RISK FACTORS IN THE MENTAL DEVELOPMENT OF PRESCHOOL CHILDREN

Before considering risk factors in the mental development of children of different ages, we will highlight the question of how to determine the severity of a child’s disorder. M. Rutter offers the following criteria for assessing possible deviations in any behavior .

1. Standards corresponding to age characteristics and
child's gender

A number of behavioral features are normal only for children of a certain age. Thus, wet diapers of infants and even children under 4–5 years of age worry parents little, while for a ten-year-old child such cases are considered a deviation from the norm.

2. Duration of persistence of the disorder
Children quite often experience various fears, seizures,

other disorders. However, cases of long-term (months or years) persistence of these conditions are rare and, naturally, should cause concern in adults.

3. Life circumstances

Temporary fluctuations in the behavior and emotional state of children are a common and normal phenomenon, since development never occurs smoothly, and temporary regression occurs quite often. However, all these phenomena and fluctuations occur more often in some conditions than in others, so it is important to take into account the circumstances of the child’s life. Thus, many children react with regression in behavior to the appearance of a younger brother or sister, and with an increase in anxiety - to a change in kindergarten or group. In general, stress increases a child's existing emotional or behavioral difficulties.

4. Sociocultural environment
Differentiation between normal and abnormal behavior cannot be made

absolute. Behavior must be assessed from the point of view of the norms of its immediate sociocultural environment. Cultural differences that exist in society significantly influence the variability of generally normal behavior.

5. Degree of violation
Individual symptoms are much more common than a whole series

symptoms at the same time. Children with multiple emotional and behavioral disorders require more attention, especially if they simultaneously affect different aspects of mental life.

6. Symptom type
Some symptoms are caused by incorrect upbringing of the child,

others – mental disorder. Thus, the habit of biting nails is equally common in both normal and mentally ill children, so this symptom in itself, although alarming, does not mean anything. At the same time, disruption of relationships with peers is much more often associated with a mental disorder and therefore requires more careful attention.

7. Severity and frequency of symptoms
Moderate, occasional behavioral difficulties for children

more common than serious, frequently recurring disorders. It is very important to find out the frequency and duration of adverse symptoms.

8. Behavior change
When I analyze children’s behavior, I should compare its manifestations

not only with those traits that are characteristic of children in general, but also with those that are common for a given child. You should be attentive to changes in the child’s behavior that are difficult to explain by the laws of normal development and maturation.

9. Situational specificity of the symptom
It is believed that a symptom, the manifestation of which does not depend on any

situation, reflects a more serious disorder than a symptom that occurs only in a specific setting.

Thus, when deciding whether a child’s behavior deviates from the norm, one should take into account a combination of all the above criteria.

Let's consider the most common difficulties in the behavior and development of preschool children. The causes of mental development disorders may be the characteristics of the individual, including neurodynamic, properties of the child: instability of mental processes, psychomotor retardation or, conversely, psychomotor disinhibition

Psychomotor disinhibition called a psychomotor disorder in which there is increased or excessive motor and speech activity.

This neurodynamic disorder manifests itself predominantly in hyperexcitable behavior with emotional instability characteristic of such behavior, ease of transition from increased activity to passivity and, conversely, from complete inaction to disordered activity.

The hyperdynamic syndrome may be based on microorganic brain lesions resulting from complications of pregnancy and childbirth, debilitating somatic diseases of early life (severe diathesis, dyspepsia), physical and mental trauma. No other childhood difficulty causes as many criticisms and complaints from parents and kindergarten teachers as this one, which is very common in preschool age.

The peak manifestations of hyperdynamic syndrome are 6–7 years. In favorable cases, by the age of 14–15 years its severity is smoothed out, and its first manifestations can be noticed already in infancy.

Hyperactive behavior – This is the behavior of children characterized by an increased need for movement. When this need is blocked by rules of behavior, i.e. in situations in which it is necessary to control and voluntarily regulate one’s motor activity, the child’s muscle tension increases, attention deteriorates, performance decreases, and fatigue sets in. The emotional release that occurs after this is a protective physiological reaction of the body to excessive overstrain and is expressed in uncontrollable motor restlessness, disinhibition, classified as disciplinary offenses.

Main signs of a hyperactive child– motor activity, impulsivity, distractibility, inattention. The child makes restless movements with his hands and feet; sitting on a chair, writhing, squirming; easily distracted by extraneous stimuli; has difficulty waiting his turn during games, classes, and other situations; often answers questions without thinking, without listening to the end; has difficulty maintaining attention when completing tasks or playing games; often moves from one unfinished action to another; cannot play calmly, often interferes with the games and activities of other children.

A hyperactive child begins to complete a task without listening to the instructions to the end, but after a while it turns out that he does not know what to do. Then he either continues aimless actions, or annoyingly asks what to do and how to do it. Several times during the task he changes the goal, and in some cases he may completely forget about it. Often distracted while working; does not use the proposed tools, therefore he makes many mistakes that he does not see and does not correct.

A child with hyperactive behavior is constantly on the move, no matter what he is doing. Each element of his movement is fast and active, but in general there are a lot of unnecessary, even obsessive movements. Often children with hyperactive behavior have insufficiently clear spatial coordination of movements. The child does not seem to “fit” into the space (he touches objects, bumps into corners, walls). Despite the fact that many of these children have bright facial expressions, moving eyes, and fast speech, they often find themselves outside the situation (lesson, game, communication), and after some time they “return” to it again. The effectiveness of “splashing” activity with hyperactive behavior is not always high; often what is started is not completed, the child jumps from one thing to another.

A child with hyperactive behavior is impulsive, and it is impossible to predict what he will do next. The child himself does not know this. He acts without thinking about the consequences, although he does not plan anything bad and is sincerely upset about the incident of which he becomes the culprit. Such a child easily endures punishment, does not hold a grudge, constantly quarrels with his peers and immediately makes peace. This is the noisiest child in the children's group.

Children with hyperactive behavior have difficulty adapting to the conditions of kindergarten, do not fit well into the children's group, and often have problems in relationships with peers. The maladaptive behavior of such children indicates insufficiently formed regulatory mechanisms of the psyche, primarily self-control as the most important condition and necessary link in the development of voluntary behavior.

The child's distractibility and motor disinhibition must be persistently and consistently overcome from the very first years of his life. There should be a clear distinction between purposeful activity and aimless mobility. It is impossible to restrain the physical mobility of such a child; this is contraindicated in the state of his nervous system. But his motor activity must be directed and organized: if he runs somewhere, then let it be to carry out some kind of assignment. Outdoor games with rules and sports activities can provide good help. The most important thing is to subordinate his actions to the goal and teach him to achieve it.

In older preschool age, a hyperdynamic child begins to be taught perseverance. When he runs around and gets tired, you can offer him to do modeling, drawing, design, and you must definitely try to make sure that interest in such an activity encourages the child to complete the work he has started. At first, the perseverance of adults is required, who sometimes literally physically hold the child at the table, helping him complete the construction or drawing. Gradually, perseverance will become habitual for him and, upon entering school, he will be able to sit at his desk for the entire lesson.

If the manifestations of hyperdynamic syndrome are not overcome, then upon entering school, the hyperactive child will face serious difficulties. Unfortunately, such a child is often considered simply disobedient and ill-mannered, and they try to influence him with strict punishments in the form of endless prohibitions and restrictions. As a result, the situation only gets worse, since the nervous system of a hyperdynamic child simply cannot cope with such a load and breakdown follows breakdown. Particularly devastating manifestations of the syndrome begin to affect approximately 13 years of age and older, determining the fate of an adult.

Disinhibition - increased physical activity caused by weakening volitional control over voluntary behavior. Disinhibition is not psychomotor agitation in a weaker degree of its manifestation, it is qualitatively different state. Many psychiatrists who note such a symptom as disinhibition in the objective status of a patient mainly mean a certain behavioral pattern that resembles the behavior of a child, or the behavior of a person in a state of alcohol intoxication.

It is worth emphasizing that disinhibition is a manifestation not so much of a quantitative increase in motor activity, but manifestation of its clearly expressed involuntary character, which is out of the control of the subject himself and cannot be controlled from the outside by other persons. The question naturally arises: how then does disinhibition differ, for example, from catatonic excitation? To answer this question, it is necessary to dwell in more detail on the phenomenon of disinhibition.

Disinhibition not always accompanied by increased physical activity. For example, a patient in a conversation with a doctor can behave quite calmly, but at the same time stretch, yawn, pick his nose, etc., which allows psychiatrists to describe the status using formulations such as “does not keep distance”, “does not maintain decency " and so on.

Disinhibition, as a behavioral phenomenon, first of all, means, based on the etymology of the word itself, a weakening of conscious control over voluntary behavior. To a certain extent we are talking about pathologies of volitional processes. Disinhibition is spoken of only when the patient has waking consciousness. Consequently, behavioral phenomena that occur during unclear consciousness, such as ambulatory automatism, somnambulism, and oneiric catatonia, should not be classified as disinhibition. Of course, in the listed conditions the patient carries out involuntary, automated (subcortical) behavior, but, most importantly, he is not aware of it. For clarification, let's use the following example. A patient suffering from schizophrenia with a syndromic diagnosis of “catatonic agitation” demonstrated the following behavior: stereotypically, for several hours, tirelessly, he made movements similar to those that a person makes when chopping wood, while he jumped and made the same sounds words of indecent content. In a strict sense, this is not psychomotor agitation, which is characterized mainly by chaos. The described behavior is characterized, first of all, by involuntariness, autonomy, stereotyping, symbolic coloring, possibly significance and unconsciousness. In extreme cases, we can talk about catatonic-impulsive disinhibition.

Let's return to the “classical” disinhibition, which is one of the three main symptoms of mania(manic triad). As paradoxical as it may seem, in the manifestation of manic disinhibition there is both an element of will and an element of awareness.

Disinhibition is a complex psychophysical process, which is described in detail by E. Kretschmer in his study of hysterical phenomena, including the following Components:

1. reflex excitation of subcortical behavioral activity - from simple reflex acts (tremors, vomiting, tics) to more complex subcortical automatisms with symbolic, often unconscious “load” (like behavioral patterns in the above examples);
2. weakening of volitional control aimed at suppressing reflex activity, on the one hand, but, on the other -
3. semi-conscious direction of voluntary activity, although weak, but still volitional activity, to maintain and strengthen reflex excitation.

Fine voluntary and reflex movements never merge, they intersect. If a person gags, this movement is reflexive or involuntary. Further, the subject can suppress it by force of will - and this will be voluntary suppression. However, the subject may not be able to suppress gagging. Of course, a person cannot, by force of will alone, voluntarily induce the act of vomiting, but if a reflex urge arises, he can, with some effort of will, support and strengthen the reflex act of vomiting - this is how uncontrollable vomiting occurs during hysteria. If you ask a healthy person to tremble, it is unlikely that he will be able to do it completely and long enough. And only with hysterical disinhibition do we see that the subject can tremble for hours, vomit endlessly, and this is not difficult for him, it is given “tirelessly.”

Why does the subject maintain reflex excitation in the case of disinhibition? This can be explained by observing the behavioral reactions of healthy people or children. Let’s imagine a person who has an inflammatory reaction with a rise in temperature, and he is shivering and “shaking.” How might he react to chills? Much depends on the situation, environment, and personal attitudes. He can, by an effort of will, significantly weaken the chills, and everyone will agree that this will require significant effort (the person will have to “gather his will into a fist”). But if he is in bed in the category of “sick,” in the presence of care and care from those around him, then the individual can allow himself to “shake to his heart’s content,” and he may notice that he can do this easily and does not experience fatigue. It is precisely due to the fact that the reflex becomes accessible to the conscious will, and their fusion gives rise to a feeling of lightness, subsequently the tendency towards disinhibition, as a subjectively pleasant state, is fixed in human behavior.

