How to treat mental and mental retardation. Diagnostics to identify the causes of speech and mental development. Methods of correction of delayed speech.

21.08.2018

According to inexorable statistics, the percentage of children with a diagnosis of RRR increases by about 2 times in the world every year. Not everyone knows what it is. And meanwhile, the abbreviation ZPRR is deciphered simply - delay psycho speech development. In addition to this deviation, children have two others, denoted by and All three in most cases are interconnected and interdependent. Not every mom and dad attach serious importance to the fact that their child barely utters individual words when his peers are already in full swing speaking sentences. Many parents are sure: the time will come and their baby will "talk." Knowledge of all the nuances of ZPRR, what it is, what caused it, how to overcome it, and why to do it, will help to avoid mistakes and correct the situation in time. After all, verbal communication among people, and especially among our youngest citizens, is directly related to adaptation in society, self-realization, the achievement of certain successes, and generally - with a full life.

Numerous researchers have focused their interest on the epidemiology of acute respiratory infections. However, the influence of local factors makes it necessary for each region to have its own estimates. Of pneumonia, in which an etiological diagnosis was reached, 19, 2% were viral, 12, 8% - bacterial and 2, 7% - mixed. Of the bronchiolitis in which the etiological diagnosis was reached, 39, 7% were viral, 1, 9% were mixed. The most frequently isolated viruses were respiratory syncytial, adenovirus and parainfluenza 3.

Despite the excellent methodology with which this study was conducted, several elements that emerged in the last 15 years require confirmation of its results. On the other hand, etiological agents have appeared, whose participation has not yet been absolutely determined.

Norms of psychoverbal development

In order to help answer the questions “SIDD - what is it? And when is it, and when is everything OK?”, We will give a scale of normal development of a child under 7 years of age. It should be noted that the psycho-speech development is a whole complex of skills and abilities. In addition to simply playing sounds, this includes correct pronunciation of words and their logical use, linking individual words into sentences, use of verbs in time without errors, as well as pronouns (I, he, me, you and so on), the ability to quite clearly and reasonably express your thoughts and desires. The diagnosis of ZPRR child should be made at the age of about 5 years. The table below will help parents find out what and at what age their baby should be able to.

Finally, the possibility of having better quality etiological diagnostic elements allows us to identify the involvement of microorganisms that were not usually associated with these images. Its importance is based on the feasibility of effective measures control or prophylaxis. Numerous studies have been conducted on this issue; We allow ourselves to indicate the most obvious. Risk factors for respiratory infection.

Definition The first episode of wheezing associated with the clinical manifestations of a viral infection in a child younger than two years old. It is a diffuse and acute inflammation of the lower respiratory tract, contagious in nature, clinically expressed by obstruction of the small respiratory tract.

