What is minimal brain dysfunction in children. Treatment of minimal brain dysfunctions in children: therapeutic possibilities of Instenon

Minimal brain dysfunction occurs in children often enough. According to various sources, minimal brain dysfunction suffer from 2 to 25% of children. Minimal brain dysfunction refers to a number of conditions in children of a neurological nature: impaired coordination of movements, emotional lability, minor speech and motor disorders, increased distractibility, absent-mindedness, behavioral disorders, learning difficulties, etc.

Unclear? Nothing, now we will try to decipher this abracadabra.
Let us make a reservation right away that doctors can “call” MMD with a variety of diagnoses: hyperactivity, attention deficit, chronic brain syndrome, organic brain dysfunction, mild childhood, psychomotor retardation, etc. In addition, children with MMD are the subject of close attention of psychologists, teachers, defectologists, speech therapists, like children who are difficult to learn or pedagogically neglected. Each child may have their own manifestations of MMD, but the basis of everything is the once experienced harmful effects that slightly damaged the brain.

Causes minimal brain dysfunction in children

Various factors lead to immaturity of the brain at the time of birth or a violation of the metabolic processes of the brain.

Factors acting before the birth of a child:

• hereditary predisposition. Someone from close relatives of the child suffers from similar disorders.
• Pathology of pregnancy and childbirth:

Prematurity.
- Diseases and toxicosis of a pregnant woman.
- The threat of abortion.
- Poor nutrition during pregnancy. Anemia in pregnancy.
- Hypoxia of the fetus and asphyxia of the newborn.
- .
- Pathology of childbirth (fast delivery, weak labor activity, etc.).

Factors at work in early childhood:

• Malnutrition in early childhood.
• Diseases suffered in early childhood, especially those in which the brain experiences a constant lack of oxygen. For example, when diseased lungs cannot fully enrich the blood with oxygen. Or congenital, when defective cardiac activity is not able to provide decent blood flow in the brain. Other.

Symptoms of minimal brain dysfunction in children

Problems in children associated with MMD flourish in full bloom during the period of preparation for school and in elementary school, when it turns out that the child, as it turns out, is completely unable to learn: he does not remember well, is distracted, writes disgustingly, and besides, he has character intolerable. Teachers and parents fight over an uncontrollable child, but it torments them: persuasion and educational conversations about the benefits of knowledge do not bring success.

So, a child with MMD has the following features:

Increased motor activity, combined with awkwardness. Children are restless, restless, they cannot do one job for a long time. They are carried somewhere all the time, they can scream loudly, run aimlessly in inappropriate environments (for example, jump up and start walking in the middle of a lesson or unceremoniously interrupt adults during a serious conversation). They are clumsy and "knock down all corners" in their path, can be unstable when walking, and fall easily, and if something falls into their hands, it will certainly be broken. These manifestations are called hyperactivity. Often hyperactivity is combined with attention deficit.

Attention deficit. An analogy immediately arises with the fact that the child lacks attention from adults, which is why he is so neglected. Yes, indeed, he lacks attention, only his own. Such children are very easily distracted by any stimuli, cannot concentrate on anything, are absent-minded, and it is difficult for them to memorize.

Sleep disorders. Usually children do not sleep well, often wake up, cry out in their sleep.

Character features. The child's mood changes rapidly and easily changes from elated to depressed (emotional lability). Sometimes he has unreasonable outbursts of rage and anger, not only towards others, but also towards himself. The child is infantile, prefers to play with younger children.

Fine motor disorders. For such children, fingers do not work well, it is problematic for them to tie shoelaces and fasten buttons, and at an older age - to use scissors, write, sew. Difficulties in writing are manifested in poor handwriting (writes small or large), as well as the fact that the child quickly gets tired of writing.

Speech disorders. Articulation of speech, auditory memory and perception suffer. It is difficult for such children to build long sentences, their speech is poor, they hardly tell and retell the text, they write essays poorly.

Violation of spatial perception. Poor orientation between “right” and “left”, mirror spelling of letters, etc.

Memory disorders. Mechanical memorization is difficult.