A similar reinforcement can be found in the behavior of a child, depending on the nature of his upbringing and his individual characteristics. Let's imagine a situation - a child fell and was slightly hurt, and he may have a reflex act without even crying, but simply screaming. He can also suppress this reflex act if his interest is concentrated on some object that occupies him. And he can “become crying” for a long time, even forgetting about the reason that caused it - as a rule, there is an over-caring and anxious mother nearby. In the further consolidation of such behavior in a child, emotional factors undoubtedly play a large role.

Thus, in disinhibition, as a persistent behavioral phenomenon, despite the fact that it is initially initiated by reflex excitation, the main thing is its voluntary (semi-conscious) strengthening, motivated:

1. situationality,
2. feeling of lightness and
3. emotional nourishment.

All three of these factors - situationality, lightness and emotionality, we we can also observe when performing voluntary movements, polished in the process of mastery and brought to the level of automatism, for example, in the triumphant performance of a ballet dance. But to achieve this, you need years of painstaking and grueling training. The wild dance of a shaman looks completely different, who, with the help of psychoactive substances, by self-inducing a trance, essentially achieves states of disinhibition and activation of subcortical motor activity, bearing an archetypal-symbolic coloring. Subsequent strengthening and voluntary reinforcement of awakened behavioral patterns leads to the same thing - lightness, emotional saturation, lack of fatigue. The shaman can dance until he simply falls from physical exhaustion. The hysterical psychoses called St. Vitus' dances looked the same.

Disinhibition is, first of all, a behavioral disorder that is characteristic of the following conditions:

1. manic state;
2. hyperkinetic syndrome and other forms of disrupted behavior in children;
3. behavioral disorders due to dementia, personality defect, dissocial personality disorder.

From behavioral disinhibition itself it is necessary to distinguish between hyperkinesis and obsessive actions, which can be described as “partial disinhibition.”

SDD, movement disorder syndrome, movement disorder syndrome, motor disorder syndrome in children

What is SDR?

Motor disinhibition syndrome (MDS) is a form of neuropsychic disorders in children, characterized by increased motor activity and excitability. They say about such children: “Hyper active children.” Synonyms for Sdr are movement disorder syndrome , movement disorder syndrome , motor activity syndrome , motor disinhibition syndrome, newborn SDS, children SDS .Motor disinhibition syndrome occurs in 20-35% of children. In most cases HAPPY BIRTHDAY is a consequence of the lungs of the brain, especially in the prenatal period and during childbirth.

Movement disorder syndrome, SDD, symptoms, signs, manifestations

What are the main symptoms, signs and manifestations of the syndrome of movement disorders, disorders, disinhibition? Manifests motor disinhibition syndrome (MDS) clumsiness, motor disinhibition, absent-mindedness, aggressiveness, distractibility, impulsiveness. Weakly expressed irregular and uncoordinated choreiform patterns are often detected, especially during emotional stress and physical exertion. Hyperkinesis is predominantly localized in the distal parts of the extremities, less pronounced in the proximal parts of the extremities and usually does not lead to impairment of self-care. Children are restless, too mobile, emotionally labile, and often change activities. They are constantly on the move, everyone wants to look and touch. They react to parents' comments by crying, screaming, and refusing to comply with their demands. Their development in the first year is often accelerated; they begin to walk early, are very active, mobile, and give the impression of being well developed mentally.

Poor studies, poor performance? Is your child doing poorly at school? Restlessness? Violation of discipline?

However, in the first years of schooling, an average or low level of mental development is revealed; sometimes the child does poorly at school, gymnasium, lyceum, and gets bad grades at school (the child is a bad student, a bad student, a bad student, a C student). Difficulties in learning and conflict situations are common. Parents often ask the question: “How to improve school performance?” Lack of concentration, restlessness, and frequent distractions give them a reputation as violators of discipline. At the same time, children may have increased abilities for a certain type of activity; some love physical education (physical education). SDR is especially pronounced in preschool and early school age; with treatment at Sarclinic, the symptoms go away. Motor disinhibition usually manifests itself at home. In a new environment, such children are often shy and timid at first with their peers.

SDD, movement disorder syndrome diagnostics

Movement disorder syndrome, movement disorder syndrome, motor disinhibition syndrome, SDR characterized by a number of signs: neurological microorganisms are noted in the form of asymmetry of cranial innervation, tendon-periosteal reflexes, i. A neurologist or pediatric neurologist identifies pathological pyramidal or extrapyramidal reflexes. According to the private medical practice Sarclinic, electroencephalography (EEG) in 39.7% shows various changes, usually of a diffuse nature, characterized by a certain constancy. Sometimes interhemispheric asymmetry and local predominance of pathological activity are detected.

SDR, movement disorder syndrome - treatment in Saratov

Sarklinik provides treatment for SDD, treatment of movement disorder syndrome in children, treatment of movement disorder syndrome in Saratov. Sarklinik successfully uses complex methods of treating motor disinhibition syndrome. The effectiveness of complex treatment of SDD, which can include a variety of reflexology, acupuncture, microacupuncture, moxatherapy, non-traditional and other techniques, reaches 95% and depends on the severity of the pathology. Treatment of movement disorder syndrome is carried out on an outpatient basis and individually. All treatment methods are safe. The Sarclinic has been operating for many years, during which time hundreds of patients aged from 1 to 18 years have been cured of motor disinhibition syndrome. If you have a disinhibited, very active child, or an overly active child, contact Sarklinik; at the first consultation, the doctor will examine the child and, if necessary, provide treatment for SDR. Sarklinik knows what to do, how to treat and cure SDD, motor disinhibition syndrome! Hyperactive children become calm and adequate.

Hyperactivity in children, treatment

Sarklinik conducts treatment of hyperactivity in children. Childhood hyperactivity, hyperactivity syndrome in children, including attention deficit disorder, attention deficit hyperactivity disorder are successfully treated. Correction of hyperactivity in children, infants, infants, toddlers, preschoolers, schoolchildren, adolescents, and adults (men and women, boys and girls) must be carried out. Sarklinik has developed a hyperactivity correction program. As a result of treatment in children, the symptoms of hyperactivity completely disappear. Sarklinik knows how to treat hyperactivity in children.

. There are contraindications. Specialist consultation is required.
Photo: Reinhold68 | Dreamstime.com\Dreamstock.ru. The people depicted in the photo are models, do not suffer from the diseases described and/or all similarities are excluded.

In every little child,
Both the boy and the girl,
There are two hundred grams of explosives
Or even half a kilo!
He must run and jump
Grab everything, kick your legs,
Otherwise it will explode:
Fuck-bang! And he’s gone!
Every new child
Gets out of diapers
And gets lost everywhere
And it is everywhere!
He's always rushing somewhere
He will be terribly upset
If anything in the world
What if it happens without him!

Song from the film “Monkeys, Go!”

There are children who were born to immediately jump out of the cradle and rush off. They cannot sit still for even five minutes, they scream the loudest and rip their pants more often than anyone else. They always forget their notebooks and write “homework” with new mistakes every day. They interrupt adults, they sit under desks, they don’t walk by the hand. These are children with ADHD. Inattentive, restless and impulsive,” these words can be read on the main page of the website of the interregional organization of parents of children with ADHD “Impulse”.

Raising a child with attention deficit hyperactivity disorder (ADHD) is not easy. Parents of such children hear almost every day: “I’ve been working for so many years, but I’ve never seen such disgrace,” “Yes, he has bad manners syndrome!”, “We need to hit him more!” The child has been completely spoiled!≫.
Unfortunately, even today, many specialists working with children know nothing about ADHD (or know only by hearsay and are therefore skeptical about this information). In fact, sometimes it is easier to refer to pedagogical neglect, bad manners and spoiling than to try to find an approach to a non-standard child.
There is also the other side of the coin: sometimes the word “hyperactivity” is understood as impressionability, normal curiosity and mobility, protest behavior, or a child’s reaction to a chronic traumatic situation. The issue of differential diagnosis is acute, because most childhood neurological diseases can be accompanied by impaired attention and disinhibition. However, the presence of these symptoms does not always indicate that a child has ADHD.
So what is attention deficit hyperactivity disorder? What is an ADHD child like? And how can you tell a healthy “butt” from a hyperactive child? Let's try to figure it out.

What is ADHD

Definition and Statistics
Attention-deficit/hyperactivity disorder (ADHD) is a developmental behavioral disorder that begins in childhood.
Symptoms include difficulty concentrating, hyperactivity, and poorly controlled impulsivity.
Synonyms: hyperdynamic syndrome, hyperkinetic disorder. Also in Russia, in the medical record, a neurologist can write for such a child: PEP CNS (perinatal damage to the central nervous system), MMD (minimal cerebral dysfunction), ICP (increased intracranial pressure).
First The description of the disease, characterized by motor disinhibition, attention deficit and impulsivity, appeared about 150 years ago, since then the terminology of the syndrome has been changed many times.
According to statistics, ADHD is more common in boys than in girls (almost 5 times). Some foreign studies indicate that this syndrome is more common among Europeans, fair-haired and blue-eyed children. American and Canadian experts use the DSM (Diagnostic and Statistical Manual of Mental Disorders) classification when diagnosing ADHD; in Europe, the International Classification of Diseases ICD (International Classification of Diseases) has been adopted ) with more stringent criteria. In Russia, the diagnosis is based on the criteria of the tenth revision of the International Classification of Diseases (ICD-10), and also relies on the DSM-IV classification (WHO, 1994, recommendations for practical use as criteria for the diagnosis of ADHD).

ADHD controversy
Disputes among scientists about what ADHD is, how to diagnose it, what kind of therapy to carry out - medicinal or using measures of a pedagogical and psychological nature - have been going on for decades. The very fact of the presence of this syndrome is also called into question: so far no one can say for sure to what extent ADHD is the result of brain dysfunction, and to what extent - the result of improper upbringing and the incorrect psychological climate prevailing in the family.
The so-called ADHD controversy has been going on since at least 1970. In the West (particularly in the USA), where drug treatment of ADHD is accepted with the help of potent drugs containing psychotropic substances (methylphenidate, dextroamphetamine), the public is alarmed that a large number of “difficult” children are diagnosed with ADHD and drugs containing drugs are unjustifiably often prescribed a lot of side effects. In Russia and most countries of the former CIS, another problem is more common - many teachers and parents are not aware that some children have characteristics that lead to impaired concentration and control. Lack of tolerance for the individual characteristics of children with ADHD leads to the fact that all the child’s problems are attributed to lack of upbringing, pedagogical neglect and parental laziness. The need to regularly make excuses for the actions of your child ("yes, we explain to him all the time" - "that means you explain poorly, since he does not understand") often leads to the fact that mothers and fathers experience helplessness and a sense of guilt, beginning to consider themselves worthless parents.

Sometimes it happens the other way around - motor disinhibition and talkativeness, impulsiveness and inability to comply with discipline and group rules are considered by adults (usually parents) to be a sign of the child’s outstanding abilities, and sometimes they are even encouraged in every possible way. ≪We have a wonderful child! He is not hyperactive at all, but simply lively and active. He’s not interested in these classes of yours, so he’s rebelling! At home, when he gets carried away, he can do the same thing for a long time. And having a quick temper is a character, what can you do about it,” some parents say, not without pride. On the one hand, these mothers and fathers are not so wrong - a child with ADHD, carried away by an interesting activity (assembling puzzles, role-playing games, watching an interesting cartoon - to each his own), can really do this for a long time. However, you should know that with ADHD, voluntary attention is primarily affected - this is a more complex function that is unique to humans and is formed during the learning process. Most seven-year-olds understand that during a lesson they need to sit quietly and listen to the teacher (even if they are not very interested). A child with ADHD understands all this too, but, unable to control himself, can get up and walk around the classroom, pull a neighbor’s pigtail, or interrupt the teacher.

