Syndrome of emotional disturbances in children. Emotional disorders in children of preschool and primary school age. Violations and their causes in alphabetical order

Borderline personality disorder is a condition characterized by rapid mood swings, impulsivity, hostility, and chaotic social relationships. People with borderline personality disorder tend to move from one emotional crisis to another. In the general population, rapid transitions of mood to impulsivity and hostility are normal in childhood and early adolescence, but smooth out with age. However, in childhood emotional distress, rapid mood swings increase in adolescence and persist into adulthood. In early adulthood, people with this disorder have highly volatile moods and are prone to intense anger.

Characteristics of emotional disorders

The main features of this disorder are:

• negative emotions - emotional lability, anxiety, uncertainty, depression, suicidal behavior;
• antagonism - hostility;
• disinhibition - impulsiveness, poor risk awareness.

The desire to harm oneself and impulsive suicide attempts are observed in seriously ill people with borderline personality disorder.

Emotional disorders are diagnosed only if:

• begin no later than early adulthood;
• deviations occur at home, at work and in the community;
• The behavior results in clinically significant distress or impairment in the patient's social, occupational, or other important areas.

Emotionally unstable personality disorder should not be diagnosed if the symptoms could be better explained by another mental condition, especially in the setting of a previous traumatic brain injury.

The main emotional disorders include:

• euphoria - a carefree manifestation of a state of apparent absence of problems;
• hyperthymia - elevated mood;
• morio - complacent, absurd fun;
• ecstasy - the highest degree of positive emotions;
• hypothymia - decreased mood;
• depression - decreased mood with deeper emotional experiences;
• dysphoria - a sad-angry mood with grumpiness, grumbling, outbursts of anger, rage, aggression and destructive actions;
• paralysis of emotions - loss of the ability to be happy, upset or experience any other emotions;
• emotional weakness - mild and capricious mood swings;
• emotional dullness - spiritual coldness, devastation, callousness, heartlessness;
• emotional coldness - loss of finer emotional boundaries. Most often it manifests itself against the background of a lack of restraint in communicating with other people;
• ambivalence of emotions - the simultaneous experience of different, sometimes contradictory feelings towards the same object;
• confusion - a feeling of bewilderment, helplessness, stupidity;
• explosiveness - excitability with violent outbursts of rage, anger and aggression, including against oneself.
• emotional viscosity - obsessive emotions.

Diagnostic criteria

• The patient must make a frantic effort to accept, or at least figuratively agree with, a real or imagined refusal.
• The style of unstable and intense interpersonal relationships is characterized by alternating between the extremes of idealization and devaluation.
• Identity disturbance is very noticeable and manifests itself as a persistent, unstable self-esteem or sense of self.
• Impulsivity manifests itself in at least two areas that occur most frequently in the patient's life, for example, spending, sex, substance abuse, reckless driving, overeating. In some cases, the attitude towards situations can develop into mania.
• Periodic suicidal behavior, gestures or threats, as well as frequent attempts to harm one’s own health.
• Affective instability due to severe mood reactivity, such as intense episodic irritability or restlessness, usually lasts several hours and only rarely lasts more than a few days.
• Chronic feelings of emptiness.
• Frequent complaints about everything, severe anger or difficulty controlling it, for example, frequent manifestations of temperament, constant aggression, recurrent fights.
• Transient stress-related paranoid ideation or severe dissociative symptoms.
• The pattern of internal experience and behavior must differ markedly from the expectations of the individual's culture.
• A robust clinical picture characterized by inflexibility and common in a wide range of personal and social situations.
• Such behavior leads to clinically significant distress and disruption in the patient’s society, especially in the area of ​​professional activity.

Principles and general management of emotional crises

The manifestation of clinical signs of emotional personality disorder determines the use of the following psychotherapeutic maneuvers by a specialist:

• Maintain a calm and non-threatening attitude;
• try to understand the crisis from the patient's point of view;
• explore possible individual causes of emotional distress;
• it is necessary to use open testing, preferably in the form of a simple survey, which will allow us to determine the reasons that stimulated the onset and course of current problems;
• strive to stimulate the patient to think about possible solutions to his problems;
• refrain from proposing solutions until problems are fully clarified;
• explore other options for possible care before considering pharmacological or inpatient options;
• suggest appropriate follow-up activities within an agreed upon time with the patient.

Short-term use of pharmacological regimens may be useful for people with emotionally labile disorder in times of crisis. Before starting short-term therapy for patients with emotional personality disorder, the specialist must:

• make sure that there is no negative effect of the selected drug with others that the patient is taking at the time of the course;
• identify the likely risks of prescriptions, including possible use of alcohol and illicit drugs;
• take into account the psychological role of the prescribed treatment for the patient, possible dependence on the drug;
• ensure that the drug is not used in place of other more appropriate interventions;
• use only one drug in the initial stages of therapy;
• avoid polypharmacy whenever possible.

When prescribing short-term treatment for emotional disorders associated with drug addiction, the following conditions should be considered:

• choose a drug, for example, a sedative with an antihistamine effect, that has a low side effect profile, low addictiveness, minimal potential for abuse and relative safety in case of overdose;
• use the minimum effective dose;
• the first dosages should be at least a third lower than the therapeutic dose if there is a significant risk of overdose;
• obtain explicit patient consent to target symptoms, monitoring measures, and expected duration of treatment;
• stop taking the drug after the trial period if there is no improvement in the target symptoms;
• consider alternative treatments, including psychological and psychotherapeutic treatments, if target symptoms do not improve or the risk of relapse does not decrease;
• adjust all your actions with the personal participation of the patient.

After the symptoms smooth out or are completely absent, it is necessary to conduct a general analysis of the therapy performed in order to determine which treatment strategy was most useful. This should be done with the participation of the patient, preferably his family or carers if possible, and should include:

• a review of the crisis and its antecedent causes, taking into account external, personal and interrelated factors;
• analysis of the use of pharmacological agents, including benefits, side effects, safety concerns regarding withdrawal symptoms and role in the overall treatment strategy;
• pharmacological treatment discontinuation plan;
• a review of psychological treatments, including their role in the overall treatment strategy and their possible role in precipitating a crisis.

If drug treatment cannot be stopped within one week, regular drug reviews should be performed to monitor for effectiveness, side effects, abuse, and dependence. The frequency of examination should be agreed upon with the patient and written down in the general therapy plan.

Possible individual therapy techniques

Patients suffering from emotional disturbances associated with sleep problems should be familiar with general sleep hygiene recommendations, including bedtime routines, avoidance of caffeine-containing products, and viewing of violent scenes or suspenseful television programs or films. and - use activities that can encourage sleep.

Specialists need to take into account the patient’s individual tolerance to sleeping pills. In any case, for emotional disorders, mild antihistamines that have a sedative effect will be prescribed.

In what cases may hospitalization be required?

Before psychiatric hospitalization is considered for a patient with an emotional personality disorder, specialists will attempt to resolve the crisis through outpatient and home treatment or other available alternatives to hospitalization.

Objectively, hospitalization for patients suffering from emotional distress is indicated if:

• the manifestation of a patient’s crises is associated with a significant risk for himself or others, which cannot be stopped by methods other than compulsory treatment;
• the patient’s actions confirming the need for his placement in a medical institution;
• submission of an application from the patient’s relatives or his service persons for the possibility of considering his placement in a medical institution.

Emotional disorders and sociopathy constitute the two largest groups of most frequently occurring disorders. Emotional disorders, as their name implies, are characterized by such abnormal emotional states as anxiety, phobia, depression, obsession, hypochondria, etc. In practice, the doctor usually determines the patient’s condition in accordance with the form that the emotional disorder takes, for example, the state of phobias or depression. These conditions are usually called “neuroses,” however, it seems to us that when diagnosing a child it is better to refrain from using this term, since such conditions in children are, to a very limited extent, similar to neurotic conditions in adults.

An example of an emotional disorder would be the case of Toby described above. It manifested itself very clearly in the girl Jane, examined during a wide population survey. At the age of about nine years old, she suddenly began to suffer greatly and feel endlessly unhappy, became suspicious and anxious, quiet and withdrawn into herself. It seemed to her that the children began to avoid her, and she came home from school in tears almost every day. She was quite stressed and frustrated, and had fits of rage up to three times a week. The teacher considered her the most unhappy child she had ever seen in her life. The girl begged her mother to pick her up from school. During the examination, she was constantly on the verge of tears, looked deeply depressed and talked about her disturbing relationships with other children. She also said that sometimes she doesn't care whether she lives or dies.

Conduct disorder or social maladjustment syndrome

A group of disorders called social maladaptation syndrome consists of behavioral disorders that cause strong disapproval of others. This includes what is commonly called bad behavior, but also a range of other types of behavior such as lying, fighting, and rudeness. Of course, just because a child has committed an illegal act, violates the law, does not mean that he has social maladaptation syndrome. To do this, it is necessary that the child’s behavior be considered abnormal in its sociocultural context and be of the nature of a social danger. Population studies have shown that almost all boys have done something that is, in principle, a violation of the law. However, most of them are completely normal guys who do not have any mental disorders. However, as already noted, it should be borne in mind that the syndrome of social maladaptation does not necessarily include the commission of illegal acts. Many children with this syndrome have never been brought before a court, and some variants of the syndrome are limited to poor behavior only in the home environment. Some children with social maladjustment syndrome may have emotional disturbances (especially depression), but socially disapproved behavior always comes to the fore.

From a logical point of view, the category of behavior disorder syndrome or social maladjustment is not satisfactory, since the diagnosis in this case depends on social norms. It also includes a highly heterogeneous mixture of disorders. Nevertheless, it was shown that its use is meaningful and very useful, since it turned out that the children it unites into one group have a lot in common with each other. Social maladjustment syndrome occurs much more often in boys than in girls, and is usually accompanied by specific reading disorders. The prognosis of mental development in this type of disorder is much worse than in emotional disorders, since the analogy of these disorders with the origin of pathological personality traits in adults can be seen quite clearly.

In fact, a significant proportion of children exhibit features of both syndromes. For this reason, the category of “mixed disorders” is also included in the diagnosis. In many ways, these mixed conditions are more similar to social maladjustment syndrome, but in some respects they occupy an intermediate position between this syndrome and emotional disorders.

Hyperkinetic syndrome

Sometimes there is a mental disorder known as hyperkinetic syndrome. Impaired motor functions and low ability to concentrate, manifested both in short concentration and increased distractibility, are the main characteristics of this syndrome.

At a young age, these children are characterized by increased activity, manifested in the form of unrestrained, disorganized and poorly controlled behavior. During adolescence, this increased activity often disappears, giving way to inert and reduced activity. The phenomena of impulsivity, expressed by mood swings, aggressiveness and disruption of relationships with peers are quite common for these children. They often have a delay in the development of mental functions, in particular speech, reading disorders and an insufficiently high level of intellectual development. This syndrome occurs four to five times more often among boys than among girls. The developmental prognosis for children with this type of disorder is not very good, and although increased activity decreases with age, many adolescents still continue to experience serious difficulties in the area of ​​social contacts.

Early childhood autism

A developmental disorder called early childhood autism is especially rare. It is a very severe disorder that begins in infancy and is characterized by the following three main features. Firstly, such children have a disruption in the development of social relationships. This manifests itself in the fact that the baby looks indifferent to everything and is unable to feel affection for his parents for a long time. When he gets older, he does not develop friendly relations with anyone, and communication proceeds in a strange pompous manner. Secondly, these children show significant developmental delays in both their understanding and use of language. In about half of the cases it does not develop at all, but when speech does occur, it is usually stereotypical, filled with echolalic phrases and incorrectly used personal pronouns. Thirdly, rituals and various coercive actions are observed in the behavior of these children. This may include carrying strange objects, strange finger movements, unusual eating habits (such as wanting to eat only warm sandwiches), or an exclusive interest in numbers and tables.

Schizophrenia

Unlike early childhood autism, schizophrenia begins only in late preschool or, which happens much more often, in adolescence. In children, as well as in adults, the onset of the disease is quite insidious. The teenager's thinking becomes confused and disrupted, his academic performance declines, relationships with others become difficult, and he experiences illusions and hallucinations (especially auditory ones). He may feel like his thoughts are being controlled from the outside. Sometimes the onset of the disease is acute and occurs against the background of both depressive and manic states, often when the sick child suddenly begins to feel like someone is stalking him, and ordinary phenomena are assigned special significance.

In general, this disease is not that rare; in fact, it affects one person in a hundred. But in the vast majority of cases, it begins at the end of adolescence or early adolescence, after school has been completed.

Developmental disorders

Finally, the last important group of problems is usually called developmental disorders. In some respects, they differ significantly from other types of mental disorders, although they very often coexist alongside them (especially with sociopathy syndrome). For this reason, I proposed to consider them as an independent (fifth) aspect in the general diagnostic scheme. However, it seems convenient here to touch upon them again very briefly.

So, this is a group of disorders whose main feature is a specific developmental delay. Biological maturation has a certain relation to its origin, but it is also influenced by social facts. A specific disorder of speech development (manifested either in delayed speech development or in pronounced pronunciation disorders) and a specific lag in the development of reading (in which, despite good intelligence, the skills of reading and sound-letter analysis of words are significantly damaged) are the two most common variants of this developmental disorders. All disorders in this group are much more common in boys (approximately four to one), and what is characteristic is that other family members often have similar problems.

