Motor disinhibition (hyperactivity). Mechanisms of motor disinhibition and their specific types of corrective work

psychomotor disinhibition)

Psychomotor: dictionary-reference book.- M.: VLADOS. V.P. Dudiev. 2008 .

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Disinhibition - increased motor activity caused by a weakening of 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 patient's objective status mainly have in mind a certain behavioral pattern that resembles the behavior of a child, or the behavior of a person in a state of intoxication.

It is worth emphasizing that disinhibition is a manifestation not so much of a quantitative increase in motor activity as a manifestation of its pronounced involuntary character, which has gone out of control of the subject himself and is not controllable 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 their status using such wording as “does not keep their distance”, “does not keep up appearances”. " etc.

Disinhibition, as a behavioral phenomenon, primarily means, based on the etymology of the word itself, the 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 a waking consciousness is fixed in the patient. Therefore, behavioral phenomena that occur with unclear consciousness, such as ambulatory automatism, somnambulism, and oneiroid catatonia, should not be attributed to disinhibition. Of course, in the listed states, the patient performs involuntary, automated (subcortical) behavior, but, most importantly, he is not aware of it. Let's take the following example for clarification. A patient suffering from schizophrenia, with a syndromic diagnosis of catatonic arousal, 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 up and published the same words of indecent content. In a strict sense, this is not psychomotor arousal, which is characterized mainly by randomness. The described behavior is characterized, first of all, by involuntariness, autonomy, stereotyping, symbolic coloring, possibly significance and unconsciousness. In extreme cases, one can speak of catatonic-impulsive disinhibition.

Let's return to the "classic" 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 enhance reflex excitation.

Normally, voluntary and reflex movement never merge, they intersect. If a person has a vomiting movement, this movement is reflex or involuntary. Further, the subject can suppress it by an effort of will - and this will be arbitrary suppression. But the subject may not be able to suppress vomiting. Of course, a person cannot voluntarily induce an act of vomiting only by an effort of will, but if a reflex urge arises, he can, by some effort of will, support, strengthen the reflex act of vomiting - this is how indomitable vomiting occurs in hysteria. If you ask a healthy person to tremble, then it is unlikely that he will be able to do it completely enough and for a long enough time. And only with hysterical disinhibition do we see that the subject can tremble for hours, vomit endlessly, and this does not constitute any difficulty 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 responses of healthy people or children. Imagine a person who has an inflammatory reaction with a rise in temperature, and he is shivering, “shaking”. How can he react to chills? Much depends on the situation, the environment, his personal attitudes. He can, by an effort of will, significantly weaken the chills, and everyone will agree that this will require considerable effort (a person will have to "collect his will into a fist"). But if he is in bed in the nomination "sick", with care and care from others, then the individual can afford to "shake freely", while he can notice that he succeeds easily, and he does not feel tired. It is precisely because the reflex is made available to the conscious will, and their merging gives rise to a feeling of lightness, that subsequently the tendency to disinhibition, as a subjectively pleasant state, is fixed in human behavior.

A similar fixation can be found in the behavior of the child, depending on the nature of his upbringing and his individual characteristics. Imagine a situation - a child fell and was slightly hurt, and he may have a reflex act not even crying, but simply screaming. He can also suppress this reflex act if his interest is fixed on some object that occupies him. And he can “roll in tears” for a long time, even forgetting about the reason that caused him - as a rule, there is an over-caring and anxious mother nearby. In the further consolidation of such behavior in a child, undoubtedly, emotional factors play an important 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) intensification, motivated by:

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

All three of these factors - situationality, lightness and emotionality, we can also observe when performing arbitrary 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 come to this, years of painstaking and exhausting training are needed. The wild dance of a shaman looks completely different, who, with the help of psychoactive substances, by homing in a trance, in fact, achieves a state of disinhibition and activation of subcortical motor activity, which has an archetypically symbolic coloring. Subsequent amplification and arbitrary reinforcement of awakened behavioral patterns leads to the same thing - lightness, emotional saturation, lack of fatigue. The shaman can dance until he simply collapses from physical exhaustion. So did the hysterical psychoses called the dances of St. Vitus.

Disinhibition is primarily a behavioral disorder that is characteristic of the following conditions:

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

From actual behavioral disinhibition, hyperkinesis and obsessive actions should be distinguished, which can be characterized as "partial disinhibition".

Disinhibition is heightened emotional excitability

Mechanisms of motor disinhibition and their specific types of corrective work

Adaptation disorders, manifested in the form of motor disinhibition, according to experts, have the most different reasons: organic, mental, social. However, most authors dealing with the problems of the so-called attention deficit hyperactivity disorder regard it mainly as a result of certain problems of an organic, neurological nature. Motor disinhibition as a disturbed behavior has many similarities with other types of deviant development, but at the moment there are criteria for distinguishing 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 in girls such problems are 4-5 times less common than in boys.

Although the hypothesis of the identity of the hyperkinetic syndrome and minimal brain dysfunction is often criticized, the causes of the disease (or condition) are usually considered complications during the entire 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. In the future, most children with similar behavioral 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 30-40s of the last century. The concept of “minimal brain damage” was formulated, which began to denote “non-progressive residual conditions resulting from early local lesions of the central nervous system in the pathology of pregnancy and childbirth (pre- and perinatal), as well as craniocerebral injuries or neuroinfections. Later, the term "minimal brain dysfunction" became widespread, which began to be used ". 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 severe intellectual development disorders” (N.N. Zavadenko, 2000). Further comprehensive study of minimal brain dysfunctions showed that it is difficult to consider them as a single clinical form. In this regard, for the latest revision of the international classification of diseases ICD-10, diagnostic criteria for a number of conditions previously classified as minimal brain dysfunctions. With regard to the problems of motor disinhibition, these are the headings R90-R98: "Behavioral and emotional disorders of childhood and adolescence"; heading P90: "Hyperkinetic disorders" (Yu.V. Popov, V.D. Vid, 1997).

