Borderline neuropsychiatric disorders in children. Children with borderline personality disorder - a cheat sheet for parents

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The latest data from medical science and the personal clinical experience of course experts form a holistic approach to the problem of neuropsychological diseases in children and adolescents.

For whom

heads of medical institutions, heads of neurological departments, child neurologists, pediatricians, psychiatrists, neonatologists and psychologists.

PROGRAM

1. Attention deficit hyperactivity disorder in children. History of the study of the issue, definition and self-limitation of the concept, risk factors, etiology: genetic, biochemical, perinatal and other concepts; pathogenesis; clinical picture and criteria for diagnosis, subtypes of the syndrome, treatment: psychological and pedagogical programs, medication, non-drug; prognosis and outcomes, transformation of the syndrome in adulthood.
2. Sleep disorders in children. Definition of sleep, classification of sleep stages, sleep and physical activity, physiological sleep phenomena. Sleep disorders in children: dyssomnias, parasomnias, complex pathological phenomena, evolutionary sleep disorders, treatment of sleep disorders.
3. Hypothalamic syndrome in children and adolescents. Structure and function of the hypothalamus. Etiology and pathogenesis of hypothalamic disorders. The main syndromes of damage to the hypothalamic region. Autonomic dystonia syndrome. Neuroendocrine disorders. Thermoregulatory disorders. Psychovegetative syndrome. Features of hypothalamic disorders in childhood and adolescence.
4. Non-epileptic paroxysms in children. Non-epileptic paroxysms in wakefulness: startle syndromes and hyperekplexia, Fejerman syndrome, Sandifer syndrome, shuddering attacks, childhood periodic syndromes, affective-respiratory attacks; non-epileptic paroxysms during sleep: benign neonatal sleep myoclonus, sleep-dependent rhythmic disorders, masturbation.
5. Epilepsy in children. Epidemiology of epilepsy, etiology and pathogenesis, pathomorphology, classification of epilepsy and its modifications, clinical picture, special forms of epilepsy in children, diagnostic methods - neuroimaging, EEG, video EEG monitoring, treatment - classification of anticonvulsants, mechanism of action, principles of mono- and polytherapy, prognosis .
6. Speech disorders in children. Anatomical and physiological mechanisms of speech. Stages of speech development. Classification of speech disorders (clinical, speech therapy, pedagogical aspects). Oral speech disorders: delayed speech development, dyslalia, bradylalia, tachylalia, dysarthria, alalia (sensory, motor), rhinolalia. Written speech disorders: dysgraphia, dyslexia. Methods of drug and non-drug correction of speech disorders.
7. Psychopathy and character accentuations in adolescents. Features of adolescence. Conditional and pathological forms of behavior disorders in adolescents. Character accents. Delinquent behavior disorders. Features of suicidal and self-destructive behavior in adolescents. Personality disorders: clinical forms. Methods of correction and work with deviant teenagers.
8. Early childhood autism. The concept of autism, the department of autism in schizophrenia and early childhood autism. Early childhood autism syndrome and childhood schizophrenia, their differential diagnosis. Phenomenology of early childhood autism. Clinical manifestations of RDA. Specific otherness in Kanner's syndrome. Asperger's syndrome, phenomenology of the syndrome and clinical manifestations.
9. Clinical and psychological methods of family diagnostics. Questionnaire for parents “Analysis of family relationships” (FA). Projective graphic technique "family sociogram". Color "relationship test". "Family through the eyes of a child."
10. Psychological diagnostics of intellectual-mnestic functions. Denver development scale, Gesell scale, Wechsler's technique, test method "intellectual development potential", Raven's technique, etc.
11. Personal techniques. Questionnaires: M. Luscher color test, drawing tests, “polar profiles” technique, personality questionnaires

Certificate of advanced training in the amount of 32 hours (License No. 3053 dated 07/03/2017).

To obtain a certificate you must provide:

• a copy of a diploma of higher or secondary vocational education (if you received a diploma outside the Russian Federation, please clarify the need for the procedure for recognizing a foreign diploma in the Russian Federation by calling the phone number listed on the website)
• a copy of the document confirming the change of surname (if it has changed).