Difficulties in learning. Given all of the above, no one will have any doubt that it will be difficult for a child to study. Usually, children have an incomplete set of symptoms of MMD, therefore, depending on the characteristics of the course of the disease, one child will experience difficulties in writing, reading is difficult for another, counting is difficult for a third, etc. At the same time, one should not think that the child is stupid, although this option is of course also possible. With MMD, it is not the intellectual abilities of the child that play a significant role in the presence of difficulties in learning, but the impossibility of their implementation.

This, first of all, is evidenced by the fact that more than 70% of children with MMD, with the correct organization of classes and competent drug treatment, catch up with their peers and study in a normal normal school. If you turn the learning process into an exciting game, increase motivation (encourage the child, praise, etc.) and, which is very important, turn on control over him (monitor the task, pronounce his actions with him, make him report on the work done) , manifestations such as hyperactivity and attention deficit are reduced or disappear altogether.

Attention! Symptoms similar to the manifestations of MMD are also observed in some other diseases (oligophrenia, psychosis, etc.), therefore, only joint long-term observation of the child by a neurologist, psychiatrist and teacher can give a complete correct assessment of the patient's condition. Consultation with a child psychiatrist is required.

Treatment of MMD

Treatment of a child with minimal brain dysfunction lengthy and requires patience. It is clear that a patient with MMD needs to be given much more attention and time than an ordinary healthy child.

1. Creation of a friendly calm environment at home, in kindergarten, school. It is necessary to understand that the child's condition is not connected with the depravity of character, selfishness and whims, but with the disease and his inadequate actions are not intentional.

2. Education and classes.

• Leading word in education child with MMD- the control. You must always be near and control the actions of the child.
• It is impossible to allow extremes in education: on the one hand, to be excessively strict and demanding with the child, to punish, on the other hand, to patronize too much. In a speech addressed to a child, avoid the words “no” and “no”, speak to him in a restrained, calm tone.
• A frequent change in the mood of the parents negatively affects the patient, as does the discrepancy in the instructions (a minute ago they say one thing, after a while - the exact opposite, or the opinions of the parents regarding the actions of the child diverge).
• You can not give the child several tasks at the same time: he will not be able to complete them and will be upset, you will also be dissatisfied. You need to give only one task and limit its execution to a certain time. After the child does it, check the implementation and praise.
• For child with MMD preferable activities that require concentration and develop fine motor skills of the hands: drawing, modeling, appliqué, embroidery, knitting.
• The daily routine should be very clear. Be sure to stick to it: the time of waking up, going to bed, doing homework, meals should be strictly observed daily.
• Limit the child's contacts with large crowds of people (noisy guests, mass children's games), this is unnecessarily exciting and contributes to distracting attention. It is better to let the child play or communicate with only one person.
• Limit TV and computer.
• Physical activity is a necessary condition. A child with MMD has a huge amount of excess energy that needs to be spent somewhere. The most suitable application for it is physical education.

3. The nutrition of the child should be age-appropriate, complete and rich in vitamins.

4. Work with a teacher.

5. Work with a speech therapist.

6. Work with a psychologist.

7. Work with parents at home (very active).

8. Drug treatment:

Drugs that improve nutrition and metabolic processes of the brain: nootropil, piracetam, cereborlysin, phenibut, encephabol, instenon, etc.

Drugs that improve blood supply to the brain: cavinton, cinnarizine, etc.
B vitamins, multivitamins.

Dietary supplements and drugs that improve brain function, containing lecithin, carnitine, taurine.
Calming agents: valerian, motherwort, novopassitis, etc.

Attention! The course of treatment and dose is prescribed by the doctor individually and depends on the course of the disease. All medicines can be given to a child only on the recommendation of a specialist.

1. What is minimal brain dysfunction (MMD)?

First, MMD is associated with a consequence of early brain damage in children. Of course, one of the parents may be quite aware of what it is, but there are probably mothers among the readers who know little about minimal brain dysfunction and have not yet thought about what it leads to.

It sounds serious enough, I agree, but it’s true that they say that “he who is armed is protected”, in this context, it is the parent who knows what kind of help his child needs if the neurologist puts minimal brain dysfunction. Let's try to start delving deeper into this topic.

