Oligophrenia in children

All painful conditions associated with irreversible damage to the structures of the child's brain during embryonic and post-embryonic development and the resulting intellectual underdevelopment and various mental problems are combined into the concept of feeblemindedness or oligophrenia in children. According to the decision of the World Health Organization, the set of pathologies of this type is usually defined as mental retardation, and the corresponding code according to ICD 10 is F70-F79.

In the United States, all forms of neurocognitive disability are legally referred to as intellectual disability; the term “oligophrenia” has fallen out of use in modern Western psychiatry.

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Causes of oligophrenia in children

In child psychiatry, the causes of mental retardation in children are divided into hereditary (genetic abnormalities and chromosomal disorders, which account for 70% of the pathology), antenatal (that is, pathogenic factors affecting the fetus during pregnancy) and postnatal (during childbirth, in the neonatal period and the first 12-24 months of life).

The pathogenesis of hereditary oligophrenia is most often caused by disturbances in the set of chromosomes or their defects. Let us name just a few of them:

Extra 21st chromosome - Down syndrome;

Extra 13th chromosome - Patau syndrome;

Fragile chromosome syndrome - X-linked mental retardation in boys, and Rett syndrome in girls;

• chromosome 4p defect – Wolf-Hirschhorn syndrome;
• chromosome 5p abnormalities - dementia in cri du chat syndrome;
• defect of chromosome 9p - Alfie syndrome, chromosome 15p - Prader-Willi syndrome, etc.

All of these are clearly expressed syndromic types of mental retardation in children, in which disturbances in the formation of various structures of the brain are the consequences of chromosomal defects.

The most common causes of oligophrenia in children associated with hereditary metabolic disorders are: iodine deficiency (neonatal thyrotoxicosis), metabolic disorder of the essential amino acid phenylalanine (phenylpyruvic oligophrenia), deficiency of the enzyme that breaks down arginine (hyperargininemia), deficiency of the lysosomal enzyme tripeptidyl peptidase (neuronal ceroid lipofuscinosis), etc.

Antenatal causes of mental retardation in a child include:

• chronic intrauterine hypoxia (lack of oxygen) of the fetus;
• placental insufficiency (intrauterine growth retardation syndrome);
• maternal infections (syphilis, toxoplasma, herpes virus, cytomegalovirus);
• rubella suffered during pregnancy (leads to rubella oligophrenia in the child);
• toxic effects of lead, mercury vapor, pesticides, phenol;
• teratogenic effects on the fetus of ethanol (alcohol), as well as a number of medications taken during pregnancy (antibiotics, aspirin, warfarin, isotretinoin, etc.);
• increased background ionizing radiation;
• preeclampsia, premature birth.

Postnatal causes of mental retardation in children primarily include acute asphyxia during childbirth or craniocerebral trauma (birth trauma to the head when applying forceps or using a vacuum extractor). Also, impaired brain function and subsequent mental retardation in children can occur with immune incompatibility of the mother and fetus according to the Rh factor of the blood.

Oligophrenia in young children can develop as a result of bacterial and viral damage to the brain by Escherichia coli, Listeria coli, Haemophilus influenza, St. Pneumonia, Neisseria meningitidis during meningitis or encephalitis.

Symptoms of oligophrenia in children

Mental retardation means significant limitations of age-appropriate intellectual and cognitive abilities and adaptive behavior that manifest in a child and remain for life - as does the biological inferiority of the brain that causes them. And the symptoms of oligophrenia in children depend on the degree of limitation of mental abilities:

• mild or first degree of oligophrenia (debility);
• moderate oligophrenia - II degree (slightly expressed imbecility);
• severe oligophrenia - grade III (significantly expressed imbecility);
• profound oligophrenia - IV degree (idiocy).

The characteristic signs of mild oligophrenia in children are considered to be: the level of intellectual development (IQ on the Wechsler scale) of 50-69 points; delayed physical development; poor memory and instability of attention; problems with abstract and logical thinking; difficulties in carrying out purposeful actions; emotional instability and mild behavioral disorders; very high suggestibility, often leading to complete dependence on the influence of strangers.

Experts note that the first signs of a minor neurocognitive disorder can in many cases only be detected after children start school – at 8-9 years old, when they have more difficulty mastering the curriculum. According to British psychiatrists, about 87% of children with mild mental retardation are only slightly slower in mastering new information and skills.

In moderate oligophrenia, IQ is determined at the level of 35-49 points, and in severe - within 20-34 - that is, the ability to think independently is minimal (in the first case) or completely absent. Such children may sleep and eat poorly, get tired and irritated quickly. Developmental delays are clearly visible at an early age: such children begin to sit, crawl, walk and talk later than age norms. Although, despite all the difficulties, children with imbecility are able to master a minimal vocabulary. There are also problems with fine motor skills, with a low ability to memorize and master the simplest self-care actions.

Oligophrenia is a non-progressive condition, i.e., non-progressive condition, but the symptoms of oligophrenia in children with moderate and severe retardation become more obvious to others with age, especially compared to their peers without disabilities. This manifests itself in a complete inability to control and adapt their behavior, which often leads to behavioral deviations in the form of attacks of psychomotor agitation, up to affective disorders resembling epilepsy, seizures and psychoses with elements of aggression. From 5% to 15% of children with limited intellectual abilities have behavioral problems, which are a significant problem for those who care for them. However, with oligophrenia caused by congenital hypothyroidism, children are lethargic and apathetic, their movements are slow, there may be a complete lack of hearing and speech. In general, in each specific case, the manifestation of certain symptoms is determined not only by the degree of brain damage, but also its pathogenesis.