The participant package includes:

• training according to the program with the issuance of a Certificate;
• collection of information and reference materials;
• daily lunches and coffee breaks.

You can view the full seminar program and register for it on the website.

Corporate training is possible (for employees of your company only) or special offers for corporate clients.

COST: 31000 rub.

Borderline mental disorders in children and adolescents

As observational experience accumulated and knowledge deepened about the human body and mental activity, doctors, psychologists and teachers came closer to the conclusion that between the psychophysical “norm” and the “developmental anomaly”, as well as between “health” and “disease”, including including mental health and mental disorder, there are no clearly dividing boundaries, but there is a certain “borderline” covering a wide range of psychophysical disorders.

Even Charles Darwin, having discovered in the totality of numerous types of deformities, the fact of their gradual “transition” into ordinary variations of the “norm”, came to the conclusion that it was impossible to strictly distinguish them. In other words, if there were no physical or mental anomalies, then the question of what “normal” was would hardly arise. On the other hand, the need to establish criteria for developmental deviations arose as a need for a practical definition of the “norm” itself.
The concept of “norm” in relation to the body, psyche, and personality, as well as the idea of ​​“health,” is ambiguous. The word “normal” often means “ordinary”, “typical”, “correct”, “ideal”, “most common”, i.e. something average. In relation to a person, such a “norm” cannot serve as an exhaustive definition, since in reality it includes not only the average statistical value, but also a series of deviations from it - variants of the “norm”.
Along with “statistical”, “ideal” and “social norms”, a person’s “subjective norm” is also distinguished, when we are talking about deviation not from the states characteristic of all other people, but from the state in which the individual was previously constantly in accordance with their previously established attitudes, views, capabilities and life circumstances. /D. Schulte/.
One of the definitions "norms" for living and social systems, the idea of ​​it as a “functional optimum” can serve, i.e. zone of optimal functioning of the system, simultaneously covering more or less wide deviations / “variants of the norm” / and having certain reserves that ensure adequate adaptation to changes in the environment. /Yu.A. Alexandrovsky/. In other words, according to the author of the definition, a normal living system is one that maintains its viability and flexible adaptation to constantly changing environmental conditions. A shift beyond the zone of optimal functioning of the body, the central nervous system and mental activity can be considered as a pathological phenomenon, or “borderline” between normal and pathological.
Under "borderline mental disorders" imply a set of mental disorders that is far from homogeneous in its manifestations and mechanism of origin, which occupies an intermediate position between “mental illness” / “psychosis” / and “mental health”. Moreover, borderline disorders are considered not as a “bridge” between mental illness and mental health, but as a unique group of nonspecific symptom complexes, similar in the severity of their manifestations and limited to the “neurotic level” (“neurotic register”) of mental disorders (Aleksandrovsky Yu.A. , Gannushkin P.B., Gurevich M.O., etc.). The group of borderline disorders in children and adolescents usually includes neurotic and pathocharacterological reactions, neuroses and pathocharacterological developments, psychopathy, neurosis-like and psychopath-like states, as well as borderline forms of intellectual disability and other less common disorders.
Under "psychosis" or actually mental illness understand the degree of severity of disorders of human mental activity in which adequate perception of the real world and behavior reflecting these disorders are impaired. Depending on the causative factors, psychoses can be relatively short-term, / for example, reactive, i.e. arising as a result of massive mental trauma; intoxication /as a result of poisoning/; infectious; traumatic /in a state of acute traumatic brain injury/, as well as chronic /schizophrenia, manic-depressive, etc./. Forms of dementia that are severe in severity are equated to psychosis.
In foreign clinical psychology and the International Classification of Diseases, 10th revision /ICD-10, WHO, 1994/ the term “mental illness” is not used, but the concept of “mental disorders” is used, uniting all types of mental disorders in humans, including psychoses /cm . section 5 of the ICD “mental and behavioral disorders”/.
To the criteria "mental health" WHO experts include:
- awareness and feeling of continuity, constancy and identity of one’s physical and mental “I”;
-a sense of constancy and identity of experiences in similar situations;
-criticism towards oneself, one’s own mental activity and its results;
- proportionality of mental reactions to the strength and frequency of environmental influences to social circumstances and situations;
-the ability to self-manage behavior in accordance with social norms, rules, laws;
- the ability to plan one’s own life activities and implement what is planned;
- the ability to change behavior depending on changing life situations, requirements and circumstances.
Mental health, as is known, is an integral part of human health as a whole, which is usually understood not simply as the absence of any disease, but as a state of complete physical, mental and social well-being (as defined by WHO). Therefore, as in any other system, any of these components holistic health is in close relationship and interdependence with its other components.