In the 1960s, the term became widespread. "minimal brain dysfunction" MMD. Minimal brain dysfunction is expressed in the age-related immaturity of higher mental functions (attention, memory, thinking). MMD is associated with difficulties in learning, social adaptation, emotional disorders, behavioral disorders that are not associated with severe intellectual development disorders. MMD in children manifests itself in the form of psychological developmental disorders, these include: the formation of writing skills (dysgraphia), reading (dyslexia), counting (dyscalculia), speech development disorders, developmental disorders of motor functions (dyspraxia); behavioral and emotional disorders include: attention deficit hyperactivity disorder, behavioral disorders. MMD is the most common form of childhood neuropsychiatric disorders, which, according to statistics, unfortunately, occurs in one in three of our children.

2. How MMD manifests itself at different ages.

Neurologists usually make the diagnosis of MMD already in the first months of a child's life, during this period parents should pay attention to the presence of increased excitability in a child, sleep disturbances, unmotivated unreasonable crying, excessive motor activity, increased muscle tone, tremor of various parts of the body, redness or marbling of the skin. integument, increased sweating, feeding difficulties and gastrointestinal disturbances.

Aged from 1 year to 3 years in children with MMD, increased excitability, motor restlessness, sleep and appetite disorders, weak weight gain, some lag in psychoverbal and motor development are often noted.

By the age of 3, attention is drawn to increased fatigue, motor awkwardness, distractibility, motor hyperactivity, impulsivity, stubbornness, and negativism. Often there is a delay in the formation of neatness skills (enuresis, encopresis). Symptoms of MMD increase by the beginning of attending kindergarten (at the age of 3 years) or school (6-7 years). This pattern may be associated with the inability of the central nervous system (CNS) to cope with the new demands placed on the child in terms of increased mental and physical stress.

The maximum severity of MMD manifestations often coincides with critical periods of psychoverbal development in children. The first period includes the age of 1-2 years, when there is an intensive development of cortical speech zones and the active formation of speech skills. The second period falls on the age of 3 years. At this stage, the child's stock of used words increases, phrasal speech improves, attention and memory actively develop. At this time, children with MMD show a delay in the development of speech and impaired articulation. The third critical period refers to the age of 6-7 years and coincides with the beginning of the formation of writing skills (writing, reading). Children with MMD at this age are characterized by the formation of school maladaptation and behavioral problems.

3. How to recognize MMD on your own?

We can say that the causes of MMD are diverse, these are:

pathology of pregnancy and childbirth (severe pregnancy);

toxicosis of the first half of pregnancy (especially the first trimester);

risk of miscarriage;

this is the harmful effect on the body of a pregnant woman of chemicals, radiation, vibration, infectious diseases, certain microbes and viruses;

this is a violation of the timing of pregnancy (a child is born prematurely or overdue), prolonged labor with stimulation of labor, accelerated, rapid labor, lack of oxygen (hypoxia) due to squeezing of the umbilical cord, asphyxia, entanglement of the umbilical cord around the neck, caesarean section, birth trauma;

infectious, cardiovascular and endocrine diseases of the mother;

incompatibility of the blood of the fetus and mother by the Rh factor;

mental trauma of the mother during pregnancy, stress, physical activity;

a child under one year old has suffered an infectious disease, accompanied by various complications, has been injured or has undergone surgery.

This all suggests that, unfortunately, your child belongs to the risk group!!!

4. Ways to help a child with MMD.

If you recognize MMD in a child, then you understand that he, like no one else, needs the attention of specialists and early medical, psychological and pedagogical support.

What specialists do the child need first of all:

neurologist;

1. neuropsychologist;

   speech pathologist-defectologist;

   teacher speech therapist

   Doctors, a neurologist and a pediatrician will help you choose an adequate course of medical treatment for your child.

A speech therapist-defectologist will help develop your child's cognitive and speech spheres, select an individual program for correcting delays in psychoverbal and mental development, and help children with intellectual disabilities.