Child development rates

Age	Skills
0-1 (month)	The emotional response of the child to appeal to him (for affectionate - a smile or any manifestation of joy, for a sharp and strict crying, sobbing, mimicry of resentment or frustration is possible).
1-3 (month)	Guan, babble, and closer to the end of 3 months - the pronunciation of individual, very simple sounds.
3-6 (month)	In babbling, first involuntary, and after deliberately combining sounds into sound combinations, the baby should be interested in what he does, listen to the new sounds he creates, and closer to 6 months more distinctly pronounce individual light syllables (ba, ma, pa and so Further). Epidemiology It is more common in infants, especially up to 6 months. It prevails in the autumn-winter months. Less than 3% of infants without risk factors require hospitalization, and their mortality is less than 1%. The situation is different when there are risk factors. In less than 30 days hospitalized for bronchiolitis, up to 35% may require intensive care with mechanical ventilation, and in premature babies with bronchopulmonary dysplasia, the hospitalization rate can reach more than 10%. Patients with congenital heart disease may require intensive care four times more often than healthy children, with a mortality rate of 37%.
6-9 (month)	Rather clear pronunciation of simple letter combinations and syllables, and closer to 9 months, babies should begin to repeat the syllables and simplest words (give, on) for adults. Also, children should already understand the meanings of some words and expressions, for example, “this is a mom,” “where is daddy?”, ““ Meav ”makes a kitty”, ““ woof ”makes a dog” and so on.
1 year)	Meaningful pronunciation of the simplest words. Someone may have only 2-3, someone 10-12, but they should already appear in the children's vocabulary. Other viral agents, such as adenovirus, parainfluenza, influenza, rhinovirus and metapneumovirus, can also cause it, although with much lower frequency. In outpatient patients, the most common route of infection is contact with the patient, and hospitalized patients - infected hands of the staff. The incubation period is from 2 to 8 days; The virus is eliminated in respiratory secretions within 3-8 days; It can be prolonged in children and children with weakened immunity. When you need to sound the alarm Pathophysiology Viral infection causes an intense inflammatory response in the small airways leading to edema and necrosis of the respiratory epithelium and its desquamation in the lumen of the bronchi, which causes obstruction of the bronchus. Some airways are partially obstructed, with a change in the normal air flow and distal capture with the help of the antenna, others completely impede the production of atelectasia. The mechanical compromise of ventilation prevents gas exchange. The most frequent change is hypoxemia, secondary to hypoventilated areas, which is usually quickly corrected with the introduction of oxygen.
1-1.5 years	The child goes on contact with pleasure, plays with enthusiasm, every day learns something new. Being engaged in active children's activities, the baby quickly develops its vocabulary, which over the next 6 months should reach approximately 100 words. The child can already formulate the most simple sentences, such as “give me a kitty”, “give me a mother”. Many words he says so far distortedly, he does not pronounce all sounds, where he is not understood, adds mimicry and gestures to speech, he can come up with new words that do not exist in nature, but by what and what he tries to say, that its development is going well. Hypercapnia is not common, except that the child is seriously ill. Depending on the degree of ventilatory disability, various degrees of severity can be determined. Although the use of clinical scales for determining severity can be discussed in studies, they facilitate clinical management and decision making. One of these scales proved to be very useful in practice. Evaluation using Tala's clinical assessment allows you to establish categories of severity. - 4 points or less: Light - from 5 to 8 points: Moderate - 9 points or more: Strong. The classic assessment of severity through sleep, nutrition, or both is practical, but must be replaced by the clinical evaluation of Tala, since it shows a great correlation with the onset of respiratory failure. Measuring oxygen saturation with a pulse oximeter is useful for monitoring oxygenation.
1.5-3 (years)	The child's speech becomes more distinct. Some children in 3 years can pronounce almost all sounds correctly, but more often there are problems with “p”, “l”, “s”, “s”, “h”, “u” and “sh”. Vocabulary in 3 years should grow to about 3,000 words and already include “where”, “because”, “when”, and, moreover, they should be used intelligently.
3-5 (years)	Children correctly pronounce all or the overwhelming majority of sounds, are well able to put words into meaningful sentences and make short stories from them, describe a picture, answer the questions posed not only uniquely "yes" or "no", but more spatially, tell something from what happened to them in a day. Hemogram: Usually normal. Both hemogram, erythrocyte sedimentation, and C-reactive protein are not useful for the diagnosis of bronchiolitis. Radiology. A chest x-ray is helpful, but not essential if there is no diagnostic doubt. The most permanent sign is hyperinflation. Peribronchial thickening, bilateral perihiral infiltrates, areas of parenchymal consolidation in areas, segmental or subsegmental atelectasis can also be observed. Etiological studies: this is usually not necessary, especially on an outpatient basis.
5-6 (years)	Most children utter sounds without distortion, can conduct a dialogue and clearly express their desires.
6-7 years	Speech is correct and meaningful. The child should not have difficulties with the retelling of what he saw, the description of the picture. Many children at this age can read, count, solve simple logic puzzles.

Deviations from these standards may be a reason for parents to consult a doctor.

This is useful in surveillance and in taking precautions for hospitalized patients. The diagnosis can be made by studying viral antigens by indirect immunofluorescence or enzyme immunoassay in the aspirate of nasopharyngeal secretions. These methods are fast and inexpensive, with high sensitivity and specificity in relation to viral culture. They will be requested on admission or as soon as possible. No new samples should be sent pending negative test results.

When you need to sound the alarm

The values of the above table are not absolute, there is no strict framework in this matter. Each person, and the baby too, is a person, a whole separate “universe”, possessing individual features peculiar only to it. Therefore, all the above data can be adjusted in the range of plus or minus, but by the age of 7, development should be normal. However, a significant lag from the norms often means not the individuality of the child, but the presence of his child's health care.

