Brain damage at the perinatal stage, as a rule, manifests itself in three variants of clinical symptoms. They depend on the localization and scale of the focus:
- Gross movement disorders, against which an intellectual deficit may also occur. A typical example of such a lesion is cerebral palsy, cerebral palsy.
- Conditions when the intellect suffers to a greater extent, and movement disorders are less pronounced. Considered moderate or moderate.
- Relatively mild lesions of the central nervous system, with a smoothed, not obvious picture of motor and intellectual anomalies. But with signs of psychological disorders.
Simply put, MDM refers to any brain pathology, which is the basis for the formation of mental pathology or movement disorders. With varying severity: from behavioral disorders to cerebral palsy.
Here it is appropriate to recall the staging of the maturation and development of intellectual abilities in children under 7 years of age. It was proposed by Piaget ( Piaget , 1994, 1997 ), highlighting 4 periods. And in each of them, children with brain dysfunctions have their own deviations.
Common manifestations by sub -periods
The first 1.5 years of life is the sensorimotor phase. If a child has suffered perinatal hypoxia of the brain, then his coordination of movements is disturbed, motor activity is weakened or increased.
The second phase is from a year to the complete formation of speech skills. During this period, children with MDM begin to lag behind their peers in speech.
The first words often appear on time (about a year), then stagnation sets in, development stops. The period of “muteness” is characterized by the fact that children understand the appeal to them with gestures and give feedback. They just keep silent.
From 2.5 to 4-6 years old, the child learns the world already without the need for tactile information, due to not only tactile information. The so-called preoperative intelligence is involved in this. In a child with brain dysfunction, it is disturbed: video motor coordination is lame, coordination between the assimilation of visual and auditory information is disordered.
There are varying degrees of problems with the pronunciation of sounds, speech therapists interpret this as dyslalia.
The phase of specific operations (from 6-7 years of age onwards), when experience and accumulated knowledge are synthesized with genetic abilities, is accompanied by learning problems in children with MMD.
There are also behavioral deviations, difficulties with social communication in the team.
The problem of diagnosis and therapy of minimal brain dysfunctions remains debatable. Next, we will take a closer look at what is outlined in the previous part of the article.
Etiology and pathogenesis of minimal brain dysfunctions
Neuropathologists perceive MMD as pathological manifestations of brain damage in the early period. And which are manifested in violation of maturation, disharmonious development of higher nervous activity.
As a result of such disorders, we are faced with the immaturity of the functional resources of the brain. Those that provide higher nervous functions: speech development, the ability to memorize, perceive and analyze information from the outside.
The level of intellectual development in children with MMD is within the normal range. Difficulties arise in the processes of learning, learning, and social adaptation.
Brain damage is usually focal in nature. Depending on the localization of the site, there are violations of one or another nervous function. One child will find it difficult to write ( dysgraphia ), another will find it difficult to work with numbers ( dyscalculia ). Also, ADHD – Attention Deficit Hyperactivity Disorder, should be considered as a variant of the manifestation of MMD.
In addition to disorders in the work of higher nervous functions, children with CNS lesions show other symptoms:
- fast fatigue from intellectual activity;
- difficulty concentrating;
- difficulties with mastering new school topics;
- poor adaptation to conditions requiring autonomic regulation – heat, stuffiness, bright light and loud noise;
- tendency to motion sickness, “seasickness”;
- headaches since childhood.
Temperament also affects manifestations. For example, at the end of the day in the kindergarten group, choleric people become overexcited, and phlegmatic people become inhibited.
A study of the anamnesis of problem children shows that many of them demonstrate the phenomena of hyperexcitability . Such a syndrome in most occurs from the first months after birth. Delayed onset, from the age of 6-8 months, occurs in about 20% of children with MMD.
Even with the observance of the requirements of caring for the child, providing him with proper nutrition and regimen, he is restless. Shouts for no apparent reason, haphazardly moves arms and legs.
Vegetative reactions are likely: sweating, redness of the skin and its marbling, increased heart rate and respiration.
Attacks of screaming are accompanied by muscle reactions: increased tone, trembling of the chin and twitching of the limbs. There is such a movement when the child opens his arms, as if for a hug – a spontaneous Moro reflex.
Sleep suffers. The child does not fall asleep for a long time, wakes up at night for no reason, gets up early. In a dream shudders, groans.
Digestion is disturbed, children do not take the breast well, they are restless during sucking. They gasp for air and often burp. Due to dysregulation of the muscles of the stomach, food from it does not pass into the intestines, the child vomits.
