Oligophrenia in children

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

In the US, all forms of neurocognitive inferiority are legislatively called intellectual disability, an intellectual disability, the term "oligophrenia" in modern Western psychiatry has disappeared.

[1], [2], [3], [4], [5], [6], [7], [8], [9]

The causes of oligophrenia in children

In children's psychiatry, the causes of oligophrenia in children are divided into hereditary (gene abnormalities and chromosomal abnormalities, which account for 70% of the pathology), antenatal (i.e., pathogenic factors affecting the fetus during pregnancy) and postnatal (during labor, during the neonatal period and the first 12-24 months of life).

The pathogenesis of hereditary oligophrenia most often causes abnormalities in the set of chromosomes or their defects. Let's name just some of them:

An extra 21st chromosome - Down syndrome;

An extra 13th chromosome - the Patau syndrome;

Syndrom of the fragile chromosome - X-linked dementia in boys, as well as Rett's syndrome in girls;

• defect of chromosome 4p - Wolff-Hirschhorn syndrome;
• chromosome anomalies 5p - dementia in catnip scream syndrome;
• chromosome defect 9p - Alfy syndrome, chromosome 15p - Prader-Willi syndrome, etc.

All this is a pronounced syndrome variety of mental inferiority in children, in which violations of the formation of various brain structures are consequences of defects in chromosomes.

The most common causes of oligophrenia in children associated with hereditary metabolic disorders: iodine deficiency (neonatal thyrotoxicosis), impaired exchange of the essential amino acid phenylalanine (phenylpyruvid oligophrenia), arginine-cleavage enzyme deficiency (hyperargininemia), lysosomal enzyme deficiency tripeptidyl peptidase (neuronal ceroid-lipofuscinosis) and etc.

Antenatal causes of mental defects in a child include:

• chronic intrauterine hypoxia (lack of oxygen) of the fetus;
• placental insufficiency (a syndrome of a delay of an intrauterine development of a fetus);
• infection of the mother (syphilis, toxoplasma, herpes virus, cytomegalovirus);
• transferred during pregnancy rubella (leads to ruberolar oligophrenia in the child);
• toxic effects of lead, mercury vapors, pesticides, phenol;
• teratogenic effects on the fruit of ethanol (alcohol), as well as a number of medications taken during pregnancy (antibiotics, aspirin, warfarin, isotretinoin, etc.);
• increased background of ionizing radiation;
• pre-eclampsia, premature birth.

For postnatal causes of oligophrenia in children, in particular, acute asphyxia during childbirth or craniocerebral trauma (birth trauma of the head when applying forceps or using a vacuum extractor). Also, impaired brain function and subsequent mental retardation in children can be with the immune incompatibility of the mother and fetus by the Rh factor of blood.

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

Symptoms of oligophrenia in children

Mental retardation means significant limitations of the age-appropriate intellectual and cognitive abilities and adaptive behaviors that are manifested in the child and remain for life - as well as causing their biological inferiority of the brain. And the symptoms of oligophrenia in children depend on the degree of limitation of mental abilities:

• easy or I degree of oligophrenia (debility);
• moderate oligophrenia - grade II (mildly expressed imbecility);
• severe oligophrenia - grade III (markedly expressed imbecility);
• deep oligophrenia - IV degree (idiocy).

Characteristic signs of mild oligophrenia in children are: the level of intellectual development (IQ on the Wexler scale) 50-69 points; lag in physical development; poor memory and instability of attention; problems with abstract and logical thinking; difficulties in implementing targeted actions; emotional instability and mild behavioral disorders; very large suggestibility, often resulting in complete dependence on the influence of unauthorized persons.

Specialists note that the first signs of a slight neurocognitive deviation in many cases can be detected only after the beginning of the school children's education - at 8-9 years, when they are more difficult to master the curriculum. According to British psychiatrists, about 87% of children with mild mental retardation are only slightly slower to learn new information and skills.

With moderate oligophrenia, IQ is defined at the level of 35-49 points, and in case of severe oligophrenia it is determined within the range of 20-34 - that is, the ability to independent thinking is minimal (in the first case) or completely absent. Such children can sleep badly and eat, quickly get tired and irritated. The lag in development is clearly traced at an early age: to sit, crawl, walk and talk, these children begin later age norms. Although, despite all the difficulties, children with imbecile can master the minimum vocabulary. Also there are problems with fine motor skills, with a low ability to memorize and master the simplest actions for self-service.