Symptoms confirming pathology:

Supportive Hydration Treatment: On an outpatient basis, it is recommended to charge the child care to give enough liquid through the mouth. In patients requiring hospitalization, the same criteria can be maintained if ingested fluids. If all previous deficiencies, then initially correct. As soon as the symptoms resolve the contribution of the mouth restart. Food: Whenever possible breastfeeding maintained. In all cases, we will try to maintain adequate intake of nutrients.

The magnitude of respiratory failure may require a power sharing or even suspend oral administration. He will also be advised to keep the patient in a semi position. For those that require hospitalization regulate the same recommendations that will be carried out by medical personnel. He may resort to physiotherapy when there is heavy discharge, which increases the risk of atelectasis. In all cases, they must evaluate the risks and rewards; it is advisable to first test the resistance to this control of pulse oximetry.

In addition to shortcomings in speech development, the STDD can manifest itself in the following:

mouth almost open all the time;
excessive saliva secretion;
aggressiveness;
inattention;
increased fatigue;
poor memory;
lag in physical development;
lack of imagination;
closure

Causes contributing to developmental disabilities

There are parents who doubt: ZPRR - what is it? Disease or not? However, scientists have long figured it out. The results of numerous studies have shown that delays in the psychoverbal development are caused by disorders in the brain and in the central nervous system. They can be caused by various factors, some of which affect the baby before birth, and some arise in the first months of life. These include:

It is advisable to control oxygen saturation, trying to keep above 92%. Nasal cannulas should be used with caution in children with acute bronchiolitis, since nasal congestion can prevent proper oxygen flow. Treatment of bronchial obstruction of adrenergic bronchodilators: While even a controversy persists about the benefits of using these drugs in children with bronchiolitis, there is evidence that justifies their use. Salbutamol can be used in the initial operation due to the clinical improvement demonstrated in children with bronchiolitis, low toxicity, ease of administration.

during pregnancy, infectious and other diseases suffered by the expectant mother;
childbirth with complications (protracted, rapid, premature, late);
injuries at birth (cervical vertebrae, skull, central nervous system);
severe infectious diseases in the first months of life;
hypoxia in the mother's womb;
neck areas at birth;
some upbringing methods (too annoying custody, suppression of any initiative and independence shown by a child, cruel treatment of him, parents’s indifference to their children, a situation where they have been left to themselves for most of the day, starting from infancy, and the parents only feeding and changing diapers);
mental trauma kids on early terms their lives.

Causes contributing to developmental disabilities

It has not yet been possible to establish characteristics for identifying children who do not respond to treatment; this may be suspended in the absence of a clinical response after a therapeutic trial. Salbutamol is used in inhalation, holding the chamber for a measured dose of an aerosol and a child's respiratory mask. It can be used 200 mg of salbutamol every 20 minutes in patients with moderate or severe bronchiolitis for an hour before deciding the fate of the patient.

Initial care plan for patients with bronchial obstruction. Another alternative is to use salbutamol when spraying. The efficacy, safety, and accumulated experience of using β 2 -adrenoreceptors does not justify the use of adrenaline in the treatment of these patients. Corticosteroids. Despite the predominant role of inflammation in the pathogenesis of airway obstruction in bronchiolitis, corticosteroids did not have a positive effect on the clinical evolution of these patients. There were no differences in the intensity or duration of the symptoms, the development of complications, the duration of oxygen therapy, or the time to eliminate the symptoms.

The diseases causing ZPRR

ZPRR at the child almost for certain will arise as accompanying, and in some cases and as one of the main symptoms at the following diseases:

genetic, disrupting the structure of brain cells;
epilepsy;
cNS abnormalities;
mental illness;
hydrocephalus;
intracranial pressure;
brain tumor;
leukodystrophy;
infringement of the nerve of the cervical vertebrae;
problems with cerebral vessels;
disturbed liquordynamics.

In addition, autism is often a satellite of ZPRR, recognized by most medical professionals as a disease nervous systemin which there are changes in areas of the brain. These pathologies are associated with mutations in the genes and changes in their interaction.