GRADUATE QUALIFYING WORK

Emotional disorders in children

Introduction

Chapter I. Emotional disorders in children of preschool and primary school age

1.2 Features of emotional development in children of preschool and primary school age

1.3 Emotional disorders in children of preschool and primary school age

Chapter II. Methods and techniques for psychodiagnostics of emotional disorders in children

2.1 Possibilities of diagnostic methods for identifying emotional disorders in children

2.2 Diagnosis of emotional development disorders in children

Conclusion

Bibliography

Application

INTRODUCTION

Relevance of the topic

Every year the number of children who are diagnosed with some kind of nervous disease increases and almost all children have some kind of deviation in the emotional sphere. According to A.I. Zakharov, by the end of primary school, less than half of children are healthy, and according to school teachers and psychologists, by middle school, a diagnosis of emotional nervous disorder can be given to most children, and in fact only a few can be called healthy. If we take into account that emotional disorders do not appear at school age, but much earlier, and by school age some children arrive with persistent nervous disorders, then sad conclusions can be drawn.

Judging by the scale of the spread of this problem, in the near future we are threatened with “complete neuroticization of the population.” Such a society will not be able to exist harmoniously in the future.

Due to its relevance, this topic deserves the attention of not only specialists in the field of child neuropathology, but also, first of all, kindergarten parents and teachers. Therefore, it is certainly necessary to think about the timely diagnosis of emotional disorders in childhood, try to identify them as early as possible, and select adequate methods in order to prevent most cases of emotional disorders and nervous diseases in children, which in turn will ensure the mental health of the younger generation.

Elaboration

A large number of scientists have dealt with the problem of emotional disorders and their diagnosis, such as Zakharov A.I., Sukhareva G.E., Gannushkin L.K., Lichko A.E., Lebedinsky V.V., Nikolskaya O.S., K Leongard, Gubinshtein S.Ya., Shchard K.E., Borodulina S.Yu., Eliseev O.P., Bardyshevskaya M.N., Nepomnyashchaya N.I. etc.

Emotional disorders in children of preschool and primary school age.

Diagnosis of emotional disorders in children of preschool and primary school age.

Clarification of the possibilities for diagnosing emotional disorders in children of preschool and primary school age.

Main goals

1) Analyze the psychological essence and meaning of emotions, and also consider the features of emotional development in children of preschool and primary school age.

2) Describe disorders of emotional development in children of preschool and primary school age.

3) Identify the possibilities of psychodiagnostic methods for identifying emotional disorders in children of preschool and primary school age.

5) Conduct a diagnosis of emotional disorders in children of the 1st grade secondary school.

Scientific and practical significance of the problem under study

A generalization of material on the problem of diagnosing emotional disorders in children is useful not only for psychologists, teachers and doctors, but also for parents.

Chapter I. Emotional development of children of preschool and primary school age

1.1 Psychological essence, the meaning of emotions

Cognizing reality, a person relates in one way or another to objects, phenomena, events, to other people, to his personality. Some phenomena of reality make him happy, others make him sad, admiration, indignation, anger, fear, etc. - all these are different types of a person’s subjective attitude to reality. In psychology, emotions are processes that reflect personal significance and assessment of external and internal situations for a person’s life in the form of experiences. Emotions and feelings serve to reflect a person’s subjective attitude towards himself and the world around him.

Emotions are a special class of subjective psychological states that reflect, in the form of direct experiences of pleasure, the process and results of practical activities aimed at satisfying its current needs. Since everything that a person does ultimately serves the purpose of satisfying his various needs, since any manifestations of human activity are accompanied by emotional experiences. Emotions, C. Darwin argued, arose in the process of evolution, as a means by which living beings establish the significance of certain conditions to satisfy their actual needs (L.D. Stolyarenko, p. 233). As our ancestors evolved, the period of growing up and training of young individuals became longer - they needed more and more time to learn how to get food and take care of themselves. In order for a child to survive, a mutual affection had to develop between him and the person who cared for him. Based on modern research data, we can confidently say that emotions are the cementing factor in the mutual attachment of mother and child. If you leave a one-year-old baby without a mother in an unfamiliar room, he will certainly react to the separation with a strong emotion. If the connection between mother and baby is disrupted for a longer period of time or is disrupted permanently, one can observe an expressive bouquet of negative emotions that can develop into severe forms of depression and can even cause general exhaustion of the body.

Undoubtedly, one of the reasons for the emergence of emotions during evolution was the need to provide a social connection between mother and child. The ecological niche of the human child is such that the bearer of all the cognitive, social and physiological skills necessary for the survival of the infant is the adult who cares for him. The child depends on the mother in everything: she satisfies his needs for food, warmth, care, and protects him from danger. Among other things, a child also needs parental love for physiological health and psychological well-being, the lack of which underlies many psychological disorders, and especially depression.

Another reason for the emergence of emotions was the urgent need for means of communication between mother and child. Numerous studies devoted to the emotional development of a child show that long before a child begins to understand speech addressed to him and pronounce individual words, he can already inform others about his internal state using a certain set of signals. for example, hunger and pain may manifest themselves through the outward expression of physical suffering. [Izard K.E., pp. 19-22].

Emotional sensations have become biologically entrenched in the process of evolution as a unique way of maintaining the life process within its optimal boundaries and warn of the destructive nature of a lack or excess of any factors.

For the first time, emotional expressive movements became the subject of study by Charles Darwin. Based on comparative studies of the emotional movements of mammals, Darwin created a biological concept of emotions, according to which expressive emotional movements were considered as a rudiment of purposeful instinctive actions that retain to some extent their biological meaning and at the same time act as biologically significant signals for individuals not only of their own, but also other types.

The result of deep theoretical thought is the biological theory of emotions by P.K. Anokhina. This theory considers emotions as a product of evolution, as an adaptive factor in the life of the animal world, as a mechanism that keeps life processes within optimal boundaries and prevents the destructive nature of the lack or excess of any factors in the life of a given organism.

The main position of P.V. Simonov’s information theory of emotions is that emotions arise when there is a mismatch between a vital need and the possibility of satisfying it. A person’s awareness of the means to satisfy a need can reduce emotions.

The James-Lange “peripheral” theory of emotions proves that the emergence of emotions is caused by changes in organic processes (for example, breathing, pulse, facial expressions). And emotions themselves are the sum of organic sensations - “a person is sad because he is crying,” and not vice versa.

In this aspect, Arnold's concept is of interest, according to which an intuitive assessment of a situation, for example, a threat, causes a desire to act, which is expressed in various bodily changes, is experienced as an emotion and can lead to action. This can be expressed this way: “We are afraid because we have decided that we are being threatened.”

Dalibor Bindra, after a critical analysis of existing theories of emotion, came to the conclusion that it is impossible to draw a rigid distinction between emotion and motivation. Emotions do not exist as a separate class of behavioral reactions; they are inseparable from sensation, perception, and motivation. Bindra puts forward his own concept of a “central motivational state” - a complex of nervous processes that arises as a result of the action of a combination of incentive stimuli of a certain type, which determines certain emotional and typical species reactions. [L.D. Stolyarenko, p.236].

The results of experimental studies suggest that the cerebral cortex plays a leading role in the regulation of emotional states. I.P. Pavlov showed that it is the cortex that regulates the flow and expression of emotions, keeps under its control all phenomena occurring in the body, has an inhibitory effect on the subcortical centers, and controls them. If the cerebral cortex comes into a state of excessive excitation, then overexcitation of the centers flying below the cortex occurs, as a result of which the usual restraint disappears. In the case of widespread inhibition, depression, weakening or stiffness of muscle movements, decline in cardiovascular activity and respiration, etc. are observed.

It can be argued that emotions arise as a result of exposure to a certain stimulus, and their appearance is nothing more than a manifestation of human adaptation mechanisms and the regulation of his behavior. It can also be assumed that emotions were formed in the process of evolution of the animal world and they reached their maximum level of development in humans, since in him they are presented objectively, at the level of feelings. [A.G. Maklakov, p.408].

The oldest in origin, the simplest and most common form of emotional experiences among living beings is the pleasure obtained from satisfying organic needs, and the displeasure associated with the inability to do this when the corresponding need intensifies. The diverse manifestations of a person’s emotional life are divided into affects, emotions themselves, feelings, moods and stress.

The most powerful emotional reaction - affect - is a strong, violent and relatively short-term emotional experience that completely captures the human psyche and predetermines a unified reaction to the situation as a whole. Examples of affect include extreme anger, rage, horror, intense joy, deep grief, and despair.

Emotions themselves, unlike affects, are longer lasting states. They are a reaction not only to events that have happened, but also to probable or remembered ones. If affects arise towards the end of the action and reflect the total, final assessment of the situation, then emotions shift to the beginning of the action and anticipate the result.

In order to understand the essence of emotions, it is necessary to proceed from the fact that most objects and phenomena of the external environment, acting on the senses, cause in us complex, multifaceted emotional sensations and feelings, which can include both pleasure and displeasure, tension or relief, excitement or calm. In addition, from the point of view of their influence on human activity, emotions are divided into sthenic and asthenic. Stenic emotions stimulate activity, increase a person’s energy and tension, and encourage him to act and speak. And, conversely, sometimes experiences lead to stiffness and passivity, then they talk about asthenic emotions. Therefore, depending on the situation and individual characteristics, emotions can influence behavior in different ways. [L.D. Stolyarenko, p.234].

It should be noted that attempts have been made repeatedly to identify the main, “fundamental” emotions. In particular, it is customary to highlight the following emotions:

1) Joy is a positive emotional state associated with the ability to sufficiently fully satisfy an actual need.

2) Surprise - an emotional reaction to sudden circumstances that does not have a clearly defined positive or negative sign.

3) Suffering is a negative emotional state associated with received reliable or apparent information about the impossibility of satisfying the most important needs of life.

4) Anger is an emotional state, negative in sign, usually occurring in the form of affect and caused by the sudden emergence of a serious obstacle to the satisfaction of a need that is extremely important for the subject.

5) Disgust is a negative emotional state caused by objects (objects, people, circumstances, etc.) contact with which comes into sharp conflict with the ideological, moral or aesthetic principles and attitudes of the subject.

6) Contempt is a negative emotional state that arises in interpersonal relationships and is generated by a mismatch in the life positions, views and behavior of the subject with the life positions, views and behavior of the object of feeling.

7) Fear is a negative emotional state that appears when the subject receives information about a real or imagined danger.

8) Shame is a negative state, expressed in the awareness of the inconsistency of one’s own thoughts, actions and appearance not only with the expectations of others, but also with one’s own ideas about appropriate behavior and appearance. [A.G. Maklakov, p.395]

It should be noted that emotional experiences are ambiguous. The same object can cause inconsistent, contradictory emotional relationships. This phenomenon is called agility, i.e. duality of feelings.

Feelings are another type of emotional state. This is the highest product of human cultural and emotional development. Feelings are even more than emotions, stable mental states that have a clearly defined objective character: they express a stable attitude towards some objects (real or imaginary).

Depending on the direction, feelings are divided into moral (a person’s experience of his relationship to other people), intellectual (feelings associated with cognitive activity), aesthetic (feelings of beauty when perceiving art, natural phenomena) and practical (feelings associated with human activity).

Feelings play a motivating role in a person’s life and activity, in his communication with people around him. In relation to the world around him, a person strives to act in such a way as to reinforce and strengthen his positive feelings. They are always connected with the work of consciousness and can be voluntarily regulated. Having a strong and lasting positive feeling for something or someone is called passion. Stable feelings of moderate or weak strength that last for a long time are called moods.

Mood is the longest lasting emotional state that colors all human behavior.

Passion is another type of complex, qualitatively unique and unique emotional state found only in humans. Passion is a fusion of emotions, motives and feelings concentrated around a certain type of activity or object (person). [L.D. Stolyarenko, p.235].

The last type of emotional response is one of the most common types of affects - stress. It is a state of excessively strong and prolonged psychological stress that occurs in a person when his nervous system receives emotional overload. Stress disorganizes a person’s activities and disrupts the normal course of his behavior. According to G. Selye, stress is a nonspecific response of the body to any demand presented to it, which helps it adapt to the difficulty that has arisen and cope with it. All that matters is the intensity of the need for restructuring or adaptation.

The very occurrence and experience of stress depends not so much on objective as on subjective factors, on the characteristics of the person himself: his assessment of the situation, comparison of his strengths and abilities with what is required of him, etc.

Close to the concept and state of stress is the concept of frustration, which is experienced as tension, anxiety, despair, anger that grips a person when, on the way to achieving a goal, he encounters unexpected obstacles that interfere with the satisfaction of needs.

The most common reaction to frustration is the emergence of generalized aggressiveness, most often directed at obstacles. Aggression, quickly turning into anger, manifests itself in violent and inappropriate reactions: insult, physical attacks on a person or object. In some cases, a person reacts to frustration by withdrawing, accompanied by aggression that is not expressed openly.

Frustration leads to emotional disturbances only when an obstacle to strong motivation arises [L.D. Stolyarenko, p. 243]

According to I.P. Pavlov, emotions play an important role in human life and perform a number of functions:

1) Reflective-evaluative function of emotions.

Emotions are a reflection of the human and animal brain of any active need (its quality and magnitude) and the likelihood (possibility) of its satisfaction, which the brain evaluates on the basis of genetic and previously acquired individual experience.

2) Switching function of emotions.

