Infantilism: genital, psychological, social

In medicine, the term infantilism (accurately translated from Latin infantia means "infancy") refers to one of the developmental disorders in which adults and children are marked by clearly inappropriate for their age physical or physiological parameters, mental or behavioral characteristics. [1]

Epidemiology

Statistically, physical retardation due to hormone deficiencies accounts for nearly 10% of growth disorders and infantilism.

The approximate prevalence of congenital hypogonadism in the population is 1:10 thousand, Shereshevsky-Turner syndrome - in one out of 2-5 thousand women; Kalman syndrome in boys-1:8 thousand, in girls - 1:40 thousand; Klinefelter syndrome is detected in one out of 650-800 newborn boys.

And the incidence of congenital hypothyroidism is estimated at one case per 3600-4500 infants.

Causes of the infantilism

The main causes of infantilism experts attribute to lagging or certain deviations in the development of a child, adolescent or adult.

Normally, during physical interaction with the environment, a set of inherited reflexes of infants develops into more coordinated actions, and by the age of one and a half the child is already trying to solve physical problems in a meaningful way, has stable attachments, shows interest and is able to adequately express his or her emotions.

However, in physical development, the formation of cognitive, emotional, intellectual abilities can be delays that cause non-compliance with known in pediatrics age norms - infantilism in children.

The etiology of this immaturity, including in adulthood, is seen according to its form as infantilism syndrome.

For example, physiologic or physical infantilism, categorized by ICD-10 under symptoms, signs, and abnormalities - as the lack of expected normal physiologic development in children and adults (with code R62.5), can occur:

• Due to placental insufficiency while carrying the baby (leading to fetal hypoxia and ontogenesis disorders);
• In the presence of malformations of intrauterine development (in particular, hypothalamic-pituitary region of the brain and thyroid gland - with neuroendocrine disorders);
• When there is insufficient secretion of somatotropin growth hormone (STH);
• Due to genetic abnormalities (including the hormone-producing anterior lobe of the pituitary gland);
• As a result of inherited mitochondrial diseases.

And infantilism and mental retardation can be associated with both perinatal encephalopathy, and neuroendocrine and/or chromosomal syndromes. [2]

Risk factors

Risk factors for lagging behind or deviations in child development, leading to one or another type of infantilism, are considered:

• Constitutional genetic predisposition;
• Deficiency of hormones that provide metabolism and processes of embryonic ontogenesis;
• Teratogenic effects on the fetus of toxic substances or drugs taken during pregnancy, as well as birth traumas that can lead to cerebral edema in the newborn;
• Intrauterine developmental anomalies and congenital malformations;
• Infectious diseases with complications that occurred at an early age;
• Psychotraumatic impact (abuse in childhood, death of the child's father or mother);
• Psychosocial factors, including pedagogical and/or socio-psychological neglect, excessive parental demandingness and vice versa - parental hypervigilance. Permissiveness, indulgence of whims, etc.

Child psychologists see a serious threat of infantilization of normally developed children and adolescents in the widespread fascination with computer games and replacement of live communication with peers with virtual contacts in social networks.

Pathogenesis

The mechanism of developmental disorders in the case of insufficiency of growth hormone produced by the anterior lobe of the pituitary gland is associated with a decrease in a number of other growth factors and disruption of the entire biochemical chain of protein synthesis, glucose metabolism, production of hormones (gonadotropic, thyroid, adrenocorticotropic).

The presence of congenital hypothyroidism leads to a deficiency of thyroid hormones, due to which there is also a delay in the development of most body systems, including - the central nervous system.

The pathogenesis of some conditions that lead to certain forms of infantilism is discussed in publications:

• Disorder of regulation of hormone secretion and metabolism
• Causes and pathogenesis of disorders of sexual development
• Behavioral disorders and problems in children
• Causes and pathogenesis of mental retardation

Symptoms of the infantilism

In somatotropin deficiency, physical infantilism is manifested by age-inappropriate body proportions (narrow chest, thin bones and weak muscles), underdevelopment of some organs and delayed puberty.

In children with congenital hypothyroidism, the first signs of physical infantilism are also manifested by growth retardation and bone age abnormalities.

With all the clinical heterogeneity, the symptoms and most characteristic signs of mental infantilism (which can be identified only with the onset of primary school or early adolescence) include age-inappropriate behavior with increased impressionability and mood swings, superficial judgments and fantasizing, inability to concentrate attention and make decisions, egocentrism with simultaneous dependence on the actions and opinions of others.

Manifestations of intellectual infantilism are disorders of attention, perception and concentration; inertia of thinking, fixation on a single thought (perseveration) and difficulties in switching the thought process.

Children with neurotic infantilism are timid and impressionable, very attached to their mother and not inclined to show independence. Signs of emotional immaturity of personality, first of all, are considered impulsiveness, inability to control their emotions and their inadequate manifestation (children often cry on minor occasions, take offense at fair remarks of elders, get angry and throw tantrums), as well as the inability to understand the feelings of others.