A neuropsychologist will conduct an express diagnosis of a preschooler's readiness for school, a diagnosis of the development of higher mental functions (attention, memory, thinking) and the emotional and personal sphere. It will help to understand the reasons for the child’s school failure and conduct remedial classes, develop an individual program for correcting the child’s cognitive sphere (development of attention, memory, thinking), help understand the reasons for the child’s bad behavior and select an individual or group form of behavior correction and emotional and personal sphere. Teach you new ways to respond to and communicate with your child. What will give you the opportunity to better understand your child, be closer to him and be more effective as a parent, and give the child the opportunity to become successful in society, mature and developed.

A speech therapist will select an individual program for the correction of speech developmental disorders, help to understand what the problem of a speech disorder is in a child, and form writing, reading and counting skills.

ENT will reveal diseases of the ENT organs (ear, throat, nose).

What distinguishes a child with functional disorders in the brain or (MMD, ZPRR) from normally developing children:

Delay and impaired speech development.

Problems of teaching at school.

Rapid mental fatigue and decreased mental performance (while general physical fatigue may be completely absent).

Sharply reduced possibilities of self-management and arbitrary regulation in any kind of activity.

Behavioral disorders from lethargy, drowsiness in solitude, to motor disinhibition, randomness, disorganization of activities in a crowded, noisy environment.

Difficulties in the formation of voluntary attention (instability, distractibility, difficulty concentrating, distributing and switching attention).

Decrease in the amount of RAM, attention, thinking (the child can keep in mind and operate with a limited amount of information).

Unformed orientation in time and space.

Increased motor activity.

Emotional-volitional instability (irritability, irascibility, impulsiveness, inability to control one's behavior in the game and communication).

Dear parents, if your child is in the “risk group” and has an unfavorable neurological status, he needs early help, support and prevention of developmental disorders, which combines psychological, pedagogical and drug treatment. Your child will be helped by such specialists as: a neurologist, a speech pathologist and a psychologist.

In our time, all these problems can be overcome, with the timely appeal of parents to specialists and the provision of joint comprehensive assistance to your child. There are enough ways to help now to help your child grow harmoniously and develop his potential.

There are various psychological programs for individual and group assistance to children with MMD, which are aimed at:

decrease in motor activity in children during the educational process;

increasing the communicative competence of the child in the family, in kindergarten and school.

development of skills of distribution of attention, motor control;

learning self-regulation skills (the ability to control oneself and constructively express one's emotions);

formation of skills of constructive communication with peers;

formation of the ability to control the impulsiveness of their actions;

recognizing your strengths and using them more effectively.

the formation of parents' ideas about the characteristics of children with manifestations of hyperactivity and attention deficit disorder.

Every caring parent in the depths of his soul knows for sure that an early appeal for qualified help will prevent and avoid many problems in the development of the child and prevent the difficulties that the child will face while studying at school.

I know that parents who love and feel their children, which are the majority, always think about the future of their children and provide them with timely support, without postponing important issues for later.

Any child is extremely active. Young children are prone to endless running around, they make a lot of sudden movements that scare their mothers. The kids torment the elders with a huge number of questions, they constantly pester. However, every kid will have the patience to play with the designer, look through the book, sit with the coloring.

If your child does not sit still at all and does not engage in quiet activities, this may be evidence that he has minimal brain dysfunction.

Signs and causes of MMD

The main signs of MMD are reduced to behavioral disorders. It can be attention deficit, hyperactivity, a tendency to fatigue quickly.

These signs serve as a signal for parents, noticing them, moms and dads should show their baby to a specialist. There can be several reasons for MMD. The most common deviation in the formation of the nervous system during the stay in the womb.

Other reasons may include social problems. This is a conflict tense situation in the family, an unwanted pregnancy, a low level of parental culture. Heredity also influences the formation of the nervous system.

Treatment of MMD

If there are certain signs that can be associated with MMD, you should seek the advice of a pediatrician, and then a neurologist. The sooner the condition is corrected, the less negative consequences will remain with the child for life. MMD can be cured without much problem.

The main thing is the correct attitude of parents to the problem, the availability of psychological and pedagogical support, and the use of special medications. Not to do without active movement.

Active movement is aimed at developing coordination of movement, dexterity, appropriate for age. The child should be given loads of a sports plan, competitions should not be held, because they contribute to an imbalance in the emotional state.