From a physiological point of view, emotion is an active state of a system of specialized brain structures that encourages behavior to be changed in the direction of minimizing or maximizing this state.

The switching function of emotions is found both in the sphere of innate forms of behavior and in the implementation of conditioned reflex activity, including its most complex manifestation.

An assessment of the likelihood of satisfying a need can occur in a person not only at a conscious level, but also at an unconscious level. The switching function of emotions is especially clearly revealed in the process of competition of motives, when a dominant need is identified, which becomes a vector of goal-directed behavior.

The dependence of emotions not only on the magnitude of the need, but also on the likelihood of its satisfaction, extremely complicates the competition of coexisting motives, as a result of which behavior is often reoriented towards a less important, but easily achievable goal.

3) Reinforcing function of emotions.

By reinforcement, I.P. Pavlov understood the action of a biologically significant stimulus, which gives a signal value to another, biologically non-existent stimulus combined with it. V. Vyrvitska came to the conclusion that direct reinforcement is not the satisfaction of any need, but the receipt of desirable and elimination of undesirable stimuli. For example, fear has a pronounced aversiveness for the animal and is actively minimized by it through the avoidance reaction.

4) Compensatory (replacement) function of emotions.

Emotions influence other cerebral systems that regulate behavior, the processes of perception of external signals and the extraction of engrams of these signals from memory, and the autonomic functions of the body.

Emotion in itself does not carry information about the surrounding world; the lack of information is replenished through search behavior, improving skills, and mobilizing engrams stored in memory. The complex meaning of emotions lies in the replacing role [Yu.B. Gippenreiter, pp. 189-194].

5) Regulatory function of emotions and feelings - when, under the influence of negative emotional states, a person may develop prerequisites for the development of various diseases, and vice versa, there are a significant number of examples when, under the influence of emotions, the healing process is accelerated, i.e. emotions regulate our health.

6) Pre-information (signal) function of emotions

The experiences that arise signal to a person how the process of satisfying his needs is going, what obstacles he encounters on his way, what he needs to pay attention to first, etc.

7) Incentive (stimulating) function of emotions.

Emotions and feelings help determine the direction of the search, as a result of which the satisfaction of an emerging need is achieved or the problem facing a person is solved.

8) Communicative function of feelings.

Mimic and pantomimic movements allow a person to convey his experiences to other people, inform them about his attitude to objects and phenomena of the surrounding reality. Facial expressions, gestures, postures, expressive sighs, changes in intonation are “the language of human feelings, a means of communicating not so much thoughts as emotions [A.G. Maklakov, p. 412].

The variety of emotional manifestations is expressed primarily in the prevailing mood of people. Under the influence of life conditions and depending on the attitude towards them, some people have a high, cheerful, cheerful mood; others - depressed, depressed, sad; for others - capricious, irritable, etc.

Significant emotional differences are also observed in the emotional excitability of people. There are people who are emotionally insensitive, for whom only some extraordinary events evoke pronounced emotions. Such people do not so much feel the situation as they are aware of it with their minds. There is another category of people - emotionally excitable ones, in whom the slightest trifle can cause strong emotions, a rise or fall in mood.

There are significant differences between people in the depth and stability of feelings. Some people are completely overwhelmed by their feelings and leave a deep imprint behind them. For other people, feelings are superficial, flow easily, unnoticeably, and pass quickly. Manifestations of affects and passions differ noticeably among people. In this regard, we can identify unbalanced people who easily lose control over themselves and their behavior. Other people, on the contrary, are always balanced, completely in control of themselves, and consciously control their behavior.

It should be noted that significant differences in the manifestation of emotions and feelings largely determine the uniqueness of a particular person, i.e. determine his individuality. [A.G. Maklakov, p.414].

Thus, emotions play an extremely important role in people's lives. Thus, today no one denies the connection between emotions and the functioning of the body. It is well known that under the influence of emotions the activity of the circulatory, respiratory, digestive organs, endocrine and exocrine glands, etc. changes. Excessive intensity and duration of experiences can cause disturbances in the body. M.I. Astvatsaturov wrote that the heart is more often affected by fear, the liver by anger, and the stomach by apathy and a depressed state. The occurrence of these processes is based on changes occurring in the external world, but affects the activity of the entire organism.

Emotions characterize human needs and the objects to which they are directed. In the process of evolution, emotional sensations and states have become biologically entrenched as a way of maintaining the life process within its optimal boundaries. Their significance for the body is to warn about the destructive nature of any factors. Thus, emotions are one of the main mechanisms for regulating the functional state of the body and human activity. Thanks to emotions, a person becomes aware of his needs and the objects to which they are directed. Another universal feature of emotions is their assistance in realizing needs and achieving certain goals. Since any emotion is positive or negative, a person can judge whether a goal has been achieved. Thus, we can conclude that emotions are most directly related to the regulation of human activity. [A.G. Maklakov, p. 393].

1.2 Features of the emotional development of children of preschool and primary school age

Emotions follow a development path common to all higher mental functions - from external socially determined forms to internal mental processes. Based on innate reactions, the child develops a perception of the emotional state of the people around him. Over time, under the influence of increasingly complex social contacts, emotional processes are formed.

The earliest emotional manifestations in children are associated with the organic needs of the child. This includes manifestations of pleasure and displeasure when satisfying or not satisfying the need for food, sleep, etc. Along with this, such elementary feelings as fear and anger begin to appear early. At first they are unconscious.

Children also develop empathy and compassion very early. Thus, at the twenty-seventh month of life, the child cried when he was shown an image of a crying person.

It should be noted that positive emotions in a child develop gradually through play and exploratory behavior. For example, research by K. Bühler showed that the moment of experiencing pleasure in children's games shifts as the child grows and develops. Initially, the child experiences pleasure at the moment of obtaining the desired result. In this case, the emotion of pleasure plays an encouraging role. The second stage is functional. A child at play brings joy not only to the result, but also to the process of the activity itself. Pleasure is now associated not with the end of the process, but with its content. At the third stage, older children begin to anticipate pleasure - the emotion in this case arises at the beginning of play activity, and neither the result of the action nor the execution itself are central in the child’s experience.

Another characteristic feature of the manifestation of feelings at an early age is their affective nature. Emotional states in children at this age arise suddenly, proceed violently, but disappear just as quickly. More significant control over emotional behavior occurs in children only in older preschool age, when they develop more complex forms of emotional life under the influence of increasingly complex relationships with people around them. [A.G. Maklakov, p.409].

Preschool age, as A.N. Leontiev wrote, is “the period of the initial actual personality structure.” It is at this time that the formation of basic personal mechanisms and formations occurs. Emotional and motivational spheres, closely related to each other, develop, and self-awareness is formed.

Preschool childhood is characterized by generally calm emotionality, the absence of strong affective outbursts and conflicts over minor issues. This new, relatively stable emotional background is determined by the dynamics of the child’s ideas. The dynamics of figurative representations are freer and softer compared to the affectively colored processes of perception in early childhood. Previously, the course of a child’s emotional life was determined by the characteristics of the specific situation in which he was included. Now the appearance of ideas allows the child to escape from the immediate situation, he has experiences that are not related to it, and momentary difficulties are not perceived so acutely and lose their former significance.

So, emotional processes become more balanced. But this does not at all mean a decrease in the richness and intensity of the child’s emotional life. A preschooler's day is so full of emotions that by the evening he can become tired and reach complete exhaustion. [I.Yu. Kulagina, V.N. Kolyutsky, p. 218].

The emotional development of a preschooler is also associated with the development of new interests, motives and needs. The most important change in the motivational sphere is the emergence of social motives, no longer conditioned by the achievement of narrowly personal, utilitarian goals. Therefore, social emotions and moral feelings begin to develop intensively. The establishment of a hierarchy of motives leads to changes in the emotional sphere. Isolation of the main motive, to which a whole system of others is subordinated, stimulates stable and deep experiences. Moreover, they relate not to the immediate, momentary, but rather distant results of activity. Feelings lose their situational nature, become deeper in semantic content, and arise in response to perceived mental circumstances. (P.M. Yakobson) [G.A. Uruntaeva, p. 254].

The desires and motivations of the child are combined with his ideas and thanks to this, the motivations are restructured. There is a transition from desires (motives) aimed at objects of the perceived situation to desires associated with imagined objects located in the “ideal” plane. The child’s actions are no longer directly related to an attractive object, but are built on the basis of ideas about the object, the desired result, and the possibility of achieving it in the near future. Emotions associated with the idea allow one to anticipate the results of the child’s actions and the satisfaction of his desires.

The mechanism of emotional anticipation is described in detail by A.V. Zaporozhets. They show how the functional place of affect in the general structure of behavior changes. Comparing the behavior of a young child and a preschooler, we can conclude that a child under 3 years of age experiences exclusively the consequences of his own actions, their assessment by an adult. They do not worry about whether an action deserves approval or censure, or what it will lead to. Affect turns out to be the last link in this chain of unfolding events.

Even before a preschooler begins to act, he has an emotional image that reflects both the future result and its assessment by adults. Emotionally anticipating the consequences of his behavior, the child already knows in advance whether he is going to act well or badly. If he foresees a result that does not meet accepted standards of upbringing, possible disapproval or punishment, he develops anxiety - an emotional state that can inhibit actions that are undesirable for others. Anticipation of the useful result of actions and the resulting high evaluation from close adults is associated with positive emotions, which additionally stimulate behavior. Adults can help the child create the desired emotional image. Wishes focused on the emotional imagination of children, and not on their consciousness, turn out to be much more effective. Thus, in preschool age there is a shift in affect from the end to the beginning of activity. Affect (emotional image) becomes the first link in the structure of behavior. The mechanism of emotional anticipation of the consequences of an activity underlies the emotional regulation of a child’s actions [I.Yu. Kulagina, V.N. Kolyutsky, pp. 219-220].

Emotional anticipation makes a preschooler worry about the possible results of his activities and anticipate the reactions of other people to his actions. Therefore, the role of emotions in a child’s activities changes significantly. If earlier he felt joy from the fact that he received the desired result, now he is happy because he can get this result. If previously a child fulfilled a moral norm in order to deserve a positive assessment, now he fulfills it, anticipating how happy those around him will be with his action.

Gradually, the preschooler begins to foresee not only the intellectual, but also the emotional results of his activities. Assuming how happy his mother will be, he gives her a gift, refusing the attractive game. It is in preschool age that a child masters the highest forms of expression - expressing feelings using intonation, facial expressions, pantomime, which helps him understand the experiences of another person

Thus, on the one hand, the development of emotions is determined by the emergence of new motives and their subordination, and on the other hand, emotional anticipation ensures this subordination. [G.A. Uruntaeva, pp. 254-255].

The structure of the emotional processes themselves also changes during this period. In early childhood, autonomic and motor reactions were included in their composition: when experiencing an insult, the child cried, threw himself on the sofa, covered his face with his hands, or moved chaotically, shouting incoherent words, his movements were uneven, his pulse was rapid ; in anger, he blushed, screamed, clenched his fists, could break something that came to hand, hit, etc. These reactions persist in preschoolers, although the external expression of emotions becomes more restrained in some children. In addition to vegetative and motor components, the structure of emotional processes now also includes complex forms of perception of figurative thinking and imagination. The child begins to be happy and sad not only about what he is doing at the moment, but also about what he still has to do. Experiences become more complex and deeper.

The content of affects changes - the range of emotions inherent in the child expands. Figurative representations acquire an emotional character and all the child’s activities are emotionally rich. [I..Kulagina, V.N. Kolyutsky, p.220].

Changes in the emotional sphere are associated with the development of not only the motivational, but also the cognitive sphere of the individual, self-awareness. The inclusion of speech in emotional processes ensures their intellectualization, when they become more conscious and generalized. The first attempts to restrain one’s feelings, for example, external manifestations of tears, can be noticed in a child at 3-4 years old. Although the baby is still not good at it. The older preschooler, to a certain extent, begins to control the expression of emotions by influencing himself with the help of words.

But still, preschoolers have difficulty restraining emotions associated with organic needs. Hunger and thirst make them act impulsively.

In preschool age, the development of communication with adults and peers, the emergence of forms of collective activity and, mainly, role-playing games lead to the further development of sympathy, empathy, and the formation of camaraderie. Higher feelings are intensively developed: moral, aesthetic, cognitive.

The source of humane feelings is relationships with loved ones. If in early childhood a child was more often the object of feelings on the part of an adult, then the preschooler turns into a subject of emotional relationships with himself empathizing with other people. Practical mastery of behavioral norms is also a source of development of moral feelings. Experiences are now caused by social sanction, the opinion of the children's society. At this age, moral assessments of actions from external requirements become the child’s own assessments and are included in his experience of relationships to certain actions or actions.

Role-playing games are also a powerful factor in the development of humane feelings. Role-playing actions and relationships help the preschooler understand the other, take into account his position, mood, desire. When children move from simply recreating actions and the external nature of relationships to conveying their emotional and expressive content, they learn to share the experiences of others.

In work activities aimed at achieving results useful for others, new emotional experiences arise: joy from general success, sympathy for the efforts of comrades, satisfaction from the good performance of one’s duties, dissatisfaction from one’s poor work.

Based on children's acquaintance with the work of adults, love and respect for it is formed. And preschoolers transfer their positive attitude towards work to their own activities. (Ya.Z.Neverovich)

Empathy for a peer largely depends on the situation and position of the child. In conditions of intense personal rivalry, emotions overwhelm a preschooler, and the number of negative expressions addressed to a peer increases sharply. The child does not give any arguments against his peer, but simply (in speech) expresses his attitude towards him, empathy for his friend sharply decreases.