Similarly, there was no evidence of a decrease in the rate of hospitalization or hospitalization time. Theophylline: There are no well-controlled studies regarding the benefit of theophylline in patients with bronchiolitis. Because of the narrow therapeutic range, it should be avoided. Perhaps its use in children with hypercapnic acute respiratory failure, who do not respond to frequent doses of β 2 adrenergic drugs, may be considered when mechanical ventilation is not available.

Antiviral treatment: although some studies show that its use could be considered in patients with complex congenital heart disease, bronchopulmonary dysplasia, cystic fibrosis, prematurity and immunodeficiency, it must be borne in mind that rivabirin is an expensive medicine with cumbersome use. In special epidemic situations associated with the influenza virus that causes severe cases of acute respiratory infection, you can specify the use of antiviral drugs with activity against this virus: amantadine, rimantadine, oseltamivir and zanamivir.

First, explain what the ACh. In this case, this abbreviation means "autistic traits." The number of autists in our society is growing every year. According to sociological and medical research data, there are about 3-5 such people per 1000 people, and there are much more people who have noticed some other autistic traits. Adult autists lead a secluded life, in most cases are single, often experiencing difficulties in the social aspect. It is possible to notice both childcare and childcare in a child from infancy, but often their first manifestations do not cause anxiety in parents, because developmental delays are attributed to age, and ACh to features of a baby’s character. Sometimes it happens that some children with ACh on the general background of a certain lagging behind their peers are characterized by unusual talents that they do not possess, for example, unique memorization of difficult words, numbers with a large number of numbers, and so on. In addition, many autistic children surprise and touch their parents with love for a certain, learned ritual, for example, compulsory washing of hands with food every day, repeating every action to the smallest detail, and the slightest deviations from the ritual are often perceived "in hostility." In addition to preparing for meals, these children often observe the ritual of preparing for bed. Kids with ACh do not throw toys, but put them in their chosen way, remaining not childishly serious, perform a series of consecutive actions with disguise and so on. The behavior of their children is not only alarming for many parents; they even like it. ZPRR with autistic features becomes quite pronounced by about 3 years. If no measures are taken during this period, the matured child will experience great difficulties at school, may withdraw into himself, withdraw from society, or begin to show aggression towards those who are not like him, who do not understand him or in some way make fun of him.

Treatment is not recommended. The use of inhaled corticosteroids, anticholinergics, aerosolized furosemide, mucolytics, or sprayed saline showed no positive effects in children with bronchiolitis. Criteria for hospitalization All patients with criteria for severity and, ultimately, with an unfavorable family environment, who do not ensure compliance with the indications, should be hospitalized.

Attention depending on the level of difficulty. Follow-up Follow-up Patients receiving outpatient treatment should be monitored daily for the first 48 hours. And then periodically, according to evolution, until the final discharge. Trustees will be instructed to give warning signs so that they are understood. An opportunity will be made to emphasize the value of prevention.

Autistic traits ZPRR: symptoms

One can suspect that the newborn baby has autism traits that can cause further developmental delays, according to the following symptoms:

strong crying and unreasonably violent reaction to seemingly insignificant discomfort and irritants (moved the lamp, turned on the TV and the like);
weak or completely absent reaction to strong stimuli (for example, an injection);
poor motor movement (legs, arms, smile);
manifestation of activity and interest aimed only at the toy, while indifference to the care and communication with people.

The older such children become, the brighter they are in the case of autistic traits ZPRR. Symptoms of this disease at the age of 1-1.5 years:

no babbling;
rarely and reluctant to respond to their call by name;
avoid looking into the eyes of other people, which is especially noticeable when the baby learns to walk;
they express a desire with gestures, and, moreover, they do it with the hand of someone who is next to them
they do not show a pen where, for example, a mother does not wave goodbye;
do not pronounce any syllables;
hard fall asleep and sleep poorly.

Symptoms from the age of 3 years:

children rarely approach other children on their own;
avoid communication, preferring to play alone;
do not react to the emotions of those who are near him;
they do not understand what it is to do in turn with other children (for example, in kindergarten) ", poorly oriented in the social environment around them.