Due to the relatively mild mental disorders that distinguish them from psychosis, borderline disorders are classified as so-called “minor psychiatry,” but they are very large in terms of the frequency and complexity of the observed phenomena. It is no coincidence that the famous domestic psychiatrist P.B. Gannushkin emphasized that “minor psychiatry, borderline psychiatry, is a more complex area that requires much more experience, skills and knowledge than major psychiatry, where we are talking about the mentally ill in the narrow sense of the word” / S. 55/. Considering the importance of this knowledge for the work of a teacher, Ozeretsky N.I., Gurevich M.O., Kashchenko V.P., E. Kraepelin, Philippe J., Boncourt P., and other Russian and foreign doctors wrote at the beginning of the 20th century about the need teaching child-adolescent borderline psychopathology to students of pedagogical universities.
The problem of diagnosing and organizing assistance to children with borderline mental disorders is complicated by the presence of a number of features characteristic of these disorders.
One of these features is the difficulty of determining the boundaries where the extreme version of the “mental norm” ends and a qualitatively different state begins, which acquires a more distinct clinical manifestation as it approaches a painful disorder. The state of transition from a “mental norm” to a clinically pronounced borderline mental disorder, /for example, neurosis/ is designated differently by different authors: “premorbid”, “functional-adaptive”, “preclinical”, “prenosological” states, “subclinical response options” , “prepsychopathic reactions”, “period of increased risk”, etc. / Selye G., Semke V.Ya., Semichov S.B., Vakhov V.P. etc./. For example, it is considered possible to include age-related psychological crises as pre-nosological forms of borderline mental disorders in children and adolescents /Sakharov E.A., 1997/. To the same extent, short-term states of decompensation in individuals with certain forms of character accentuations that do not reach the level of persistent neurotic or psychopathic reactions can be classified as subclinical forms of reaction. It is no coincidence that Gannushkin P.B. wrote about borderline disorders as a stripe that has two borders - “one from health, the other from illness,” which are characterized by instability and uncertainty.
Another feature of borderline mental disorders is the difficulty of strictly differentiating them, i.e. division into certain clinical forms, which, however, does not provide grounds for abandoning the existing criteria for their definition. This feature is not a sign of the imperfection of modern knowledge about the human psyche, but a reflection of the objective reality that “... there are no and cannot be pure phenomena either in nature or in society... The very concept of purity is a certain narrowness, one-sidedness of human knowledge, which does not fully embrace the subject in all its complexity” /V.I. Lenin/.
The next feature of borderline mental disorders, which is extremely important for practical psychologists and teachers, is that when external or internal conditions that facilitate or aggravate the functioning of the child’s body and psyche change, they can either approach “normal” or pathology (“ compensation" - "decompensation"). The higher the level of demands placed on the “borderline subject,” the more difficult it is for him to maintain the expedient functions characteristic of the “norm.” (Gurevich M.O.).
For example, children with so-called mental retardation, who successfully study in the conditions of a “compensation or correction class” or the corresponding type of special school, are easily decompensated and reduce the quality of education when returning to the standard conditions of a general education institution. Another example: a teenager who has suffered a traumatic brain injury in the past, with the onset of endocrine changes in adolescence, reveals a noticeable decrease in mental performance, an exacerbation of affective character traits, instability of mood, well-being and other psychological characteristics that were previously unusual for him, not associated with any or an external reason.
On the contrary, healthy children who have suffered any long-term infectious disease associated with a hospital stay easily catch up with their peers upon returning to school; As a rule, their puberty period proceeds harmoniously, if it is not complicated by unfavorable external factors.
Along with the concepts of “borderline mental disorder” and “prenosological condition”, the phrase "children at risk", which has different meanings, and therefore requires, if used, appropriate clarification on the part of the author.
So, for example, in medicine, the risk group includes practically healthy children, but living in families with tuberculosis, psychosis, alcoholism, drug addiction, etc. This group includes children who have suffered certain perinatal harms, but do not show signs of obvious pathology. In other words, we are talking about children at risk, i.e. the likelihood of the occurrence of one or another pathology, which does not reveal itself at the time of the study, although psychiatrists tend to include “prenosological forms” of borderline mental disorders as a risk group.
Children with “mental developmental delays” or with severe anti-disciplinary behavior disorders due to underdevelopment of emotional and volitional personality traits can be considered as children with borderline mental disorders who already need appropriate psychological and pedagogical correction, but at the same time they can also be classified as a risk group children due to the high probability of their developing delinquency, i.e. illegal behavior. Therefore, the correct organization of psychological and pedagogical assistance to children with those types of borderline mental disorders that create difficulties in learning or cause behavioral disorders at school and beyond, simultaneously serves the task of early prevention of crime among minors.
Thus, borderline mental disorders, widespread in the child and adolescent population, in our opinion, should be included in the sphere of competence of a practical psychologist of any educational institution, which will make it possible in practice to ensure the widely declared “principle of individually oriented work” with children experiencing certain personal problems, as well as effective interaction with related specialists.