Passive observation of a peer’s activities causes dual experiences in a preschooler. If he is confident in his abilities, then he rejoices at the success of another, and if he is not confident, then he experiences envy.

When children compete with each other, realistically assessing their capabilities, comparing themselves with a friend, the desire for personal success increases the power of expressions to the highest level. In group competitions, the main core is the interests of the group, and success or failure is shared by everyone together, the strength and number of negative expressions decreases, because against the general background of the group, personal successes and failures are less noticeable.

The child experiences the most vivid positive emotions in a situation of comparing himself with a positive literary character, actively empathizing with him and with the confidence that in a similar situation he would do the same. Therefore, there are no negative emotions towards the character.

Sympathy and sympathy encourage the child to commit the first moral actions. Even a 4-5 year old child fulfills moral standards, showing a sense of duty primarily towards those with whom he sympathizes and sympathizes. R. Ibragimova’s research made it possible to trace how the sense of duty develops throughout preschool age.

The beginnings of a sense of duty are observed in the third year of life. The child obeys the adult’s demands without realizing their meaning. During this period, there is only a process of accumulation of initial moral ideas: “possible”, “impossible”, “bad”, “good” and correlating them with one’s actions and deeds. A child’s emotional reactions to the positive or negative side of adults’ actions are unstable. He may give in, but only under the influence of an adult or out of sympathy and sympathy for someone.

The first more or less complex manifestations of feelings of duty occur in children 4-5 years old. Now, on the basis of life experience and initial moral ideas, a moral consciousness arises in the child, he is able to understand the meaning of the demands placed on him and relate them to his own actions and actions, as well as to the actions and actions of others.

The child experiences joy, satisfaction when he performs worthy actions and grief, indignation, dissatisfaction when he himself or others violate generally accepted requirements or commit unworthy actions. The feelings experienced are caused not only by the assessment of adults, but also by the child’s own evaluative attitude towards his own and others’ actions, but these feelings themselves are shallow and unstable. At the age of 5-7, a child develops a sense of duty towards many adults and peers; a preschooler begins to experience this feeling towards children as well.

The sense of duty manifests itself most clearly at the age of 6-7 years. The child realizes the necessity and obligation of the rules of social behavior and subordinates his actions to them. The ability to self-esteem increases. Violation of rules and unworthy actions cause awkwardness, guilt, embarrassment, and anxiety.

By the age of 7, the sense of duty is not based only on attachment and extends to a wider circle of people with whom the child does not directly interact. The experiences are quite deep and last a long time.

The development of camaraderie and friendship occurs long before children begin to understand their relationships with their comrades in terms of moral standards. At the age of 5, children develop friendships with many children in turn, depending on the circumstances. At 5-7 years old, friendships between one child and many children remain, although paired friendships are more common. Friendship in small subgroups is most often born in the game on the basis of gaming interests and inclinations, including intellectual interests. Paired friendship is characterized by deep sympathy. Kids are friends because they play together, because playing and being friends are equivalent for them. Older preschoolers play with those with whom they are friends on the basis of sympathy and respect.

The development of intellectual feelings in preschool age is associated with the development of cognitive activity. Joy in learning something new, surprise and doubt, bright positive emotions not only accompany the child’s small discoveries, but also cause them. The surrounding world and nature especially attract the child with its mystery and mystery. Surprise gives rise to a question that needs to be answered.

The development of aesthetic feelings is associated with the development of children’s own artistic and creative activity and artistic perception.

Children's aesthetic feelings are interconnected with moral ones. The child approves of the beautiful and good, condemns the ugly and evil in life, art, and literature. Older preschoolers begin to judge actions not only by their results, but also by their motives; they are concerned with such complex ethical issues as the fairness of rewards, retribution for harm caused, etc. [G.A. Uruntaeva, pp. 255-260].

In the second half of preschool childhood, the child acquires the ability to evaluate his own behavior and tries to act in accordance with the moral standards that he learns.

Foreign psychologists have shown that the assimilation of ethical standards and the socialization of a child’s moral behavior proceed faster and easier in certain family relationships. The child must have a close emotional connection with at least one parent. Children are more willing to imitate caring parents than indifferent ones. In addition, they accept the behavior and attitudes of adults, communicating more often and participating in joint activities with them.

When interacting with loving parents, children receive not only positive or negative emotional reactions to their actions, but also explanations of why some actions should be considered good and others bad. All this leads to an earlier awareness of ethical standards of behavior.

The assimilation of moral norms, as well as the emotional regulation of actions, contributes to the development of voluntary behavior in a preschooler. [I.Yu.Kulagina, V.N.Kolyutsky, p.224].

Thanks to intensive intellectual and personal development, by the end of preschool age, its central new formation is formed - self-awareness. Self-esteem appears in the second half of the period on the basis of the initial, purely emotional self-esteem (“I’m good”) and a rational assessment of other people’s behavior. The child first acquires the ability to evaluate the actions of other children, and then his own actions, moral qualities and skills.

The child judges moral qualities mainly by his behavior, which either agrees with the norms accepted in the family and peer group or does not fit into the system of these relationships. His self-esteem therefore almost always coincides with an external assessment, primarily with the assessment of close adults.

When assessing practical skills, a 5-year-old child exaggerates his achievements. By the age of 6, high self-esteem remains, but at this time children no longer praise themselves in such an open form as before. At least half of their judgments about their success contain some kind of justification. By the age of 7, most self-esteem of skills becomes more adequate.

In general, a preschooler’s self-esteem is very high, which helps him master new activities and, without doubt or fear, engage in educational activities in preparation for school. An adequate image of “I” is formed in a child through a harmonious combination of knowledge gleaned from his own experience and from communication with adults and peers. [I.Yu.Kulagina, V.N.Kolyutsky, p.225].

Thus, the features of emotional development in preschool age are that:

1) The child masters social forms of expressing feelings.

2) The role of emotions in the child’s activities changes, emotional anticipation is formed.

3) Feelings become more conscious, generalized, reasonable, arbitrary, non-situational. A system of motives is formed, which forms the basis for the arbitrariness of mental processes and behavior in general.

4) Higher feelings are formed - moral, intellectual, aesthetic.

5) There is a development of imagination, imaginative thinking and voluntary memory. [G.A.Uruntaeva, p.260].

The turning point in the mental development of a child is the crisis of 7 years, which occurs at the border of preschool and junior school age.

The main symptoms of this crisis include:

Loss of spontaneity: the child begins to understand what this or that desired action may cost him personally. If previously behavior was structured and implemented according to desires, now, before doing anything, the child thinks about what it might cost him;

Maneuvering: his soul becomes closed and he begins to play a role, pretending to be something and hiding something at the same time;

Symptom of “bitter candy”: when a child feels bad, at this age he tries to hide it from others.

Along with this, you can easily notice that during this period of time the child changes dramatically and becomes more difficult to raise than before. You can often encounter aggressiveness (verbal and physical), and in some children it takes on extreme forms in the form of a destructive attitude towards things. The child becomes hot-tempered, is rude in response to some kind of dissatisfaction or from an adult, he has poor communication, and is disobedient. Some children may even refuse to eat and drink.

You can often encounter the exact opposite phenomenon - absolutely passive behavior. Such children bother their parents and educators with excessive passivity and absent-mindedness. It is clear that the cause in both cases is childhood experiences. They are being restructured. From “I myself” and “I want” to “This is how it should be” is a long way, and a preschooler goes through it in just 3-4 years. [V.A. Averin, pp. 229-230].

All psychological new formations of preschool age together will allow the child to fulfill a new role for himself - the role of a schoolchild. And it is the formation and level of development of psychological processes that determines the child’s level of readiness for school and his first steps to adapt to it.

Readiness for learning consists of a certain level of development of mental activity, cognitive interests and readiness for voluntary regulation of behavior. [V.A.Averin, p.232].

The beginning of school life expands the perception of the world around us, increases experience, expands and intensifies the child’s sphere of communication. Under the influence of a new way of life, which forms a new social situation for the development of a primary school child, the arbitrariness in the child’s behavior and activities makes a significant progress in its development.

At primary school age, the leading factor in the development of voluntary behavior is educational activity, partly work in the family. The latter is associated with the child having certain responsibilities in the family, when the activity itself begins to be of a pronounced voluntary nature.

1. For the development of voluntary behavior, it is important that a child is able not only to be guided by the goals that an adult sets for him, but also the ability to independently set such goals and, in accordance with them, independently organize and control his behavior and mental activity. In the first and second grades, children are still characterized by a low level of arbitrariness in behavior; they are very impulsive and unrestrained. Children are not yet able to independently overcome even minor difficulties they encounter in learning. Therefore, at this age, the education of voluntariness consists in systematically teaching children to set goals for their activities and persistently strive to achieve them, i.e. teach them independence.

2. The next moment in the development of voluntary behavior is associated with the growing importance of relationships between schoolchildren. It is during this period that collective connections arise, public opinion, mutual assessment, exactingness and other phenomena of social life are formed. On this basis, a direction begins to be formed and determined, new moral feelings appear, and moral requirements are assimilated.

Everything that has been said is important in the lives of third and fourth graders, but is poorly manifested in the lives of students in grades 1-2. While they still remain indifferent to whether they received a reprimand in private with the teacher or in the presence of the whole class; at the same time, a remark made in the presence of comrades to a third or fourth grade student is experienced much stronger and more acutely. [Averin V.A., pp. 288-290].

High grades for a young student are the key to his emotional well-being, a source of pride and a source of other rewards.

In addition to the status of a good student, broad social motives for studying also include duty, responsibility, the need to get an education, etc. They are also recognized by students and give a certain meaning to their educational work. But these motives remain only “known” in the words of A.N. Leontyev. If, in order to receive a high mark or praise, a child is ready to immediately sit down to study and diligently complete all tasks, then the abstract concept of duty for him or the distant prospect of continuing his education at a university cannot directly encourage him to study. Nevertheless, social motives for learning are important for the personal development of a schoolchild, and in children who perform well from the 1st grade, they are quite fully represented in their motivational systems.

The motivation of underachieving schoolchildren is specific. In the presence of strong motives associated with obtaining a grade, the range of their social motives for learning is narrowed, which impoverishes motivation as a whole. Some social motives appear in them by the 3rd grade.

The broad social motives of learning correspond to the value orientations that children take from adults and mainly internalize in the family. What is the most valuable and significant thing in school life? First-graders, who had only studied for one quarter, were asked what they liked and disliked about school. Future excellent students value the educational content and school rules from the very beginning: I like mathematics and Russian because it’s interesting,” “I like that the lessons are given,” “Everyone needs to be good and obedient.” Future C-students and low-achieving students gave different answers: “I like that there are holidays at school,” “I like after-school activities, we all play and hang out there.” starting their school life, they have not yet acquired adult values ​​and are not focused on the essential aspects of learning.

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A textbook on psychiatry for medical university students is based on training programs for students in Ukraine, Belarus and Russia, as well as the International Classification ICD 10. All main sections of diagnosis, differential diagnosis, therapy of mental disorders, including psychotherapy, as well as the history of psychiatric science are presented. .

For medical university students, psychiatrists, medical psychologists, interns and doctors of other specialties.

V. P. Samokhvalov. Psychiatry. Publishing house "Phoenix". Rostov-on-Don. 2002.

Main manifestations include:

- Attention disorders. Inability to maintain attention, decreased selective attention, inability to concentrate on a subject for a long time, frequent forgetting of what needs to be done; increased distractibility, excitability. Such children are fussy and restless. Attention is reduced even more in unusual situations when you need to act independently. Some children cannot even watch their favorite TV shows to the end.

- Impulsiveness. IN the form of sloppy completion of school assignments, despite efforts to do them correctly; frequent shouting from the seat, noisy antics during classes; “interfering” with the conversation or work of others; impatience in line; inability to lose (as a result of this, frequent fights with children). The manifestations of impulsivity may change with age. At an early age, this is urinary and fecal incontinence; at school - excessive activity and extreme impatience; in adolescence - hooligan antics and antisocial behavior (theft, drug use, etc.). However, the older the child, the more pronounced and noticeable the impulsiveness is to others.

- Hyperactivity. This is an optional feature. In some children, motor activity may be reduced. However, physical activity differs qualitatively and quantitatively from the age norm. In preschool and early school age, such children constantly and impulsively run, crawl, jump, and are very fussy. By puberty, hyperactivity often decreases. Children without hyperactivity are less aggressive and hostile towards others, but they are more likely to experience partial developmental delays, including school skills.

Additional signs

Impaired coordination is noted in 50–60% in the form of the inability to make fine movements (tying shoelaces, using scissors, coloring, writing); balance disorders, visual-spatial coordination (inability to play sports, ride a bike, play with a ball).

Emotional disturbances in the form of imbalance, hot temper, intolerance to failure. There is a delay in emotional development.

Relationships with others. In mental development, children with activity and attention disorders lag behind their peers, but strive to be leaders. It's difficult to be friends with them. These children are extroverts, they look for friends, but quickly lose them. Therefore, they often communicate with more “amenable” younger ones. Relationships with adults are difficult. Neither punishment, nor affection, nor praise affects them. It is “bad manners” and “bad behavior” from the point of view of parents and teachers that are the main reason for turning to doctors.

