children's autism); 2) encephalopathic forms at tserebrastenichesny and psychoorganic syndromes, a children's cerebral palsy; 3) the intellectual insufficiency caused by defects of analyzers and sense bodys; 4) the intellectual insufficiency caused by defects of education and information since the early childhood.

Clinic.

 Kliniko-psikhofiziologichesky manifestations of boundary intellectual insufficiency are various and depend on a number of factors. The local disturbances which to a greater or lesser extent are expressed in difficulty of assimilation and perception of the quantitative, temporary and space relations and also disturbances of specific school skills (the account, the letter, reading) are inherent in many children with boundary intellectual insufficiency.
At sick children later, than at healthy, such concepts as "right-left", "over-under" form. They with difficulty apply the pretexts reflecting the space relations insufficiently well perform tasks for a constructive praksis, not always truly understand weights, time, distance, number and a ratio of number and quantity, and also lexical and grammatical structures reflecting the space relations.
Children experience difficulty at a mental arithmetic with boundary intellectual insufficiency and upon transition to the following ten, relatives on writing of figure confuse (for example, 6 and 9; 12 and 21); incorrectly choose arithmetic actions (make subtraction instead of addition); make mistakes at record of answers (poorly keep in mind of a condition of an example).
Children with boundary intellectual insufficiency by the letter badly hold a line, often pass or do not finish letters or syllables, double them; confuse letters, similar on a tracing (for example, "N" and "п"), quite often give to letters a mirror tracing, at transfer of the word sometimes begin to write it since the beginning, in 30% of cases do not put an end at the end of the offer.
Mistakes of children with boundary intellectual insufficiency when reading are similar to that by the letter. They read sometimes hasty, it is obscure, distorting words, passing average syllables, inserting pl passing vowels.
At children with boundary intellectual insufficiency functions of attention, especially in the presence of asthenic or tserebrastenichesky syndromes are broken. Their attention differs in the raised exhaustion, an otvlekayemost, narrowing of volume. And at some children the so-called direct (natural) attention, at others — any more suffers (cultural).
For children with boundary intellectual insufficiency gross violations of memory are uncharacteristic; to their thicket those its mechanisms which demand mobilization of attention suffer. However at a number of children also more considerable decrease in random access memory, the mediated storing, information nagruzhayemost, reproduction of information is noted. Children with boundary intellectual insufficiency have a motive of storing generally game while at normally developing — educational.
Also changes of thinking are ambiguous at children with boundary intellectual insufficiency: one can think of the distracted and generalized categories, others do not possess such abilities. However with age at children with boundary intellectual insufficiency abilities to purposefully think, solve problems of analogy, to form generic names etc. develop. In general children with this pathology have higher level of ability to the practical solution of a question and low verbal.
Most of children with boundary intellectual insufficiency suffer from these or those disturbances of the speech. They note late formation of the internal speech. They use pretexts, adverbial participles, adjectives less often, but more often than healthy and suffering from an oligophrenia, use neologisms. In the speech of children with boundary intellectual insufficiency disturbances of a fonetiko-phonemic and lexical and grammatical system are noted. At some of them the period of manifestation of the first syllables or even phrases, the period of questions is late. The poor lexicon is characteristic of 90% of children; they experience difficulties at speech registration of the decisions and actions. Answers to questions at them are impulsive, without preliminary considering.
Role-playing and subject games of children with boundary intellectual insufficiency are simple and are not beyond household subjects. In game they have no status of the leader, play with younger children more willingly, and show excessive mobility, bring disorganization in game.

Diagnosis.

Differential diagnosis of boundary intellectual insufficiency and oligophrenia most often requires complex kliniko-psychology and pedagogical inspection. In certain cases the correct diagnosis can be made only after long dynamic supervision. Boundary intellectual insufficiency differs from an oligophrenia mainly in the fact that at the first children have no expressed inertness and rigidity of thinking. They well perceive the help, are capable to carry out nonverbal tests, are more bright.

Treatment, prevention.

The main method of correction of boundary intellectual insufficiency is pedagogical influence. At us in the country special schools and separate classes at usual schools for children about ZPR working according to the program of mass school, but with the extended term of training in special techniques are organized. The complex of rehabilitation actions includes also drug treatment of patients with boundary intellectual insufficiency, its choice depends on a clinical form and weight of an illness. Most often use nootropic drugs (generally Aminalonum and Pantogamum).
Treatment with Aminalonum (Gammalonum) is begun with 0,125 g (1/2 tablets) a day. For children till 3 flyings the maximum daily dose makes 0,5 g; 4 — 7 years — 0,75 g; 8 — 14 years: average therapeutic 1,0 g, the maximum dose — 2,0 g. Children cannot appoint Aminalonum to night with hyper dynamic and psychopatholike syndromes, with a sleep disorder, convulsive and other paroxysmal phenomena.
Pantogamum is shown mainly to children with symptoms of the residual and organic pathology raised by convulsive readiness, hyperkinesias. An initial dose of this drug of 0,25 g, for children of 7 — 12 years of average daily 1,0 g.
The above-stated drugs appoint in the form of two-month courses 2 — 3 times in a year.
At boundary intellectual insufficiency it is also recommended to appoint vitamins of group B (Cobamamidum, a pyridoxine), polyvitaminic complexes (Panhexavitum, Undevitum, dekamevit, Hexavitum, Pentovitum, etc.). The drugs containing phosphorus, calcium, iron are shown (fosfren, a calcium gluconate, iron glycerophosphate, etc.). It is the most reasonable to appoint vitaminous and mineralsoderzhashchy drugs to the children who are physically weakened with low mental activity.
It is necessary for children with residual and organic and neurologic symptomatology twice in a year (especially in the spring and in the fall) to carry out treatment by resorptional drugs and biostimulators (Cerebrolysinum, an aloe, FIBS a vitreous, a lidaz) and dehydrating therapy.
Prevention of boundary intellectual insufficiency consists in the prevention of pathology of pregnancy, childbirth, early neuroinfections and craniocereberal injuries, alcoholism of parents.

 
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