Again, autonomic dysregulation of the gastrointestinal tract causes an increase and decrease in intestinal motility. Hence – frequent and loose stools, followed by constipation.
early childhood period
From one to three years, children with CNS damage have:
- strong excitability of the nervous system;
- restless behavior, spontaneous movements;
- sleep problems;
- disorders of appetite and digestion;
- poor dynamics of weight gain;
- subtle lag in the development of psychoverbal function, motor skills.
Deficiency and lag in psychomotor maturation (in comparison with peers) is well visualized by 2-3 years. At this age, the diagnosis of minimal brain dysfunctions is most often made for the first time.
If you pay attention to the child, then from the first years you can notice motor disinhibition – hyperkinetic phenomena. Children are clumsy, they have problems with fine motor skills of hands, precise finger movements.
Hence the difficulties with self-care skills: fastening buttons, tying shoelaces
Therefore, they hardly master the skills of self-service, for a long time they cannot learn how to fasten buttons, lace up their shoes.
The desire of parents to educate the child early, with MMD, overloads his brain. Instead of growing intellect, children become stubborn, naughty. Possible neuroses, tics. The opposite result is not excluded: a slowdown in psychoverbal development.
By the age of 3 years, the following come to the fore:
- motor awkwardness;
- high fatigue, asthenia ;
- difficulty concentrating;
- tendency to impulsiveness;
- stubbornness and negativity.
Urinary incontinence (enuresis) and fecal incontinence ( encopresis ) are often superimposed on such phenomena.
A jump, an increase in the manifestations of MMD, as a rule, coincides with changes in the external environment. At 3 years old – kindergarten, at 6-7 – school.
This phenomenon is explained by the weak resources of the damaged brain for adaptation. Since during these periods the child experiences a sharp jump in physical and mental stress.
The greatest difficulties for children with MMD at school are associated with maladjustment in the team and behavioral disorders.
Psychological difficulties in such cases entail psychosomatic disorders, the debut of VVD.
Preschool children with MMD are hyperexcitable and clumsy. At the same time, they are scattered, distracted, restless and quickly get tired. Motor activity can both increase, and vice versa – slow down.
Behavioral and social deviations are noticeable: infantilism, impulsiveness
Schoolchildren experience problems with learning, assimilation of new things. Behavioral disorders are aggravated: psycho-emotional instability, low self-esteem, insecurity. And at the same time – hot temper, cockiness, aggressiveness. Social phobias and opposition are being laid.
With the entry into adolescence, behavioral deviations against the background of MMD become aggravated. Children behave more aggressively, the corners are sharpened in relationships at school and at home, in the family. Academic performance suffers, the risk of early initiation to alcohol, psychoactive substances is high.
Such a danger requires directing the efforts of doctors, parents and teachers to identify and eliminate the manifestations of MMD.
That is, it is noticeable that the jump in the symptoms of MMD falls on certain periods of psychoverbal development. The first one falls on 1-2 years, at which time the cortical zones responsible for speech skills are actively developing.
The second period is 3 years. At this age, children accumulate vocabulary, develop the skills of forming phrases, improve attention and memory. With MMD, in this phase, a lag in speech and articulation becomes noticeable.
The third critical period is considered to be 6-7 years. The child begins to master writing and reading, which increases the requirements for the functional abilities of the brain.
Noticeable, the symptoms of brain dysfunctions become at the elementary school level.
A complex of behavioral disorders is characteristic:
- high excitability;
- disinhibition of drives;
- there is no self-control, a sense of guilt is not developed;
- there is no age-appropriate criticality.
The behavior of such children is disinhibited: they are not assiduous, they jump up from their seats. they don’t walk, but run, distract themselves and interfere with their neighbors in the desk. They grab onto several things at once, they rarely finish what they started.
Promises are made and immediately broken (forgotten). They show inadequate playfulness, negligence, carelessness. Intellectual activity is weakened. The instinct of self-preservation is reduced – they often fall, get injured and bruised.
At first glance, children with MMD show a choleric temperament. However, the essence of their inconsistency and behavior lies in the weakness of the functional regulation of the brain.
The lack of self-control and criticality arises due to the underdevelopment of the frontal cortex. Since these areas are responsible for control, moral and volitional properties of the individual.
Psychophysiological features of children with MMD
A child with minimal MD does not have typical, specific symptoms. The appearance of “small neurological signs” in early childhood, which are combined with emotional and volitional deviations, may suggest a problem. Because of what there is a lack of intellectual abilities.
For children with non-severe forms of MD, mental retardation is quite typical. But if mental retardation is accompanied by irreversible intellectual impairment, from with MMD, the lag is due to behavior, then it is reversible.