Partial developmental delays. Despite a normal IQ, many children perform poorly in school. The reasons are inattention, lack of perseverance, intolerance to failure. Partial delays in the development of writing, reading, and counting are characteristic. The main symptom is the discrepancy between a high intellectual level and poor performance at school. The criterion for partial delay is that skills lag behind the required ones by at least 2 years. However, it is necessary to exclude other causes of academic failure: perceptual disorders, psychological and social causes, low intelligence and inadequate teaching.

Behavioral disorders. Not always observed. Not all children with conduct disorders will have problems with activity and attention.

Bed-wetting. Trouble falling asleep and morning sleepiness.

Disorders of activity and attention can be divided into 3 types: with a predominance of inattention; with a predominance of hyperactivity; mixed.

Diagnostics

There must be inattention or hyperactivity and impulsivity (or all manifestations at the same time) that do not correspond to the age norm.

Features of behavior:

1) appear before 8 years of age;

2) are found in at least two areas of activity - school, home, work, games, clinic;

3) are not caused by anxiety, psychotic, affective, dissociative disorders and psychopathy;

4) cause significant psychological discomfort and maladjustment.

Inattention:

1. Inability to focus on details, careless mistakes.

2. Inability to maintain attention.

3. Inability to listen to spoken speech.

4. Inability to complete tasks.

5. Low organizational skills.

6. Negative attitude towards tasks that require mental effort.

7. Loss of items necessary to complete the task.

8. Distractibility by extraneous stimuli.

9. Forgetfulness. (Of the listed signs, at least six must persist for more than 6 months.)

Hyperactivity and impulsivity(at least four of the following symptoms must persist for at least 6 months):

Hyperactivity: the child is fussy and restless. Jumps up without permission. Runs aimlessly, fidgets, climbs. Cannot rest or play quiet games;

Impulsiveness: shouts out the answer without hearing the question. Can't wait his turn.

Differential diagnosis

To make a diagnosis, you need: a detailed life history. Information must be obtained from everyone who knows the child (parents, caregivers, teachers). Detailed family history (presence of alcoholism, hyperactivity syndrome, tics in parents or relatives). Data about the child's current behavior.

Information is required about the child’s academic performance and behavior in the educational institution. There are currently no informative psychological tests for diagnosing this disorder.

Disorders of activity and attention do not have clear pathognomonic signs. This disorder can be suspected based on medical history and psychological testing taking into account diagnostic criteria. To make a final diagnosis, a trial prescription of psychostimulants is indicated.

The phenomena of hyperactivity and inattention can be symptoms of anxiety or depressive disorders, mood disorders. The diagnosis of these disorders is made if their diagnostic criteria are met. The presence of an acute onset of hyperkinetic disorder at school age may be a manifestation of a reactive (psychogenic or organic) disorder, manic state, schizophrenia, or neurological disease.

Drug treatment is effective in 75–80% of cases, with a correct diagnosis. Its action is largely symptomatic. Suppressing symptoms of hyperactivity and attention disorders facilitates the child's intellectual and social development. Drug treatment is subject to several principles: only long-term therapy ending in adolescence is effective. The selection of the drug and dose are based on the objective effect, and not on the patient’s sensations. If the treatment is effective, then it is necessary to make trial breaks at certain intervals to find out whether the child can do without the drugs. It is advisable to take the first breaks during the holidays, when the psychological stress on the child is less.

Pharmacological agents used to treat this disorder are CNS stimulants. The mechanism of their action is not fully known. However, psychostimulants not only calm the child, but also affect other symptoms. The ability to concentrate increases, emotional stability, sensitivity to parents and peers appear, and social relationships improve. Mental development may improve dramatically. Currently used are amphetamines (dexamphetamine (Dexedrine), methamphetamine), methylphenidate (Ritalin), pemoline (Zilert). Individual sensitivity to them varies. If one of the drugs is ineffective, switch to another. The advantage of amphetamines is their long duration of action and the presence of prolonged forms. Methylphenidate is usually taken 2-3 times a day, it often has a sedative effect. The intervals between doses are usually 2.5–6 hours. Long-acting forms of amphetamines are taken once a day. Doses of psychostimulants: methylphenidate - 10–60 mg/day; methamphetamine - 5-40 mg/day; pemoline - 56.25–75 mg/day. Treatment is usually started with low doses and gradually increased. Physical dependence usually does not develop. In rare cases of tolerance development, switch to another drug. It is not recommended to prescribe methylphenidate to children under 6 years of age, and dexamphetamine to children under 3 years of age. Pemoline is prescribed when amphetamines and methylphenidate are ineffective, but its effect may be delayed, lasting 3-4 weeks. Side effects - loss of appetite, irritability, epigastric pain, headache, insomnia. Pemoline has an increase in the activity of liver enzymes, possible jaundice. Psychostimulants increase heart rate and blood pressure. Some studies indicate a negative effect of drugs on height and body weight, but these are temporary effects.

If psychostimulants are ineffective, imipramine hydrochloride (Tofranil) is recommended in doses of 10 to 200 mg/day; other antidepressants (desipramine, amfebutamone, phenelzine, fluoxetine) and some antipsychotics (chlorprothixene, thioridazine, sonapax). Neuroleptics do not contribute to the social adaptation of the child, so the indications for their use are limited. They should be used in cases of severe aggressiveness, uncontrollability, or when other therapy and psychotherapy are ineffective.

Psychotherapy

Psychological assistance to children and their families can achieve a positive effect. Rational psychotherapy is advisable, explaining to the child the reasons for his failures in life; Behavioral therapy with parent training in reward and punishment methods. Reducing psychological tension in the family and at school, creating an environment favorable to the child contributes to the effectiveness of treatment. However, psychotherapy is ineffective as a method of radical treatment for disorders of activity and attention.

Monitoring of the child’s condition should be established from the beginning of treatment and carried out in several directions - studying behavior, school performance, social relationships.

Hyperkinetic behavior disorder (F90.1).

The diagnosis is made by meeting the criteria for hyperkinetic disorder and the general criteria for conduct disorder. Characterized by the presence of dissocial, aggressive or defiant behavior with a pronounced violation of relevant age and social norms, which are not symptoms of other mental conditions.

Therapy

Applicable psychostimulants are amphetamine (5-40 mg/day) or methylphenidate (5-60 mg/day), antipsychotics with a pronounced sedative effect. It is recommended to use normothimic anticonvulsants (carbamazepine, valproic acid salts) in individually selected doses. Psychotherapeutic techniques are largely socially conditioned and are of an auxiliary nature.

Behavioral disorders (F91).

They include disorders in the form of destructive, aggressive or antisocial behavior, in violation of accepted social norms and rules, and causing harm to other people. Violations are more serious than quarrels and pranks of children and adolescents.

Etiology and pathogenesis

A number of biopsychosocial factors underlie conduct disorder:

Relationship with parents' attitudes. Poor or improper treatment of children influences the development of maladaptive behavior. Etiologically significant is the struggle of parents among themselves, and not the destruction of the family. The presence of mental disorders, sociopathy or alcoholism in parents plays an important role.

Sociocultural theory - the presence of difficult socio-economic conditions contributes to the development of behavioral disorders, since they are considered acceptable in conditions of socio-economic deprivation.

Predisposing factors are the presence of minimal dysfunction or organic brain damage; rejection by parents, early placement in boarding schools; improper upbringing with harsh discipline; frequent changes of teachers and guardians; illegitimacy.

Prevalence

Quite common in childhood and adolescence. It is detected in 9% of boys and 2% of girls under the age of 18. The ratio of boys to girls ranges from 4:1 to 12:1. It is more common in children whose parents are antisocial individuals or suffer from alcoholism. The prevalence of this disorder correlates with socioeconomic factors.

Clinic

The conduct disorder must last for at least 6 months, during which at least three manifestations are observed (the diagnosis is made only before the age of 18):

1. Stealing something without the knowledge of the victim and fighting more than once (including forgery of documents).

2. Running away from home for the entire night at least 2 times, or once without returning (when living with parents or guardians).

3. Lying frequently (except when lying to avoid physical or sexual punishment).

4. Special participation in arson.

5. Frequent absenteeism from classes (work).

6. Unusually frequent and severe outbursts of anger.

7. Special entry into someone else’s house, premises, car; special destruction of someone else's property.

8. Physical cruelty to animals.

9. Forcing someone into sexual relations.

10. Using a weapon more than once; often the instigator of fights.

11. Theft after a struggle (eg, punching the victim and snatching a wallet; extortion or armed robbery).

12. Physical cruelty to people.

13. Defiant provocative behavior and constant, outright disobedience.

Differential diagnosis

Individual acts of antisocial behavior are not sufficient to make a diagnosis. Bipolar disorder, schizophrenia, pervasive developmental disorder, hyperkinetic disorder, mania, and depression should be excluded. However, the presence of mild, situationally specific symptoms of hyperactivity and inattention; low self-esteem and mild emotional manifestations do not exclude the diagnosis of conduct disorder.

Emotional disorders specific to childhood (F93).

The diagnosis of emotional (neurotic) disorder is widely used in child psychiatry. In terms of frequency of occurrence, it is second only to behavioral disorders.

Etiology and pathogenesis

In some cases, these disorders develop when the child has a tendency to overreact to everyday stressors. It is assumed that such features are inherent in character and genetically determined. Sometimes such disorders arise as a reaction to constantly worrying and overprotective parents.

Prevalence

It is 2.5% among both girls and boys.

Therapy

No specific treatment has been identified to date. Some types of psychotherapy and work with families are effective. For most forms of emotional disorders, the prognosis is favorable. Even severe disorders gradually soften and disappear over time without treatment, leaving no residual symptoms. However, if an emotional disorder that began in childhood continues into adulthood, it often takes the form of a neurotic syndrome or affective disorder.

Phobic anxiety disorder of childhood (F93.1).

Minor phobias are usually typical for childhood. Emerging fears relate to animals, insects, darkness, death. Their prevalence and severity varies with age. With this pathology, the presence of pronounced fears characteristic of a certain phase of development is noted, for example, fear of animals in the preschool period.

Diagnostics

The diagnosis is made if: a) the onset of fears corresponds to a certain age period; b) the degree of anxiety is clinically pathological; c) anxiety is not part of a generalized disorder.

Therapy

Most childhood phobias resolve without specific treatment as long as parents take a consistent approach of support and encouragement. Simple behavioral therapy with desensitization of situations that cause fear is effective.

Social anxiety disorder (F93.2).

Wariness of strangers is normal for children aged 8-12 months. This disorder is characterized by persistent, excessive avoidance of contact with strangers and peers, interfering with social interaction, lasting more than 6 months. and combined with a distinct desire to communicate only with family members or persons whom the child knows well.

Etiology and pathogenesis

There is a genetically determined predisposition to this disorder. In families of children with this disorder, similar symptoms were observed in mothers. Psychological trauma and physical damage in early childhood can contribute to the development of the disorder. Differences in temperament predispose to this disorder, especially if parents encourage the child to be modest, shy and withdrawn.

Prevalence

Social anxiety disorder is not common and is predominantly observed in boys. It can develop as early as 2.5 years, after a period of normal development or a state of minor anxiety.

Clinic

A child with social anxiety disorder has persistent, recurrent fear and/or avoidance of strangers. This fear occurs among adults and in the company of peers, and is combined with normal attachment to parents and other loved ones. Avoidance and fear go beyond age criteria and are combined with problems in social functioning. Such children avoid contact for a long time even after meeting. They slowly “thaw”; usually only natural in the home environment. Such children are characterized by redness of the skin, difficulty speaking, and mild embarrassment. There are no fundamental communication impairments or intellectual decline observed. Sometimes timidity and shyness make the learning process difficult. The true abilities of a child can only manifest themselves under exceptionally favorable upbringing conditions.

Diagnostics

Diagnosis is based on excessive avoidance of contact with strangers for 6 months. and more, interfering with social activity and relationships with peers. Characterized by a desire to deal only with familiar people (family members or peers whom the child knows well), a warm attitude towards family members. The age of manifestation of the disorder is no earlier than 2.5 years, when the phase of normal anxiety towards strangers passes.

Differential diagnosis

Differential diagnosis is carried out with adaptation disorder, which has a clear association with recent stress. At separation anxiety symptoms manifest themselves in relation to persons who are attachment figures, and not in the need to communicate with strangers. At severe depression and dysthymia there is isolation in relation to all persons, including acquaintances.

Therapy

Psychotherapy is preferred. Effective development of communication skills in dancing, singing, and music classes. Parents are explained the need to restructure relationships with the need to stimulate the child to expand contacts. Anxiolytics are prescribed in short courses to overcome avoidance behavior.

Sibling rivalry disorder (F93.3).

It is characterized by the appearance of emotional disorders in young children following the birth of a younger sibling.

Clinic

Rivalry and jealousy can manifest as noticeable competition between children to gain attention or affection from their parents. This disorder must be accompanied by an unusual degree of negative feelings. In more severe cases, this may be accompanied by open cruelty or physical harm to the younger child, belittlement and malice towards him. In milder cases, the disorder manifests itself in the form of a reluctance to share anything, a lack of attention, and a lack of friendly interactions with the younger child. Emotional manifestations take various forms in the form of some regression with the loss of previously acquired skills (control of bowel and bladder function), and a tendency to infantile behavior. Often such a child copies the behavior of the baby in order to attract more attention from the parents. Confrontation with parents, unmotivated outbursts of anger, dysphoria, severe anxiety or social withdrawal are often noted. Sometimes sleep is disturbed, and the demand for parental attention often increases, especially at night.

