RU2396904C1 - Method of predicting development of school dysadaptation - Google Patents

Abstract

FIELD: medicine. ^ SUBSTANCE: invention relates to field of medicine, in particular to pediatrics, and is intended for predicting school dysadaptation at initial stage of education by sum of additional factors of social and biological risk. Method includes questionnaire poll of parents and examination of children with analysis of medical history, which detect factors influencing development of school dysadaptation syndromes, assigning each of them corresponding coefficient, their summing up: if sum of additional risk factors is higher or equals 0.68 prediction about possible realisation in child of school dysadaptation syndromes at the initial stage of education is made and correcting measures of medical and psychological character are prescribed, if the sum of additional risk factors is lower than 0.68 prediction about favourable course of school adaptation is made and such children are subjected to standard methods of observation. ^ EFFECT: method allows carrying out preventive measures. ^ 3 ex

Description

The invention relates to medicine, in particular to pediatrics, and can be used to predict school maladaptation.

School maladaptation is a violation of the adaptation of the student’s personality to the conditions of study at school as a particular phenomenon of a disorder of the general ability for mental adaptation in connection with pathological factors. At the moment, there is one document in the school system that regulates the issues of school adaptation. This is the Order of the Ministry of Health of the Russian Federation and the Ministry of Education of the Russian Federation dated June 30, 1992 N186 / 272 "On improving the system of medical support for children in educational institutions. According to it, adaptation assessment should be carried out at the end of the first school year, which leads to a delayed medical-pedagogical correction (1) .

A known method for predicting the complications of the course of adaptation in children upon admission to preschool. The essence of this method: in the daytime and nightly urine of a child, the ratio of albumin and globulin is determined, and with a difference between the coefficients below 4.9, a complicated course of adaptation is predicted. The disadvantages of the method are: the complexity, the need to study urine twice a day (2).

A known method for preclinical diagnosis of disorders of the health status of children and adolescents. The content of sulfhydryl groups of erythrocytes and the level of hemoglobin are determined in the patient’s blood. When the values of HB blood below 123 g / l and SH-groups below 2.6 units. at primary school age, a child’s preclinical health disorder is diagnosed. The disadvantages of the method are: invasiveness, the impossibility of multiple studies, associated material costs (3).

The closest method in essence to the proposed method is a method for predicting a failure to adapt to the beginning of schooling at 7-year-old first-graders by calculating the sum of diagnostic coefficients - 21 factors of social and biological history using a formalized table compiled using Wald's sequential analysis. If the value of the sum of diagnostic coefficients is more than +13, a forecast is made about the unfavorable course of adaptation. The disadvantages of the prototype are the ability to predict only pronounced neurotic reactions, the high complexity of the method and the low accuracy of the method is 60% (4).

The proposed method is devoid of the disadvantages of the known methods.

The aim of the invention is to predict the development of school maladaptation in primary school children at the beginning of training.

This goal is achieved by the fact that forecasting is carried out in two stages, at the first stage, before the start of the school year, parents are questioned in which social and biological risk factors are identified and assigned prognostic factors; at the second stage, at the beginning of the school year, children are examined (identification of complaints, determination of visual acuity, examination of ENT organs (otoscopy, laryngoscopy, rhinoscopy), detection of speech defects) and the data of the medical record are analyzed, and prognostic coefficients of the child’s diseases are established, the coefficients of the first and the second stage, with an amount greater than or equal to 0.68, make a prediction about the possible realization of the syndrome of school maladaptation in the child at the initial stage of training and prescribe corrective measures for medical Who and psychological, when the sum of the coefficients less than 0.68 to make predictions about favorable current school adaptation, these children are subject to standard management.

Comparison of the proposed method with others known in the field of medicine, showed its compliance with the criteria of the invention.

The method is implemented in two stages as follows.

At the first stage, before the start of the school year, parents are questioned, where they are offered to answer 13 questions of a social and biological nature at home:

1. Complete or single-parent family

2. Age of mother at birth

3. Mother's education

4. Characteristics of housing

5. Type of family relationship

6. The nature of the lifestyle of the child

7. The presence of a computer in a child’s room

8. The presence of a TV in the child’s room

9. Did the child attend kindergarten

10. The regularity of visits to kindergarten

11. The child has periodic pain

12. The presence of a child with sleep disorders

13. The presence of a child's appetite disorders

At the second stage, children are examined, identifying their complaints, determining their visual acuity using the Sivtsev-Golovin table, the presence of speech defects, examination of ENT organs (otoscopy, rhinoscopy and laryngoscopy) and analyze medical records with the results of the Mantoux test.