The characteristics of children with deep (IV) degree oligophrenia are manifested in the absence of thinking abilities (with idiocy, the IQ level is less than 20 points) and speech. Deep mental retardation in children is almost always determined at birth or soon after. Most of these children have significant damage to the central nervous system and are unable to respond to external stimuli, perceive speech, recognize parents, experience and express emotions (there is no conscious facial expression), coordinate movements, touch objects, feel taste, smell, and even pain. A common symptom is mechanical multiple repetition of the same movement or, conversely, falling into a state of complete immobility.

It should be borne in mind that some syndromic oligophrenias (Down, Crouzon, Apert syndromes, etc.) are characterized by typical external signs, in particular, craniofacial anomalies, conduction disorders of the oculomotor nerves (with strabismus or nystagmus) and general muscle innervation (with paresis or convulsions). And from the cardiovascular and endocrine systems, there are many nonspecific symptoms.

Diagnosis of oligophrenia in children

Studying the anamnesis (including family history), complete information about the mother's pregnancy and childbirth, assessing the child's physiological development and its general development are the basis on which the diagnosis of mental retardation in children is based. However, child psychiatrists do not hide the fact that it is quite difficult to determine mental retardation in children of early and preschool age (unless, of course, it is a clearly expressed syndrome): testing the level of mental abilities according to Wechsler (according to the WAIS version for preschoolers) is designed for children five years and older, assessing the level of adaptive behavior and sociability - with the help of a special rating scale - is also not easy. The only thing left is checking vocabulary and the ability to put cubes together.

So, checking mental development (except for pronounced imbecility and idiocy) can be difficult, but at the same time the doctor needs to structure the symptoms (often non-specific) as accurately as possible and link the clinical picture with the causes of developmental delay.

Blood tests can help with this - general, biochemical, for enzymes, for RW, Anti-HSV-IgM, toxoplasma and CMV (cytomegalovirus), urine analysis for amino acids, genetic testing, etc. And only instrumental diagnostics - encephalography, CT and MRI of the brain - can reveal existing craniocerebral disorders. For more information, see the article - Diagnostics of mental retardation.

The correct determination of developmental pathology is ensured by differential diagnostics, since many conditions and diseases (epilepsy, schizophrenia, etc.) have partially similar psychoneurological symptoms.

In 66 countries around the world, the diagnosis of mental retardation in children is carried out according to the Diagnostic and Statistical Manual of mental disorders (DSM) developed by the American Psychiatric Association (APA), and is based on three criteria: a deficit in general mental abilities, significant limitations in one or more areas of adaptive behavior, and evidence that intellectual limitations became apparent in childhood or adolescence.

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Treatment of oligophrenia in children

Foreign doctors directly tell parents of children with mental retardation that mental retardation is not a disease, but a condition, and it is impossible to cure such children: there is no cure for mental retardation.

Therefore, treatment of mental retardation in children is, in fact, rehabilitation of children with mental retardation: thanks to the efforts of parents and teachers of special educational institutions, most children with mental retardation (except for idiocy and severe imbecility) can learn a lot. Only this will take more time and require more effort.

Children with mild intellectual disabilities need attention, support and positive motivation, while children with moderate mental retardation should be helped to master basic communication skills with other children and adults and taught basic self-care. In special schools, rehabilitation is carried out using methods of therapeutic and correctional pedagogy, and many children with moderate mental retardation acquire basic skills in counting, writing, reading, drawing and manual labor.

Etiological treatment is applicable in cases where oligophrenia is associated with hereditary metabolic disorders or enzymopathies (phenylketonuria).

Symptomatic treatment of oligophrenia in children prescribed by doctors - using tranquilizers (sedatives) or neuroleptics (antipsychotic drugs) - is aimed at relieving increased tension and obsessive-compulsive disorders, improving mood, and is also necessary for psychotic agitation and severe behavioral disorders with pronounced aggressiveness.

But these drugs cause a lot of side effects, and constant use of neuroleptics has almost inevitable consequences in the form of extrapyramidal movement disorders, rigidity or involuntary muscle spasms, persistent sleep and visual acuity disorders. Memory may also decrease and amnesia may develop.

It is considered more appropriate to use B vitamins. For example, the drug Gamalate B6 (in the form of a solution for oral administration) - with magnesium glutamate hydrobromide, gamma-aminobutyric acid and vitamin B6, which has a sedative effect (inhibits the processes of excitation of the central nervous system) and at the same time helps to increase concentration and improve memory.

Traditional treatment of mental retardation in children involves herbal treatment: decoction of valerian roots (children should not be given pharmaceutical alcohol tincture). Medicinal plants ginkgo biloba and ginseng root are also used. Homeopathy is not used in the treatment of children with mental retardation.

The prognosis for oligophrenia in children is lifelong intellectual disability of varying degrees and associated mental health problems. In severe forms (significant imbecility) and profound oligophrenia (idiocy) – disability that may require stay in specialized medical institutions.

Prevention of oligophrenia consists of a full examination of the woman when planning pregnancy (it is necessary to take a blood test for TORCH infections); it is also necessary to consult with geneticists, especially if there were cases of children with various syndromes of mental retardation in the history of the families of future parents. Congenital toxoplasmosis, cytomegalovirus, syphilis are subject to mandatory treatment before pregnancy. Pregnant women should definitely take folic acid in the first trimester of pregnancy and beware of infections (rubella, etc.)

According to the American Academy of Child and Adolescent Psychiatry (AACAP), mental retardation affects nearly 6.5 million people in the United States, of whom more than 550,000 are between the ages of 6 and 20. In the UK, there are up to 300,000 children and adolescents with varying degrees of mental retardation.

Oligophrenia in children affects 2-3% of the total population of the planet. 75-90% have a mild form of the pathology.