Mild intellectual disabilities (debility) is the mildest form of mental retardation, characterized by a significant decrease in the ability to abstract thinking and generalization with the preservation of motor skills. Typical for imbecility is visual-imaginative thinking, the inability to build complex conclusions, difficulty in capturing internal connections between objects and events, underdevelopment of moral and volitional qualities, lack of initiative, easy suggestibility. Along with specific, corrective and symptomatic therapy, patients need social adaptation, proper psychological education, special school and labor training.
F70 Mental retardation of mild degree
Mild intellectual disabilities is the mildest degree of oligophrenia, which also includes imbecility and idiocy. Debility is the most common type of intellectual decline in children. It accounts for about 75% of all cases of mental retardation. Along with the term “imbecility” in medicine and psychology, such names as “mild oligophrenia” and “mental subnormality” are used.
Debility should be distinguished from borderline mental retardation (borderline intelligence), which is formed as a result of a delay in the mental development of a child caused by external factors: unfavorable living conditions of a child (for example, rough treatment of children or lack of care for them in the family), intellectual deprivation, congenital or acquired physical defects in early childhood (for example, blindness, deafness), limiting the cognitive abilities of the child and hindering his correct mental development.
Depending on the degree of underdevelopment of intellectual and mental abilities, debility is classified into mild, moderate and severe. Like other variants of oligophrenia, according to the predominant manifestations, debility is divided into atonic, asthenic, dysphoric and stenic forms.
Among the causes of mild intellectual disabilities, hereditary factors (fermentopathy, endocrinopathy, microcephaly) and various adverse effects on the fetus during intrauterine development are primarily distinguished. The latter include infectious diseases suffered by the mother during pregnancy (rubella, toxoplasmosis, measles, cytomegaly, syphilis); rhesus conflict, fetoplacental insufficiency, fetal hypoxia; toxic effects on the fetus when the pregnant woman uses narcotic substances, alcohol, tobacco, some medications.
Debility can occur as a result of birth trauma, asphyxia of a newborn, congenital hydrocephalus, infectious lesions of the central nervous system suffered in early childhood (encephalitis, purulent meningitis, meningoencephalitis) and severe traumatic brain injuries.
Mild intellectual disabilities is characterized by a lack of ability to develop complex concepts, make complex generalizing conclusions and think in abstract concepts. Children with mild intellectual disabilities are characterized by a visual-imaginative type of thinking. They are able to perceive only the external side of events and often cannot understand the whole situation. Correctly perceiving images, a child suffering from debility can hardly find internal connections between them and has difficulty comparing them. Along with the mental retardation in such children, speech underdevelopment is often noted. Typical are the impoverishment of vocabulary, agrammatism, inertia and slowness of speech (bradylalia). Mild debility is manifested by a limited ability to generalize and abstract thinking, with a good orientation in everyday everyday situations.
School education for children with debility is given with great difficulty. They have a hard time learning the spelling rules, have difficulty retelling the text they have read, and have a poor understanding of what exactly needs to be done according to the task. Mathematics is a particularly difficult subject for them. Sometimes, among those with imbecility, there are children with partial giftedness: absolute hearing, excellent mechanical memory, artistic talent, the ability to mentally perform arithmetic operations with large numbers.
Mild intellectual disabilities is accompanied by a limitation of cognitive needs, underdevelopment of aesthetic, moral and volitional qualities. As a result, patients are unable to form their own judgment and worldview. At the same time, they easily imitate others, adopt other people’s views and quite often strictly adhere to them. Weakness of will, lack of independence and initiative in case of imbecility is combined with easy suggestibility, which can make a moron an obedient tool in the hands of other people. Without understanding the consequences and fulfilling someone’s will, such a person can commit a crime or act within the framework of a criminal group.
By their nature, patients can be benevolent, affectionate and good-natured or, conversely, aggressive, vicious, stubborn and vindictive. Quite often among them there are people with enhanced primitive drives (for example, sexual).
In most cases, debility is detected when a child begins to study at school. Such a child should be examined by a neurologist, psychologist and psychiatrist, in case of speech disorders — by a speech therapist. Psychometry, psychological tests with plot pictures and experiments on image classification help to diagnose debility. Depending on the degree of debility, the patient’s IQ can range from 69 to 40%.
In the neurological status, those suffering from debility usually do not reveal any pathological abnormalities, including motor disorders. In most cases, there is an insufficiently expressive facial expression and restriction of small differentiated movements. For a deeper assessment of the state of the central nervous system, patients undergo electroencephalography, echoencephalography and rheoencephalography, according to indications — MRI of the brain.
When making a diagnosis of “debility” to a child, the doctor should exclude the presence of borderline mental retardation caused by a delay in neuropsychiatric development against the background of normal mental potential. In addition, debility must be differentiated from a decrease in intelligence, which develops against the background of schizophrenia and epilepsy of early childhood.
Children with a diagnosis of “debility” should be monitored by a neuropsychiatrist. If debility develops against the background of endocrinopathy, then it is additionally necessary to follow up with an endocrinologist. In cases where it is possible to establish and eliminate the cause that caused the debility, specific therapy is carried out. If toxoplasmosis or congenital syphilis is detected, appropriate etiotropic treatment is prescribed, in the presence of fermentopathy, dieting is necessary, with endocrinopathy — hormone therapy.
Symptomatic therapy for mild intellectual disabilities may include anticonvulsants, dehydration agents, restorative treatment, nootropics (gamma-aminobutyric acid, piracetam), neuroprotectors and metabolites (glutamic acid, B vitamins), psychotropic drugs. With increased fatigue and asthenia, the use of psychostimulants (amphetamine, pemoline) is indicated, with excessive emotional excitability — chlordiazepoxide, chlorpromazine, haloperidol.
Along with drug therapy, children with debility need corrective treatment using pedagogical, psychological and speech therapy techniques. The main purpose of corrective treatment is psychological support, correction of behavioral disorders and training, and for older children — the acquisition of skills and abilities necessary for independent household and professional activities. According to the indications, speech therapy classes are conducted for the correction of systemic speech underdevelopment, correction of bradylalia, correction of stuttering, etc.
Specialists in pediatrics, social psychology, pedagogy, pediatric neurology and psychiatry work together on the problem of social adaptation of patients with debility. The task is not only to adapt patients with debility to independent life in society, but also to protect them from involvement in criminal gangs, where they are used as obedient and easily controlled performers.
The correct organization of education, work and life of patients with mild intellectual disabilities is extremely important in social adaptation. Children should be trained in specialized schools, where the educational process will correspond to their mental capabilities. In the future, they are able to master a simple specialty and perform simple work that does not require a quick switch of attention, initiative or independence. According to some data, with adequate education and training, up to 70% of patients successfully adapt to society, work and even create families.