The positive effect of psychostimulants in the medical treatment of children with such disorders is explained by the hypothesis that children with hyperkinetic syndrome are “underexcited” in terms of brain activation, and therefore excite and stimulate themselves with their hyperactivity to compensate for this sensory deficiency. Lowe et al. found an insufficient activity of metabolic processes in the forebrain 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 response (V.V. Kovalev, 1995). It is in this age period more mature subordinate relations are established between the hierarchically subordinate structures of the motor analyzer. And these violations, still unstable subordinate relations are an important mechanism for the emergence of disorders of the psychomotor level of response ”(cited by V.V. Kovalev, 1995).

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

However, as our research and counseling experience show, children with similar behavioral problems also have a variety of emotional and affective characteristics. Moreover, in children with behavioral problems of the type of motor disinhibition, as a rule, attributed by most authors to a single "hyperactivity syndrome", fundamentally different, opposite "in sign" features of the development of the affective sphere as a whole are often found.

The specificity of our study lies in the fact that the problems of motor disinhibition were considered not only from the point of view of the features and differences of the neurological status, but also the affective status. And the analysis of the 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, the analysis of the affective status of children with behavioral problems according to the type of motor disinhibition can be carried out in terms 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 affective-emotional sphere of a child can be assessed by the degree of formation of four levels of the basic affective regulation system (BAR 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, so similar in its manifestation in most children, may have a different “nature”. Moreover, the latter is determined not only by the problems of the neurological status, but also by the peculiarities of the tonic support of the child's life activity - the level of the child's mental activity and the parameters of his performance, that is, first of all, it depends on the specifics of the functioning of the levels of basic affective regulation.

Materials and methods of research

The analyzed group included 119 children aged 4.5-7.5 years, whose parents complained about motor and speech disinhibition, uncontrollability children, significantly complicating their adaptation in preschool and school educational institutions. Often, children came with pre-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 included in 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. A detailed and specifically oriented psychological history taking, where the following were assessed:

features of early psychomotor development;

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

the presence of indirect signs of neurological distress.

2. Analysis of the features of the operational characteristics of the child's activities,

3. An 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. The study of the features of the formation of various levels of arbitrary regulation of activity:

arbitrary possession of mental functions;

keeping the activity algorithm;

voluntary regulation of emotional expression.

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

6. Analysis of the emotional and affective characteristics of the child. 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 needed by the child when working with certain tasks was necessarily assessed. The following types of assistance were used:

help "toning" the child and his activities;

organizing assistance (i.e., building an activity algorithm “instead of” a child, programming this activity and controlling it by an adult).

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

Research results and discussion

In the course of the study, significant differences were revealed between the manifestations of the studied developmental features. These results made it possible to divide 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 (respectively, 15 girls and 21 boys);

13 children made up the third group.

The presence of indirect or obvious (objectified in medical documents) signs of neurological distress, as a rule, expressed to a sufficient degree, was specific for children in the first group. In the early stages, this, first of all, was manifested in changes in muscle tone: muscle hypertonicity or muscle dystonia, uneven muscle tone, was noted much more often. Quite often, already in the early stages of development, the child was diagnosed with perinatal encephalopathy (PEP). Indirect signs of neurological trouble were manifested during this period by fountain regurgitation, sleep disturbances (sometimes inversion of the sleep-wake mode), piercing, "heart-rending" screams. The increased muscle tone of the lower extremities - sometimes even the inability to relax the muscles of the legs - led to the fact that, having risen to his feet early, the child stood "till you drop." Sometimes the child began to walk early, and walking itself was more like an uncontrollable run. Children, as a rule, did not take well any "solid" complementary foods (sometimes up to 3-3.5 years they hardly took solid food).

In the stories of mothers about their anxieties (in 62 out of 70 cases), the most common recollection was that the child was very difficult to calm down, he screamed a lot, was in his arms all the time, demanded motion sickness, the constant presence of his mother.

Specific for this developmental variant was the presence of a significant number of signs of neurological trouble in the anamnesis, a change (as a rule, acceleration and less often - a violation of the sequence) of early motor development. All this, according to the totality of signs, can be qualified as minimal brain dysfunctions, the result of which was the insufficient formation of the voluntary (regulatory) component of activity in general (N.Ya. Semago, M.M. Semago, 2000).

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

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

The following features of development were specific for the children that we referred to the second group (36 cases).

In the picture of the early development of children, there were no signs of pronounced neurological distress, and in terms of timing and pace, early psychomotor and emotional development largely in line with the average. However, somewhat more often than the average for the population, there was a change not in the timing, but in the very sequence of motor development. Doctors identified problems associated with minor disorders of autonomic regulation, minor eating disorders, and sleep. Children of this group were sick more often, including, more often than the average for the population, in the first year of life, there were dysbacteriosis, variants of allergic manifestations.

The mothers of most of these children (27 out of 36) recalled their anxiety about relationships with children in the first year of life as uncertainty about their actions. Often they did not know how to calm the child, how to feed or swaddle him properly. 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 accustom them to "handling". In some cases, such behavior was dictated by the grandparents, less often by the father of the child (“You can’t spoil, accustom to motion sickness, to hands”).

When examining children of this group, first of all, the reduced background of mood and, most often, low indicators of general mental activity attracted attention. Children often needed encouragement and a kind of “toning” from an adult. It was this type of assistance that turned out to be the most effective for the child.