ZPRR with autistic features in this age gap can manifest itself the following deviations:

small vocabulary;
replacing verbal requests for gestures;
weak ability to combine words that are already familiar;
rare appeals to adults or other children with requests;
the inability or unwillingness to tell parents, for example, what was interesting today in kindergarten and the like;
improper use of pronouns (to the question “what is your name?” the child answers “to call you Sasha”);
inability to play those games that require fantasy, imagination;
fatal attachment to only one thing (a toy, a book, a fairy tale, a television program);
auto-aggression (self-harm).

Older children with a diagnosis of ZPRR and ACh have difficulty learning, inattention to school and other tasks that are not interesting, aggression (after all, the child’s poor grades are already being punished in some way).

Diagnostics

The installation of the final diagnosis of RRR is made on the basis of a complex. First of all, the attending physician is obliged to:

clarify data (anamnesis) on how the pregnancy proceeded, childbirth, what were the features of the first months of a child's life (infection, injuries, etc.);
analyze the child's behavior on the basis of personal communication with him, check him for attentiveness, ability of logical thinking, memorization, understanding of the questions asked, and so on (a child of 5 years, the RRMA manifests not only speech therapy problems, but also an inability to think logically, to solve simple tasks age, navigate in terms of “faster-longer”, “more-less” and the like, logically explain the compared values, colors, characteristics of familiar objects);
conduct clinical examinations (examination by a neuropathologist, speech therapist, neuropsychologist);
in some cases, the doctor may refer the child to tests (chromosome tests, metabolic and genetic tests, and others);
sometimes carry out differential computer diagnostics.

With an accurate diagnosis of ZPRR disability give, as a rule, for 1-2 years. It is established on the basis of a conclusion. Longer than 2 years, disability is not given because the term “delay” means a temporary phenomenon and presupposes the achievement of a norm sooner or later. Therefore, after the expiry of the disability period, children must again pass a commission and take a new ITU opinion.

The main methods of treatment

All doctors agree with the opinion: the earlier treatment of ZPRR was started, the more favorable the prognosis will be.

Treatment methods for each baby may vary. This directly depends on the reasons for the delayed development. In all cases, an integrated approach is required, because only speech therapy or pills cannot achieve 100% success. Currently, treatment options include:

1. Reflexology microcurrents. At the same time, minimal electric impulses are produced on bioactive points and areas of the brain where violations are detected, as well as those that are responsible for speech development, after which the CNS is restored. The greatest effect of the method was observed in patients with hydrocephalus. The method is applied until the children reach the age of 6 months.

2. Drug therapy.

3. Speech therapy classes, correction of diction and pronunciation.

4. Stimulating therapy.

5. Work with a psychologist, psychotherapist.

In severe cases, the treatment of ZRRR includes the use of autoneuritis therapy (the introduction of nootropics into the brain) and microsurgery (with the addition of additional vessels to the areas of the brain responsible for speech).

Excellent results are achieved by treatment in Israel, Germany, and China.

Additional methods

Surprisingly good results are obtained by the treatment of ZPRR in children unconventional methods. These include:

osteopathy (manual impact on specific points of the body. At the same time, a balance in the work of the nervous system, psyche, and metabolism is achieved);
therapeutic riding (hippotherapy);
swimming with dolphins (dolphin therapy);
the impact of not child music, smells (aromatherapy);
multiple lessons on logical thinking and motility (puzzles, lego), active games.

Parents should be much and regularly deal with children who have a lag in psychoverbal development, using any available games, inventing fun, interesting, and understandable tasks for the child.

Opinions of parents and doctors

Relatives of children diagnosed with ZPRR, reviews of treatment, the activities of doctors and disability leave different, depending on the result. Concerning disability: many mothers and fathers are against being given to a child under 3 years old, and they believe that a certain lag in speech development is completely avoidable, so there is no need to put a stigma on the child. Also, many parents are opposed to sending a child to specialized pre-school childcare facilities, perhaps rightly believing that the developmental gap will disappear more quickly in a regular kindergarten. The only thing with which every parent agrees is that you need to study a lot with lagging children, you need to contact a speech therapist, if possible apply unconventional treatment, which helps very well, especially in cases of the presence of other than ZPRR, also ACh.

A lot of grateful comments about the treatment of children in the Clinic of Restorative Neurology (Moscow), whose doctors truly work wonders and help almost completely get rid of ZPRR, autism and other abnormalities.