Many parents have noticed that the child behaves strangely - he is capricious for no reason, often cries, screams or even fights. How to react to such a condition, should you start worrying? Specialists recommend immediately seeking help from psychologists or psychiatrists. It is possible that the little person is sick. It is important to exclude borderline personality disorder and other dangerous clinical syndromes.

It is quite difficult to identify the first symptoms of borderline personality disorder in a child. Unfortunately, many parents mistake this condition for a normal age-related change in the psyche. You need to be able to distinguish banal irritation from dangerous signs of pathology.

What to pay attention to:

1. Strong dependence on loved ones - the child is afraid of independence, shifts responsibility for his mistakes to others.
2. Abnormal anxiety – fears, constant worries, phobias for no reason.
3. Demonstrative behavior - children with psychoasthenic disorders try in every possible way to attract the attention of others.
4. Emotional imbalance – BPD is often accompanied by moodiness, outbursts of anger, and aggression.
5. Weak-willed psychopathy - often diagnosed in adolescents, manifested by a lack of principles and a desire to violate generally accepted norms of behavior.
6. Imbalance of emotional state - depression, reluctance to communicate, emotional coldness and restraint.
7. Paranoid ideas - fixation on one thought, suspicion, hypersensitivity to prohibitions and refusals.

It is important to understand that borderline personality disorder often provokes suicidal tendencies and unmotivated aggression towards others.

Causes of the pathological condition

Often parents are surprised by the diagnosis and claim that there was no reason for the appearance of BPD. Unfortunately, it is quite difficult to prevent the occurrence of mental disorders, since often the source of the problem is a hereditary factor (genetic predisposition). Also, the “motivator” of borderline personality disorder in a child can be physical trauma and damage to the central nervous system received by the fetus during pregnancy.

Separately, it is worth highlighting acquired psychopathy. Problems in children often arise as a result of improper upbringing, for example, excessive rigidity in the behavior of parents or, conversely, gentleness of upbringing, permissiveness.

What should parents do?

It is important to understand that untimely detection and lack of adequate treatment can provoke quite dangerous complications. Most often, doctors note difficulties with adaptation to society and socialization. That is why, at the first suspicion of BPD, you need to consult a child psychologist (psychiatrist). To confirm or refute pathology, doctors use the Wechsler method and Schulte tables. Hardware studies, for example, an electroencephalogram to obtain data on the state of the central nervous system, will also be useful.

Treatment for borderline personality disorder takes a long time. Typically, the doctor monitors the child for 6-8 months, identifies the cause of the disease and selects an adequate set of measures. First of all, it is necessary to eliminate the source of anxiety, develop an ideal daily routine, and corrective programs. Under certain conditions, a specialist prescribes drug treatment (drugs are selected individually, based on the severity of symptoms and the physical characteristics of the patient).