It is important to know that ADHD children are not “spoiled,” “ill-mannered,” or “pedagogically neglected” (although such children, of course, also exist). This is worth remembering for those teachers and parents who recommend treating such children with vitamin P (or simply a belt). ADHD children disrupt classes, act out during breaks, are insolent and disobey adults, even if they know how to behave, due to objective personality traits inherent in ADHD. This needs to be understood by those adults who object to “diagnosing a child,” arguing that these children “just have that kind of character.”

How ADHD manifests itself
Main manifestations of ADHD
G.R. Lomakina in her book “Hyperactive Child.” How to find a common language with a restless person≫ describes the main symptoms of ADHD: hyperactivity, impaired attention, impulsivity.
HYPERACTIVITY manifests itself in excessive and, most importantly, confused motor activity, restlessness, fussiness, and numerous movements that the child often does not notice. As a rule, such children speak a lot and often confusedly, without finishing sentences and jumping from thought to thought. Lack of sleep often aggravates the manifestations of hyperactivity - the child’s already vulnerable nervous system, without having time to rest, cannot cope with the flow of information coming from the outside world and defends itself in a very peculiar way. In addition, such children often have problems with praxis—the ability to coordinate and control their actions.
ATTENTION DISORDERS manifest themselves in the fact that it is difficult for the child to concentrate on the same thing for a long time. His ability to selectively concentrate attention is not sufficiently developed - he cannot distinguish the main thing from the secondary. A child with ADHD constantly “jumps” from one thing to another: “loses” lines in the text, solves all examples at the same time, drawing the tail of a rooster, paints all the feathers at once and all colors at once. Such children are forgetful, do not know how to listen and concentrate. Instinctively, they try to avoid tasks that require prolonged mental effort (it is typical for any person to subconsciously shy away from activities, the failure of which he foresees in advance). However, the above does not mean that children with ADHD are unable to maintain attention on anything. They cannot focus only on what is not interesting to them. If they are fascinated by something, they can do it for hours. The trouble is that our lives are full of activities that we still have to do, despite the fact that they are not always exciting.
IMPULSIVITY is expressed in the fact that the child’s action often precedes thought. Before the teacher has time to ask the question, the ADHD student is already raising his hand, the task has not yet been fully formulated, and he is already completing it, and then, without permission, he gets up and runs to the window - simply because he became interested in watching how the wind blows from birch trees last leaves. Such children do not know how to regulate their actions, obey rules, or wait. Their mood changes faster than the direction of the wind in autumn.
It is known that no two people are exactly alike, so the symptoms of ADHD manifest differently in different children. Sometimes the main complaint of parents and teachers will be impulsivity and hyperactivity; in another child, attention deficit is most pronounced. Depending on the severity of symptoms, ADHD is divided into three main types: mixed, with severe attention deficit, or with a predominance of hyperactivity and impulsivity. At the same time, G.R. Lomakina notes that each of the above criteria can be expressed at different times and to varying degrees in the same child: “That is, to put it in Russian, the same child today can be absent-minded and inattentive, tomorrow - resemble an electric broom with with an Energizer battery, the day after tomorrow - move from laughing to crying and vice versa all day, and after a couple of days - fit inattention, mood swings, and irrepressible and confused energy into one day.

Additional symptoms common in children with ADHD
Coordination problems detected in approximately half of ADHD cases. These may include problems with fine movements (tying shoelaces, using scissors, coloring, writing), balance (children have difficulty riding a skateboard and two-wheeled bicycle), or visual-spatial coordination (inability to play sports, especially with a ball).
Emotional disturbances often observed in ADHD. The emotional development of a child, as a rule, is delayed, which is manifested by imbalance, hot temper, and intolerance to failures. Sometimes they say that the emotional-volitional sphere of a child with ADHD is in a ratio of 0.3 with his biological age (for example, a 12-year-old child behaves like an eight-year-old).
Disorders of social relations. A child with ADHD often experiences difficulties in relationships not only with peers, but also with adults. The behavior of such children is often characterized by impulsiveness, intrusiveness, excessiveness, disorganization, aggressiveness, impressionability and emotionality. Thus, a child with ADHD is often a disruptor to the smooth flow of social relationships, interaction and cooperation.
Partial developmental delays, including school skills, are known to be the discrepancy between actual academic performance and what would be expected based on a child's IQ. In particular, difficulties with reading, writing, and counting (dyslexia, dysgraphia, dyscalculia) are common. Many children with ADHD in preschool age have specific difficulties understanding certain sounds or words and/or difficulty expressing themselves in words.

Myths about ADHD
ADHD is not a perceptual disorder! Children with ADHD hear, see, and perceive reality just like everyone else. This distinguishes ADHD from autism, in which motor disinhibition is also common. However, in autism, these phenomena are caused by impaired perception of information. Therefore, the same child cannot be diagnosed with ADHD and autism at the same time. One excludes the other.
ADHD is based on a violation of the ability to perform a given task, an inability to plan, carry out, and complete a task begun. Children with ADHD feel, understand, and perceive the world in the same way as everyone else, but they react to it differently.
ADHD is not a disorder of understanding and processing received information! A child with ADHD is, in most cases, able to analyze and draw the same conclusions as anyone else. These children know very well, understand and can even easily repeat all those rules that they are constantly reminded, day after day: “don’t run”, “sit still”, “don’t turn around”, “keep quiet during the lesson”, “drive” behave just like everyone else,” “clean up your toys.” However, children with ADHD cannot follow these rules.
It is worth remembering that ADHD is a syndrome, that is, a stable, single combination of certain symptoms. From this we can conclude that at the root of ADHD lies one unique feature that always forms slightly different, but essentially similar behavior. Broadly speaking, ADHD is a disorder of motor function and planning and control, rather than perceptual and comprehension function.

Portrait of a hyperactive child
At what age can ADHD be suspected?
“Hurricane”, “tough in the butt”, “perpetual motion machine” - what definitions do parents of children with ADHD give their children! When teachers and educators talk about such a child, the main thing in their description will be the adverb “too”. The author of a book about hyperactive children, G.R. Lomakina, notes with humor that “there are too many such children everywhere and always, he is too active, he can be heard too well and far away, he is too often seen absolutely everywhere. For some reason, such children not only always end up in some kind of story, but such children also always end up in all the stories that happen within ten blocks of the school.”
Although today there is no clear understanding of when and at what age we can say with confidence that a child has ADHD, most experts agree that that this diagnosis cannot be made before five years. Many researchers argue that signs of ADHD are most pronounced between 5 and 12 years of age and during puberty (from about 14 years of age).
Although ADHD is rarely diagnosed in early childhood, some experts believe that There are a number of signs that suggest the likelihood of a baby having this syndrome. According to some researchers, the first manifestations of ADHD coincide with the peaks of a child’s psycho-speech development, that is, they most clearly manifest themselves at 1-2 years, 3 years and 6-7 years.
Children prone to ADHD often have increased muscle tone in infancy, experience problems with sleep, especially falling asleep, are extremely sensitive to any stimuli (light, noise, the presence of a large number of unfamiliar people, a new, unusual situation or environment), during When awake, they are often overly active and agitated.

What is important to know about a child with ADHD
1) Attention deficit hyperactivity disorder is considered to be one of the so-called borderline mental states. That is, in a normal, calm state, this is one of the extreme variants of the norm, but the slightest catalyst is enough to bring the psyche out of the normal state and the extreme variant of the norm has already turned into some kind of deviation. The catalyst for ADHD is any activity that requires increased attention from the child, concentration on the same type of work, as well as any hormonal changes that occur in the body.
2) Diagnosis of ADHD does not imply a delay in the child’s intellectual development. On the contrary, as a rule, children with ADHD are very smart and have fairly high intellectual abilities (sometimes above average).
3) The mental activity of a hyperactive child is characterized by cyclicity.. Children can work productively for 5-10 minutes, then the brain rests for 3-7 minutes, accumulating energy for the next cycle. At this moment, the student is distracted and does not respond to the teacher. Mental activity is then restored and the child is ready to work within the next 5-15 minutes. Psychologists say that children with ADHD have the so-called. flickering consciousness: that is, they can periodically “fall out” during activity, especially in the absence of motor activity.
4) Scientists have found that motor stimulation of the corpus callosum, cerebellum and vestibular apparatus of children with attention deficit hyperactivity disorder leads to the development of the function of consciousness, self-control and self-regulation. When a hyperactive child thinks, he needs to make some movements - for example, swing in a chair, tap a pencil on the table, mutter something under his breath. If he stops moving, he seems to “fall into a stupor” and loses the ability to think.
5) It is typical for hyperactive children superficiality of feelings and emotions. They They cannot hold a grudge for long and are not vindictive.
6) A hyperactive child is characterized by frequent mood changes- from stormy delight to unbridled anger.
7) The consequence of impulsivity in ADHD children is hot temper. In a fit of anger, such a child can tear up the notebook of a neighbor who offended him, throw all his things onto the floor, and shake out the contents of his briefcase onto the floor.
8) Children with ADHD often develop negative self-esteem- the child begins to think that he is bad, not like everyone else. Therefore, it is very important that adults treat him kindly, understanding that his behavior is caused by objective difficulties of control (that he does not want, but cannot behave well).
9) Often in ADHD children reduced pain threshold. They are also practically devoid of any sense of fear. This can be dangerous for the health and life of the child, as it can lead to unpredictable fun.

MAIN manifestations of ADHD Preschoolers Attention deficit: often gives up, doesn’t finish what he started; as if he doesn’t hear when people address him; plays one game in less than three minutes. Hyperactivity:“hurricane”, “an awl in one place.” Impulsivity: does not respond to requests and comments; does not sense danger well. Primary School Attention deficit: forgetful; disorganized; easily distracted; can do one thing for no more than 10 minutes. Hyperactivity: restless when you need to be quiet (quiet hour, lesson, performance). Impulsiveness: can't wait for his turn; interrupts other children and shouts out the answer without waiting for the end of the question; intrusive; breaks the rules without apparent intent. Teenagers Attention deficit: less perseverance than peers (less than 30 minutes); inattentive to details; plans poorly. Hyperactivity: restless, fussy. Impulsiveness: reduced self-control; reckless, irresponsible statements. Adults Attention deficit: inattentive to details; forgets about appointments; lack of ability to foresight and planning. Hyperactivity: subjective feeling of anxiety. Impulsivity: impatience; immature and unreasonable decisions and actions.

How to recognize ADHD
Basic diagnostic methods
So, what to do if parents or teachers suspect that their child has ADHD? How to understand what determines a child’s behavior: pedagogical neglect, shortcomings in upbringing or attention deficit hyperactivity disorder? Or maybe just character? In order to answer these questions, you need to contact a specialist.
It’s worth saying right away that, unlike other neurological disorders, for which there are clear methods of laboratory or instrumental confirmation, There is no objective diagnostic method for ADHD. According to modern expert recommendations and diagnostic protocols, mandatory instrumental examinations for children with ADHD (in particular, electroencephalogram, computed tomography, etc.) are not indicated. There are a lot of studies that describe certain changes in the EEG (or the use of other functional diagnostic methods) in children with ADHD, but these changes are nonspecific - that is, they can be observed both in children with ADHD and in children without this disorder. On the other hand, it often happens that functional diagnostics do not reveal any deviations from the norm, but the child has ADHD. Therefore, from a clinical point of view The basic method for diagnosing ADHD is an interview with parents and the child and the use of diagnostic questionnaires.
Due to the fact that with this violation the boundary between normal behavior and disorder is very arbitrary, the specialist has to establish it in each case at his own discretion(unlike other disorders where guidelines still exist). Thus, due to the need to make a subjective decision, the risk of error is quite high: both failure to identify ADHD (this especially applies to milder, “borderline” forms) and identification of the syndrome where it actually does not exist. Moreover, subjectivity doubles: after all, the specialist is guided by anamnesis data, which reflects the subjective opinion of the parents. Meanwhile, parental ideas about what behavior is considered normal and what is not can be very different and are determined by many factors. Nevertheless, the timeliness of diagnosis depends on how attentive and, if possible, objective people from the child’s immediate environment (teachers, parents or pediatricians) will be. After all, the sooner you understand the child’s characteristics, the more time it takes to correct ADHD.