Psychological and pedagogical support should be provided not only by specialists. In the first place is the concern of parents. The child's viewing of television programs is limited, computer games are excluded, the child is not taken to noisy places, and large companies are avoided. The kid must strictly adhere to the daily routine, engage with educational toys.

Parents should try to improve the memory and attention of their child. Also, parents should monitor their speech, avoid reproaches, screams, swearing. Communication with the baby is based on a friendly attitude, speech should be soft, calm, restrained.

If the 2 methods above do not give any results, you need to turn to medical support. Here self-treatment is unacceptable. Doctors usually prescribe antidepressants, psychostimulants.

Symptoms of MMD

Symptoms of this disease appear in preschool age. If the symptoms described above are detected within 6 months or more, you should definitely consult a doctor. At the same time, the symptoms of MMD appear not only at home, but also during their stay in the children's team. The main features of MMD:

• hyperactivity;
• impulsiveness;
• low level of attention.

Such children run and jump a lot, spin a lot, cannot sit still in one place, they can make movements that do not carry any meaning. There are other behavioral characteristics:

• the child cannot play quiet games;
• he can't do what he was told to go through with;
• constantly distracted by any stimuli;
• often loses things;
• makes many mistakes when performing any task;
• cannot listen carefully, does not perceive information by ear, while asking questions, interrupting;
• gives an answer to the question, without listening to it, without delving into the essence;
• shows unreasonable aggression;
• cannot play with peers without conflict, because he violates the rules of the game.

MMD can disrupt the entire period of the child's development, so you need to adequately treat the problem and take all measures to eliminate the disease. A neurologist and a speech therapist, a pediatrician and a psychologist will help parents in the fight against violations.

With timely treatment, the problem can be eliminated quite quickly, the baby will develop harmoniously and achieve good results.

Key words: minimal brain dysfunction, hyperkinetic chronic brain syndrome, minimal brain damage, mild childhood encephalopathy, mild brain dysfunction, childhood hyperkinetic response, impaired activity and attention, hyperkinetic behavioral disorder, attention deficit hyperactivity disorder (ADHD)

So, together let's try to remember some special moments in your child's life and behavior and answer the following questions.

• Perhaps, in the first year of life, he gave you a lot of trouble, and was observed by a neurologist with a diagnosis of PEP? He cried a lot and burped, slept badly, reacted (and now too) to the weather; slightly lagged behind in the pace of psychoverbal and motor development?
• Perhaps he has an unusual head shape, or is it clearly larger (smaller) than his peers? Unsymmetrical face, different ears, eye color?
• Does he often suffer from acute respiratory infections and is prone to allergies, does he always have a stuffy nose and nosebleeds?
• It is possible that the baby has vision problems, meteorological dependence, dizziness, constipation, pain in the abdomen, legs or head, he is motion sick in transport, sometimes a wet bed happens at night?
• Previously, he walked on tiptoe for a long time, clubfooted, and now instantly, incorrectly tramples shoes, maybe he has flat feet, stoop or scoliosis?
• Does it look like an "electric broom"? The child is constantly on the move and cannot sit still even for a minute;inattentive and distracted, instantly distracted, invariably loses and forgets everything; quick-tempered and irritable, first speaks and does, and then thinks? Patience is not his virtue?
• Or vice versa? Perhaps it would be a good idea to compare his behavior with a turtle? The child is inconspicuous and quiet, mysterious and mysterious, convenient for adults, obedient and always agreeing in everything, "head in the clouds" extremely slow thinking, even slower in action?
• The child cannot fall asleep on his own, this requires significant mother's efforts and a lot of time; night sleep is extremely restless, constantly on the move, often waking up, talking and crying out in a dream, and in the morning it is difficult to get him out of bed?
• Are you worried that the child sucks his finger, bites his nails, he has tics, he is very anxious and impressionable, you can list his fears all day?
• He is already big, and yet, speech is slurred, swallows and pronounces some sounds incorrectly? It happens that he stumbles, and it is difficult for him to describe a picture in a book or tell what happened in the kindergarten? Is learning poetry a big pain?
• From infancy it is impossible to call him an athlete? He is clumsy, awkward, does not know how to run and jump well; legs are tangled, often stumbles, falls and touches all corners; “likes” to understand things, unlike his peers, it is difficult for him to fasten buttons, tie shoelaces, insert a key into the lock, he does not catch the ball well, etc.
• Does he have difficulty writing, reading, counting, poor memory, poor handwriting...?