Based on the analysis of the data of both stages, each factor is assigned a specific numerical coefficient calculated according to the Fletcher method, where in the first stage:

NS - single-parent family - 0.22

KK - communal apartment or dormitory - 0.31

AC - authoritarian family relations - 0.52

ES - emotional relationships in the family - 0.25

MP - a sedentary lifestyle of a child - 0.24

NK - the presence of a computer in a child’s room - 0.05

NT - the presence of a TV in a child’s room - 0.23

DS - did not attend kindergarten or did not attend it regularly - 0.04

NB - the presence in a child of pain of various localization - 0.20

ON - appetite disorders and / or selective attitude to products - 0.22

NS - sleep disturbances in a child - 0.20

in the second stage:

HP - speech impairment - 0.14

NZ - visual impairment - 0.20

LP - pathology of ENT organs - 0.21

TI - tuberculosis and / or turn tuberculin test - 0.14.

Then, if the child has these risk factors, the corresponding coefficients are summarized. In the course of data analysis, a confidence interval and standard deviation were determined, as a result of which a value of 0.68 was obtained, which is prognostic.

If NS + VM + OM + KK + AS + ES + MP + NK + NT + DS + NB + NA + NS + HP + NS + LP + TI ≥0.68, then the child is predicted to develop maladaptation (if in the amount of additional risk factors are dominated by social factors, a set of measures is prescribed in accordance with established factors: elimination of video equipment from the child’s room, conducting psychocorrectional classes in the family, relevant recommendations are given on the regimen of the child’s day and organization of his workplace; if unfavorable psychological factors prevail in total, psychocorrective behind yatiya with a child; with appropriate medical risk factors, necessary classes with a speech therapist for speech correction, ophthalmologist for vision improvement, immunomodulating agents and vitamins and minerals in the pathology of upper respiratory tract or bend tuberculin tests in addition to conventional therapy);

if NS + VM + OM + KK + AS + ES + MP + NK + NT + DS + NB + NA + NS + HP + NS + LP + TI <0.68, then the prognosis for the development of maladaptation is favorable.

The method is illustrated by the following examples.

Clinical example 1

Veronika A., 6 years 9 months, according to the results of the survey, the following risk factors were identified: the presence in the room of the TV - 0.05, the presence in the room of the computer - 0.23, the presence of abdominal pain - 0.20, restless sleep - 0.20 . The sum of additional risk factors at the first stage is 0.05 + 0.23 + 0.20 + 0.20 = 0.68

During the second stage of the examination - examination of the child and work with the medical record - the diagnosis was made: healthy - coefficient of the additional risk factor - 0.00.

The total amount of additional risk factors was 0.68, which allows us to conclude that the girl is at risk of developing school maladaptation.

Examination of the child 2 months after the start of training revealed that the adaptive potential (according to the Baevsky P.M. methodology), which characterizes the adaptation strain, is 2.59, with a norm not exceeding 2.10. During the first half of the year she was sick - 11 school days were missed. In addition, the class teacher noted that she was hyperactive, impulsive, often in conflict with other children and inattentive - this, in turn, also indicates that the girl has school maladaptation. Our forecast was confirmed (5).

Taking into account the predominance of additional factors of a social nature in the sum of additional risk factors, it is necessary to ensure, after the forecasting, that the psychologist / teacher joins the family to optimize living conditions (remove the TV and computer from the child’s room, organize his workplace correctly, give recommendations on the daily routine) and conduct family psychocorrectional classes.

Clinical example 2

Dima P., 7 years 1 month, according to the results of the first stage of the examination, the following risk factors were identified - poor appetite - 0.20, the presence of a TV in the room - 0.05. The amount of additional risk factors in the first stage was 0.20 + 0.05 = 0.25.

During the second stage, the diagnosis was made: chronic tonsillitis - the coefficient of the additional risk factor is 0.21

The total amount of additional risk factors was 0.25 + 0.21 = 0.46, which allows us to make a forecast about the absence of a future risk of school disadaptation. Given the presence of a chronic somatic pathology in a child, it is necessary, in addition to traditional treatment, to recommend a course of immunomodulating drugs and vitamin-mineral complexes.