The formation of the regulatory sphere of these children (according to age) turned out to be sufficient. These children before fatigue(this is of fundamental importance) coped well with special tests for the level of regulatory maturity, kept the algorithm of activity. But the possibility of regulating emotional expression was most often insufficient. (Although it should be noted that before the age of 7-8 years, healthy children may show difficulties in emotion regulation even in expert situations).

Thus, in general, we can talk about a sufficient level of voluntary regulation of children belonging to the second group. At the same time, the level of voluntary regulation of the emotional state often turned out to be 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 level affective regulation, according to the results of an integral assessment of the child's behavior and the responses of parents, a distortion of the proportions of the system was usually observed, as a rule, due to hyperfunction of the 3rd level of affective regulation, and in rough cases - of the 2nd and 4th levels. .

From the point of view of the analysis of the affective status, one often had to talk about insufficient affective toning, already starting from the 2nd level of affective regulation (that is, its hypofunction) and, as a result, about a change in proportions in the toning of the 3rd and 4th levels.

In this case, especially when fatigue sets in, the affective toning necessary for solving behavioral problems can be compensatory manifested in an increase in the protective mechanisms of the 2nd level of affective regulation.

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

Perhaps, precisely because in children with early childhood autism (3rd group 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 erroneously diagnosed.

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

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

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

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

An analysis of the condition of children in 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 the style of their 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 subgroups);

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

According to the characteristics of the pace of activity, the following patterns were revealed:

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

in children of the second group, the pace of activity before the onset of fatigue might not have been slowed down, but after the onset of fatigue, it 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 working capacity - the latter was most often insufficient in children of both groups.

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

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

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

Similar differences in the affective status of children in the first and second groups are considered by us as the leading mechanisms of the revealed behavioral features in both cases.

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

The children assigned by us to the third group (13 people) showed both signs of neurological trouble and rather pronounced regulatory immaturity, as well as a low level of mental tone, uneven tempo characteristics of activity, problems of insufficient formation 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 link of mental functions - in our typology of deviant development (M.M. Semago, N.Ya. Semago, 2005), such a state is determined as "Partial misformation of mixed type" (diagnosis code: N33-x). The fate of these children (6 people) indicators of the level of mental tone were unstable (which may also indicate the possible neurodynamic features 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, on the basis of the idea of ​​general and specific patterns of development, we substantiated the need for an adequate direction of corrective work with children of the categories under study, taking into account the understanding of the mechanisms of impaired adaptation.

The technologies of correctional and developmental work for children with problems in the formation of an arbitrary component of activity are described in our previous articles, which set out the principles and sequence of work on the formation of an arbitrary 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 due to 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, “tonifying” that increase the overall level of mental tone of the child. They can be considered as an increase in the protective mechanisms of the 2nd level of affective regulation. Consequently, correctional technologies in this case should be oriented, first of all, to the harmonization of the system of affective regulation. Speaking about the methodological foundations of building correctional programs, it is necessary to rely on the theory of K.S. Lebedinskaya -O.S. Nikolskaya (1990, 2000) on the structure and mechanisms of basic affective regulation (tonization) 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 “rhythmization” by 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 method of bodily -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 (than younger child, topics greater value is given 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 that increase the tone of the child due to direct contact with him - bodily and tactile, leading, in turn, to an increase in overall mental tone.

The distant methods of rhythmic organization of the environment included:

Establishment of a clear repeating with affective consolidation (pleasure) mode (rhythm) of the child's life. The very rhythm and events of the day should be experienced by the child together with the mother, giving pleasure to both.

The 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 arising chaotic movements(having as their goal autotonization of the child, but destructive in their behavioral manifestations). The same tasks were often solved in the family with the help of a child drawing to a particular melody. In this case, the toning mechanisms specific to the second level were connected to polymodal toning methods (movement rhythm, color changes, musical accompaniment). In the activities of specialists educational institutions(PPMS centers) such work can be carried out as part of art therapy.

Actually, the system of tactile toning, accompanied by specific intonationally designed "chants" (like folklore refrains).

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

The methods of distant toning include the methods of mental toning by the mechanisms of the first level of affective toning: the creation of sensory comfort and the search for the optimal intensity of certain influences, which fit well into such a type of psychotherapy as "landscape therapy", a specific organization of the "living" environment: comfort, safety , sensory comfort. This kind of "distant" toning can be carried out both by a specialist when working with children, and at home in the family when implementing the system of filial therapy.

If such methods are not enough to organize the correct behavior of the child and increase his mental tone, special methods of tactile toning are used directly for the tasks of normalizing behavior. These techniques, first of all, are taught by the mother of the child (the person replacing her). An appropriate technology for teaching the mother (filial therapy) and the corresponding sequence of the tonic methods of work themselves were developed. This correctional program was called "Increasing mental tone (PWP program)".

The system of work to increase the level of the mental tone of the child was to be carried out by the mother every day, for 5-10 minutes, according to a certain scheme and in a certain sequence. The scheme of work included the obligatory consideration of the main laws of development (primarily cephalocaudal, proximodistal laws, the law of the main axis), following the principle of sufficiency of impact.

The toning techniques themselves were variants of stroking, patting, tapping of various frequencies and strengths (certainly pleasant for the child), performed first from the top of the head to the shoulders, then from the shoulders through 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, the mothers were familiarized with a sufficient amount of folklore materials (chants, sentences, chants, etc.). It should be noted that the effect of this type of “conversational” communication with children (in a certain rhythm and intonation) 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) the actual tactile influences are not adequate either to age or to the patterns of mother-child dyadic relations. In this case it is enough efficient technology work, in addition to the rhythmically organized and predictable life of the child, which allows to increase his mental tone, is his inclusion in the so-called folklore group.