Stages of diagnosing ADHD
1) Clinical interview with a specialist (child neurologist, pathopsychologist, psychiatrist).
2) Use of diagnostic questionnaires. It is advisable to obtain information about the child “from different sources”: from parents, teachers, a psychologist at the educational institution that the child attends. The golden rule in diagnosing ADHD is confirmation of the disorder from at least two independent sources.
3) In doubtful, “borderline” cases, when the opinions of parents and specialists regarding the presence of a child with ADHD differ, it makes sense video recording and its analysis ( recording of the child’s behavior in class, etc.). However, help is also important in cases of behavioral problems without a diagnosis of ADHD - the point, after all, is not the label.
4) If possible - neuropsychological examination a child, the purpose of which is to establish the level of intellectual development, as well as to identify often concomitant violations of school skills (reading, writing, arithmetic). Identification of these disorders is also important in terms of differential diagnosis, because in the presence of reduced intellectual capabilities or specific learning difficulties, attention problems in the classroom may be caused by the program not matching the child’s level of abilities, and not by ADHD.
5) Additional examinations (if necessary)): consultation with a pediatrician, neurologist, and other specialists, instrumental and laboratory tests for the purpose of differential diagnosis and identification of concomitant diseases. A basic pediatric and neurological examination is advisable due to the need to exclude “ADHD-like” syndrome caused by somatic and neurological disorders.
It is important to remember that behavioral and attention disorders in children can be caused by any common somatic diseases (such as anemia, hyperthyroidism), as well as all disorders that cause chronic pain, itching, and physical discomfort. The cause of “pseudo-ADHD” may also be side effects of certain medications(for example, biphenyl, phenobarbital), as well as a number of neurological disorders(epilepsy with absence seizures, chorea, tics and many others). The child's problems may also be due to the presence sensory disorders Here again, a basic pediatric examination is important to identify visual or hearing impairments that, if mild, may be underdiagnosed. Pediatric examination is also advisable due to the need to assess the general somatic condition of the child and identify possible contraindications regarding the use of certain groups of medications that can be prescribed to children with ADHD.

Diagnostic questionnaires
ADHD criteria according to DSM-IV classification
Attention disorder
a) is often unable to concentrate on details or makes careless mistakes when completing school assignments or other activities;
b) often have problems maintaining attention on a task or game;
c) problems often arise with organizing activities and completing tasks;
d) is often reluctant to engage in or avoid activities that require sustained attention (such as class assignments or homework);
e) often loses or forgets things needed to complete tasks or other activities (for example, a diary, books, pens, tools, toys);
f) is easily distracted by extraneous stimuli;
g) often does not listen when spoken to;
h) often does not adhere to instructions, does not complete assignments, homework or other work completely or to the proper extent (but not out of protest, stubbornness or inability to understand instructions/tasks);
i) forgetful in daily activities.

Hyperactivity - impulsiveness(at least six of the following symptoms must be present):
Hyperactivity:
a) cannot sit still, constantly moves;
b) often leaves his seat in situations where he must sit (for example, in class);
c) runs around a lot and “turns things over” where this should not be done (in adolescents and adults, the equivalent may be a feeling of internal tension and a constant need to move);
d) is unable to play quietly, calmly, or rest;
e) acts “as if wound up” - like a toy with the motor turned on;
f) talks too much.

Impulsiveness:
g) often speaks prematurely, without hearing the question to the end;
h) impatient, often cannot wait for his turn;
i) frequently interrupts others and interferes with their activities/conversations. The above symptoms must have been present for at least six months, occur in at least two different environments (school, home, playground, etc.) and not be caused by another disorder.

Diagnostic criteria used by Russian specialists

Attention disorder(diagnosed when 4 of 7 signs are present):
1) needs a calm, quiet environment, otherwise he is not able to work and concentrate;
2) often asks again;
3) easily distracted by external stimuli;
4) confuses details;
5) does not finish what he starts;
6) listens, but seems not to hear;
7) has difficulty concentrating unless a one-on-one situation is created.

Impulsiveness
1) shouts in class, makes noise during the lesson;
2) extremely excitable;
3) it is difficult for him to wait his turn;
4) excessively talkative;
5) hurts other children.

Hyperactivity(diagnosed when 3 out of 5 signs are present):
1) climbs on cabinets and furniture;
2) always ready to go; runs more often than walks;
3) fussy, squirms and writhes;
4) if he does something, he does it with noise;
5) must always do something.

Characteristic behavior problems must be characterized by early onset (before six years) and persistence over time (manifest for at least six months). However, before entering school, hyperactivity is difficult to recognize due to the wide range of normal variants.

And what will grow from it?
What will grow from it? This question worries all parents, and if fate has decreed that you become the mother or father of an ADHD child, then you are especially worried. What is the prognosis for children with attention deficit hyperactivity disorder? Scientists answer this question in different ways. Today they talk about three most possible options for the development of ADHD.
1. Over time symptoms disappear, and children become teenagers and adults without deviations from the norm. Analysis of the results of most studies indicates that from 25 to 50 percent of children “outgrow” this syndrome.
2. Symptoms to varying degrees continue to be present, but without signs of developing psychopathology. These are the majority of people (50% or more). They have some problems in everyday life. According to surveys, they are constantly accompanied by a feeling of “impatience and restlessness,” impulsiveness, social inadequacy, and low self-esteem throughout their lives. There are reports of a higher frequency of accidents, divorces, and job changes among this group of people.
3. Developing severe complications in adults in the form of personality or antisocial changes, alcoholism and even psychotic states.

What path is prepared for these children? In many ways, this depends on us, adults. Psychologist Margarita Zhamkochyan characterizes hyperactive children as follows: “Everyone knows that restless children grow up to be explorers, adventurers, travelers and company founders. And this is not just a frequent coincidence. There are quite extensive observations: children who in elementary school tormented teachers with their hyperactivity, as they get older, are already interested in something specific - and by the age of fifteen they become real experts in this matter. They gain attention, concentration, and perseverance. Such a child can learn everything else without much diligence, and the subject of his hobby - thoroughly. Therefore, when they say that the syndrome usually disappears by high school age, this is not true. It is not compensated for, but results in some kind of talent, a unique skill.”
The creator of the famous airline JetBlue, David Neelyman, is happy to say that in his childhood he was not only diagnosed with such a syndrome, but also described it as “flamboyant”. And the presentation of his work biography and management methods suggests that this syndrome did not leave him in his adult years, moreover, that it was to him that he owed his dizzying career.
And this is not the only example. If you analyze the biographies of some famous people, it will become clear that in childhood they had all the symptoms characteristic of hyperactive children: explosive temperament, problems with learning at school, a penchant for risky and adventurous undertakings. It is enough to take a closer look around, remember two or three good friends who have succeeded in life, their childhood years, in order to draw a conclusion: a gold medal and a red diploma very rarely turn into a successful career and a well-paid job.
Of course, a hyperactive child is difficult in everyday life. But understanding the reasons for his behavior can make it easier for adults to accept a “difficult child.” Psychologists say that children are especially in dire need of love and understanding when they least deserve it. This is especially true for a child with ADHD who exhausts parents and teachers with his constant “antics.” The love and attention of parents, the patience and professionalism of teachers, and timely help from specialists can become a springboard for a child with ADHD into a successful adult life.

HOW TO DETERMINE WHETHER YOUR CHILD'S ACTIVITY AND IMPULSIVITY IS NORMAL OR HAS ADHD? Of course, only a specialist can give a complete answer to this question, but there is also a fairly simple test that will help worried parents determine whether they should immediately go to the doctor or whether they just need to pay more attention to their child. ACTIVE CHILD - Most of the day he “does not sit still”, prefers active games to passive ones, but if he is interested, he can also engage in quiet activities. — He talks quickly and a lot, asks an endless number of questions. He listens to the answers with interest. “For him, sleep and digestive disorders, including intestinal disorders, are rather an exception. - In different situations, the child behaves differently. For example, he is restless at home, but calm in the kindergarten, visiting unfamiliar people. - Usually the child is not aggressive. Of course, in the heat of a conflict, he can kick up a “colleague in the sandbox,” but he himself rarely provokes a scandal. HYPERACTIVE CHILD — He is in constant motion and simply cannot control himself. Even if he is tired, he continues to move, and when completely exhausted, he cries and becomes hysterical. - He speaks quickly and a lot, swallows words, interrupts, does not listen to the end. Asks a million questions, but rarely listens to the answers. “It’s impossible to put him to sleep, and if he does fall asleep, he sleeps in fits and starts, restlessly.” — Intestinal disorders and allergic reactions are quite common. — The child seems uncontrollable; he does not react at all to prohibitions and restrictions. A child’s behavior does not change depending on the situation: he is equally active at home, in kindergarten, and with strangers. - Often provokes conflicts. He does not control his aggression: he fights, bites, pushes, and uses all available means. If you answered positively to at least three points, this behavior persists in the child for more than six months and you believe that it is not a reaction to a lack of attention and love on your part, then you have reason to think about it and consult a specialist.

Oksana BERKOVSKAYA | editor of the magazine "Seventh Petal"

Portrait of a hyperdynamic child
The first thing that catches your eye when meeting a hyperdynamic child is his excessive mobility in relation to his calendar age and some kind of “stupid” mobility.
As a baby, such a child gets out of diapers in the most incredible way. ...It is impossible to leave such a baby on the changing table or on the sofa even for a minute from the very first days and weeks of his life. If you just gape a little, he will definitely twist somehow and fall to the floor with a dull thud. However, as a rule, all consequences will be limited to a loud but short scream.
Not always, but quite often, hyperdynamic children experience certain sleep disturbances. ...Sometimes the presence of hyperdynamic syndrome can be assumed in an infant by observing his activity in relation to toys and other objects (however, this can only be done by a specialist who knows well how ordinary children of this age manipulate objects). The exploration of objects in a hyperdynamic infant is intense, but extremely undirected. That is, the child throws away the toy before exploring its properties, immediately grabs another (or several at once) only to throw that one away a few seconds later.
...As a rule, motor skills in hyperdynamic children develop in accordance with age, often even ahead of age indicators. Hyperdynamic children, earlier than others, begin to hold their heads up, roll over onto their stomachs, sit, stand up, walk, etc. ... It is these children who stick their heads between the bars of the crib, get stuck in the playpen net, get tangled in duvet covers, and quickly and dexterously learn to remove everything that caring parents put on them.
As soon as a hyperdynamic child is on the floor, a new, extremely important stage begins in the life of the family, the purpose and meaning of which is to protect the life and health of the child, as well as family property from possible damage. The activity of a hyperdynamic baby is unstoppable and overwhelming. Sometimes relatives get the impression that it operates around the clock, almost without a break. Hyperdynamic children do not walk from the very beginning, but run.
...It is these children aged from one to two - two and a half years old who pull tablecloths with tableware onto the floor, drop televisions and Christmas trees, fall asleep on the shelves of empty wardrobes, endlessly, despite the prohibitions, turn on the gas and water, and also overturn pots with contents of different temperatures and consistencies.
As a rule, no attempts to reason with hyperdynamic children have any effect. They are fine with memory and speech understanding. They just can't help themselves. Having committed another trick or destructive act, the hyperdynamic child himself is sincerely upset and does not understand at all how it happened: “She fell on her own!”, “I walked, walked, climbed in, and then I don’t know,” “I didn’t touch it at all.” !
...Quite often, hyperdynamic children exhibit various speech development disorders. Some begin to speak later than their peers, some - on time or even earlier, but the problem is that no one understands them, because they do not pronounce two-thirds of the sounds of the Russian language. ...When they speak, they wave their arms a lot and confusedly, shift from foot to foot or jump in place.
Another feature of hyperdynamic children is that they do not learn not only from others’ mistakes, but even from their own mistakes. Yesterday, a child was walking on the playground with his grandmother, climbed onto a high ladder, and could not get down. I had to ask the teenage boys to take it down from there. The child was clearly frightened when asked: “Well, are you going to climb this ladder now?” — he answers earnestly: “I won’t!” The next day, on the same playground, the first thing he does is run to that same ladder...