When examining the boy 2 months after the start of training, the adaptive potential (according to the Baevsky P.M. methodology) was 1.79. During the first two quarters, he was never sick. In the characteristics of the class teacher it is said that he is calm, attentive, collected. No signs of school maladaptation were found. Our favorable outlook was confirmed (5).

Clinical example 3

We examined 56 children. The sum of additional risk factors ≥0.68 was observed in 28 children. Of these, the adaptation tension (adaptive potential ≥2.11, frequent acute respiratory viral infections, the presence of signs of school maladaptation in behavior) after 6 months was detected in 23 children. The sum of additional risk factors <0.68 was noted in 28, of which good adaptation was detected in 20 children. The sensitivity of the method (6) is: 23/28 * 100% = 83%.

The specificity of the method (6): 20/28 * 100% = 71%.

Thus, children with a sum of additional risk factors greater than 0.68 are included in the risk group for the development of school adaptation, and corrective measures should be taken in the early stages of education.

This method can be used in children of primary school grades. A significant advantage of this method is ease of use, which allows you to assign both stages of the study to the class teacher. In addition, conducting surveys before the start of training allows you to timely identify the risk group for the development of school adaptation and to begin corrective events in the first days of training - to conduct specialist consultations, draw up an individual examination and observation plan.

Sources used

1. Order of the Ministry of Health of the Russian Federation and the Ministry of Education of the Russian Federation of June 30, 1992 N186 / 272 "On improving the system of medical support for children in educational institutions."

2. Patent RU 93026965 A, 6 G01N 33/68, 1995.11.20 Popova V.A., Pogorelova T.N., Dluzhevskaya T.S., Afonin A.S., Nekrasova L.I. A method for predicting the complicated course of adaptation in children upon admission to preschool.

3. Patent RU 2161799 C2, 7 G01N 33/48, G01N 33/72 1998.05.26 Filosofova MS, Shnitkova EV A method for preclinical diagnosis of disorders of children and adolescents.

4. Zhdanova L.A. Diagnosis and prediction of clinical and functional deviations in children in the first year of school. - diss. Cand. honey. Sciences, Ivanovo, 1984.

5. Bayevsky P.M. Prediction of health on the verge of norm and pathology. - M., - 1979.

6. R. Fletcher, S. Fletcher, E. Wagner. Clinical Epidemiology. The basics of evidence-based medicine. - Per. from English - M.: Media Sphere, 3rd ed., 2004.

Claims (1)

A method for predicting the development of school maladaptation, including determining prognostic factors, characterized in that forecasting is carried out in two stages: at the first stage, before the start of the school year, parents are questioned; at the second stage, at the beginning of the school year, children are examined, revealing the presence of pathology of the organ of vision, ENT organs, and tuberculosis; the social and biological risk factors identified by the results of both stages are assigned the following prognostic factors: single-parent family (PS) - 0.22; the age of the mother (VM) at the time of birth is 18 years old or less - 0.08; mother's education (OM) - secondary or vocational - 0.02; communal apartment or hostel (CC) - 0.31; authoritarian family relations (AO) - 0.52; emotional relations in the family (EA) - 0.25; sedentary lifestyle of a child (MP) - 0.24; the presence of a computer in a child’s room (NK) - 0.05; the presence of a TV in the child’s room (NT) - 0.23; the child did not attend kindergarten or did not attend it regularly (CP) - 0.04; the presence in the child of pain of various localization (NB) - 0.20; impaired appetite and / or selective attitude to products (ON) - 0.22; sleep disturbances in a child (NS) - 0.20; speech impairment (HP) - 0.14; visual impairment (NC) - 0.20; pathology of ENT organs (LP) - 0.21; tuberculosis and / or turn tuberculin test (TI) - 0.14; and in the event that NS + VM + OM + KK + AS + ES + MP + MP + NK + NT + DS + NB + NA + NS + NR + NC + LP + TI ≥0.68, then the development of school maladaptation, if NS + VM + OM + KK + AS + ES + MP + MP + NK + NT + DS + NB + NA + NS + HP + NS + LP + TI <0.68, then the child does not predict the development of school maladaptation.