Lecture
Combined developmental disorders in a child are a situation in which the child simultaneously presents various types of developmental disorders, such as physical, psychological, intellectual and social. These disorders may be linked to a variety of causes, which can overlap and interact with one another.
According to the position of L. S. Vygotsky, the presence of a defect in a given analyzer or an intellectual impairment causes not merely the isolated loss of a single function, but also a range of interrelated deviations, as a result of which a coherent picture of atypical, distinctive development takes shape. The complexity of the structure of abnormal development lies in the presence of a primary defect, caused by biological factors, and secondary deviations, formed as a consequence of the primary one. Complex forms of child development include the combination of two or more psychophysical disorders (of vision, hearing, speech, mental development) in one child. As synonyms for the term "complex disorders" the literature also uses other terms equivalent to it: "complex defect," "complex developmental anomalies," "combined disorders," "combined impairments," "multiple disorders" and, increasingly established in recent times - "complex structure of the disorder". The increased attention to this category of children in recent years can be explained by the further expansion of the differentiated approach to the instruction and upbringing of abnormal children, as well as by the tendency toward a quantitative increase in this category of children.
Developmental disorders can be isolated (single) or complex (multiple).
A single disorder – is a disorder of one particular bodily system (vision, hearing).
Multiple (also known as complex, combined, comorbid) developmental disorders include cases when a child (adolescent) simultaneously shows
the presence of two or more disorders, each of which constitutes an independent primary developmental defect.
Typical variants – deafblindness, a combination of sensory and general motor disorders: visual impairment and cerebral palsy (CP), deafness and cerebral palsy, sensory and intellectual disorders, and others.
Combined developmental disorders, in whose structure one of the disorders is caused by another (i.e., represents a secondary developmental deviation), for example deaf-muteness (in which the absence of speech is determined by a primary severe impairment of auditory function), do not belong to the category of multiple disorders.
. Here are some causes of combined developmental disorders:
Genetic factors: Heredity plays an important role in shaping a child's development. Combined disorders may be caused by the presence of several genetic mutations or anomalies that interact with one another.
Chromosomal anomalies: Certain chromosomal anomalies can lead to combined developmental disorders. For example, syndromes associated with deletions or duplications of parts of chromosomes can cause several different physical and psychological anomalies.
Exposure to external factors during pregnancy: Various harmful factors, such as toxins, infections, stress and inadequate nutrition, can affect the developing organism of the child, causing combined disorders in his or her development.
Premature birth: Children born prematurely may face the risk of various developmental disorders due to insufficiently formed organs and systems.
Medical conditions: The presence of medical conditions, such as premature aging, rare genetic diseases or chronic illnesses, can lead to combined developmental disorders.
Deviations in early childhood: Insufficient stimulation, inadequate care, lack of social contact or other deviations in early childhood can contribute to the development of combined disorders.
Environmental exposure: Environmental factors, such as pollution of the environment or unfavorable living conditions, can affect a child's development and contribute to combined disorders.
Social factors: Unfavorable social conditions, poverty, lack of access to education and healthcare can also contribute to combined developmental disorders.
Depending on the structure of the disorder, children with combined disorders are divided into three main groups.
The first includes children with two pronounced psychophysical disorders, each of which can cause a developmental anomaly: deafblind children, mentally retarded deaf children, hard-of-hearing children with (primary) delayed mental development.
The second includes children with one significant psychophysical disorder (the leading one) accompanied by another disorder, expressed to a mild degree, but noticeably aggravating the course of development: mentally retarded children with a slight hearing loss. In such cases one speaks of a "complicated" defect.
The third group includes children with so-called multiple disorders, when there are 3 or more (primary) disorders, expressed to varying degrees and leading to significant deviations in the child's development: mentally retarded, visually impaired, deaf children. Multiple defects can, in particular, also include the combination in one child of a whole series of minor disorders that have a negative cumulative effect; for example, when minor disorders of motor function, vision and hearing are combined, a child may show pronounced speech underdevelopment.
It is believed that children with complex developmental disorders are a rare, statistically insignificant category of abnormal children. Meanwhile, according to research data and the observations of experienced practicing defectologists, these children make up on average up to 40% of the population of special educational institutions.
The process of instruction becomes considerably more complicated when it concerns a child with a complex defect. A complex defect is not simply the sum of two (or more) defects; it is qualitatively distinctive and has its own structure, different from the anomalies that make up the complex defect.