Hyperdynamic children are the ones who get lost. And there is absolutely no strength left to scold the child who is found, and he himself does not really understand what happened. “You left!”, “I just went to look!”, “Were you looking for me?!” - all this discourages, angers, makes you doubt the mental and emotional capabilities of the child.
...Hyperdynamic children, as a rule, are not evil. They are not able to harbor grudges or plans for revenge for a long time, and are not prone to targeted aggression. They quickly forget all insults; yesterday’s offender or the one offended today is their best friend. But in the heat of a fight, when already weak braking mechanisms fail, these children can be aggressive.

The real problems of a hyperdynamic child (and his family) begin with schooling. “Yes, he can do anything if he wants! All he has to do is concentrate - and all these tasks will be a breeze for him!” - nine out of ten parents say this or approximately this. The trouble is that a hyperdynamic child absolutely cannot concentrate. Sitting down for homework, within five minutes he is drawing in a notebook, rolling a typewriter on the table, or simply looking out the window behind which the older kids are playing football or preening the feathers of a raven. Another ten minutes later he will really want to drink, then eat, then, of course, go to the toilet.
The same thing happens in the classroom. A hyperdynamic child is like a speck in the eye for a teacher. He endlessly spins around, gets distracted and chats with his desk neighbor. ...He is either absent from work in class and then, when asked, answers inappropriately, or takes an active part, jumps on his desk with his hand raised to the sky, runs out into the aisle, shouting: “Me! I! Ask me! - or simply, unable to resist, shouts out the answer from his seat.
The notebooks of a hyperdynamic child (especially in primary school) are a pitiful sight. The number of errors in them competes with the amount of dirt and corrections. The notebooks themselves are almost always wrinkled, with bent and dirty corners, with torn covers, with stains of some kind of unintelligible dirt, as if someone had recently eaten pies on them. The lines in the notebooks are uneven, letters creep up and down, letters are missing or replaced in words, words are missing in sentences. The punctuation marks seem to appear in a completely arbitrary order - author's punctuation in the worst sense of the word. It is the hyperdynamic child who can make four mistakes in the word “more.”
Reading problems also occur. Some hyperdynamic children read very slowly, stumbling over every word, but they read the words themselves correctly. Others read quickly, but change endings and “swallow” words and entire sentences. In the third case, the child reads normally in terms of pace and quality of pronunciation, but does not understand what he read at all and cannot remember or retell anything.
Problems with mathematics are even less common and are usually associated with the child’s total inattention. He can solve a difficult problem correctly and then write down the wrong answer. He easily confuses meters with kilograms, apples with boxes, and the resulting answer of two diggers and two-thirds does not bother him at all. If there is a “+” sign in the example, the hyperdynamic child can easily and correctly perform subtraction, if there is a division sign, he will perform multiplication, etc. and so on.

A hyperdynamic child constantly loses everything. He forgets his hat and mittens in the locker room, his briefcase in the park near the school, his sneakers in the gym, his pen and textbook in the classroom, and his grade book somewhere in the trash heap. In his backpack there are books, notebooks, shoes, apple cores and half-eaten sweets that coexist calmly and closely.
At recess, a hyperdynamic child is a “hostile whirlwind.” The accumulated energy urgently requires an outlet and finds it. There is no fight that our child will not get involved in, there is no prank that he will refuse. Stupid, crazy running around during recess or after-school activities, ending somewhere in the solar plexus of one of the members of the teaching staff, and appropriate indoctrination and repression is the inevitable ending to almost every school day of our child.

Ekaterina Murashova | From the book: “Children are “mattresses” and children are “catastrophes””

Disinhibition is increased motor activity caused by weakening volitional control over voluntary behavior. Disinhibition is not psychomotor agitation in a weaker degree of its manifestation, it is a qualitatively different state.

Many psychiatrists who note such a symptom as disinhibition in the objective status of a patient mainly mean a certain behavioral pattern that resembles the behavior of a child, or the behavior of a person in a state of alcohol intoxication.

It is worth emphasizing that disinhibition is a manifestation not so much of a quantitative increase in motor activity, but rather a manifestation of its clearly expressed involuntary nature, which is out of the control of the subject himself and cannot be controlled from the outside, by other persons. The question naturally arises: how then does disinhibition differ, for example, from catatonic excitation? To answer this question, it is necessary to dwell in more detail on the phenomenon of disinhibition.

Disinhibition is not always accompanied by increased motor activity. For example, a patient in a conversation with a doctor can behave quite calmly, but at the same time stretch, yawn, pick his nose, etc., which allows psychiatrists to describe the status using formulations such as “does not keep distance”, “does not maintain decency " and so on.

Disinhibition, as a behavioral phenomenon, first of all, means, based on the etymology of the word itself, a weakening of conscious control over voluntary behavior. To a certain extent, we are talking about the pathology of volitional processes. Disinhibition is spoken of only when the patient has a waking consciousness. Consequently, behavioral phenomena that occur during unclear consciousness, such as ambulatory automatism, somnambulism, and oneiric catatonia, should not be classified as disinhibition. Of course, in the listed conditions the patient carries out involuntary, automated (subcortical) behavior, but, most importantly, he is not aware of it. For clarification, let's use the following example. A patient suffering from schizophrenia with a syndromic diagnosis of “catatonic agitation” demonstrated the following behavior: stereotypically, for several hours, tirelessly, he made movements similar to those that a person makes when chopping wood, while he jumped and made the same sounds words of indecent content. In a strict sense, this is not psychomotor agitation, which is characterized mainly by chaos. The described behavior is characterized, first of all, by involuntariness, autonomy, stereotyping, symbolic coloring, possibly significance and unconsciousness. In extreme cases, we can talk about catatonic-impulsive disinhibition.

Let's return to the “classical” disinhibition, which is one of the three main symptoms of a manic state (manic triad). As paradoxical as it may seem, in the manifestation of manic disinhibition there is both an element of will and an element of awareness.

Disinhibition is a complex psychophysical process, which is described in detail by E. Kretschmer in his study of hysterical phenomena, which includes the following components:

1. reflex excitation of subcortical behavioral activity - from simple reflex acts (tremors, vomiting, tics) to more complex subcortical automatisms with symbolic, often unconscious “load” (like behavioral patterns in the above examples);
2. weakening of volitional control aimed at suppressing reflex activity, on the one hand, but, on the other -
3. semi-conscious direction of voluntary activity, although weak, but still volitional activity, to maintain and strengthen reflex excitation.

Normally, voluntary and reflex movements never merge, they intersect. If a person gags, this movement is reflexive or involuntary. Further, the subject can suppress it by force of will - and this will be voluntary suppression. However, the subject may not be able to suppress gagging. Of course, a person cannot, by force of will alone, voluntarily induce the act of vomiting, but if a reflex urge arises, he can, with some effort of will, support and strengthen the reflex act of vomiting - this is how uncontrollable vomiting occurs during hysteria. If you ask a healthy person to tremble, it is unlikely that he will be able to do it completely and long enough. And only with hysterical disinhibition do we see that the subject can tremble for hours, vomit endlessly, and this is not difficult for him, it is given “tirelessly.”

Why does the subject maintain reflex excitation in the case of disinhibition? This can be explained by observing the behavioral reactions of healthy people or children. Let’s imagine a person who has an inflammatory reaction with a rise in temperature, and he is shivering and “shaking.” How might he react to chills? Much depends on the situation, environment, and personal attitudes. He can, by an effort of will, significantly weaken the chills, and everyone will agree that this will require significant effort (the person will have to “gather his will into a fist”). But if he is in bed in the category of “sick,” in the presence of care and care from those around him, then the individual can allow himself to “shake to his heart’s content,” and he may notice that he can do this easily and does not experience fatigue. It is precisely due to the fact that the reflex becomes accessible to the conscious will, and their fusion gives rise to a feeling of lightness, and subsequently the tendency towards disinhibition, as a subjectively pleasant state, is fixed in human behavior.

A similar reinforcement can be found in the behavior of a child, depending on the nature of his upbringing and his individual characteristics. Let's imagine a situation - a child fell and was slightly hurt, and he may have a reflex act without even crying, but simply screaming. He can also suppress this reflex act if his interest is concentrated on some object that occupies him. And he can “become crying” for a long time, even forgetting about the reason that caused it - as a rule, there is an over-caring and anxious mother nearby. In the further consolidation of such behavior in a child, emotional factors undoubtedly play a large role.

Thus, in disinhibition, as a persistent behavioral phenomenon, despite the fact that it is initially initiated by reflex excitation, the main thing is its arbitrary (semi-conscious) strengthening, motivated by:

1. situationality,
2. feeling of lightness and
3. emotional nourishment.

We can observe all three of these factors - situationality, lightness and emotionality - when performing voluntary movements, polished in the process of mastery and brought to the level of automatism, for example, in a triumphant performance of ballet dance. But to achieve this, you need years of painstaking and grueling training. The wild dance of a shaman looks completely different, who, with the help of psychoactive substances, by self-inducing a trance, essentially achieves a state of disinhibition and activation of subcortical motor activity, which has an archetypal-symbolic coloring. Subsequent strengthening and voluntary reinforcement of awakened behavioral patterns leads to the same thing - lightness, emotional saturation, lack of fatigue. The shaman can dance until he simply falls from physical exhaustion. The hysterical psychoses called St. Vitus' dances looked the same.

Disinhibition is, first of all, a behavioral disorder that is characteristic of the following conditions:

1. manic state;
2. hyperkinetic syndrome and other forms of disrupted behavior in children;
3. behavioral disorders due to dementia, personality defect, dissocial personality disorder.

Hyperkinesis and obsessive actions, which can be described as “partial disinhibition,” should be distinguished from behavioral disinhibition itself.

Disinhibition is increased emotional excitability

Mechanisms of motor disinhibition and specific types of correctional work

Adaptation disorders, manifested in the form of motor disinhibition, according to experts, have a variety of causes: organic, mental, social. However, most authors dealing with the problems of the so-called attention deficit hyperactivity disorder regard it primarily as a result of certain problems of an organic, neurological nature. Motor disinhibition as a disordered behavior has many similarities with other types of deviant development, but at the moment there are criteria for identifying a group of disorders in which hyperactivity is the main problem.

Data on the prevalence of such behavioral disorders vary widely (from 2% to 20% in the pediatric population). It is well known that girls have such problems 4-5 times less often than boys.

Although the hypothesis of the identity of hyperkinetic syndrome and minimal cerebral dysfunction is often criticized, the causes of the disease (or condition) are usually considered to be complications throughout the perinatal period, diseases of the nervous system during the first year of life, as well as injuries and diseases that occurred during the first three years child's life. Subsequently, the majority of children with similar behavior problems are diagnosed with “mild brain dysfunction” or “minimal brain dysfunction” (Z. Trzhesoglava, 1986; T.N. Osipenko, 1996; A.O. Drobinskaya 1999; N.N. Zavadenko , 2000; B.R. Yaremenko, A.B. Yaremenko, 2002; I.P. Bryazgunov, E.V. Kasatikova, 2003).