The inclusion of the mother in the work with the child also had a tactical task proper. As preliminary studies have shown (Semago N.Ya., 2004), it was the mothers of children with insufficient mental tone who turned out to be insolvent in their parental position in the first year of a child's life. Hence, one of our assumptions was that the low level of the mental tone of the child may be the result of, among other things, insufficient tactile, bodily, rhythmic maternal behavior proper. In this regard, it is precisely such a full-fledged maternal behavior at an early age of a child 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 mental tone of the child is a specially selected range of games (having a large volume of the 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 have a repetitive stereotypical character (from infantile games like “We drove, we went, into the hole boo”, “Ladushki”, etc. to a number of ritual folklore games and stereotypical ball games that have a high affective charge for the child ).

At the moment, monitoring of a number of children included in such correctional work continues. Work continues on the analysis of the criteria for the effectiveness of corrective work. Of the positive changes obtained as a result of this comprehensive program with children of different ages, the following can be distinguished:

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

the periods of active working capacity of the child, the overall productivity of his activity increase;

the relationship in the mother-child dyad, mutual understanding between mother and child is significantly improved;

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

Emphasizing that classes on “toning” the mental sphere of the child in this case were combined with elements of psychotherapeutic work, it should be noted that outside of such a context, no one can be effective. correctional program. But in this case, the work to increase the mental tone of the child was the main "backbone" element of correctional work.

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Zavadenko N.N. How to understand a child with hyperactivity and attention deficit. - M .: Shkola-Press, 2000. (Therapeutic pedagogy and psychology. Appendix to the journal "Defectology". Issue 5).

Zavadenko N.N., Petrukhin A.S., Solovyov, O.I. Minimal brain dysfunction in children. Cerebrolysin for minimal brain dysfunction. - M.: EBEVE, 1997.

Kovalev V.V. Psychiatry childhood. - M.: Medicine, 1995.

Machinskaya R.I., Krupskaya E.V. EEG-analysis of the functional state of the deep regulatory structures of the brain in hyperactive children aged 7-8 // Human Physiology.. - V. 27 -№3.

Osipenko T.N. Psychoneurological development of preschoolers. - M.: Medicine, 1996.

Popov Yu.V., Vid V.D. Modern clinical psychiatry. - M.: Expert Bureau-M, 1997.

Semago N.Ya., Semago M.M. Problem children: the basics of diagnostic and corrective work of a psychologist. - M .: ARKTI, 2000. (Bib-ka psychologist-practitioner).

Semago N.Ya. New approaches to psychological assessment children with motor disinhibition // Issues of mental health of children and adolescents .. - No. 4.

Semago N.Ya., Semago M.M. Organization and content of the activities of a psychologist of special education. - M, ARKTI, 2005. (Library of a practicing psychologist).

Tzhesoglava 3. Mild brain dysfunction in childhood. - M.: Medicine, 1986.

Farber DA, Dubrovinskaya N.V. Functional organization of the developing brain // Zh. Human Physiology.. - T 17. - No. 5. 1

School maladaptation: emotional and stress disorders // Sat. report Vseross. scientific-practical conf. - M, 1995.

Yaremenko B.R., Yaremenko A.B., Goryainova T.B. Minimal brain dysfunction in children. - St. Petersburg: Salit-Medkniga, 2002.

Motor disinhibition (hyperactivity)

Parents often turn to doctors about the 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 of both domestic and foreign scientists are 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 a disease? What regime do such children need, how should parents, educators and teachers treat them?

We will try to answer these and other questions that often concern parents. The word "hyperactivity" comes from the Greek word "hyper" meaning "a lot" and the Latin word "activus" meaning active. Therefore, hyperactivity in literal translation 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 of a younger age) for movement, come under the influence of conflict traumatic situations and defects in education, or be detected from the first years or even months of life. Let's consider each of these possibilities in turn.

Movement is one of the manifestations of the vital activity of the organism, providing its connection with external environment. As you know, with age, physical activity of a person undergoes physiological changes. It is especially developed in children of the first 3-4 years of life and slows down significantly in the elderly and senile age. All this has a specific physiological explanation. In young children, the processes of inhibition are weakly expressed. As a result, they cannot focus their attention on one subject or one game for a long time. The desire for knowledge of the environment, in many respects still 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 in order to look inside. Due to the low mobility of the main nervous processes (excitation and inhibition), it is difficult for a child of 2-5 years old to suddenly stop his activity. If, by their intervention, adults suddenly interrupt his lesson, and even shout or punish him, then the child often has a protest reaction in the form of crying, screaming, refusing to fulfill the demands of his parents. This is a physical, normal phenomenon. Therefore, you should not try to limit the natural mobility of the child. If the child's screams or the noise created during the game disturbs you, 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 motor activity of the child. They see other children of the same age who may be calmer and less active. It is good if, with these fears, the mother turns to a doctor, who should reassure her and give the right advice. Unfortunately, sometimes the first adviser is neighbors, inexperienced educators and other random people. It is not uncommon for a practically healthy child to be given widely available sedative potions and tablets, or the fashionable infusions of various herbs. Do not self-medicate without the advice of a doctor! Only a doctor can dispel your doubts, give a correct conclusion about the health of the child and, if necessary, prescribe treatment.

Now consider the hyperactivity of children, which arose as a result of various external influences. In such cases, parents note that a previously calm child suddenly becomes overly mobile, restless, and whiny. This is especially common 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 education: a very strict (suppressive) style, excessive guardianship, and the absence of uniform requirements for all family members.

Unfortunately, there are still so-called socially neglected families in relation to the child, when they are generally given little attention, often punished for no reason, and make unbearable demands. If at the same time children are witnesses of quarrels between parents, and besides, one of them or both suffer from alcoholism, then there are more than enough reasons for hyperactivity and other neurotic disorders. From such families, they rarely seek medical help or bring 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 the 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 are convinced that the upbringing was wrong and therefore decide to change their attitude towards the child, present him with certain requirements and restrictions, break old habits that have taken root over the years. The well-known 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 quite 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, to be constant to the end in your requirements.