Diagnostics

Sibling rivalry disorder is characterized by a combination of:

a) evidence of the existence of sibling rivalry and/or jealousy;

b) started within the months following the birth of the youngest (usually the next) child;

c) emotional disturbances, abnormal in degree and/or persistence and combined with psychosocial problems.

Therapy

A combination of individual rational and family psychotherapy is effective. It is aimed at reducing stress and normalizing the situation. It is important to encourage your child to discuss relevant issues. Often, thanks to such techniques, the symptoms of disorders soften and disappear. To treat emotional disorders, antidepressants are sometimes used, taking into account individual indications and in minimal dosages, and anxiolytics in short courses to facilitate psychotherapeutic measures. General strengthening and biostimulating treatment is important.

Disorders of social functioning with onset specific to childhood and adolescence (F94).

A heterogeneous group of disorders that share common impairments in social functioning. A decisive role in the occurrence of disorders is played by changes in adequate environmental conditions or deprivation of favorable environmental influences. There are no noticeable gender differences in this group.

Selective mutism (F94.0).

Characterized by a persistent refusal to speak in one or more social situations, including in childcare settings, with the ability to understand spoken language and converse.

Etiology and pathogenesis

Selective mutism is a psychologically determined refusal to speak. A predisposing factor may be maternal overprotection. Some children develop the disorder after experiencing emotional or physical trauma in early childhood.

Prevalence

It is rare, occurring in less than 1% of patients with mental disorders. Equally common or even more common in girls than boys. Many children have delayed speech initiation or articulation problems. Children with selective mutism are more likely to have enuresis and encopresis than children with other speech disorders. Mood swings, compulsive traits, negativism, behavioral disorders with aggression in such children manifest themselves more at home. Outside the home they are shy and silent.

Clinic

Most often, children speak at home or with close friends, but remain silent at school or with strangers. As a result, they may perform poorly academically or become the target of peer bullying. Some children outside the home communicate using gestures or interjections - “hmm”, “uh-huh”, “uh-huh”.

Diagnostics

Diagnostic criteria:

1) normal or almost normal level of speech understanding;

2) sufficient level in speech expression;

3) demonstrable information that the child can speak normally or almost normally in some situations;

4) duration more than 4 weeks;

5) there is no general developmental disorder;

6) the disorder is not due to a lack of sufficient knowledge of spoken language required in a social situation in which the inability to speak is noted.

Differential diagnosis

Very shy children may not speak in unfamiliar situations, but they will recover spontaneously as the embarrassment subsides. Children who find themselves in situations where another language is spoken may be reluctant to switch to the new language. The diagnosis is made if children have fully mastered the new language, but refuse to speak both their native and new languages.

Therapy

Individual, behavioral and family therapy are successful.

Tic disorders (F95).

Tiki- involuntary, unexpected, repetitive, recurrent, irregular, stereotyped motor movements or vocalizations.

Both motor and vocal tics can be classified as simple or complex. Common simple motor tics include blinking, neck jerking, nose twitching, shoulder jerking, and facial grimacing. Common simple vocal tics include coughing, sniffling, grunting, barking, snorting, and hissing. Common complex motor tics include beating oneself, touching oneself and/or objects, jumping, squatting, and gesticulating. A common set of vocal tics includes the repetition of special words, sounds (palilalia), phrases, and curse words (coprolalia). Tics tend to be experienced as overwhelming, but they can usually be suppressed for varying periods of time.

Tics often occur as an isolated phenomenon, but they are often combined with emotional disorders, especially obsessive or hypochondriacal phenomena. Specific developmental delays are sometimes associated with tics.

The main feature distinguishing tics from other movement disorders is the sudden, rapid, transient and limited nature of movements in the absence of a neurological disorder. Characterized by the repetition of movements and their disappearance during sleep, the ease with which they can be voluntarily caused or suppressed. The lack of rhythm allows them to be distinguished from stereotypy in autism or mental retardation.

Etiology and pathogenesis

One of the most important factors in the occurrence of tics is a violation of the neurochemical regulation of the central nervous system. Head injuries play a role in the occurrence of tics. The use of psychostimulants enhances existing tics or causes their appearance, which suggests the role of dopaminergic systems, in particular, increased dopamine levels in the occurrence of tics. Additionally, the dopamine blocker haloperidol is effective in treating tics. The pathology of noradrenergic regulation is proven by the worsening of tics under the influence of anxiety and stress. No less important is the genetic cause of disorders. Currently, there is no satisfactory explanation for variations in the course, reactions to pharmacological drugs, or family history of tic disorders.

Transient tic disorder (F95.0).

This disorder is characterized by the presence of single or multiple motor and/or vocal tics. Tics appear many times a day, almost every day for a period of at least 2 weeks, but no more than 12 months. There should be no history of Gilles de la Tourette syndrome or chronic motor or vocal tics. Onset of the disease before the age of 18 years.

Etiology and pathogenesis

Transient tic disorder most likely has either an unexpressed organic or psychogenic origin. Organic tics are more common in family history. Psychogenic tics most often undergo spontaneous remission.

Prevalence

Between 5 and 24% of school-age children suffered from this disorder. The prevalence of tics is unknown.

Clinic

This is the most common type of tic and is most common between 4 and 5 years of age. Tics usually take the form of blinking, facial grimacing, or head jerking. In some cases, tics occur as a single episode, in others there are remissions and relapses over a period of time.

The most common manifestation of tics:

1) Face and head in the form of grimacing, wrinkling of the forehead, raising the eyebrows, blinking the eyelids, closing the eyes, wrinkling the nose, fluttering the nostrils, clenching the mouth, baring the teeth, biting the lips, sticking out the tongue, extending the lower jaw, bending or shaking the head, twisting the neck, head rotation.

2) Hands: rubbing, twitching fingers, twisting fingers, clenching hands into fists.

3) Body and lower limbs: shrugging shoulders, jerking legs, strange gait, swaying body, jumping.

4) Respiratory and digestive organs: hiccups, yawning, sniffing, noisy blowing air, wheezing, increased breathing, belching, sucking or smacking sounds, coughing, clearing the throat.

Differential diagnosis

Tics should be differentiated from other movement disorders (dystonic, choreiform, athetoid, myoclonic movements) and neurological diseases (Huntington's chorea, Sydenham's chorea, parkinsonism etc.), side effects of psychotropic drugs.

Therapy

From the very beginning of the disorder, it is not clear whether the tic disappears spontaneously or progresses, becoming chronic. Since drawing attention to tics makes them worse, it is recommended to ignore their occurrence. Psychopharmacological treatment is not recommended unless the disorder is severe and not disabling. Behavioral psychotherapy aimed at changing habits is recommended.

A type of tic disorder in which there are or have been multiple motor tics and one or more vocal tics that do not occur simultaneously. The onset almost always occurs in childhood or adolescence. The development of motor tics before vocal tics is characteristic. Symptoms often worsen during adolescence, with elements of the disorder typically persisting into adulthood.

Etiology and pathogenesis

The large role of both genetic factors and disorders of the neurochemical function of the central nervous system.

Prevalence

Clinic

Characteristically, there are either motor or vocal tics, but not both. Tics occur many times a day, almost every day, or periodically for more than one year. Onset before age 18. Tics appear not only during intoxication with psychoactive substances or as a result of known diseases of the central nervous system (for example, Huntington's disease, viral encephalitis). The types of tics and their localization are similar to transient ones. Chronic vocal tics are less common than chronic motor tics. Vocal tics are often not loud or strong, and consist of noises created by contraction of the larynx, abdomen, and diaphragm. Rarely they are multiple with explosive, repetitive vocalizations, coughing, and grunting. Like motor tics, vocal tics can be spontaneously suppressed for a while, disappear during sleep and intensify under the influence of stress factors. The prognosis is somewhat better in children who become ill at the age of 6–8 years. If the tics involve the limbs or trunk, rather than just the face, the prognosis is usually worse.

Differential diagnosis

It is also necessary to treat tremors, mannerisms, stereotypies or disorders in the form of bad habits (head tilting, body swaying), more often found in childhood autism or mental retardation. The voluntary nature of stereotypies or bad habits and the lack of subjective distress about the disorder distinguish them from tics. Treatment of attention deficit hyperactivity disorder with psychostimulants intensifies existing tics or accelerates the development of new tics. However, in most cases, after stopping the drugs, the tics stop or return to the level that existed before treatment.

Therapy

Depends on the severity and frequency of tics, subjective experiences, secondary disturbances at school and the presence of other concomitant psychotic disorders.

Psychotherapy plays a major role in treatment.

Minor tranquilizers are ineffective. In some cases, haloperidol is effective, but the risk of side effects of this drug, including the development of tardive dyskinesia, should be taken into account.

It is characterized as a psychoneurological disease with multiple motor and vocal tics (blinking, coughing, pronouncing phrases or words, for example “no”), which sometimes increase and decrease. It occurs in childhood or adolescence, has a chronic course and is accompanied by neurological, behavioral and emotional disorders. Gilles de la Tourette syndrome is most often hereditary.

Gilles de la Tourette first described this disease in 1885, studying it at Charcot's clinic in Paris. Modern ideas about Gilles de la Tourette syndrome were formed thanks to the works of Arthur and Elaine Shapiro (60-80s of the XX century).

Etiology and pathogenesis

The morphological and mediator basis of the syndrome has been identified in the form of diffuse disturbances of functional activity mainly in the basal ganglia and frontal lobes. Several neurotransmitters and neuromodulators have been proposed to play a role, including dopamine, serotonin, and endogenous opioids. The main role is played by genetic predisposition to this disorder.

Prevalence

Data on the prevalence of the syndrome are contradictory. Fully expressed de la Tourette's syndrome occurs in 1 in 2000 (0.05%). The lifetime risk of the disease is 0.1–1%. In adulthood, the syndrome begins 10 times less often than in childhood. Genetic evidence suggests autosomal dominant inheritance of Gilles de la Tourette syndrome with incomplete penetrance. The sons of mothers with de la Tourette syndrome are at greatest risk of developing this disease. Familial accumulation of Gilles de la Tourette syndrome, chronic tic and obsessive-compulsive neurosis is shown. Carriage of the gene that causes Gilles de la Tourette syndrome in males is accompanied by an increased likelihood of obsessive-compulsive disorder in females.

Clinic

The presence of multiple motor and one or more vocal tics is typical, although not always simultaneously. Tics occur many times during the day, usually in paroxysms, almost daily or With intermittently for a year or more. The number, frequency, complexity, severity and location of tics vary. Vocal tics are often multiple, with explosive vocalizations, and sometimes obscene words and phrases (coprolalia) are used, which may be accompanied by obscene gestures (copropraxia). Both motor and vocal tics can be voluntarily suppressed for short periods of time, exacerbated by anxiety and stress, and appear or disappear during sleep. Tics are not associated with non-psychiatric diseases such as Huntington's disease, encephalitis, intoxication, and drug-induced movement disorders.

Gilles de la Tourette syndrome occurs in waves. The disease usually begins before the age of 18; tics of the muscles of the face, head or neck appear at 6–7 years of age, then over the course of several years they spread from top to bottom. Vocal tics usually appear at 8–9 years of age, and at 11–12 years old obsessions and complex tics appear. 40–75% of patients have features of attention deficit hyperactivity disorder. Over time, symptoms stabilize. There is a frequent combination of the syndrome with partial developmental delays, anxiety, aggressiveness, and obsessions. Children with Gilles de la Tourette syndrome often have learning difficulties.

Differential diagnosis

Most difficult with chronic tics. Typical characteristics of tic disorders are repetition, rapidity, irregularity, and involuntariness. At the same time, some patients with de la Tourette's syndrome believe that a tic is a voluntary reaction to the sensation that precedes it. This syndrome is characterized by a wave-like course with onset in childhood or adolescence.

- Sydenham's chorea (minor chorea) is a consequence of a neurological complication of rheumatism, in which choreic and athetotic (slow worm-like) movements are observed, usually of the arms and fingers and movements of the torso.

- Huntington's chorea is an autosomal dominant disease manifested by dementia and chorea with hyperkinesis (irregular, spastic movements, usually of the limbs and face).

- Parkinson's disease is a late-life disease characterized by a mask-like appearance of the face, gait disturbances, increased muscle tone (“cogwheel”), and rest tremor in the form of “rolling pills.”

- Drug-induced extrapyramidal disorders develop during treatment with neuroleptics, late neuroleptic hyperkinesis is the most difficult to diagnose. Since antipsychotics are used in the treatment of Gilles de la Tourette syndrome, it is necessary to describe in detail all the patient’s disorders before starting drug treatment.

Therapy

Aimed at reducing tic manifestations and social adaptation of the patient. Rational, behavioral, individual, group and family types of psychotherapy play an important role. Restraint training (or the “like-like” type of tic fatigue) is recommended, even against the backdrop of successful drug treatment.

Drug treatment is currently the main method of therapy. Treatment begins only after a complete examination, with minimal doses of drugs with a gradual increase over several weeks. It is preferable to start with monotherapy. To date, haloperidol remains the drug of choice. It blocks D2 receptors in the basal ganglia area. Children are prescribed 0.25 mg/day, increasing by 0.25 mg/day. weekly. The therapeutic range is from 1.5 to 5 mg/day, depending on age. Pimozide is sometimes preferred because it has a greater affinity for striatal neural pathways than for mesocortical pathways. It has fewer side effects than haloperidol, but is contraindicated in patients with heart disease. Doses from 0.5 to 5 mg/day. Other antipsychotics are also used - fluorophenazine, penfluridol.