For the first time, detailed clinical descriptions of functional brain failure appeared in the literature in the 30s and 40s of the last century. The concept of “minimal brain damage” was formulated, which came to mean “non-progressive residual conditions resulting from early local lesions of the central nervous system during the pathology of pregnancy and childbirth (pre- and perinatal), as well as traumatic brain injuries or neuroinfections. Later, the term “minimal cerebral dysfunction” became widespread and was used by “. in relation to a group of conditions that are different in their causes and mechanisms of development (etiology and pathogenesis), accompanied by behavioral disorders and learning difficulties not associated with pronounced impairments of intellectual development” (N.N. Zavadenko, 2000). Further comprehensive study of minimal brain dysfunctions showed that they are difficult to consider as a single clinical form. In this regard, for the latest revision of the international classification of diseases ICD-10, diagnostic criteria were developed for a number of conditions previously classified as minimal brain dysfunctions. In relation to problems of motor disinhibition, these are headings P90-P98: “Behavioral and emotional disorders of childhood and adolescence”; rubric P90: “Hyperkinetic disorders” (Yu.V. Popov, V.D. Vid, 1997).

The positive effect of psychostimulants in the drug treatment of children with such disorders is explained by the hypothesis that children with hyperkinetic syndrome, from the point of view of brain activation, are “underexcited”, and therefore excite and stimulate themselves with their hyperactivity in order to compensate for this sensory deficiency. Lowe et al. found insufficient activity of metabolic processes in the anterior regions of the brain in children with signs of disinhibition.

In addition, the period from 4 to 10 years of age is considered the period of the so-called psychomotor reaction (V.V. Kovalev, 1995). It is during this age period that more mature subordination relationships are established between hierarchically subordinate structures of the motor analyzer. And these violations, “. still unstable subordination relationships are an important mechanism for the occurrence of disorders of the psychomotor level of response” (cited by V.V. Kovalev, 1995).

Thus, if in preschool age hyperexcitability, motor disinhibition, motor clumsiness, absent-mindedness, increased fatigue, infantilism, and impulsivity prevail among children with signs of minimal brain dysfunction, then among schoolchildren the difficulties of organizing their behavior and academic difficulties come to the fore.

However, as our research and consulting experience show, children with similar behavior problems also have a variety of emotional and affective characteristics. Moreover, in children with behavioral problems of the type of motor disinhibition, usually classified by most authors as a single “hyperactivity syndrome,” often fundamentally different features of the development of the affective sphere as a whole are found that are opposite in sign.

The specificity of our study is that the problems of motor disinhibition were considered not only from the point of view of the characteristics and differences of the neurological status, but also the affective status. And the analysis of behavioral problems and characteristics of the child was based on identifying not only the causes, but also the psychological mechanisms underlying them.

In our opinion, an analysis of the affective status of children with behavioral problems based on the type of motor disinhibition can be carried out from the point of view of the model of basic affective regulation proposed in the school of K.S. Lebedinskaya - O.S. Nikolskaya (1990, 2000). In accordance with this model, the mechanisms of formation of the child’s affective-emotional sphere can be assessed by the degree of formation of the four levels of the basic affective regulation system (BA levels), each of which can be in a state of increased sensitivity or increased endurance (hypo- or hyperfunctioning).

The working hypothesis was that motor disinhibition itself, which is so identical in its manifestation in most children, may have a different “nature.” Moreover, the latter is determined not only by problems of neurological status, but also by the peculiarities of the tonic support of the child’s vital activity - the level of the child’s mental activity and the parameters of his performance, that is, first of all, it depends on the specific functioning of the levels of basic affective regulation.

Materials and research methods

The analyzed group included 119 children aged 4.5-7.5 years, whose parents complained about motor and speech disinhibition, uncontrollability children, which significantly complicates their adaptation in preschool and school educational institutions. Often children came with existing diagnoses, such as attention deficit hyperactivity disorder, hyperexcitability syndrome, and minimal brain dysfunction.

It should be noted that children whose symptoms of motor disinhibition were part of some more “general” psychological syndrome (total underdevelopment, distorted development, including Asperger’s syndrome, etc.) were not included in the analyzed group.

In accordance with the objectives of the study, a diagnostic block of methods was developed, which included:

1. Detailed and specifically oriented collection of psychological history, where the following was assessed:

features of early psychomotor development;

features of early emotional development, including the nature of interaction in the mother-child dyad (the mother’s main worries and worries regarding her interaction with the child in the first year of life were analyzed);

the presence of indirect signs of neurological ill-being.

2. Analysis of the features of the operational characteristics of the child’s activity,

3. Assessment of the level of mental tone (for these purposes, together with Candidate of Medical Sciences O.Yu. Chirkova, a special thematic questionnaire for parents was developed and tested).

4. Study of the characteristics of the formation of various levels of voluntary regulation of activity:

voluntary possession of mental functions;

maintaining the activity algorithm;

voluntary regulation of emotional expression.

5. Study of the developmental features of various aspects of the cognitive sphere.

6. Analysis of the child’s emotional and affective characteristics. It should be emphasized that special attention was paid to assessing the general level of mental activity and mental tone of the child.

7. In addition, the type of assistance required by the child when working with certain tasks was necessarily assessed. The following types of assistance were used:

assistance that “tonicizes” the child and his activities;

organizing assistance (that is, constructing an algorithm of activity “instead” of the child, programming this activity and monitoring it by an adult).

Indicators of the level of general mental activity of the child, pace of activity, and other performance parameters were correlated with an assessment of the child’s emotional and affective characteristics. For this purpose, an integral assessment of the profile of bipolar disorder as a whole was carried out, and the states of individual levels of basic affective regulation were also assessed according to O.S. Nikolskaya. In this case, it was assessed which of the BAP levels (1-4) was in a state of increased sensitivity or increased endurance (hypo-or hyperfunctioning).

Research results and discussion

The study revealed significant differences between the manifestations of the developmental features under study. These results made it possible to divide the 119 examined children into three groups:

We assigned 70 children to the first group (20 girls, 50 boys);

the second group consisted of 36 children (15 girls and 21 boys, respectively);

13 children made up the third group.

Specific to the children we classified in the first group was the presence in the anamnesis of indirect or explicit (objectified in medical documents) signs of neurological distress, usually quite pronounced. In the early stages, this was primarily manifested in changes in muscle tone: muscle hypertonicity or muscle dystonia - uneven muscle tone - were much more common. Quite often, already in the early stages of development, a child was diagnosed with perinatal encephalopathy (PEP). Indirect signs of neurological ill-being were manifested during this period by profuse regurgitation, sleep disturbances (sometimes inversion of the sleep-wake regime), and shrill, “heart-rending” screams. Increased muscle tone in the lower extremities - sometimes even the inability to relax the leg muscles - led to the fact that, having risen to his feet early, the child stood “until he dropped.” Sometimes the child began to walk early, and the walking itself was more like an unstoppable run. Children, as a rule, did not accept any “solid” complementary foods well (sometimes until the age of 3-3.5 years they had difficulty accepting solid food).

In mothers' stories about their worries (in 62 out of 70 cases), the most common memory was that the child was very difficult to calm down, he screamed a lot, was in her arms all the time, required rocking, and the constant presence of the mother.

Specific to this type of development was the presence of a significant number of signs of neurological distress in the anamnesis, changes (usually acceleration and, less often, disruption of the sequence) of early motor development. All this, based on the totality of signs, can be qualified as minimal brain dysfunctions, the consequence of which was the insufficient formation of the voluntary (regulatory) component of activity as a whole (N.Ya. Semago, M.M. Semago, 2000).

Thus, the motor disinhibition observed in children of the first group can essentially be considered “primary” and only intensifies in its manifestations when the child is tired.

Children of the second group demonstrated deficits in the regulation of their own activity already at the most elementary levels - the level of performing simple motor tests according to a model (up to the age of 5.5 years) and the level of performing simple motor programs according to a model (for older children). It is quite obvious that hierarchically higher and later developing levels of behavior regulation in general turned out to be clearly deficient in children of this group.

For the children we classified in the second group (36 cases), the following developmental features were specific.

The picture of early development of children did not reveal signs of pronounced neurological ill-being, and from the point of view of timing and pace, early psychomotor and emotional development generally corresponded to average normative indicators. However, somewhat more often than the population average, changes occurred not in the timing, but in the sequence of motor development itself. Doctors identified problems associated with minor disturbances of autonomic regulation, minor eating disorders, and sleep disorders. Children in this group were sick more often, including dysbacteriosis and variants of allergic manifestations more often than the population average in the first year of life.

The mothers of the majority of these children (27 out of 36) recalled their anxieties about relationships with children in the first year of life as uncertainty in their actions. Often they did not know how to calm the child down, how to feed or swaddle him correctly. Some mothers recalled that they often fed the baby not in their arms, but in the crib, simply supporting the bottle. Mothers were afraid to spoil their children and did not teach them to “handle” them. In some cases, such behavior was dictated by the grandparents, less often by the child’s father (“You can’t pamper, teach him to be rocked, to be handled”).

When examining children in this group, the first thing that caught our attention was a decreased background mood and, most often, low indicators of general mental activity. Children often needed encouragement and a kind of “toning” from an adult. This type of help was the most effective for the child.

The development of the regulatory sphere of these children (in accordance with age) turned out to be sufficient. These children before fatigue sets in(this is of fundamental importance) they coped well with special tests for the level of regulatory maturity and maintained the algorithm of activity. But the ability to regulate emotional expression was most often insufficient. (Although it should be noted that before the age of 7-8 years, healthy children may demonstrate difficulties regulating emotions even in expert situations).

Thus, in general, we can talk about a sufficient level of voluntary regulation of children classified as the second group. At the same time, the level of voluntary regulation of the emotional state was often insufficiently formed, which shows a clear relationship between the formation of the regulation of emotions and emotional expression and the specifics of the formation of the actual affective regulation of behavior.

As for the features of the formation of leveled affective regulation, according to the results of an integral assessment of the child’s behavior and the parents’ responses, a distortion of the proportions of the system was usually observed, as a rule, due to the hyperfunction of the 3rd level of affective regulation, and in severe cases - of the 2nd and 4th levels .

From the standpoint of analyzing affective status, it was often necessary to talk about insufficient affective tonization, already starting from the 2nd level of affective regulation (that is, its hypofunction) and, as a consequence, about a change in the proportions in tonization of the 3rd and 4th levels.

In this case, especially with the onset of fatigue, the affective tonization necessary for solving behavioral problems can be compensatory manifested in the growth of protective mechanisms of the 2nd level of affective regulation.

This kind of “toning” is specific to the hypofunction of the second level of affective regulation (the level of affective stereotypes), and the “unjustified fearlessness” and playing “at risk” that appears in situations of fatigue characterize the features of the third level of affective regulation - the level of affective expansion.

Perhaps, precisely due to the fact that in children with early childhood autism (3rd group of RDA according to O.S. Nikolskaya) there is a “breakdown” of the entire system of affective regulation or a gross distortion of the interaction of this particular level, such children quite often, especially in early and preschool age, ADHD is mistakenly diagnosed.

The emergence of stereotypical motor reactions in children, manifesting themselves as motor disinhibition, in this case has fundamentally different mental mechanisms.

Thus, for children of the second group, various manifestations of motor and speech disinhibition indicate not hyperactivity, but a decrease in mental tone against the background of fatigue and a compensatory need to activate and “tonicize various levels of affective regulation” through motor activity - jumping, stupid running, even elements stereotypical movements.

