Diagnosis of borderline mental deficiency

The origin of the violation is varied. In the etiology of abnormalities, the main role is played by the biological basis, manifested by non-coarse decreases in the pace of development of the brain systems, light organic damage to the central nervous system. Additional adverse effects have environmental conditions.

The pathogenetic basis of borderline intellectual deficiency is slow maturation and lack of function of phylogenetically young brain structures.

Most often there is immaturity of the frontal lobes of the cerebral hemispheres, providing complex mental activity – programming and control of conscious behavior, complex actions. States are heterogeneous in origin.

The causes of the disorder can be grouped as follows:

• Pathology of pregnancy and childbirth.  Hypoxia, incompatibility of the Rh factor and the ABO system, intoxication, infection during pregnancy leads to a lag in development. During childbirth causes are injuries, asphyxia.
• Neuroinfections, traumatic brain injuries.  Early infectious and traumatic brain damage is manifested by lags in intellectual development. The severity of symptoms depends on the intensity of the damaging factor and the age of its impact.
• Chronic somatic diseases.  Neurological, endocrine pathologies have a negative effect. The lag of intellectual functions is formed on the basis of asthenic syndrome, hormonal changes.
• Pedagogical neglect. Inadequate education, conditions of cognitive deprivation, lack of information lead to developmental delays. The risk group is children from dysfunctional families.

There may be a delay in the pace of development of brain regions or non-coarse organic damage to the central nervous system, accompanied by loss of functions and structural elements important for the implementation of complex intellectual processes. In the second case, more persistent clinical manifestations are observed. Frontier intellectual deficiency is defined through personal immaturity, a weak reduction of cognitive functions, and tends to reverse development and compensation.

Classification of borderline intellectual inadequacy

The most common and clinically justified is the classification developed by the Soviet and Russian psychiatrist, Professor V. V. Kovalev. The types of borderline intellectual deficiency are determined by the author on the psychopathological mechanisms and origin. Differentiation is made according to the structure of the defect, the ratio of the symptoms of the disease and the manifestations of impaired development.

There are three types of deviations:

• Disontogenetic.  Border intelligence is due to the uneven maturation of systems and brain structures. Specific disorders – mental infantilism, partial delays in the development of components of cognitive activity, distorted mental development (some forms of EDA).
• Encephalopathic. The basis for the lag in intellectual development is the residual effects of organic damage to the central nervous system. Diagnosed with cerebroscence, psychoorganic syndrome, cerebral palsy.
• Dysontogenetic-encephalopathic (mixed).  This form includes general speech underdevelopment. Included uncomplicated version of ONR, ONR with neurological and psychopathological syndromes, motor alalia (persistent speech underdevelopment).

Symptoms of borderline intellectual failure

Clinical signs of borderline intelligence become noticeable at preschool and primary school years. There is a pronounced violation of the functions of voluntary attention – children are restless, easily distracted, “do not hear” the adult.

The lack of integration of the functions of the brain is manifested by difficulties in recognizing non-standard (inverted, unfinished) images, connecting the details of the picture into a whole. Violated the perception of spatial relationships, orientation in his own body. Expressed motor disinhibition, underdeveloped fine motor skills. In the future, this becomes the basis of problems in the formation of school skills – reading, writing, spelling, and counting.

Schoolchildren revealed a limited vocabulary, low erudition. Understanding of social situations is difficult – children and adolescents do not know how to meet, offer help, resolve conflicts. The skills of hygiene, domestic self-service are late formed. In senior schoolchildren and adults, abstract-logical thinking is not well developed, which is manifested by a lack of understanding of humor, popular expressions, and sayings. The emotional sphere is characterized by instability, mood swings.

With cerebrastenic syndrome, there is a decrease in memory, rapid fatigue, exhaustion during exercise. In mental infantilism, borderline intellectual deficiency is combined with a lag of emotional-volitional functions – children prefer gaming activities, do not assimilate the norms and rules, and do not retain instructions. Sometimes there is a lack or underdevelopment of speech, insufficiently formed learning skills (reading, writing, spelling, counting).

• The main complication of borderline intellectual failure is educational and professional maladjustment. Primary school curriculum can be mastered by most children. The introduction of complex subjects that require developed abstract-logical thinking – physics, algebra, geometry – reveals the problem of learning.

The academic failure of adolescents becomes a provoking factor of behavioral disorders: aggressiveness, audacity, absenteeism, initiation to asocial groups. The more complex the school program and subsequent training, the higher the risk of disadaptation. The most favorable outcome is observed in small rural schools, reducing the requirements for students. Teens manage to get an incomplete secondary education, to master the working profession.