The alpha2-adrenergic receptor stimulator clonidine is effective. Its action is associated with stimulation of presynaptic receptors of noradrenergic endings. It significantly reduces excitability, impulsivity and attention disorders. Dose 0.025 mg/day. followed by an increase every 1–2 weeks to the average therapeutic dose of 0.05 to 0.45 mg/day.

Drugs that affect serotonergic transmission are applicable - clomipramine (10-25 mg/day), fluoxetine (5-10 mg/day), especially in the presence of obsessions. Sertraline and paroxetine may be effective, but experience with their use is insufficient. The effect of benzodiazepines, antagonists of narcotic analgesics, and some psychostimulants is being studied.

Other emotional and behavioral disorders, usually beginning in childhood and adolescence (F98).

Inorganic enuresis (F98.0).

It is characterized by involuntary urination during the day and/or at night, inappropriate for the mental age of the child. Not caused by a lack of control over bladder function due to a neurological disorder, epileptic seizures, or structural abnormalities of the urinary tract.

Etiology and pathogenesis

Bladder control develops gradually and is influenced by neuromuscular characteristics, cognitive function, and possibly genetic factors. Disturbances in one of these components can contribute to the development of enuresis. Children with enuresis are approximately twice as likely to have developmental delays. 75% of children with non-organic enuresis have close relatives suffering from enuresis, which confirms the role of genetic factors. Most children with enuresis have an anatomically normal bladder, but it is “functionally small.” Psychological stress can worsen enuresis. The birth of a sibling, the start of school, the breakup of a family, and moving to a new place of residence play a big role.

Prevalence

Enuresis affects more men than women at any age. The disease occurs in 7% of boys and 3% of girls by age 5, 3% of boys and 2% of girls by age 10, and 1% of boys, and is almost completely absent in girls by age 18. Daytime enuresis is less common than nighttime enuresis, occurring in approximately 2% of 5-year-old children. Unlike nocturnal, daytime enuresis is more common in girls. Mental disorders are present in only 20% of children with non-organic enuresis; they are most common in girls or in children with daytime and nocturnal enuresis. In recent years, descriptions of rare forms of epilepsy have increasingly appeared in the literature: the epileptic variant of enuresis in children (5-12 years old).

Clinic

Inorganic enuresis can be observed from birth - “primary” (in 80%), or occur after a period of more than 1 year of acquired bladder control - “secondary”. Late onset is usually observed between 5 and 7 years of age. Enuresis may be a single symptom or associated with other emotional or behavioral disorders, and constitutes the primary diagnosis if involuntary urination occurs several times a week or if other symptoms show a temporary association with enuresis. Enuresis is not associated with any specific sleep phase or time of night, and is more often observed in a random manner. Sometimes it occurs when it is difficult to transition from the slow phase of sleep to the fast phase. Emotional and social problems resulting from bedwetting include low self-esteem, feelings of inadequacy, social limitations, inhibitions, and intrafamily conflict.

Diagnostics

The minimum chronological age for diagnosis should be 5 years, and the minimum mental age should be 4 years.

Involuntary or voluntary urination on bed or clothing may occur during the day (F98.0) or night (F98.01) or occur during the night and day (F98.02).

At least two episodes per month for children aged 5–6 years and one event per month for older children.

The disorder is not associated with a physical illness (diabetes, urinary tract infections, seizures, mental retardation, schizophrenia and other mental illnesses).

The duration of the disorder is at least 3 months.

Differential diagnosis

It is necessary to exclude possible organic causes of enuresis. Organic factors are most often found in children who have daytime and nocturnal enuresis, combined with frequent urination and an urgent need to empty the bladder. They include: 1) disorders of the genitourinary system - structural, neurological, infectious (uropathy, cystitis, hidden spina bifida, etc.); 2) organic disorders causing polyuria - diabetes mellitus or diabetes insipidus; 3) disorders of consciousness and sleep (intoxication, somnambulism, epileptic seizures), 4) side effects of treatment with certain antipsychotic drugs (thioridazine, etc.).

Therapy

Due to the polyetiology of the disorder, various methods are used in treatment.

Hygiene requirements include toilet training, limiting fluid intake 2 hours before bed, and occasionally waking up at night to use the toilet.

Behavioral therapy. In the classic version - conditioning a signal (bell, beep) on the time of the onset of involuntary urination. The effect is observed in more than 50% of cases. This therapy uses hardware methods. It is reasonable to combine this treatment option with praise or rewards for longer periods of abstinence.

Drug treatment

However, the effect is not always long lasting. There are reports of the effectiveness of the use of driptan (the active substance is oxybutrin), which has a direct antispasmodic effect on the bladder and a peripheral M-cholinergic effect with a decrease in hypertonicity of the parasympathetic nervous system. Doses 5 - 25 mg/day.

Traditional options for psychotherapy for enuresis are not effective in some cases.

Inorganic encopresis (F98.1).

Inorganic encopresis is fecal incontinence at an age when control over bowel activity must be physiologically developed and when toilet training has been completed.

Bowel control develops sequentially from the ability to refrain from bowel movements at night, then during the day.

The achievement of these developmental features is determined by physiological maturation, intellectual abilities, and degree of culture.

Etiology and pathogenesis

Lack of or insufficient toilet training may result in delayed bowel control. Some children suffer from intestinal contractile dysfunction. The presence of a concomitant mental disorder is often indicated by bowel movements in inappropriate places (with normal consistency of discharge). Sometimes encopresis is associated with neurodevelopmental problems, including inability to maintain attention for long periods of time, being easily distractible, hyperactivity, and poor coordination. Secondary encopresis is sometimes a regression associated with stress factors (the birth of a sibling, parental divorce, change of place of residence, start of school).

Prevalence

This disorder is observed in 6% of 3-year-olds and 1.5% of 7-year-olds. 3–4 times more common in boys. Approximately 1/3 of children suffering from encopresis also have enuresis. Most often, encopresis is observed during the daytime; if it occurs at night, the prognosis is unfavorable.

Clinic

The decisive diagnostic sign is the act of defecation in inappropriate places. The excretion of excrement (in bed, clothes, on the floor) can be either voluntary or involuntary. Frequency of at least one manifestation per month for at least 6 months. Chronological and mental age of at least 4 years. The disorder must not be associated with a physical illness.

Primary encopresis: if the disorder was not preceded by a period of monitoring of bowel function of at least 1 year.

Secondary encopresis: the disorder was preceded by a period of control of bowel function lasting 1 year or more.

In some cases, the disorder is caused by psychological factors - disgust, resistance, inability to obey social norms, while there is normal physiological control over bowel movements. Sometimes the disorder is observed due to physiological retention of feces with secondary intestinal overflow and discharge of feces in inappropriate places. This delay in defecation may occur as a result of conflicts between parents and child when teaching bowel control or due to painful bowel movements.

In some cases, encopresis is accompanied by smearing feces on the body, the environment, or may involve inserting a finger into the anus and masturbation. In this case, concomitant emotional and behavioral disorders are often observed.

Differential diagnosis

When making a diagnosis, it is important to consider: 1) encopresis caused by an organic disease (colon aganglionosis), spina bifida; 2) chronic constipation, including an overload of feces and subsequent soiling with semi-liquid feces as a result of “intestinal overflow”.

However, in some cases, encopresis and constipation can coexist, in such cases a diagnosis of encopresis is made with additional somatic coding of the condition that caused the constipation.

Therapy

Psychotherapy aimed at reducing tension in the family and alleviating the emotional reactions of a person suffering from encopresis (emphasis on increasing self-esteem) is effective. Constant positive reinforcement is recommended. For fecal incontinence associated with intestinal dysfunction secondary to a period of fecal retention (constipation), the patient is taught the rules of hygiene. Measures are taken to relieve pain during defecation (anal fissures or hard stools); in these cases, pediatrician supervision is necessary.

Feeding disorder in infancy and childhood (F98.2).

Manifestations of nutritional disorders are specific to infancy and early childhood. They include refusal to eat, extreme pickiness in the presence of adequate quantity and quality of food and a feeding person; in the absence of organic disease. Chewing “Rumination” gum (repeated regurgitation without nausea and disturbances in the functioning of the gastrointestinal tract) may be observed as a concomitant disorder. This group includes regurgitation disorder in infancy.

Etiology and pathogenesis

The existence of several etiological factors (various disorders of the relationship between mother and child) is assumed. As a result of an inadequate relationship with the mother, the child does not receive sufficient emotional satisfaction and stimulation and is forced to seek satisfaction on his own. The inability to swallow food is interpreted as an attempt by the infant to restore the feeding process and provide satisfaction that the mother is unable to provide. Overstimulation and tension are considered possible causes.

Dysfunction of the autonomic nervous system plays a role in this disorder. A number of children with this disorder have gastroesophageal reflux or hiatal hernia, and sometimes frequent regurgitation is a symptom of intracranial hypertension.

Prevalence

Rarely seen. Observed in children from 3 months. up to 1 year and in mentally retarded children and adults. It is equally common among girls and boys.

Clinic

Diagnostic criteria

Recurrent regurgitation without vomiting or associated gastrointestinal disease, lasting at least 1 month, following a period of normal function.

Weight loss or inability to achieve the desired body weight.

With obvious manifestations, the diagnosis is beyond doubt. Partially digested food or milk returns to the mouth without vomiting or retching. The food is then swallowed again or expelled from the mouth. Characteristic is a posture with tension and an arched back, head backwards. The child makes sucking movements with his tongue, and it seems that he is enjoying his activity.

The baby is irritable and hungry between burping periods.

Typically, this disease has spontaneous remissions, but severe secondary complications may develop - progressive malnutrition, dehydration, or decreased resistance to infections. There is a deterioration in well-being, increased underdevelopment or developmental delays in all areas. In severe cases, mortality reaches up to 25%.

The disorder may manifest as abnormal pickiness, atypical undereating, or overeating.

Differential diagnosis

Differentiate with a congenital anomaly or infections of the gastrointestinal tract, which may cause regurgitation of food.

This disorder should be distinguished from:

1) conditions when a child takes food from adults other than nursing persons or caregivers;

2) an organic disease sufficient to explain the refusal to eat;

3) anorexia nervosa and other eating disorders;

4) general mental disorder;

5) feeding difficulties or feeding management disorders (R63.3).

Therapy

Complications (nutritional dystrophy, dehydration) are mainly treated.

It is necessary to improve the child’s psychosocial environment and conduct psychotherapeutic work with those caring for the child. Behavioral therapy by aversive conditioning is effective (at the moment of the onset of the disorder, an unpleasant substance is given, for example, lemon juice), this has the most pronounced effect.

Several studies have reported that allowing patients to eat as much as they want reduces the severity of the disorder.

Eating inedible things (pika) in infancy and childhood (F98.3).

Characterized by persistent ingestion of non-food substances (dirt, paint, glue). Pica may occur as one of many symptoms as part of a mental disorder, or may occur as a relatively isolated psychopathological behavior.

Etiology and pathogenesis

The following reasons are assumed: 1) the result of an abnormal relationship between mother and child, affecting the unsatisfactory state of oral needs; 2) specific nutritional deficiency; 3) cultural factors; 4) presence of mental retardation.

Prevalence

The disease is most common among children with mental retardation, but can also occur in young children with normal intelligence. Frequency of occurrence: 10–32.3% of children aged 1 to 6 years. It is observed equally often in both sexes.

Clinic

Diagnostic criteria

Repeated consumption of non-food substances for about 1 month.

Does not meet the criteria for disorders such as autism, schizophrenia, Klein-Levine syndrome.

Eating inedible substances is considered pathological from the age of 18 months. Usually children try paints, plaster, ropes, hair, clothes; others prefer dirt, animal feces, rocks and paper. Clinical consequences can sometimes be life-threatening, depending on the object ingested. With the exception of mentally retarded children, the peak usually subsides by adolescence.

Differential diagnosis

Non-food substances can be eaten by people with disorders such as autism, schizophrenia and some physical disorders (Klein-Lewin syndrome).

Eating unusual and sometimes potentially dangerous substances (animal food, garbage, drinking toilet water) is a common behavioral pathology in children with underdevelopment of some organ (psychosocial dwarfism).

Therapy

Treatment is symptomatic and includes psychosocial, behavioral and/or family approaches.

Behavioral therapy using aversive techniques or negative reinforcement (weak electrical stimuli, unpleasant sounds, or emetics) is most effective. Positive reinforcement, modeling, and corrective therapy are also used. Increasing parental attention to a sick child, stimulation and emotional education play a therapeutic role.

Secondary complications (eg, mercury, lead poisoning) must be treated.

Stuttering (F98.5).

Characteristic features - frequent repetition or prolongation of sounds, syllables or words; or frequent stops, hesitation in speech with disturbances in its smoothness and rhythmic flow.

Etiology and pathogenesis

The exact etiological factors are not known. A number of theories have been put forward:

1. Stuttering block theories(genetic, psychogenic, semantic). The basis of the theory is the cerebral dominance of speech centers with a constitutional predisposition to the development of stuttering due to stress factors.