That is, for this category of children, motor disinhibition is a compensatory reaction to mental exhaustion; The motor excitation occurring in children of this group can be considered compensatory or reactive.

In the future, such behavior problems lead to developmental deviation towards disharmony of the extrapunitive type (in accordance with our typology (2005), diagnosis code: A11 -x).

Analysis of the condition of children of the first and second groups allows us to conclude that there are significant differences between them in terms of parameters:

specifics of early psychomotor development;

subjective difficulties of mothers and their style of interaction with the child;

level of mental tone and mental activity;

level of maturity of regulatory functions;

features of the development of the cognitive sphere (in most children by subgroup);

the type of assistance needed (organizing for children of the first group and stimulating for children of the second group).

Based on the characteristics of the pace of activity, the following patterns were identified:

in children of the first group, as a rule, the pace of activity was uneven or accelerated due to impulsiveness;

in children of the second group, the pace of activity before the onset of fatigue may not have been slowed down, but after the onset of fatigue most often became uneven, slowed down, or, less often, accelerated, which negatively affected the results of the child’s activity and criticality;

There were no significant differences between children in terms of performance - the latter was most often insufficient in children of both groups.

At the same time, a profile of basic affective regulation specific to each group of children was identified:

increasing endurance at individual levels (hyperfunction) for children of the first group;

increasing their sensitivity (hypofunction) for children of the second group.

We consider such differences in the affective status of children of the first and second groups as the leading mechanisms of the identified behavioral characteristics in both cases.

This understanding of the fundamentally different mechanisms of behavioral maladaptation makes it possible to develop specific, fundamentally different approaches and methods of psychological correction for the two variants of behavioral problems discussed.

The children we assigned to the third group (13 people) showed both signs of neurological distress and quite pronounced regulatory immaturity, as well as a low level of mental tone, uneven tempo characteristics of activity, and problems of insufficient development of the cognitive sphere. Apparently, the symptoms of motor disinhibition in these children were only one of the manifestations of the lack of formation of both the regulatory and cognitive components of mental functions - in our typology of deviant development (M.M. Semago, N.Ya. Semago, 2005) such a condition is defined as “Partial immaturity of mixed type” (diagnosis code: NZD-x). For these children (6 people), the indicators of the level of mental tone were inconsistent (which may also indicate possible neurodynamic characteristics of these children), and the integral assessment of the level of mental tone was difficult.

Further, based on an understanding of the psychological mechanisms underlying such types of deviant development, based on the idea of ​​general and specific patterns of development, we substantiated the need for an adequate direction of correctional work with children of the studied categories, taking into account the understanding of the mechanisms of adaptation disorders.

Technologies of correctional and developmental work for children with problems in the formation of a voluntary component of activity are described in our previous articles, which outline the principles and sequence of work on the formation of a voluntary component of activity (N.Ya. Semago, M.M. Semago 2000, 2005).

Technologies of correctional and developmental work for children with a reduced level of mental tone are presented for the first time.

Since such behavioral problems, from our point of view, are caused by a reduced level of mental tone and mental activity in general (increased sensitivity of the 1st and 2nd levels of basic affective regulation), signs of disinhibition in this case act as compensatory mechanisms, “tonic” , increasing the overall level of mental tone of the child. They can be considered as an increase in protective mechanisms of the 2nd level of affective regulation. Consequently, correctional technologies in this case should be focused, first of all, on the harmonization of the affective regulation system. Speaking about the methodological foundations for constructing correctional programs, it is necessary to generally rely on the theory of K.S. Lebedinskaya - O.S. Nikolskaya (1990, 2000) about the structure and mechanisms of basic affective regulation (toning) in normal and pathological conditions (4-level model of the structure of the affective sphere).

The proposed correctional and developmental approaches are based on two main principles: the principle of toning and “rhythmizing” the child’s environment (including through distant sensory systems: vision, hearing) and the actual methods aimed at increasing the level of mental toning, for example, the bodily method -oriented therapy and related techniques adapted to work with children.

Depending on the degree of insufficiency of mental tone and the age of the child (the younger the child, the greater importance is attached to contact, bodily methods that are more natural for the child), the volume of the necessary rhythmic organization of the environment and the actual tactile rhythmic influences were developed, increasing the child’s tone due to direct contact with him - bodily and tactile, leading, in turn, to an increase in overall mental tone.

We included the following as distant methods of rhythmic organization of the environment:

Establishing a clear, repeating routine (rhythm) of the child’s life with affective reinforcement (pleasure). The very rhythm and events of the day should be experienced by the child together with the mother, giving pleasure to both.

Selection of adequate rhythmically organized musical and poetic works that are presented to the child in a situation before the onset of obvious fatigue, thereby preventing, to a certain extent, compensatory chaotic movements that arise (with the goal of autotonizing the child, but destructive in their behavioral manifestations). These same problems were often solved in the family by drawing by the child to one tune or another. In this case, multimodal tonization methods (rhythm of movement, changes in color, musical accompaniment) were connected to tonization mechanisms specific to the second level. In the activities of specialists from educational institutions (PPMS centers), such work can be carried out within the framework of art therapy.

Actually, a system of tactile toning, accompanied by specific intonationally designed “chants” (similar to folklore refrains).

Playing simple folklore games and ball games that have a stereotypical, repetitive nature.

Distant tonization methods also include methods of mental tonization using the mechanisms of the first level of affective tonization: creating sensory comfort and searching for the optimal intensity of certain influences, which fit well into this type of psychotherapy as “landscape therapy”, the specific organization of the “living” environment: comfort, safety , sensory comfort. This kind of “distant” tonization can be carried out both by a specialist when working with children, and at home in the family when implementing a system of branch therapy.

If such methods for organizing the correct behavior of a child and increasing his mental tone are not enough, special techniques of tactile toning are used directly for the tasks of normalizing behavior. These techniques are, first of all, taught to the child’s mother (the person replacing her). An appropriate technology for training the mother (branch therapy) and an appropriate sequence of the tonic work techniques themselves were developed. This correctional program was called “Increasing mental tone (PGP program).”

The system of work to increase the level of mental tone of the child had to be carried out by the mother daily, for 5-10 minutes according to a certain scheme and in a certain sequence. The work scheme included mandatory consideration of the basic laws of development (primarily cephalocaudal, proximo-distal laws, the law of the main axis), adherence to the principle of sufficiency of influence.

The toning techniques themselves were variations of stroking, patting, tapping of varying frequencies and strengths (certainly pleasant for the child), performed first from the top of the head to the shoulders, then from the shoulders to the arms and from the chest to the tips of the legs. All these “touches” of the mother were necessarily accompanied by sentences and “conspiracies” corresponding to the rhythm of the touches. To solve these problems, mothers were familiarized with a sufficient amount of folklore materials (songs, sentences, chants, etc.). It should be noted that the effect of this type of “conversational” communication with children (in a certain rhythm and intonation pattern) is noted by psychologists and other specialists working with children with early childhood autism of the O.S. group. Nikolskaya.

Our observations have shown that for older children (7-8 years old), tactile influences themselves are not adequate either to age or to the patterns of dyadic mother-child relationships. In this case, a fairly effective technology of work, in addition to the rhythmically organized and predictable life of the child, which makes it possible to increase his mental tone, is his inclusion in the so-called folklore group.

Involving the mother in working with the child also had a strictly tactical task. As preliminary studies have shown (Semago N.Ya., 2004), it was the mothers of children with insufficient mental tone who found themselves untenable in their parental position in the first year of the child’s life. Hence, one of our assumptions was that the low level of mental tone of the child may be a consequence, among other things, of insufficient tactile, bodily, and rhythmic maternal behavior. In this regard, it is precisely such full-fledged maternal behavior at a child’s early age that is one of the main factors in the formation of a harmonious system of affective regulation in children.

Another direction of our work to harmonize the affective sphere and increase the level of the child’s mental tone is a specially selected range of games (having a large volume of motor component), with the help of which the child could also receive affective saturation and, thereby, increase his tonic mental resource. These included games that had a repetitive stereotypical nature (from infant games such as “We drove, we drove, bang into the hole,” “Ladushki,” etc. to a number of ritual folklore games and stereotypical games with a ball, which have a high affective charge for the child ).

Currently, monitoring of a number of children included in such correctional work continues. Work continues to analyze the criteria for the effectiveness of correctional work. Among the positive changes obtained as a result of carrying out this comprehensive program with children of different ages, the following can be highlighted:

in most cases, there is a significant decrease in the number of complaints about motor disinhibition of children both from parents and from specialists of the educational institutions in which they are located;

the periods of active work capacity of the child and the overall productivity of his activities increase;

The relationship in the mother-child dyad and mutual understanding between mother and child are significantly improved;

As a result of involving mothers in working with their own children, most of them acquired the ability to “read” and more sensitively assess the emotional and physical well-being of the child.

Emphasizing that classes to “tonicize” the child’s mental sphere in this case were combined with elements of psychotherapeutic work, it should be noted that without such a context, no correctional program can be effective. But in this case, work to increase the child’s mental tone was the main “system-forming” element of correctional work.

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Motor disinhibition (hyperactivity)

​Parents often turn to doctors about increased motor activity of the child, which is difficult to control and correct. In medicine, such conditions are referred to as hyperactivity or disinhibition. Numerous special studies by both domestic and foreign scientists have been devoted to this issue. What is it and why does it occur? Is hyperactivity a normal physiological phenomenon or is it one of the signs of illness? What kind of regime do such children need, how should parents, educators and teachers treat them?

We will try to answer these and other questions that often worry parents. The word hyperactivity comes from the Greek hyper - much and the Latin activus - active. Therefore, hyperactivity literally means increased activity. In the medical sense, hyperactivity in children is an increased level of physical activity at school and at home. It can be either a natural manifestation of the physiological needs of a child (especially younger ones) for movement, occur under the influence of conflicting, traumatic situations and defects in upbringing, or be detected from the first years or even months of life. Let's consider all these possibilities in order.

Movement is one of the manifestations of the vital activity of the body, ensuring its connection with the external environment. As is known, with age, a person’s motor activity undergoes physiological changes. It is especially developed in children of the first 3-4 years of life and slows down significantly in old age. All this has a specific physiological explanation. In young children, inhibition processes are weakly expressed. As a result, they cannot focus their attention on one subject or one game for a long time. The desire to understand the environment, which is still largely unknown, encourages children to often change their occupation. They are constantly on the move, they want to see everything, touch it themselves, even break it to look inside. Due to the low mobility of the main nervous processes (excitation and inhibition), it is difficult for a 2-5 year old child to suddenly stop his activity. If adults suddenly interrupt his activities with their intervention, and even shout or punish him, then the child often has a protest reaction in the form of crying, screaming, and refusal to comply with the parents’ demands. This is a physical, normal phenomenon. Therefore, you should not try to limit the child’s natural mobility. If you are bothered by the child's screaming or the noise created during play, try to occupy him with something else, more interesting, but do not demand that he stop immediately.

However, parents, especially young ones, in some cases are concerned about the child’s motor activity. They see other children the same age who may be calmer and less active. It is good if with these concerns the mother turns to a doctor, who should reassure her and give the right advice. Unfortunately, sometimes the first adviser is neighbors, inexperienced teachers and other random people. A practically healthy child is often given widely available sedative mixtures and tablets or infusions of various herbs that have become fashionable. You cannot self-medicate without a doctor’s recommendation! Only a doctor can dispel your doubts, give the correct conclusion about the child’s health and, if necessary, prescribe treatment.

Now let's look at the hyperactivity of children that arises as a result of various external influences. In such cases, parents note that a previously calm child suddenly becomes overly active, restless, and whiny. This happens especially often during the first physiological crisis between the ages of 2 and 4 years. The cause of hyperactivity can be various diseases, including the nervous system (mainly in older children), but most often - defects in education. The latter can be divided into three groups - three extremes of upbringing: a very strict (suppressive) style, excessive guardianship, and the absence of uniform requirements imposed by all family members.