Oligophrenia refers to non-progressive, that is, not progressive, conditions, but the symptoms of oligophrenia in children with moderate and severe backwardness become more evident with others, especially when compared to peers without disabilities. This manifests itself in a complete inability to control and adapt their behavior, which often leads to behavioral abnormalities in the form of bouts of psychomotor agitation, including affective disorders resembling epilepsy of seizures and psychoses with elements of aggression. From 5% to 15% of children with intellectual disabilities have behavioral problems, which are a significant problem for those who take care of them. However, with oligophrenia caused by congenital hypothyroidism, children are sluggish and apathetic, their movements are slow, there may be complete absence of hearing and speech. In general, in each specific case, the manifestation of certain symptoms determines not only the degree of brain damage, but also its pathogenesis.

Features of children with deep (IV) degree oligophrenia are manifested in the absence of cognitive abilities (idiocy is less than 20 IQ) and speech. Deep mental retardation in children is almost always determined at birth or shortly thereafter. Most of these children have significant CNS damage 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, taste, smell and even pain. A frequent symptom is a mechanical multiple repetition of the same movement, or, conversely, falling into a state of complete immobility.

It should be borne in mind that for some syndromic oligophrenia (Down syndrome, Cruson, Apera, etc.), typical external signs, in particular craniofacial anomalies, conduction disorders of the oculomotor nerves (with strabismus or nystagmus) and general muscle innervation (with paresis or cramps). And from the side of the cardiovascular and endocrine system there are many nonspecific symptoms.

Diagnosis of oligophrenia in children

The study of anamnesis (including family history), complete information about the mother's pregnancy and childbirth, the evaluation of the physiological development of the child and its general - the basis on which the diagnosis of oligophrenia in children is based. However, children's psychiatrists do not hide the fact that in early and preschool children it is difficult to determine oligophrenia (unless, of course, this is a clearly expressed syndrome): testing the level of intellectual capacity according to Wexler (according to WAIS for preschoolers) is designed for children of five years and older, to assess the level of adaptive behavior and communicability - with the help of a special rating scale - is also not easy. It remains to check the vocabulary and the ability to add cubes.

So the check of mental development (except for pronounced imbecility and idiocy) is difficult, but the physician needs to structure the symptoms as precisely as possible (often non-specific) to the maximum and connect the clinical picture with the reasons for the delay in development.

This can help blood tests - general, biochemical, enzymes, RW, Anti-HSV-IgM, toxoplasm and CMV (cytomegalovirus), urine analysis for amino acids, genetic testing, etc. And only instrumental diagnostics - encephalography, CT and MRI of the brain - can detect existing craniocerebral disorders. For additional information see the article - Diagnosis of mental retardation.

Correctness of the developmental pathology is determined by differential diagnosis, since many conditions and diseases (epilepsy, schizophrenia, etc.) have a partially similar psychoneurological symptomatology.

In 66 countries, the diagnosis of oligophrenia 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 general mental deficiency, significant limitations in one or more areas of adaptive behavior and evidence that the limitations of intelligence have become apparent to children or adolescents.

[10], [11], [12]

Treatment of oligophrenia in children

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

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

Children with mild intellectual underdevelopment need attention, support and positive motivation, and children with a moderate degree of oligophrenia should be helped to master the elementary skills of communicating with other children and adults, to accustom them to simple self-service. In special schools, rehabilitation is carried out using methods of curative and correctional pedagogy, and many children with moderate oligophrenia receive initial skills in counting, writing, reading, drawing, and manual labor.

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

The symptomatic treatment of oligophrenia in children, using tranquilizers (sedatives) or antipsychotics (antipsychotics), is prescribed by doctors to relieve heightened tension and obsessive-compulsive disorders, to improve mood, and is also necessary for psychotic stimulation and severe behavior disorders with severe aggressiveness .

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

More appropriate is the use of 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 CNS excitation) and at the same time time helps to increase concentration and memory.

Alternative treatment of oligophrenia in children, involves the treatment of herbs: decoction of the roots of valerian drug (children should not be given a drug alcoholic tincture). Medicinal plants of ginkgo biloba and ginseng root are also used. Homeopathy in the treatment of children with mental retardation is not applied.

The prognosis of oligophrenia in children is the lifelong inferiority of the intellect of various degrees and the accompanying problems of a mental nature. In severe forms (significant imbecility) and profound oligophrenia (idiocy), disability, which may require the presence in specialized medical institutions.

Prevention of oligophrenia is the full examination of a woman in the planning of pregnancy (must pass a blood test for TORCH-infection); also should be consulted by geneticists, especially if in the history of families of future parents there were cases of the birth of children with various syndromes of mental disability. Obligatory treatment before pregnancy is subject to congenital toxoplasmosis, cytomegaly, syphilis. Pregnant women should take folic acid in the first trimester of pregnancy and beware of infections (measles rubella, etc.)

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

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