Causes of complex developmental disorders
For early diagnosis of a complex disorder, knowledge of the causes that can lead to the impairment of several bodily functions at once is very important. A complex developmental disorder can be caused by one or several causes, which may differ or be identical in origin.
Several variants of an etiologically complex disorder can be considered:
The last two variants of the causes of complex disorders have been studied the most, where one illness (hereditary or exogenous) can become the cause of a complex or even multiple developmental disorder in a child.
For example: Children with hearing impairment and reduced intellect
Developmental features of children with reduced hearing and intellect.
Among the first to be studied were children with impairment of both intellect and hearing. The difficulty of studying this group of children lies in the fact that the absence or reduction of hearing secondarily causes a decline in intellect of the oligophrenia type. Specially organized research and the practice of instructing and educating mentally retarded children with hearing impairment is conditioned by both hereditary and exogenous factors. The methods developed as a result of studying these children made it possible to identify differential-diagnostic criteria by which it became possible to distinguish a hard-of-hearing child with normal intellect, thereby enriching the methods of differential diagnosis. The works of L.I. Tigranova, M.F. Titova, L.S. Tomoshyunene, M.S. Pevzner, G.P. Bertyn, N.Yu. Donskaya and other scholars were devoted to children with impaired hearing and reduced intellect.
In describing children assigned to this category of complex disorder, researchers noted the complexity of diagnosis. Particular difficulty is caused by the differential-diagnostic delimitation of secondary specific intellectual underdevelopment in cases of hearing loss. Unlike children with hearing impairment who have intact intellect, in the category under consideration children display pronounced inertness, poor switchability from one type of activity to another, an inability to make use of help offered, uncritical behavior and a low level of self-control. A significant lag in speech development is revealed: vocabulary is extremely limited, and phrasal speech is at a rudimentary stage.
The limited nature of ideas about the surrounding world, the immaturity of interests, and the poverty of emotions turn out to be factors that determine the pace and quality of development of mentally retarded deaf children.
The study of the features of the mental activity of mentally retarded children with hearing impairment reveals their difficulty in understanding learning tasks. Helplessness manifests itself in repeated manipulations of objects that replace the search for a solution, and in the chaotic nature of the child's actions. Children join in learning activity with great difficulty; they are characterized by an extremely low receptiveness to the teacher's help; orientation in a task is achieved only after a prolonged and repeated explanation of its purpose and content.
Particular difficulties are observed when performing construction tasks and when filling in a missing part of a picture story. The children are unable to single out the essential features of objects, being distracted instead by non-essential ones, which is especially clearly manifested, for example, when comparing different objects. The children have not developed the ability to comprehend the arrangement of figures in space, and they cannot retain in memory a holistic image of the object under consideration.
An analysis of the cognitive activity of children in this category shows that the combination of two primary defects gives rise to a tendency toward stereotypy. Observations show extreme passivity in the use of verbal speech even when a need for it has formed.
An examination of underachieving hard-of-hearing schoolchildren revealed and described a group of mentally retarded children. They should be taught in special classes of a school for the hard of hearing or worked with according to an individual program. These studies became the psychological basis for the principle of differentiated instruction of hard-of-hearing children with and without intellectual impairments.
At present, such auxiliary classes operate in most Type 1 and Type 2 schools, where instruction is carried out according to the programs of a special general-education school for deaf children. The main task in teaching mentally retarded deaf and hard-of-hearing children is to prepare them for socially useful labor and to develop in them the ability to organize and carry out work activity accessible to them.
The instructional program in the special classes is built on the basis of the programs of the school for the deaf and is also oriented toward the analogous program of the auxiliary school. The specifics of working with non-hearing children who have intellectual impairments can be traced already at the initial stage of education. Systematic classroom instruction is preceded by a propaedeutic period, in the course of which certain important tasks are addressed that matter for all further work: the degree of the children's readiness to fulfill the program requirements is identified, as well as their potential capabilities. In the course of pedagogical observation the teacher determines the level of knowledge and skills of each child, including his or her speech development and individual characteristics, and on the basis of the information obtained maps out ways of applying a differentiated approach.
Over the course of nine years children with hearing and intellectual impairments study the elementary foundations of mathematics, language, the natural sciences and the visual arts, and take classes in physical education, rhythmics, vocational training and object-based practical instruction. Work is also carried out to develop their auditory perception and to form oral speech.