2. Theories of the beginning(includes relapse theory, need theory, and anticipation theory).

3. Learning theory is based on an explanation of the principles of the nature of reinforcement.

4. Cybernetic theory(speech is an automatic feedback-type process. Stuttering is explained by a failure of feedback).

5. Theory of changes in the functional state of the brain. Stuttering is a consequence of incomplete specialization and lateralization of language functions.

Recent research suggests that stuttering is a genetically inherited neurological disorder.

Prevalence

Stuttering affects 5 to 8% of children. The disorder is 3 times more common in boys than in girls. In boys it is more stable.

Clinic

Stuttering usually begins before the age of 12 years, in most cases there are two acute periods - between 2–4 and 5–7 years. It usually develops over several weeks or months, starting with the repetition of initial consonants or whole words that are the beginning of a sentence. As the disorder progresses, repetitions become more frequent, with stuttering on more important words and phrases. Sometimes it may be absent when reading aloud, singing, talking to pets or inanimate objects. The diagnosis is made when the disorder lasts for at least 3 months.

Clonic-tonic stuttering (rhythm, tempo, fluency of speech are disturbed) - in the form of repetition of initial sounds or syllables (logoclonus), at the beginning of speech clonic convulsions with transition to tonic.

Tonic-clonic stuttering characterized by disturbances in the rhythm and fluency of speech in the form of hesitations and stops with frequent increased vocalization and severe breathing disorders accompanying speech. Additional movements are observed in the muscles of the face, neck, and limbs.

During stuttering there are:

Phase 1 - preschool period. The disorder appears sporadically with long periods of normal speech. After such a period, recovery may occur. During this phase, stuttering occurs when children are excited, upset, or need to talk a lot.

Phase 2 occurs in elementary school. The disorder is chronic in nature with very short periods of normal speech. Children realize and painfully experience their lack. Stuttering affects the main parts of speech - nouns, verbs, adjectives and adverbs.

Phase 3 occurs after 8–9 years and lasts until adolescence. Stuttering occurs or intensifies only in certain situations (calling to the board, shopping in a store, talking on the phone, etc.). Some words and sounds are more difficult than others.

Phase 4 occurs in late adolescence and in adults. Expressed fear of stuttering. Substitution of words and bouts of verbosity are typical. Such children avoid situations that require verbal communication.

The course of stuttering is usually chronic, with periods of partial remissions. Between 50 and 80% of children who stutter, especially mild cases, recover.

Complications of the disorder include decreased performance in school due to shyness, fear of speech disorders; restrictions in choosing a profession. For those suffering from chronic stuttering, frustration, anxiety, and depression are typical.

Differential diagnosis

Spasmodic dysphonia is a speech disorder similar to stuttering, but differs in the presence of an abnormal breathing pattern.

Blurred speech In contrast, stuttering is characterized by erratic and dysrhythmic speech patterns in the form of rapid and abrupt bursts of words and phrases. When speech is unclear, there is no awareness of one's shortcomings, while people who stutter are acutely aware of their speech impairments.

Therapy

Includes several directions. The most typical are distraction, suggestion and relaxation. People who stutter are taught to speak simultaneously with rhythmic movements of the hand and fingers or in a slow, sing-song voice. The effect is often temporary.

Classical psychoanalysis and psychotherapeutic methods are not effective in treating stuttering. Modern methods are based on the view that stuttering is a form of learned behavior not associated with neurotic manifestations or neurological pathology. Within the framework of these approaches, it is recommended to minimize factors that increase stuttering, reduce secondary disorders, and convince a stutterer to speak, even with a stutter, freely, without embarrassment and fear, in order to avoid secondary blocks.

An effective self-therapy method is based on the premise that stuttering is a specific behavior that can be changed. This approach includes desensitization, which reduces emotional reactions and fear of stuttering. Because stuttering is something a person does, and a person can learn to change what they do.

Drug treatment is auxiliary in nature and is aimed at relieving symptoms of anxiety, severe fear, depressive symptoms, and facilitating communication interactions. Calming, sedative, and general restoratives are applicable (valerian, motherwort, aloe, multivitamins and B vitamins, magnesium preparations). In the presence of spastic forms, antispasmodics are used: mydocalm, sirdalud, myelostan, diafen, amizil, theophedrine. Tranquilizers are used with caution; Mebicar 450–900 mg/day is recommended, in short courses. Dehydration courses have a significant effect.

Alternative drug treatment options:

1) For clonic stuttering, Pantogam is used from 0.25 to 0.75 - 3 g/day, courses lasting 1–4 months.

2) Carbamazepines (mainly Tegretol, Timonil or Finlepsin-Reterd) with 0.1 g/day. up to 0.4, g/day. for 3–4 weeks, with a gradual reduction in dose to 0.1 g/day. as maintenance treatment, lasting up to 1.5–2 months.

Comprehensive treatment of stuttering also includes physiotherapeutic procedures, courses of general and specialized speech therapy massage, speech therapy, and psychotherapy using the suggestive method.

Speech excitedly (F98.6).

A speech fluency disorder that involves problems with the speed and rhythm of speech, causing speech to become unintelligible. Speech is disordered, unrhythmic, consisting of quick and sharp bursts, which usually contain incorrectly composed phrases (periods of pauses and bursts of speech are not related to the grammatical structure of the sentence).

Etiology and pathogenesis

The causes of the disorder are unknown. Individuals suffering from this disorder have similar occurrences among family members.

Prevalence

There is no information on prevalence. More common in boys than girls.

Clinic

The disorder begins between the ages of 2 and 8 years. Develops over weeks or months and worsens in situations of emotional stress or pressure. A duration of at least 3 months is required to make a diagnosis.

Speech is fast, bursts of speech make it even more incomprehensible. About 2/3 of children recover spontaneously by adolescence. In a small percentage of cases, secondary emotional disturbances or negative family reactions occur.

Differential diagnosis

Excited speech should be differentiated from stuttering, other speech development disorders, characterized by frequent repetition or prolongation of sounds or syllables that impair speech fluency. The main differential diagnostic feature is that when speaking excitedly, the subject usually does not realize his disorder; even in the initial stages of stuttering, children are very sensitive to their speech defect.

Therapy

In most cases, with moderate to severe severity, speech therapy is indicated.

Psychotherapeutic techniques and symptomatic treatment are indicated in the presence of frustration, anxiety, signs of depression, and difficulties in social adaptation.

Family therapy is effective when it is aimed at creating adequate conditions in the family for the patient.

AND ABOUT. Karelina

The problem of the emotional well-being of children in the family and preschool is one of the most pressing, since a positive emotional state is one of the most important conditions for personal development.

The child's high emotionality, which colors his mental life and practical experience, is a characteristic feature of preschool childhood. The internal, subjective attitude of a child to the world, to people, to the very fact of his own existence is an emotional perception of the world. In some cases it is joy, fullness of life, agreement with the world and oneself, lack of affectivity and withdrawal into oneself; in others - excessive tension in interaction, a state of depression, low mood or, conversely, pronounced aggression.

Thus, the emotional worldview of a preschooler is “an expression of subjective experience, its intensity and depth, the maturity of emotions and feelings in general.”

The emotional experience of a child, that is, the experience of his experiences, can have both positive and negative connotations, which has a direct impact on his current well-being. Modern scientific data convincingly show that the result of a positive-oriented childhood experience: trust in the world, openness, willingness to cooperate provides the basis for positive self-realization of a growing personality.

For the mental health of children, a balance of positive and negative emotions is necessary, ensuring the maintenance of mental balance and life-affirming behavior. Violation of the emotional balance contributes to the emergence of emotional disorders, leading to deviations in the development of the child’s personality and disruption of his social contacts.

An analysis of the psychological literature (,,,) allows us to identify three groups of disorders in the development of the emotional sphere of a preschool child: – mood disorders; – behavioral disorders; – psychomotor disorders.

Mood disorders can be divided into 2 types: with increased emotionality and its decrease. Group 1 includes conditions such as euphoria, dysphoria, depression, anxiety syndrome, and fears. The 2nd group includes apathy, emotional dullness, parathymia.

Euphoria is an elevated mood not associated with external circumstances. A child in a state of euphoria is characterized as impulsive, striving for dominance, and impatient.

Dysphoria is a mood disorder with a predominance of angry-sad, gloomy-dissatisfied, with general irritability and aggressiveness. A child in a state of dysphoria can be described as sullen, angry, harsh, unyielding.

Depression is an affective state characterized by a negative emotional background and general passivity of behavior. Depression in preschool age in its classic form is usually atypical and erased. A child with a low mood can be described as unhappy, gloomy, pessimistic.

Anxiety syndrome is a state of causeless concern, accompanied by nervous tension and restlessness. A child experiencing anxiety can be defined as insecure, constrained, and tense.

Fear is an emotional state that occurs when one perceives an impending danger. A preschooler who experiences fear looks timid, frightened, and withdrawn.

Apathy is an indifferent attitude towards everything that happens, which is combined with a sharp drop in initiative.

An apathetic child can be described as lethargic, indifferent, passive.

Emotional dullness is a flattening of emotions, first of all, the loss of subtle altruistic feelings while maintaining elementary forms of emotional response.

Parathymia, or inadequacy of emotions, is a mood disorder in which the experience of one emotion is accompanied by the external manifestation of an emotion of the opposite valence.

Emotional dullness and parathymia are characteristic of children suffering from schizophrenia.

Behavioral disorders include hyperactivity and aggressive behavior: normative instrumental aggression, passive aggressive behavior, infantile aggression, defensive aggression, demonstrative aggression, purposefully hostile aggression,.

Hyperactivity is a combination of general motor restlessness, restlessness, impulsiveness of actions, emotional lability, and impaired concentration. A hyperactive child is restless, does not finish what he starts, and his mood changes quickly.

Normative-instrumental aggression is a type of childhood aggression, where aggression is used mainly as a norm of behavior in communication with peers.

An aggressive child behaves defiantly, is restless, pugnacious, takes initiative, does not admit guilt, and demands the submission of others. His aggressive actions are a means to achieve a specific goal, so he experiences positive emotions upon achieving the result, and not at the moment of aggressive actions.

Passive-aggressive behavior is characterized by whims, stubbornness, a desire to subjugate others, and an unwillingness to maintain discipline.

Infantile aggressiveness manifests itself in the child’s frequent quarrels with peers, disobedience, making demands on parents, and the desire to insult others.

Defensive aggression is a type of aggressive behavior that manifests itself both normally (an adequate response to external influences) and in an exaggerated form, when aggression occurs in response to a variety of influences.

The occurrence of hypertrophied aggression may be associated with difficulties in decoding the communicative actions of others.

Demonstrative aggression is a type of provocative behavior aimed at attracting the attention of adults or peers. In the first case, the child uses verbal aggression in indirect form, which manifests itself in various statements in the form of complaints about a peer, in a demonstrative cry aimed at eliminating the peer. In the second case, when children use aggression as a means of attracting the attention of peers, they most often use physical aggression - direct or indirect, which is involuntary, impulsive in nature (directly attacking another, threats and intimidation - as an example of direct physical aggression or destruction products of the activity of another child in the case of indirect aggression).

Purposeful hostile aggression is a type of childhood aggressiveness where the desire to harm another is an end in itself. Aggressive actions of children, bringing pain and humiliation to peers, do not have any visible goal - neither for others, nor for themselves, but imply pleasure from causing harm to others. Children use mainly direct physical aggression, while their actions are particularly cruel and cold-blooded, and there are absolutely no feelings of remorse.

Psychomotor disorders include: 1. amyia, lack of expressiveness of the facial muscles, observed in certain diseases of the central or peripheral nervous system; 2. hypomimia, a slight decrease in the expressiveness of facial expressions; 3. inexpressive pantomime.

As T.I. Babaeva emphasizes, the condition for the socio-emotional development of a child is his “ability to “read” the emotional state of the people around him, to empathize and, accordingly, to actively respond to it.” Therefore, disorders in the emotional development of a preschooler include difficulties in adequately determining the emotional states of people, since in the practice of teaching and raising children, the task of forming emotionality is solved only in fragments, and primary attention is paid to the development of thought processes. One of the reasons for this situation is the lack of coverage of the issue of emotional impact.

Disorders of emotional development in preschool age are caused by two groups of reasons:

Constitutional reasons (type of the child’s nervous system, biotonus, somatic features, that is, disruption of the functioning of any organs).

Features of the child’s interaction with the social environment. A preschooler has his own experience of communicating with adults, peers and a particularly significant group for him - the family, and this experience can be unfavorable: 1) if the child is systematically subjected to negative evaluations from an adult, he is forced to repress into the unconscious a large amount of information coming from the environment . New experiences that do not coincide with the structure of his “I-concept” are perceived negatively by him, as a result of which the child finds himself in a stressful situation.

2) With dysfunctional relationships with peers, emotional experiences arise that are characterized by severity and duration: disappointment, resentment, anger.

3) Family conflicts, different demands on the child, misunderstanding of his interests can also cause him negative experiences. The following types of parental attitudes are unfavorable for the emotional and personal development of a preschooler: rejection, overprotection, treatment of the child according to the principle of a double bond, over-demandingness, avoidance of communication, etc. Among the emotional traits that develop under the influence of such parental relationships, aggressiveness, self-aggressiveness, lack of ability to emotionally decenter, feelings of anxiety, suspiciousness, emotional instability in communicating with people. Whereas close, intense emotional contacts, in which the child is “the object of a friendly, but demanding, evaluative attitude, ... form confidently optimistic personal expectations in him.”