Boundary intellectual insufficiency – heterogeneous group of conditions of the deviating development which is characterized by the easy decrease in intelligence which is between norm and an oligofreniya. It is shown by insufficient development of verbal and abstract thinking, a limited lexicon, a narrow outlook, unstable attention. Children lag behind the training program, duplicate classes. Diagnostics is performed by the psychiatrist and the psychologist, clinical and psychodiagnostic methods are used. Medicamentous therapy is selected depending on the main disease, correctional occupations are directed to elimination of cognitive deficiency.
Boundary intellectual insufficiency
Boundary intellectual insufficiency is called also boundary intellectual backwardness, boundary level of intellectual development. In special cases the terms "minimum brain dysfunction", "the detained development", "delay of rates of mental development" are applied. A general characteristic of these violations – the easy, corrected insufficiency of intelligence which is not reaching the level of defective development. Differs from moronity in smaller firmness, a possibility of compensation. Heterogeneity of etiologichesky, pathogenetic mechanisms and clinical signs interferes with exact definition of an epidemiological indicator. According to researches of the middle of the 20th century, prevalence fluctuates from 1,5 to 3%.
Reasons of boundary intellectual insufficiency
The origin of violation is various. In a deviation etiology the main role is played by the biological basis which is shown not rough decrease in rates of development of systems of a brain, small organic damages of TsNS. The additional negative impact is made by environment conditions. The causes of frustration can be grouped as follows:
- Pathologies of pregnancy and childbirth. The hypoxia, incompatibility on a Rhesus factor and the AVO system, intoxication, an infection during pregnancy leads to lag of development. At the time of delivery injuries, asphyxia become the reasons.
- Neuroinfections, craniocereberal injuries. Early infectious and traumatic damages of a brain are shown by lags of intellectual development. Expressiveness of symptoms depends on intensity of the damaging factor and age of its influence.
- Chronic somatic diseases. The negative impact is exerted by neurologic, endocrine pathologies. Lag of intellectual functions is formed on the basis of an asthenic syndrome, hormonal shifts.
- Pedagogical neglect. The wrong education, conditions of a cognitive deprivation, a lack of information lead to arrests of development. Risk group – children from dysfunctional families.
Pathogenetic basis of boundary intellectual insufficiency – the slowed-down maturing and insufficiency of functions phylogenetic young brain structures. Immaturity of frontal lobes of the big hemispheres of a brain providing difficult mental activity – programming and control of conscious behavior, difficult actions is most often observed. States are diverse by origin. The delay of rate of development of departments of a brain or not rough organic injury of the central nervous system which is followed by loss of the functions and structural elements important for realization of difficult intellectual processes can prevail. In the second case more permanent clinical manifestations are observed. Boundary intellectual insufficiency is defined by personal immaturity, not rough decrease in cognitive functions, tends to the return development and compensation.
The most widespread and clinically reasonable is the classification developed by the Soviet and Russian psychiatrist, professor V. V. Kovalyov. Types of boundary intellectual insufficiency are determined by the author by psychopathological mechanisms and an origin. Differentiation is made according to structure of defect, a ratio of symptomatology of a disease and manifestations of the broken development. Three types of deviations are allocated:
- Dizontogenetichesky. The boundary intelligence is caused by unevenness of maturing of systems and structures of a brain. Concrete frustration – mental infantility, partial arrests of development of components of cognitive activity, the distorted mental development (RDA some forms).
- Entsefalopatichesky. Lags of intellectual development are the cornerstone the residual phenomena of organic defeat of TsNS. It is diagnosed at a tserebrasteniye, a psychoorganic syndrome, a cerebral palsy.
- Dizontogeneticheski-entsefalopatichesky (mixed). The general underdevelopment of the speech belongs to this form. The uncomplicated option of OHP, OHP with neurologic and psychopathological syndromes, a motor alaliya (a resistant speech underdevelopment) is included.
Symptoms of boundary intellectual insufficiency
Clinical signs of boundary I.Q. become noticeable at preschool and younger school age. The expressed violation of functions of any attention is observed – children are restless, easily distract, "do not hear" the adult. Insufficiency of integration of functions of a brain is shown by difficulties in recognition non-standard (turned, not finished drawing) images, connection of details of the drawing in whole. Perception of the spatial relations, orientation in own body is broken. The motive rastormozhennost is expressed, small motility is underdeveloped. Further it becomes a basis of problems when forming school skills – readings, letters, a spellingovaniye, accounts.