If BPD is caused by genetic abnormalities, but therapy is limited to stopping attacks and correcting the child’s behavior. Regardless of the causes of mental disorders, parents must strictly follow the instructions of doctors and periodically undergo examinations in the clinic.

Basically, it is generally accepted that children are susceptible to colds and various viral diseases, although mental illnesses in children are quite common and cause many problems for both the patients themselves and their parents. Just as in adult patients, childhood mental illnesses are diagnosed based on a number of symptoms and signs that are specific to certain disorders. But it should be taken into account that the diagnostic process in children can be especially difficult, and some behavioral forms may look like symptoms of mental disorders.

For example, this category includes strange eating habits, excessive nervousness, and emotionality, which can be regarded as part of the child’s normal development. Behaviors become symptoms when they occur too frequently, interfere with the child's ability to function within the family, or occur in an age-inappropriate manner. If parents notice strange behavior, then it is necessary to have the child examined by a doctor. There are currently no laboratory tests that specifically diagnose mental disorders. Doctors use methods such as x-rays and blood tests, which are necessary to exclude somatic diseases and side effects of medications that are the cause of symptoms.

If no physical illness is identified, the child is referred for consultation to a psychologist or adolescent psychiatrist, who are specialists in child mental disorders. Psychiatrists and psychologists use special tests that are used to assess the patient’s mental state. The doctor's diagnosis is based on identifying typical symptoms in the child. Also, the doctor is based on his own observations and comments from the patient’s parents and teachers. Their opinion is necessary, since in general children find it difficult to explain on their own what their problems are, and they also cannot understand how their illness manifests itself.

Causes of mental illness in children

The causes of mental illness in children are no less numerous than in adults, and most of them are triggered by a combination of certain factors that are almost impossible to predict, and therefore prevent. But, if the signs can be recognized in a timely manner and treatment is started without delay, then severe manifestations of the disease can be avoided, or they can be minimized. Scientists have found that in the modern world, approximately every fifth patient of psychiatrists is a minor, and at least five percent of children on our planet are susceptible to mental illness.

Mental childhood disorders do not go away without a trace; they leave their negative mark on the development and social capabilities of the little person. But if professional help is provided in a timely manner, many diseases of the child’s psyche can be fully cured, including some of which can be adapted to. There are also diseases that leave children disabled. Basically, specialists diagnose mental problems in children such as obsessiveness syndrome, tics, in which the child has involuntary movements, or tends to utter sounds that do not make sense. In childhood, anxiety disorders and various fears can be observed.

With behavioral disorders, children ignore any rules and demonstrate aggressive behavior. The list of common diseases includes pervasive disorders related to thinking disorders, and so on, and so on. It happens that doctors use the designation “Borderline mental disorders” in children. This means that there is a state that is an intermediate link between deviation and norm. The causes of mental disorders in children are different. They are often caused by hereditary factors, diseases, and traumatic lesions. Therefore, parents should focus on comprehensive methods.

Treatment of mental illness in children

For parents, it is always a problem to choose a doctor if a child develops a mental disorder. One should not limit oneself to consultation with a psychiatrist and the use of medicinal treatment methods. It would be correct if immediately after birth the baby is examined by an osteopath and other specialists. Many mental disorders require long-term treatment. And if the treatment of adult patients has certain proven schemes, then child psychiatry is less developed. Currently, experts are constantly conducting research in search of effective ways to combat childhood mental illness.

Today, the same drugs that are used to treat adults are used, of course, in different dosages. Basically, among the methods of treating children with mental disorders, several options are used. When using medications, good results can be achieved. Children are prescribed antipsychotics, anti-anxiety drugs, including mood stabilizers and various stimulants. Psychotherapeutic methods play a significant role in child psychiatry. The psychotherapist helps the child cope with the disease, choosing special strategies for this.

Among the types of psychotherapy for children, the most acceptable are cognitive behavioral therapy, supportive therapy, as well as interpersonal and. It is very important to determine appropriate treatment if a child develops symptoms of a mental disorder. Children who have not been treated for mental disorders continue to suffer from these problems; such people are susceptible to alcoholism and even suicide.