The symptoms of genital infantilism in men have been named above, and in adolescent girls and women there are three degrees of genital infantilism:

• Grade 1 infantilism - with rudimentary uterus and amenorrhea (absence of menses);
• Infantilism of the 2nd degree - with a uterine body diameter of no more than 30 mm and irregular, scanty and painful menstruation;
• Grade 3 infantilism - with a slightly reduced uterus and almost normal but often painful periods.

Forms

In addition to the already named physical, distinguish a number of other types or forms of infantilism, and each of them has its own causes - explicit or hidden.

In the delay of general development (physical, mental and mental) is defined psychophysical infantilism. Depending on the degree of retardation of the child's development and features of its manifestations distinguish: harmonic infantilism (if physical and mental development lags proportionally and its manifestations do not go beyond the emotional-volitional sphere) and disharmonic infantilism, which is a specific disorder of personality development with psychopathic behavioral deviations.

Lack of development against the background of systemic diseases of internal organs and pathologies of general metabolism can be defined as somatic infantilism or somatogenic infantilism. For example, in congenital hypothyroidism, as well as an extreme degree of thyroid dysfunction - myxedema, many metabolic processes are disturbed in the body, negatively affecting its development. [3] This also applies to patients with monogenic juvenile mODY-diabetes. [4]

In such cases may be used and such a definition as organic infantilism, although some experts use this term if the cause of infantilism lies in the lesion of brain structures and impaired function of the central nervous system.

It should be noted that genetic infantilism can be determined only in cases where the child's developmental delay is etiologically associated with a hereditary disease or one of the congenital syndromes of functional disorders of the pituitary gland or adrenal cortex.

By the way, the term intestinal infantilism, dating back to the beginning of the 20th century, is outdated and is not used, since this pathology, associated with hypersensitivity of the intestinal mucosa to alpha-gliadin, the protein of gluten (gluten) of cereals, is called celiac disease (gluten enteropathy). [5]

Motor or motor infantilism is a delay in the development of fine motor skills and can be caused by: minimal brain dysfunction - with diffuse alteration of the brain or its frontal lobes during pregnancy and childbirth; prolonged oxygen deprivation of the fetal brain; significant prematurity of infants; congenital synaptic inhibition of the motor and premotor cortex of the large hemispheres. Fine motor skills are also underdeveloped in children with attention deficit hyperactivity disorder.

Read also - brain Dysfunction in Adults and Children

Genital infantilism refers to underdevelopment of the external genitalia (genitals), and sexual or gender infantilism refers to delayed or absent sexual development/maturation. These disorders affect the reproductive systems of women and men.

Genital infantilism is considered synonymous with hypogonadism: hypogonadotropic - with primary deficiency of gonadoliberin (gonadotropin-releasing hormone, GnRH) or pituitary - when insufficient secretion of the same GnRH is caused by disorders of prenatal development of the pituitary gland. [6]

The reproductive organs of the fetus develop from the 4th-5th to the 20th week of gestation. The so-called infantile uterus - uterine infantilism or gonadal infantilism in women - is the result of congenital anomalies due to gene mutations. Violations of intrauterine formation of the reproductive system organs, leading to aplasia of the uterus (often with vaginal hypoplasia), are fully manifested in Meyer-Rokitansky-Kuster-Hauser syndrome - due to abnormalities in the transformation of embryonic müllerian ducts.

Underdevelopment of the uterus is characteristic of swyer syndrome and adrenogenital syndrome, a deficiency of the enzyme 17-alpha-hydroxylase (which is required for the biosynthesis of sex steroids).

Cervical infantilism, i.e. Cervical infantilism, is observed in disorders of the development of the female genital tract - cervical agenesis, which is most often combined with congenital absence of the vagina and underdeveloped (or absent) uterus. The main causative factors include various teratogenic effects on the fetus and gene mutations (in particular, those responsible for the synthesis of the enzyme 21-hydroxylase).

Pituitary ovarian infantilism is the result of isolated hypogonadotropic ovarian hypofunction. It is also found in all girls with partial absence of one X chromosome - shereshevsky-Turner syndrome. In this syndrome, in addition to gonadal dysgenesis, puberty is delayed, and sexual infantilism, as in kalman syndrome, is the result of hypothalamic-pituitary dysfunction and deficiency of GnRH, FSH (follicle-stimulating hormone) and LH (luteotropin).

Read more: vaginal and uterine malformations

Sexual infantilism in males is associated with dysontogenesis (underdevelopment) of the genitalia. Thus, the presence of micropenis, as well as testicular aplasia are caused either by hypoplasia of Leydig cells - endocrinocytes of the interstitial tissue of the testicles, or klinefelter syndrome - partial insensitivity to male sex hormones (androgens). Hypogonadism and chromosomal abnormalities in noonan syndrome also lead to disorders of male sexual development at the early embryonic stage.