Doctors about children with ZPRR believe that the developmental lag, not caused by serious diseases (cerebral palsy, Down syndrome and others), can be completely reduced to zero, if treatment is started on time.

Delayed speech development is characterized by qualitative and quantitative underdevelopment of vocabulary, lack of expression of expressive speech, the lack of phrasal speech in a child by 2 years and coherent speech by 3 years.

Psychoverbal developmental delay is diagnosed in children over 5 years old, among whom, on average, 20% have this disease. It is at this time that the child begins to actively communicate with others, and the parents notice that something is wrong. But 5 years is already quite a late age to start treatment for RRD. If the child has not spoken at all before the age of 6 years, then the probability of his cure is extremely small, and if there is no question even after 7 years, then it will not be there.

In children with delayed speech development, there is a difference between speech comprehension and verbal voicing. They often correctly fulfill various requests, show objects, pictures, etc. on the instructions, but cannot name them.

What is the difference Delay of speech (ZRR) from the delay of psycho-speech development (ZPRR)?

Speech development delay

Delayed speech development is when only speech suffers, and the child’s mental and emotional development is normal. This is the case when a child understands everything and fulfills requests, but speaks little or very badly.

Delayed psycho-speech development

The delay in psycho-speech development implies that in addition to the delay in the development of speech, the child also has a lag of general intellectual character and development in general.

20 %

Children older than 5 years suffer ZPRR

0,2 %

Chances to cure ZPRR in a child over 6 years old

25%

Children Out of 100 suffer ZRR in Ukraine

How to determine if your child has a delay in speech development?

Disturbance of speech development is an important pathological factor that has an extremely negative effect on the mental, emotional, cognitive and social development of the individual. The earlier the irregularities are revealed and the more accurately the causes are determined, the more favorable the treatment prospects are.

Signs of delayed speech development:

a child at 4 months does not react emotionally to the gestures of adults, does not smile, and does not liven up when his mother addresses him.

the child is already 8-9 months old, and there is no babbling (recurring ba-ba-ba, pa-pa-ta, etc. combinations), and in a year it is an unusually quiet child, which makes little sounds.

the child is already one and a half, and he does not say simple words, for example, “mother” or “give”

a child at 1.5 years old does not understand simple words — his name or the names of surrounding objects: he is not able to fulfill the simplest requests “come here,” “sit down.”

the child has difficulty sucking or chewing. For example, if a one-and-a-half year old child does not know how to chew and chokes even with a piece of pear.

at two years old, the child uses only a few separate words and does not try to repeat new words.

child in 2.5 years of active vocabulary less than 20 words and imitations.

a child in 2.5 does not know the names of the surrounding objects and body parts: at the request, he cannot show a familiar object or bring anything that is out of his sight.

a child at 2.5 does not know how to make phrases of two words (for example, “give water”)

a child in 3 years speaks so incomprehensibly that even his relatives can hardly understand him.

a child of 3 years does not speak simple sentences (subject, predicate, addition), does not understand simple explanations or stories about events in the past or the future.

a child in 3 years speaks too quickly, swallowing the end of words or, conversely, extremely slowly, stretching them, although there is no example of such a speech at home.

a child in 3 years speaks mostly phrases from cartoons and books, but does not build his own sentences - this is a sign of a serious developmental disorder.

a child at 3 years old mirrors what adults say when he is, even if the place is the reason for an urgent appeal to a specialist, and a psychiatrist!

the child, regardless of age, always has his mouth slightly open or there is increased salivation for no apparent reason (not related to the growth of teeth)

ZRR NEGATIVELY SAYS ON THE FORMATION OF THE CHILD'S PERSONALITY. IF THE ENVIRONMENTAL COMMUNICATION IS DIFFICULT, THIS IMPOSTS THE RIGHT DEVELOPMENT OF COGNITIVE PROCESSES, INFLUENCES THE EMOTIONALLY-VOLUNTARY SPHERE AND HINDERS A CHILD, SENSITIVELY, FULLY CHANGED CHANGES AND THE CHARACTERISTICS OF THE FOCUS

Causes of delayed speech

The development of speech is quite a complex psycho-physiological process. To master the speech, the child needs:

VISION (THE CHILD SHOULD SEE THE ADULT'S ARTIKULATION TO FOLLOW THEY TO REPEAT IT FOLLOWING)