Unfortunately, there are still so-called socially neglected families in relation to the child, when they receive little attention at all, are often punished for no reason, and make unreasonable demands. If at the same time children witness quarrels between parents, and besides, one of them or both suffers from alcoholism, then there are more than enough reasons for hyperactivity and other neurotic disorders. Such families rarely seek medical help or bring in a child when he already has pronounced pathological character traits.

One of the common causes of hyperactivity in children is the opposite type of upbringing, when they are allowed to do everything and children do not know any prohibitions at first. Such a child is an idol in the family, his abilities are constantly hypertrophied. But at a certain stage, parents become convinced that the upbringing was wrong and therefore decide to change their attitude towards the child, present him with certain requirements and restrictions, and break old habits that have taken root over the years. The famous Soviet teacher A. S. Makarenko wrote that raising a child normally and correctly is much easier than re-educating. Re-education requires more patience, strength and knowledge, and not every parent has all this. Often in the process of re-educating a child, especially if it is not carried out entirely correctly, various neurotic reactions may occur in children, including hyperactivity, negativism, and aggressive behavior. In most of these cases, no special treatment is required; it is enough to build your relationship with the child correctly and be constant in your demands until the end.

Now let’s consider the type of hyperactivity that occurs from the first years or even months of a child’s life and is mainly not a pedagogical, but a medical problem. Let us first present one of the characteristic observations.

A 3-year-old boy, Sasha, was brought to me for consultation. Parents are concerned that the child is very active, fast, restless, constantly on the move, often changes his occupation, and does not respond to the comments of others. From the mother’s detailed story, it was established that this is the first child from young, healthy parents. Her father is an engineer, her mother is a gymnastics coach, at the beginning of her pregnancy she was intensely involved in sports, suffered from a cold and took antibiotics.

From the first days of his life the boy was very restless and whiny. They repeatedly consulted doctors, but no changes were found in the activity of the heart, lungs, gastrointestinal tract and other internal organs. The boy slept very poorly until he was one year old, and his parents and grandparents took turns staying with him throughout the night. Rocking, a pacifier, and being picked up didn't help much. Started sitting and walking on time. After a year, sleep gradually regulated, however, according to the parents, new troubles began. The boy became very fast, fussy and absent-minded.

The parents told all this without the child, who was waiting in the hallway with the grandmother. When he was brought into the office and he saw the doctors in scrubs, he began to scream, cry, and break away from his parents. It was decided to watch the boy at home in his usual environment. He reacted to the arrival of a stranger with some fear, kept walking away and looking expectantly. He soon became convinced that no one was paying attention to him and began to play with toys, but he could not concentrate on any of them. All his movements are fast and swift. Slowly and gradually I became involved in the conversation with the doctor. It turned out that the boy reads syllables and has known letters since he was two years old, although his parents try to keep books out of his field of vision. Performs simple arithmetic operations up to five. Using various distracting methods, we were able to examine the child. Examination revealed no clear organic signs of damage to the nervous system.

In a conversation with parents, it was found out that upbringing is carried out correctly. Despite his hyperactivity and uncontrollability, he clearly knows what not to do. So, he doesn’t touch the dishes, TV, or radio in the room; it’s as if they don’t exist for him. But the toys in the room were scattered haphazardly. It should be noted that parents also do the right thing when it comes to toys: they don’t give a lot at once, they hide old ones for a while, and they don’t buy new ones often. It was clear that the child’s condition was not due to defects in upbringing. Parents do not consider the child a “prodigy,” although he is already beginning to read and shows aptitude for counting. They are more frightened by this somewhat premature mental development, and especially by his behavior.

Advice is given not to be afraid of the early development of the child’s abilities, to periodically offer him the simplest children’s books, and, if the boy wishes, to read with him in the form of a game. It is also recommended to go for long walks more often (until you get a little tired). In order to regulate behavior, it was decided to prescribe some medications. Suddenly, music started playing in the next room. The boy suddenly changed, the fussiness that had taken place disappeared, he stood for a few seconds, listening, and quickly ran towards the sounds of music. Now the parents remembered another “oddity” of the child: he simply listens to calm, slow music, stands quietly for a long time near the receiver and is always dissatisfied when it is turned off. And indeed, the boy stood calmly near the radio, slightly waved his hands (as if conducting), his body swayed slightly to the sides. This went on for about ten minutes, then the parents turned off the receiver. There was a short-term negative reaction, but no protest. Parents note that the child often brings a number of his favorite records to play, which he remembers by their appearance: he is ready to listen to them endlessly, which he is naturally denied, since this also frightens the parents to some extent.

The child's reaction to music slightly changed our recommendations. Parents are advised to allow their child to listen to their favorite records 2-3 times a day, gradually increasing their number. It is also recommended to take the child to someone who plays the piano and allow him to “touch” the instrument himself. It was decided to abstain from drug treatment for now. The results of the re-examination showed that our recommendations were correct. Some ordering of the child's behavior was noted, although he continues to remain fast and somewhat fussy.

We have described a fairly typical case of early hyperactivity that arose in the first months of life. It is characterized by a special type of increased motor activity, combined with restlessness, increased distractibility, absent-mindedness, impaired concentration, and increased excitability. In this case, aggressiveness, negativism, some awkwardness and clumsiness may be observed. A hyperactive child rushes around the apartment like a whirlwind, causing real mayhem and chaos in it, constantly breaking, hitting, crumbling something. He is the instigator of quarrels and fights. His clothes are often torn and dirty, personal belongings are lost, scattered or piled up. It is very difficult, and sometimes almost impossible, to calm him down. Parents are perplexed - where does this inexhaustible energy come from, which does not give peace and rest to the whole family? A figurative description of a hyperactive child was given by the mother of a 5-year-old boy, which is given in the book by A.I. Barkan “His Majesty the Child as He Is. Secrets and riddles" (1996): "Has no one yet created a perpetual motion machine? If you want his secrets, study my child." Such children cause a lot of trouble to parents, educators and teachers. Parents have a number of questions: why did everything happen and is it their fault, what awaits the child in the future, will this affect his mental abilities?

These and other questions have long been closely studied by child neurologists and psychiatrists. Much remains unclear and controversial, but some issues have already been resolved. In particular, it was found that when the child’s hyperactivity occurred early, the mother’s pregnancy often proceeded with complications: severe gestosis of pregnancy, somatic diseases, non-compliance with the work and rest schedule, etc. It is known that you should take care of your child’s health even before birth. After all, a person’s life begins not from birth, but from the first days of pregnancy. Therefore, even now in some Eastern countries, age is calculated from the moment of conception. Science has established that some diseases of children can occur even in the prenatal period, during development in the womb. An unhealthy lifestyle, poor nutrition of the mother, lack of vitamins and amino acids also disrupt the development of the unborn child. A pregnant woman should be more careful than ever in the use of various medications, especially psychotropic drugs, sleeping pills, and hormones.

At the same time, one should not conclude from the above that treatment cannot be taken during pregnancy. After all, a pregnant woman can get the flu, bronchitis, pneumonia, etc. In such cases, the prescription of medications is mandatory, but all treatment is carried out as prescribed and under the supervision of a doctor.

There is reliable evidence that hereditary factors play a role in the occurrence of childhood hyperactivity. Upon detailed questioning of grandparents, it is often possible to find out that the parents of their grandchildren were also hyperactive in childhood or had similar neurological disorders. Similar disorders are often detected in relatives on the side of both fathers and mothers. Consequently, early childhood hyperactivity is often a consequence of abnormal intrauterine development or is hereditary.

Regarding the further development of such children, the following can be said. Based on large statistical studies, it has been proven that hyperactive children, as a rule, do not experience mental retardation. At the same time, they quite often have certain difficulties in their studies, even unsatisfactory or only mediocre performance in 1-2 subjects (usually writing and reading), but this is mainly a consequence of defects in upbringing or improper pedagogical influence.

Another interesting feature of hyperactive children should be noted. Quite often, in the first year of life, their physical and mental development occurs at a faster pace. Such children begin to walk and pronounce individual words earlier than their peers. One may get the impression that this is a very gifted, brilliant child, from whom much can be expected in the future. However, in preschool age and especially in the first years of school, one has to make sure that the mental development of such children is at an average level. At the same time, they may have increased abilities for a certain type of activity (music, mathematics, technology, playing chess, etc.). These data should be used in educational and pedagogical work.

As is known, almost any child in the presence of conflict situations, especially frequently repeated ones, can develop a number of neurotic disorders. This especially applies to hyperactive children. If insufficient attention is paid to their upbringing or it is carried out incorrectly, then various functional disorders of the nervous system gradually arise and are recorded.

In relationships with such a child, it is necessary, first of all, to proceed from the unity of requirements on the part of all family members. Such children should not see in one of the family members their constant protector, who forgives them everything and allows them what others prohibit. The attitude towards such a child should be calm and even. No concessions (discounts) should be made on the characteristics of his nervous system. Already at an early age, a child should be taught what not to do and what to do. He perceives everything else as “possible.”

In educational work, it is necessary to take into account the increased physical activity of such children. Therefore, games should be primarily active. Given the increased distractibility of such children, their type of activity should be changed more often. It is necessary to provide the most practical outlet for the hyperactivity of such a child. If at the same time he sleeps poorly, especially at night, you can take long walks the day before, up to moderate fatigue. In our example with Sasha, his increased interest in music is noted. If similar tendencies can be found in hyperactive children, then this should be used as much as possible in education.

It has been noted that hyperactive children do not adapt well to a new unfamiliar environment or a new team. When enrolling such a child in kindergarten, very often a number of complications initially arise: after a few days, children refuse to attend kindergarten, cry, and are capricious. In this regard, it is very important to first instill a love for peers and being in a team; You should also talk with the teacher in advance about the child’s characteristics. If a visit to kindergarten begins suddenly, then the negative traits of the child’s behavior may increase; in many cases, he disrupts the general order in the group with his negativism and stubbornness.

About the same thing can happen during a visit to school, especially in cases where there is no proper contact with the teacher. Lack of concentration, restlessness, and frequent distractions give these children a reputation for disruptive behavior. Constant reproaches and comments from teachers contribute to the formation of an inferiority complex in the child. He seems to be protecting himself with unmotivated impulsive behavior. This can be expressed in damage to surrounding objects, foolishness, and some aggressiveness. A hyperactive child needs a special approach at school; it is better to put him in one of the first desks, call him to answer more often, and generally give him the opportunity to “discharge” his existing hyperactivity. For example, you can ask him to bring something or give it to the teacher, help him collect diaries, notebooks, wipe the board, etc. This will be invisible to classmates and will help the child sit through the lesson without breaking discipline. Naturally, every teacher will find many such distracting techniques.

If hyperactive children show a desire, in addition to attending school, to study music or attend a sports section, they should not be prevented from doing this. Moreover, there is no reason to exempt them from physical education, participation in competitions and other events. Of course, such a child needs to be periodically shown to a neurologist, who will decide on the appropriateness and nature of treatment measures.

We looked at various manifestations of hyperactivity in children and the causes of their occurrence. It is difficult to give advice to parents for each specific case. It should be remembered that one of the main measures for normalizing and managing the behavior of such a child is properly conducted upbringing and training.

What exactly should you do? First of all, remember that children with ADHD have a very high threshold of sensitivity to negative stimuli, and therefore the words “no”, “you can’t”, “don’t touch”, “I forbid” for them are, in fact, an empty phrase. They are not susceptible to reprimands and punishment, but they respond very well to praise and approval. Physical punishment should be abandoned altogether. See →