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 a consultation. Parents are worried that the child is very mobile, fast, restless, constantly on the move, often changes occupation, does not respond to comments from others. From the detailed story of the mother, 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 went in for sports intensively, suffered from a cold and took antibiotics.

From the first days of his life, the boy is very restless and whiny. Repeatedly turned to doctors, however, from the side of the activity of the heart, lungs, gastrointestinal tract and other internal organs, no changes were found. The boy slept very badly for up to a year, and his parents, grandparents took turns with him throughout the night. Sickness, a dummy, picking up helped little. He started to sit and walk on time. After a year, sleep gradually adjusted, however, according to the parents, new troubles began. The boy became very fast, fussy and distracted.

All this was told by the parents without the child, who was waiting in the corridor with his grandmother. When he was brought into the office and he saw doctors in dressing gowns, he began to scream, cry, and escape from his parents. It was decided to see the boy at home in his usual surroundings. He reacted to the arrival of a stranger with some fright, all the time he went away and watched expectantly. Soon he became convinced that no one was paying attention to him and began to deal with toys, but he could not concentrate on any of them. All his movements are fast and swift. Slowly and gradually joined the conversation with the doctor. It turned out that the boy reads in syllables, he knows letters from the age of two, although his parents try to keep books less in his field of vision. Performs simple arithmetic operations up to five. Through various distracting methods, it was possible to examine the child. Examination of clear organic signs of damage to the nervous system was not established.

In a conversation with parents, it was found out that education is carried out correctly. Despite hyperactivity and unbridledness, he clearly knows what not to do. So, he does not touch the dishes in the room, the TV, the radio, they seem to not exist for him. But the toys in the room were scattered at random. It should be noted that with regard to toys, parents also do the right thing: they don’t give a lot at once, they hide the old ones for a while, 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 "wunderkind", although he is already beginning to read and shows ability in counting. They are more afraid of this somewhat premature mental development, and especially his behavior.

Advice is given not to be afraid of the early development of the child's abilities, periodically offer him the simplest children's books, and, if the boy wishes, read with him in the form of a game. It is also recommended to go for long walks more often (up to a little fatigue). In order to streamline the behavior, it was decided to prescribe some medications. Suddenly, music began to play in the next room. The boy suddenly changed, the fussiness that had taken place passed, he stood for several seconds, listening, and quickly ran to the sounds of music. Now the parents remembered another "strangeness" of the child: he just listens to calm slow music, stands quietly near the receiver for a long time and is always unhappy when it is turned off. And indeed, the boy stood calmly near the radio, waved his arms slightly (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 without protest. Parents note that the child often brings to play a number of his favorite records, which he remembers appearance: he is ready to listen to them endlessly, which, of course, they refuse him, since this also frightens his parents to some extent.

The child's reaction to music changed our recommendations somewhat. Parents are advised to allow the child to listen to his favorite records 2-3 times a day, gradually expanding 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 refrain from medical treatment for the time being. The results of the re-examination showed that our recommendations were correct. Some ordering of the child's behavior is noted, although he continues to be quick and somewhat fussy.

We have described a fairly typical case of early hyperactivity occurring from 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. At the same time, aggressiveness, negativism, some awkwardness and clumsiness can be observed. A hyperactive child rushes around the apartment like a whirlwind, causing real mayhem and chaos in it, constantly breaking something, hitting, crumbling. He is the instigator of quarrels and fights. His clothes are often torn and soiled, personal items are lost, scattered or piled up. It is very difficult to calm him down, and sometimes almost impossible. Parents are at a loss - where does this inexhaustible energy, which haunts and rests the whole family, come from? A figurative description of a hyperactive child is 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 mysteries” (1996): “Really no one has created a perpetual motion machine yet? If you want his secrets, study my child." Such children bring 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 in case of early hyperactivity of the child, the pregnancy in the mother often proceeded with complications: pronounced gestosis of pregnancy, somatic diseases, non-compliance with the regime of work and rest, etc. It is known that taking care of the health of the child should be even before his birth. After all, a person's life begins not from birth, but from the first days of pregnancy. Therefore, even now, in some countries of the East, 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, malnutrition of the mother, lack of vitamins and amino acids also disrupt the development of the unborn child. A pregnant woman, as never before, should be careful in the use of various medicinal substances, especially such as psychotropic drugs, sleeping pills, hormones.

At the same time, it should not be concluded from what has been said that treatment cannot be taken during pregnancy. After all, a pregnant woman can get flu, bronchitis, pneumonia, etc. In such cases, the appointment of medications is mandatory, but any treatment is carried out as prescribed and under the supervision of a doctor.

There are strong indications that hereditary factors play a role in the development 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 line of both fathers and mothers. Consequently, early childhood hyperactivity is often the result of abnormal intrauterine development or is hereditary.

Relatively further development such children are as follows. 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 (more often in writing and reading), but this is mainly a consequence of educational defects or incorrect pedagogical influence.

It should be noted one more interesting feature hyperactive children. Quite often, in their first year of life, physical and mental development proceeds at a faster pace. Such children, earlier than their peers, begin to walk and pronounce individual words. One might get the impression that this is a very gifted, brilliant child, from whom much can be expected in the future. However, at preschool age, and especially in the first years of schooling, 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 you know, almost any child with conflict situations, especially frequently recurring, a number of neurotic disorders may occur. This is especially true for 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 them.