The instruction of schoolchildren who have a combination of hearing and intellectual impairment is built on the basis of the general laws of the acquisition of knowledge, taking into account the developmental characteristics of children in this category.
In recent years, the number of pupils with complex developmental disorders has increased in preschool educational institutions of the compensatory type for hard-of-hearing children. As practice shows, these children cannot cope with the content of the program for teaching hard-of-hearing children and therefore need a special organization and a change in the content, forms and methods of educational and upbringing work, which must be adequate to their capabilities.
A team of authors consisting of L.A. Golovchits, N.D. Shmatko, O.P. Gavrilushkina, L.V. Dmitrieva, N.D. Sokolova and V.M. Shagova developed the «Program for the Upbringing and Instruction of Hard-of-Hearing Preschoolers with Complex (Combined) Developmental Disorders». The content of the program differs significantly, owing to the developmental characteristics of children in this group, in the limiting of the amount of material and the lowering of the requirements for its mastery.
The education of mentally retarded children with hearing impairments is organized within a specially organized instructional and upbringing environment, taking into account the characteristics of their development and the distinctive nature of the complex disorder.
For example: The system of correctional-pedagogical assistance to children with complex developmental disorders
Correctional-pedagogical assistance to children with complex developmental disorders is oriented toward resolving their individual and social needs, which requires the ordering of forms and functional systems.
At the foundation of building a system of pedagogical assistance to children with complex developmental disorders lies the principle of humanism, which means faith in the potential capabilities of the child and recognition of the human being as the supreme life value. All areas of correctional-pedagogical assistance to children must contribute to the development of the child and to the fullest, least painful possible entry into social life.
Correctional-pedagogical assistance to such children is oriented toward socialization. Considering this approach in general terms, one can say that it covers the problem of the interaction of the individual and society in the aspect of the social formation of the personality and its self-development.
Important for the success of correctional interaction is the principle of integrity, which presupposes the unity of diagnosis and correction.
Among the most important provisions for organizing correctional-pedagogical work is the principle of complex (multifaceted) impact. The application of this principle ensures that, with respect to each child who has a complex disorder, objective decisions are made on the basis of comprehensive diagnostic data, with the results taken into account by all participants in the instructional-correctional-upbringing interaction. Coordinated interaction among specialists of different profiles is carried out within the framework of the following permanently operating dynamic modules.
Participants in the system of correctional work with children:
Module I: Comprehensive-diagnostic. This stage is regarded as a unified organizational and content-activity system, in which different specialists, as well as the family, are involved. Its main goal is the implementation of a comprehensive approach to studying the personality of a child with a complex disorder, and it constitutes the first stage in developing an individual developmental route.
Module II: Correctional-diagnostic.
The task of this module is to identify the developmental characteristics of children with complex disorders, which determines the outlook for structuring correctional-pedagogical work.
In the course of dynamic observation of children in the correctional-developmental process, the following are determined:
Observing the child during instruction, in routine moments and in free activity makes it possible to form a complete picture of the nature and content of the child's leading activity, and of its distinctive features.
An important condition is the systematic nature of the observations and the thorough, precise recording of the data obtained. In the course of the dynamic psychological-pedagogical study of the child, his or her working capacity, attention and degree of fatigue are noted, and negative features are also identified that could have remained hidden during the initial examination and manifested only in the course of pedagogical work. The outcome of implementing the aims of Module II is the adoption of collegial decisions with respect to each child on the basis of the results of comprehensive diagnosis and psychological-pedagogical study of the child in the correctional-developmental process at the initial stage, namely: the group and class in which the child should study are specified, and the provisions for structuring correctional pedagogical work are determined.
Module III: Correctional-pedagogical. This module represents an organized, purposeful correctional-pedagogical process in which teachers, psychologists, parents and children interact. Correctional-pedagogical activity is an integral and inseparable part of the pedagogical process. Among the main tasks of this stage one can identify the following: clarifying and setting the goals of pedagogical work, designing variants of optimal conditions for raising and teaching children, and implementing in practice the correctional-pedagogical interaction of specialists with children. The final result of the tasks of the entire correctional-pedagogical process is the child's mastery of abilities, knowledge and skills and their application in independent life.
Thus, the tasks of the psychology of children with complex developmental disorders consist of:
It is important to understand that combined developmental disorders are usually multifaceted and depend on the interaction of different factors. Assessment and assistance in such cases require a comprehensive approach, including medical diagnosis, psychological support, correctional pedagogy and other specialized methods.
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