Diagnosis of borderline mental deficiency

The identification of borderline intellectual deficiency is complicated by the lack of clear criteria for diagnosis, the various levels of society’s requirements for the intellectual abilities of children of certain groups. Critical periods are enrollment and graduation from high school.

Primary diagnosis is carried out by a psychiatrist – a specialist talks with parents and child, assesses the level of speech development, the ability to establish productive contact, solve simple logical problems, understand the figurative meaning of phrases. Specific diagnostics are performed by a pathopsychologist, a set of techniques is selected individually, taking into account the age and abilities of the child.

The general survey design includes:

• Tests of intelligence.  A common technique is the children’s version of the test Wechsler (WISC). The borderline development of intelligence corresponds to a gap of 70-80 points. For the examination of patients with general speech underdevelopment, only the non-verbal part is used.
• The study of memory. The test is “10 words”, “Reproduction of the story”, “Mediated memory”, “Pictogram”. Reduction of results is considered in favor of cerebrastenic syndrome.
• The study of attention.  Functions of active attention are investigated using the methods of “Schulte Table”, “Correction test”, “Red-black tables”. The exhaustion of mental activity, instability of concentration, impaired switchability are evaluated. Abnormalities reveal the organic component.
• The study of thinking.  The methodology is “Comparison of concepts”, “Elimination of the superfluous”, “Classification”, “Simple analogies”, “Explanation of proverbs and metaphors”. At the borderline level of intelligence, a slight decrease in the analytic-synthetic function, a reduced ability to abstract, is determined.

The most important differential diagnosis with a slight degree of oligophrenia. The key signs of borderline intellectual deficiency are lower persistence of disorders, better learning, IQ above 70 points (according to Wexler).

Treatment of borderline intellectual failure

The treatment of borderline forms of intellectual deficiency is carried out by a psychiatrist, neurologist, psychologist. Methods are selected individually, depending on the main diagnosis.

Treatment is necessarily complemented by rehabilitation measures that contribute to a better adaptation of the child to the educational institution. Teachers and parents are involved in the process. At the stage of treatment, the students need more sparing conditions that allow them to overcome the intellectual lag – additional extracurricular activities, detailed analysis of errors, etc.

The most common areas of therapy:

• The use of medicines.  The choice of drugs is determined by the pathogenesis, the leading disease clinic. Often used drugs that stimulate metabolic processes and blood circulation in the brain – nootropics, calcium channel blockers, psychostimulants, amino acids.
• Psychological and pedagogical correction. Classes are held on a regular basis, focused on the development and compensation of lagging functions. Techniques of engaging several modalities at once are used: motor, tactile, visual, audio

The prediction of borderline intellectual inadequacy is often favorable – treatment, special learning conditions make it possible to compensate for the lag, to achieve a normal development of intelligence. Prevention of violations of this type should begin with a period of planning and managing pregnancy: it is necessary to maintain the health of the expectant mother, to lead a healthy lifestyle, to undergo regular perinatal examinations.

The second stage is taking care of the child’s health. Lack of injury, prolonged somatic diseases reduce the likelihood of intellectual delay. The third stage is the creation of environmental conditions that stimulate the development of cognitive functions. It is necessary to pick up toys, games, classes in accordance with age, take care of attending kindergarten, pay enough attention to the development of the child.

Borderline intellectual disability is a heterogeneous group of states of deviant development, which is characterized by a slight decrease in intelligence, located between the norm and oligophrenia. It is manifested by insufficient development of verbal-logical and abstract thinking, limited vocabulary, narrow outlook, unstable attention.

Children lag behind the curriculum, duplicate classes. Diagnostics is carried out by a psychiatrist and psychologist, clinical and psychodiagnostic methods are used. Drug therapy is selected depending on the underlying disease, corrective classes are aimed at eliminating cognitive deficits.

Frontier intellectual disability is also called frontier mental retardation, the frontier level of intellectual development. In particular cases, the terms “minimal brain dysfunction”, “delayed development”, and “delay in the rate of mental development” are used. The general characteristic of these disorders is mild, corrected insufficiency of the intellect, which does not reach the level of defective development.

It differs from debilityal capacity by less stamina, possibility of compensation. The heterogeneity of etiological, pathogenetic mechanisms and clinical signs hinders the precise determination of the epidemiological indicator. According to studies of the mid-XX century, the prevalence ranges from 1.5 to 3%.