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

In educational work, it is necessary to take into account the increased motor activity of such children. Therefore, games should be primarily mobile. Given the increased distractibility of such children, it is necessary to change the nature of their activities more often. It is necessary to give the practically most expedient way out of such a child's hyperactivity. If at the same time he does not sleep well, 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 is noted that hyperactive children do not adapt well to a new unfamiliar environment, a new team. When such a child is placed in a kindergarten, a number of complications often arise at the beginning: after a few days, the children refuse to attend the kindergarten, cry, and act up. In this regard, it is very important to first instill love for peers, being in a team; it is also necessary to talk with the teacher in advance about the characteristics of the child. If the visit kindergarten begins suddenly, it is possible to strengthen the negative traits of the child's behavior, in many cases he violates the general order in the group with his negativism and stubbornness.

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

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

We examined the various manifestations of hyperactivity in children and the causes of their occurrence. It is difficult to give advice to parents on a case-by-case basis. At the same time, it should be remembered that one of the main measures for normalizing and controlling the behavior of such a child is properly conducted education and training.

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

Every child is an individual. And what is it? How to develop it? And how to understand a child, how to take into account it, this individuality, if the child does not sit still, quickly gets irritated, turns around, constantly drops something, spills and at the same time ties the neighbor's cat to a chair? In order to make it easier to find successful parenting and teaching methods, we will talk today about some categories of children with whom it is often difficult to get along. So, if your child finds it difficult to sit still, if he fusses, moves a lot, is clumsy and often drops things, if he is inattentive and easily distracted, if the child's behavior is poorly controlled, then your child may be hyperactive.

The authors of the psychological dictionary attribute inattention, distractibility, impulsivity, and increased motor activity to external manifestations of hyperactivity. Often hyperactivity is accompanied by problems in relationships with others, learning difficulties, low self-esteem. At the same time, the level of intellectual development in children does not depend on the degree of hyperactivity and may exceed the age norm. The first signs of hyperactivity are observed before the age of 7 years and are more common in boys than in girls.

There are different opinions about the causes of hyperactivity: these can be genetic factors, features of the structure and functioning of the brain, birth injuries, infectious diseases suffered by a child in the first months of life. The presence of hyperactivity is determined by a specialist - a doctor after a special diagnosis. If necessary, drug treatment is prescribed.

However, the approach to the treatment of the child and his adaptation should be comprehensive. As noted by a specialist in working with hyperactive children, Dr. med. Sciences Yu.S. Shevchenko, “not a single pill can teach a person how to behave. Inappropriate behavior that arose in childhood can be fixed and habitually reproduced. This is where the psychologist comes to the rescue, who, working closely with parents, can teach the child effective ways communication with peers and adults.

No one has yet managed to achieve that a hyperactive child becomes obedient and docile, and learning to live in the world and cooperate with it is quite a feasible task.

How to identify a hyperactive child?

The main manifestations of hyperactivity can be divided into 3 blocks: active attention deficit, motor disinhibition and impulsivity. American psychologists Baker and Alvord offer the following criteria for identifying hyperactivity in a child.

Criteria for hyperactivity

Active Attention Deficit:

• Inconsistent, difficult to keep attention.
• With great enthusiasm, he takes on the task, but never finishes it.
• Experiencing organizational difficulties.
• Often loses things.
• Avoids boring tasks.
• Often forgetful.
• Constantly fidgeting.

Motor disinhibition:

• Shows signs of restlessness (drumming fingers, moving in chair, running, climbing).
• Sleeps much less than other children.

Impulsiveness:

• Unable to wait their turn.
• Poor concentration.
• Cannot control or regulate behavior.

If at least 6 of the listed signs appear before the age of 7 years, it can be assumed that the child is hyperactive. Often adults believe that if a child moves a lot, is restless, then he is hyperactive. This point of view is erroneous, because. other manifestations of hyperactivity are not taken into account.

How to help a hyperactive child?

The appearance of a hyperactive child from the first minutes complicates the life of any team. He interferes, jumps up. Of course, even a very patient parent, such behavior can infuriate.

A hyperactive child is physically unable to listen carefully for a long time, sit quietly and restrain his impulses. If you want him to be attentive, try not to notice that he is fidgeting and jumping up. Having received a remark, the child will try to behave “good” for some time, but will no longer be able to concentrate on the task. Another time, in the right situation, you can train the skill of perseverance and reward the child only for calm behavior, without requiring active attention from him at that moment.

Note! A child, working one-on-one with an adult, as a rule, does not show signs of hyperactivity and copes with work much more successfully.

Cheat sheet for adults or Rules for working with hyperactive children

Adjust the daily routine and stick to it carefully. Repeating day after day, the order helps to understand what is happening and what he needs to do at a certain time.

• Work with the child at the beginning of the day, not in the evening.
• Divide work into short periods. Use physical exercises.
• Be a dramatic, expressive teacher.
• Reduce requirements for accuracy at the beginning of work.
• Sit next to your child during class. Use tactile contact.
• Negotiate with the child about certain actions in advance.
• Use a flexible system of rewards and punishments.
• Encourage immediately, without postponing for the future.
• Provide choice.
• Keep calm. No composure - no advantage!

How to play with such a child?

When choosing games, especially mobile games, it is necessary to take into account the characteristics of children: attention deficit, physical activity, impulsivity, fatigue, inability to obey group rules for a long time. In the game it is difficult to wait for your turn and take into account the interests of others. It is desirable to use games with clear rules that contribute to the development of attention.