At school students the limited lexicon, low erudition comes to light. The understanding of social situations is complicated – children and teenagers are not able to get acquainted, offer the help, to resolve the conflicts. Skills of hygiene, household self-service are late formed. At the senior school students and adults the abstract and logical thinking is insufficiently developed that is shown by misunderstanding of humour, popular expressions, sayings. The emotional sphere differs in instability, mood swings.
At a tserebrastenichesky syndrome decrease in storing, bystry exhaustion, exhaustion at loadings is observed. At mental infantility boundary intellectual insufficiency is combined with lag of emotional and strong-willed functions – children prefer game activity, do not acquire norm and the rule, do not hold the instruction. Sometimes absence or underdevelopment of the speech, insufficient formation of educational skills (reading, the letter, a spellingovaniye, the account) is defined.
The main complication of boundary intellectual insufficiency – educational and professional disadaptation. The training program of initial classes can be mastered by most of children. Introduction of the difficult objects demanding the developed abstract and logical thinking – physics, algebras, geometry – reveals learning ability problems. Educational poor progress of teenagers becomes a provocative factor of behavioural violations: aggressions, impudences, truancies, familiarizing with asocial groups. The school program and the subsequent vocational training are more difficult, the risk of disadaptation is higher. The optimum outcome is observed at the small rural schools reducing requirements to pupils. Teenagers manage to get incomplete secondary education, to master a working profession.
Detection of boundary intellectual insufficiency is complicated by lack of accurate criteria of diagnostics, various level of requirements imposed by society to mental abilities of children of separate groups. Receipt and release from high school become the critical periods. Primary diagnostics is carried out by the psychiatrist – the expert talks to parents and the child, estimates the level of speech development, ability to come into productive contact, to solve simple logical problems, to understand figurative sense of phrases. Specific diagnostics is carried out patopsikhology, a set of techniques is selected individually taking into account age and abilities of the child. The general scheme of inspection includes:
- Tests of intelligence. A widespread technique is the children's version of the test of Wexler (WISC). Boundary development of intelligence corresponds to an interval of 70-80 points. For inspection of patients with the general underdevelopment of the speech only a nonverbal part is used.
- Memory research. Test "10 words", "Reproduction of the story", "The mediated memory", "Pictogram" is applied. Decrease in results is considered in favor of a tserebrastenichesky syndrome.
- Attention research. Functions of active attention are investigated by means of techniques "Shulte's Tables", "Proof test", "Red-black tables". The exhaustion of mental activity, instability of concentration, violation of a pereklyuchayemost is estimated. Aberrations reveal an organic component.
- Thinking research. The technique "Comparison of concepts", "An exception superfluous", "Classification", "Simple analogies", "The explanation of proverbs and metaphors" is used. At boundary I.Q. easy decrease in analitiko-synthetic function, the reduced ability to abstraction is defined.
Differential diagnostics with easy degree mental retardation is most important. Key signs of boundary intellectual insufficiency are smaller firmness of violations, the best learning ability, IQ is higher than 70 points (according to Wexler).
Treatment of boundary intellectual insufficiency
Treatment of boundary forms of intellectual insufficiency is carried out by the psychiatrist, the neurologist, the psychologist. Methods are selected individually, depend on the main diagnosis. Treatment is surely supplemented with the rehabilitation actions promoting the best adaptation of the child to educational institution. Teachers, parents are connected to process. At a treatment stage more sparing conditions allowing to overcome intellectual lag – additional after-hour classes, detailed analyses of mistakes etc. are necessary for pupils. The most widespread directions of therapy:
- Application of medicines. The choice of medicines is defined by pathogenesis, clinic of the leading disease. The drugs stimulating exchange processes and blood circulation of a brain – nootropa, blockers of calcic channels, psychostimulators, amino acids are often used.
- Psychology and pedagogical correction. Classes are given on a regular basis, are focused on development and compensation of the lagging behind functions. Are used technology of involvement of several modalities at once: motive, tactile, visual, audialny.
Forecast and prevention
The forecast of boundary intellectual insufficiency often favorable – treatment, special conditions of training allow to compensate lag, to reach normal development of intelligence. Prevention of violations of this kind has to begin with the period of planning and conducting pregnancy: it is necessary to support health of future mother, to lead a healthy lifestyle, to regularly undergo perinatal inspections. The second stage – care about health of the child. Absence of injuries, long somatic diseases reduce probability of an intellectual delay. The third stage – creation of the conditions of the environment stimulating development of informative functions. It is necessary to select toys, games, occupations according to age, to take care of visit of kindergarten, to pay enough attention to development of the child.