If you have already addressed a neurologist with such or similar complaints, then you simply physically could not leave the doctor's office without a long list of pills and your favorite diagnosis - MMD. And yet, what is minimal brain dysfunction?

A short digression into the history of neurology. For the first time, a mild disorder of behavior and learning in children, accompanied by impulsivity, motor disinhibition and inattention, combined with neurological microsymptoms and normal intelligence, was officially designated by pediatric neurologists as "minimal brain dysfunction" or "MMD" back in the middle of the 20th century. At that time, the diagnosis of MMD brought a lot of benefits, thanks to this term, neurologists clearly identified the totality of the actual problems of children's behavior and learning, formed the directions for the further movement of advanced scientific thought.

But this diagnosis quickly became outdated, it did not reveal the essence of the problem at all, and when translated into understandable language it meant only one thing: “somewhere and something is slightly disturbed in the functioning of the brain.” I can imagine your facial expression, if in a car service, after a thorough inspection of your favorite car, your legitimate question is “So what about the car?” you get a thoughtful answer from a mechanic, convincingly waving printouts of computer diagnostics “We completely figured it out! It seems that something, somewhere and somehow, a little slightly, but the operation of the engine is disrupted ... ".

In the USSR, this conveniently wonderful diagnosis rapidly spread in pediatric neurology and pediatrics in the 60s of the last century, since, without much mental stress, it freely allowed to manipulate clinical information and designate practically any, real or imaginary, violations of children's behavior in combination with minimal neurological symptoms.

Everyone liked the winning term, and with the light hand of domestic neurologists, the convenient diagnosis of MMD quickly turned into a big city dump where you could find almost everything: from a variant of the norm to specific disorders in the development of learning skills and motor function, as well as attention deficit hyperactivity disorder. With the help of MMD, it was easy, without delving into the essence of the problem, to explain to parents from the position of "science" all the above moments of the life and behavior of their child. To the insidious parental question about the causes of MMD, an elegant answer followed: perinatal encephalopathy (PEP) is to blame! Particularly corrosive parents received, as a "last bullet", data from instrumental research methods with mysterious scientific graphs and numbers. Outdated and uninformative echoencephalography ( ECHO-EG) and rheoencephalography ( REG), modern, but unnecessary in this case, electroencephalography ( EEG) and transcranial dopplerography (TCDG), served as irrefutable proof of the correctness of the diagnosis. But the most unpleasant thing is not even that, the diagnosis of MMD almost always automatically led to the appointment of handfuls of useless, and sometimes simply harmful, medicines. At first, such appointments were made exclusively for a noble medical purpose, at present, the aggressive policy of pharmaceutical companies plays an important role in this. And until now, many mothers of schoolchildren begin their story in my office with a proud statement: “We have MMD! And we are actively being treated ... ".

Attention! Already in 1968, pediatric neurologists and psychiatrists around the world abandoned the unsuccessful diagnosis of MMD, replacing it in the second edition of the American Classification of Psychiatric Diseases (DSM-II) with the term "hyperkinetic reaction of childhood". The final transformation of MMD intoattention deficit hyperactivity disorder (ADHD) occurred in 1994 in the fourth edition of the American Classification of Psychiatric Diseases (DSM-IY).

At the end of the tour, a logical question arises: “If MMD is a myth, an outdated term, then what to do with the above complaints? Maybe this is the norm?

Answer: No, of course not! This is a problem, sometimes quite serious, requiring careful consideration. Only a small request: “you don’t need to hide it in the old MMD closet.” And you need to start solving this problem not with instrumental examinations and a handful of pills, but with a competent consultation of a child psychologist and speech therapist, and only then come to a consultation with a neurologist, who will determine the need for further examination and treatment.