• "Find the difference." The child draws a simple picture (a cat, a house) and passes it to an adult, while he turns away. An adult draws a few details and returns the picture. The child should notice what has changed in the drawing. Then the adult and the child change places.
• "Affectionate Paws". 6-7 small items of various textures: a piece of fur, a brush, beads, cotton wool. Everything is laid out on the table. The child is invited to bare his arm to the elbow; the parent explains that the “animal” will walk on the hand and touch it with gentle paws. It is necessary to guess with closed eyes which "animal" touched the hand - to guess the object. Touches should be stroking, pleasant. Variant of the game: the "beast" will touch the cheek, knee, palm.
• "Chants-whispers-silences" 3 palm silhouettes: red, yellow, blue. These are signals. When an adult raises a red hand - a "chant", you can run, scream, make a lot of noise; yellow palm - "whisper" - you can quietly move and whisper; to the “silent” signal - a blue palm - the children should freeze in one place or lie on the floor and not move. The game should end with silence.
• "An hour of silence and an hour is possible."
• “Let's say hello”: 1 clap - we say hello to the hand, 2 clap - with shoulders, 3 clap - with backs.
• "We catch mosquitoes."

A few words about punishment

• The reason for the punishment should be clear to the child.
• Punishment is applied immediately after the offense.
• Punishment should be natural. For example, if a child painted the walls with a felt-tip pen, remove the felt-tip pen. When you give a felt-tip pen - give a large sheet of paper and draw with it.
• Physical punishment. Remember - you were punished? Did you enjoy it? Did it help you? What would help you? It is better to punish a child by depriving him of good things than by doing him bad things.
• Think: “Why do I often punish the child? Maybe my requirements are too high? Maybe I'm taking out my feelings on him?

1. Lyutova E., Monina G. Crib for parents.
2. Gippenreiter Yu.B. Communicate with the child. How?
3. Gippenreiter Yu.B. We continue to communicate with the child. So?
4. Schaeffer E. It is not good to be capricious.
5. Gasanov R.F. Formation of the concept of attention deficit disorder in children.
6. Chutko L.S., Palchik A.B. Attention deficit hyperactivity disorder.

Fears and Obsessions

The emergence of various fears is quite typical for childhood and puberty. Most often it is a neurotic fear of the dark, loneliness, separation from parents and loved ones, increased attention to one's health. In some cases, these fears are short-term (10-20 minutes), quite rare and usually caused by some emotionally significant situations. They easily pass after a soothing conversation, the child develops a critical attitude towards them. In other cases, fears may take the form of short attacks that occur quite often and have a relatively long period of time (1-1.5 months). The reason for such seizures are protracted traumatic situations for the child's psyche (a serious illness of relatives and friends, an intractable conflict at school or in the family, etc.). Often an attack of fear is accompanied by unpleasant bodily sensations (“heart stops”, “not enough air”, “lump in the throat”), motor fussiness, tearfulness and irritability. With timely identification and taking adequate measures, fears gradually disappear.

Otherwise, they can take a protracted course (from several months to a year or more), and then even therapeutic measures do not always give the desired results. Fears appear in the form of obsessions, obsessive actions. Among obsessions, fears of infection and illness, fear of sharp objects (especially needles), enclosed spaces, and an obsessive fear of speech in stutterers predominate. With age, there is a fear of being called to the board or a fear of verbal answers, accompanied by an inability to coherently present the material with good preparation. Often, anxious-obsessive expectation and fear lead to failure when trying to perform even a habitual action.

Obsessive movements and actions can also be quite diverse. At school and primary school age, elementary obsessive tics are often found (blinking, wrinkling the forehead and nose, twitching the shoulders, sniffing, grunting, etc.). Harmful habitual actions (sucking fingers, biting nails, plucking hair, etc.) are closely related to obsessive actions. They are not always intrusive, and the fight against them mainly comes down to the use of measures of psychological and pedagogical influence.

In older children and adolescents, obsessive fears become more complex, and actions take the form of painful protective, sometimes quite complex rituals. An obsessive fear of infection is accompanied by frequent washing of hands, an obsessive fear of getting a bad mark leads to a number of prohibitions (for example, not going to the cinema or watching TV on certain days, not taking a bus or tram that has a certain number in the room). Quite often, teenagers have rituals (to go to tests and exams in “happy” shirts, socks, etc.) and ritual objects (braid around the neck with a “happy” trinket, a “lucky” pencil or pen, etc.) . Obsessive thoughts, obsessive counting (windows in houses, cars, men and women met on the street, etc.), obsessive repetition of the same words are also possible. As a rule, obsessions arise against the background of various difficult experiences for the child, as well as in children with certain character traits: timidity, anxiety, suspiciousness, etc.

Dysmorphophobia

In a more mature (adolescent) age, other fears of dysmorphia may appear. This is understood as an unreasonable conviction that one has a physical defect that is unpleasant for others. This phenomenon occurs predominantly in girls.

Often a teenager finds defects in the face (large or thin nose, hump, too full lips, ugly ears, the presence of acne and blackheads, etc.). Sometimes these are shortcomings in the figure (small or too tall, full hips, narrow shoulders, excessive thinness or fullness, thin legs, etc.).

Thoughts about one's imaginary defectiveness occupy a central place in the adolescent's experiences and determine the entire stereotype of his behavior. He can spend hours looking at himself in the mirror, finding more and more flaws. The teenager begins to retire, so as not to be the subject of discussion, eschews the company of peers. At school, he tries to sit in the back of the classroom, to be closer to the wall, he is very reluctant to go to the blackboard to answer, and during breaks he also seeks to retire. Sometimes, to cover up an imaginary defect in the face, grows long hair, wears shirts with a high collar. On the street, he covers his face with a hat or scarf pulled over his eyes.

Painful thoughts about their ugliness often lead a teenager to a cosmetologist with a request to eliminate a physical defect (shorten the nose, eliminate the hump, “fix” the ears, etc.). These students should be consulted by a psychiatrist.