Mental infantilism or psychoaffective immaturity is considered a type of psychotic disorder, particularly asthenic psychopathy. Also, disharmonic mental infantilism in children and adults is often observed in cases of schizoid personality disorder and in schizophrenia. In children, there is an etiologic link with autistic disorder - asperger's syndrome.

Psychological infantilism is often replaced by the phrase "adult child", and the peculiarity of such personality is manifested in the lack of self-control and self-regulation skills, willpower and responsibility. Practically identical to psychological personal infantilism - immaturity of an individual in the emotional and volitional sphere, mental features of which are manifested by emotional lability (instability), increased excitability and impulsiveness, the presence of behavioral patterns and lack of self-criticism, as well as difficulties with adaptation in the team or problems in personal relationships.

Intellectual infantilism is considered a mental disorder with cognitive abilities that are not age-appropriate. For more information, see. - mental retardation in children

Emotional infantilism is defined when an older child or adult demonstrates emotions typical of younger children, shows inappropriate reactions (especially in a situation where there is no way to satisfy their desires) and is unable to understand their own feelings and recognize and interpret the emotions of others.

Neurotic infantilism develops as psychopathologic on the background of neurotic disorders and disorders in persons with emotional-volitional immaturity.

Taking into account the predominant areas of manifestation of developmental disorders, some specialists distinguish social infantilism, as well as legal infantilism. The first case refers to the lack of skills of interaction with others (family members, coworkers, etc.) and unpreparedness to fulfill the responsibilities of adults. In the second case, adults - like children who resist any restrictions - do not have an "internal brake", that is, a clear idea of responsibility for their actions and what they have no right to do. In its extreme form, this can resemble legal nihilism with absolute rejection of legal norms as such.

Complications and consequences

Fertility and reproductive problems with inability to get pregnant - complications and consequences of genital infantilism 1-2 degree in women.

In intellectual infantilism, there is a serious decline in the school performance of children and adolescents.

Personal or psychological infantilism in relationships jeopardizes any interpersonal and intra-family ties and social contacts. In addition to difficulties with adaptation to the rules of society, adolescents with disharmonious psychological infantilism have distorted formation of personality and general motivation, and in adults can progress personality disorder, develop anxiety-depressive states and aggravate psychopathic type of behavior.

Diagnostics of the infantilism

The clinical diagnosis of personality, psychiatric, and neurotic infantilism can cause some difficulty in identifying the specific disorders that underlie this abnormality.

Based on the history, symptoms and diagnostic criteria, the psychiatrist conducts a test for infantilism, which includes a scale for assessing psychopathological symptoms (negative and positive), various psychophysical and behavioral tests, including the level of logical thinking, memory, reaction time, etc.

When parents go to the doctor about the child's underdevelopment, an X-ray of the hand is prescribed - to determine the bone age, as well as taking blood tests to determine the level of various hormones (STH, TTG, ACTH, etc.).

Laboratory tests are also necessary to diagnose developmental disorders of the reproductive system (underdevelopment of the genitalia), as well as to clarify the history of syndromal abnormalities. Then the karyotype is analyzed, the level of thyroid, sex and other hormones in the blood.

Differential diagnosis

Differential diagnoses include borderline personality disorder, oligophrenia, Angelman syndrome, emotional disorders (including hyperthymia), and other types of neurocognitive pathologies.

More information in the materials:

• Study of the neuropsychic sphere
• Diagnosis of disorders of sexual development
• Diagnosis of syndromes due to sex chromosome aberrations
• Diagnosis of mitochondrial diseases
• Diagnosis of congenital hypothyroidism

Treatment of the infantilism

No doctor can accelerate physical, mental or psycho-emotional development, and infantilism of psychological and mental origin becomes a persistent characteristic of the personality.

What to do if a child is underdeveloped, parents will be advised by a child psychologist. And how to get rid of infantilism, will advise an experienced psychotherapist, whose arsenal includes such a method as cognitive behavioral therapy.

What therapeutic measures help to cope with emotional instability of children and adults with infantilism, read in the publication - increased emotional lability syndrome.

And the treatment of hypogonadism, functional disorders of the adrenal cortex, thyroid dysfunction or hypothalamic-pituitary dysfunction, etiologically associated with impaired development of genitalia and sexual development, is the appointment of long-term (often lifelong) hormone replacement therapy.

Prevention

Since genetically related conditions are responsible for nearly half of moderate mental retardation and more than one-third of childhood developmental delays, prevention may consist of medical and genetic counseling when planning a pregnancy.

Forecast

Psychologists believe that proper upbringing can significantly improve the prognosis of harmonic infantilism in children. But immaturity of adult personality often form a lifestyle - frivolous, carefree and irresponsible.

Psychogenic pathological infantilism can lead to passive confrontation with society. And the inability to make independent decisions, inability to think through their actions and weigh their possible consequences makes a person an easy object for various manipulations, including criminal ones.