In preschoolers, mental retardation is manifested by a violation of three functions:
- perception of new information;
- ability to concentrate;
- memory deviations.
Disturbances in spatial representations are considered typical manifestations of mental retardation in children. The child is poorly oriented in his own body, his fine motor skills are weakened. The function of attention suffers: it becomes fragmented, its volume is limited.
Many children with mental retardation have a peculiarity of memory: involuntary memorization is better in terms of productivity than attempts to learn any material.
Children are characterized by labile, unstable emotions. It is difficult for them to adapt to the team in the group, in the classroom. Mood swings are combined with asthenia, fatigue. There are such children who have emotional deviations combined with a lack of cognitive activity.
Communication with such children is difficult. For an ordinary person, their peer, a child with behaves unpredictably. Acts thoughtlessly, impulsively. Children around them may be aggressive. Parents often mention when talking that their children have no friends.
Signs of MMD
Anomalies are noted in various areas of higher nervous activity. This is confirmed by the ambiguity of the results of psychological testing of children with MMD. In different subtests , different results are noted: increased, decreased, or even in some places – normal.
Anomalies of perception:
- unable to perceive and distinguish the sizes of objects;
- get confused between the parties (left-right);
- do not distinguish between top and bottom;
- find it difficult to navigate in space;
- get confused in time;
- sometimes there are violations of reading, writing (for example, the inscription of letters and words in a mirror image).
Neurological disorders, if any, are mild. Reflexes are slightly asymmetric, hearing is weak, visual acuity is reduced, coordination is slightly disordered, etc.
How many signs one patient will have depends on the extent of brain damage. Gross anomalies are rare.
There are various forms of aphasia. Speech development slows down. Due to impaired auditory perception, slight pronunciation disorders may occur.
Motor activity, if impaired, may have a different character. Tremors, muscle rigidity, uncontrolled sweeping movements, tics. Naturally, fine motor skills and coordination suffer.
As mentioned above, there may be problems with counting, writing, spelling rules. With motor disorders – difficulty with tracing the contour. It is difficult to get organized, to complete the work that has been started.
Abstract thinking suffers the most. There are also difficulties with the synthesis of concepts. Weak arbitrary memory makes it difficult to form conclusions and conclusions. A floating type of thinking is characteristic.
Constitution of the psyche
There is neurotic behavior:
- nail biting;
- biting a pen, pencil;
- children suck their fingers;
- unconsciously nodding;
- eat food out of the usual order (start with dessert);
- get tired easily;
- nocturnal enuresis is typical;
- hygiene skills are formed and fixed with great difficulty.
Emotions and will
Uncontrolled impulsivity, irritability and irritability. The ability to self-control and criticism is reduced.
Disorders of circadian rhythms (drowsiness in the morning, activity in the evening). They experience less need to sleep than their peers. They sleep restlessly, toss and turn. Sleep is either superficial or extremely deep.
The ability to contact with peers is weak, obsessive affection is possible. In games, they are impulsive, losing – annoyed. They prefer a narrow circle of 1-2 children. Reach out to those who are younger than them.
Physical parameters, as a rule, also with deviations. Although sometimes in somatic development they are ahead of their peers.
The level of intelligence allows a higher level of social behavior of the child than that which is realized. Authorities are not recognized. The behavior may not be appropriate for the current situation.
Trusting, tend to imitate elders and peers. Periodic irritability and aggression change to attention to those who are nearby, and vice versa. Changes in the environment are difficult to accept, they strive to maintain the familiar environment in everything. They love boasting, self-esteem, as a rule, is underestimated.
Concentration of attention
Typical distraction. The concentration of attention is weakened. Viscosity of speech, inertia of motility are characteristic.
Frequency of symptoms
It is rare for a child to have less than one of the above symptoms. Next, let’s see how often certain symptoms of MMD occur.
The most common symptom, 90-95%. The consequences of MMD do not allow children to concentrate and for a long time to delay concentration on the subject of activity. Weak ability to ignore external stimuli that are easily distracted.
It is also a frequent occurrence, found in 75-85% of children. Talkativeness is one of the most common manifestations. At the same time, up to 20% of children with MDM have signs of hypoactivity .
Complex of neurological phenomena
75-80% have 5-6 mild neurological abnormalities:
- difficulty making complex movements;
- tics of mimic muscles;
- trembling of the muscles of the chest and back;
- restless fingers;
- deviations from tendon reflexes, problems with coordination.
It occurs in 70-75%. Children of any age group with MMD are prone to neurosis, anxiety, and tearfulness. The mood is constantly changing. Failures are perceived with great feelings, resulting in either irritability or phobia.