Motor disinhibition

Motor disinhibition is one of the most common behavioral disorders in childhood and early adolescence. It manifests itself in restlessness, an abundance of insufficiently targeted movements. Violent playfulness, the desire to run a race, jump, start various outdoor games are combined in such children with increased distractibility, inability to concentrate for a long time. The child cannot concentrate on the teacher's explanations, is easily distracted when doing homework, as a result of which his academic performance is seriously affected.

Along with motor disinhibition, emotional instability, irritability, and a tendency to aggressive actions and conflicts are often encountered. Such teenagers, as a rule, are constant violators of discipline.

Motor disinhibition gradually smoothes out as they grow older and may completely disappear at 15-16 years of age.

Asks Hope
My child is 2 years 9 months old, was born on time, by caesarean (weak labor) on the Apgar scale 8-9 points, height 50, weight 3100. We always thought that our child was calm, cried a little, did not cause problems, ate well, put on weight. Since birth, we have been observed by a neurologist with a diagnosis of PEP, s-m tonic disorders. We follow all the recommendations of doctors, we are undergoing treatment. Went at 8 months, sat down on time, began to turn around, slept well. But after a year he began to wake up at night crying, after a while it passed, a year later he wakes up again at night with screams, we turned to the "rehabilitation center", diagnosed with PEP, hypertension syndrome, subcompensated form, ZRR. Conducted a course of reflexology, massage, drank pantogam, pricked cortexin, an excitation reaction began, I fell asleep badly, everything was canceled. At home, he can watch cartoons for a long time, collect puzzles, draw, sculpt, read books, behave well, sleep soundly day and night, fall asleep easily. AT recent times misbehaves in crowded places - squeals, runs away, fights, if one of the strangers makes a remark, can hit, rolls on the floor, if I scare him with someone else's aunt, can come up to her and extend a hand - ready to go with her. In the doctors' offices, he climbs everywhere, touches everything, it is impossible to talk with the doctor. One doctor says that this is disinhibition, the other is a hyperactivity syndrome, but he behaves calmly at home, there are no signs of hyperactivity that are characteristic of such children, and such a diagnosis cannot be made only on the basis of behavior in public places, because he can behave like this due to fatigue and boredom. Please explain whether our child has hyperactivity or disinhibition, is there a difference? Thank you.

Answer
Whether your child has hyperactivity or not, I cannot say, you need to know the data of a neurological examination (EEG, ultrasound, etc.) and examine the child.
As for hyperactivity and motor disinhibition, these are synonyms.

Hyperactivity is a collection of symptoms associated with excessive mental and motor activity. The diagnosis of hyperactivity is usually made when parents complain that the child is too mobile, restless and misbehaves, his arms and legs are in constant motion, he fidgets in his chair, does not calm down for a minute and is unable to concentrate on one thing. However, there is no precise definition of this condition or a special test that would unambiguously confirm the diagnosis of hyperactivity (motor disinhibition). The onset of the disease begins in infancy or at the age of two or three years. This condition is often accompanied by sleep disturbances. When a child is very tired, the hyperactivity is exacerbated.

The reasons.
In the occurrence of hyperactivity, according to most experts, the most important role is played by those factors that affect the development of the brain during pregnancy, childbirth and infancy. These can be infections, injuries, premature or difficult births. Sometimes you can talk about hyperactivity as a hereditary trait. Unfavorable pregnancy. Toxicosis, disease of the internal organs of the mother during pregnancy, nervous stress. affect the central nervous system fetal lack of vitamins and amino acids. The use of drugs by a woman during pregnancy, such as sleeping pills, hormonal drugs, tranquilizers, adversely affects the child. Unfavorable childbirth. Childbirth pathology. Infection and toxification of the first years of a child's life.
Although hyperactivity is usually associated with normal intellectual development, cases of mental retardation or emotional disturbances are also possible.

Hyperactive children need a strict regime, and all their activities should be as regular as possible. In order for such children to willingly study and succeed where they have only failed before, they need frequent praise, encouragement, and special attention. It is very important to teach family members how to properly handle a hyperactive child.

Mandatory must be:
- Morning exercises, outdoor games and long walks. Physical exercises of the child and outdoor games will allow you to remove excessive muscle and nervous activity. If the baby does not sleep well, it is better to play active games in the evening as well.
- Active games that simultaneously develop thinking.
- Massage. It reduces the heart rate, lowers the excitability of the nervous system.

It would be nice to give the child to the sports section. Such sports are shown where the child learns to follow the rules, control himself, interact with other players. it team games. Like hockey, football, basketball.

Hyperactive children may show a marked ability for a particular occupation. For example, music, sports or chess. This hobby should be developed. Unfortunately, some children never get rid of hyperactivity; they are more likely to become chronic alcoholics or mentally ill people in the future.

The remaining signs of hyperactivity and impulsivity should be taken into account in career guidance. However, the prognosis for hyperactive children is usually good. As you grow and mature, the symptoms of hyperactivity decrease.

A hyperactive child is often difficult to communicate with. Parents of such a child should remember that the baby is not to blame. Strict parenting is not suitable for hyperactive children. You can not shout at the child, severely punish, suppress. Communication should be soft, calm, without emotional outbursts, both positive and negative. Do not overload your child with extra activities. But you can’t allow everything to such a child, otherwise he will quickly begin to manipulate his parents. It is worth encouraging the child even for minor achievements. Make sure that the child does not overwork.

In 70% of hyperactive children, this symptom persists into adolescence. In 50% of children, hyperactivity syndrome persists into adulthood. In adolescence and adulthood, fatigue, inability to learn, and inattention remain. Often hyperactive children are talented. Signs of hyperactivity were observed in many famous people, for example, Thomas Edison, Lincoln, Salvador Dali, Mozart, Picasso, Disney, Einstein, Bernard Shaw, Newton, Pushkin, Alexander the Great, Dostoevsky.

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