RU2599345C1 - Method of detecting alexithymia for subsequent correction in adolescents with sensory disorders accompanied by disorders of psychological development - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, more specifically to psychiatry, and can be used in diagnosing alexithymia in adolescents with sensory disorders, accompanied by disorders of psychological development. Method includes using a screening "scale for detection of alexithymia in adolescents with sensory disorders, accompanied by disorders of psychological development" to determine main components of alexithymia. Responses are evaluated by degree of clinical significance from 1 to 3 points and summed up. Based on component scale "difficulties identifying senses" evaluating in three points presence of feature in responses to questions on lack of understanding own senses, presence of "bodily sensations even unclear to doctor", difficulties in determining senses in situation "when I am upset", difficulties in their verbalisation and absence of habit of dreaming of future and difficulty in determining reason "why I am crying". Based on component scale "difficulties in describing senses" evaluating in three points difficulties in determining own internal sensations, need for verbalisation of own senses and relation to other people, particularly to close ones, and difficulties in determining own senses. Based on component scale "externally-oriented mind-set" evaluating in three points presence of feature of "preference of talking about matters and not about feelings", preference watching humorous programs and not "films on foreign problems", agreement with confirmation "knowing solutions to problems is more important than understanding of their causes", at reluctance to know cause problems and understanding own feelings. In two points evaluating responses "neither" to all questions. In one point is evaluating agreement with statements "I dream of future, "when I cry I always know reason", "can easily say what I feel", "want to know cause my problem", "important to understood own feelings". If total score is 22 and below, norm is determined without alexithymia manifestations. If total score is 23-28, risk group is determined and psycho-corrective and psycho-educational measures are taken. If total score is 29 or higher, alexithymia is determined and psychotherapeutic, psycho-corrective and psycho-educational measures are taken.

EFFECT: method enables to detect alexithymia in adolescents with sensory disorders, accompanied by disorders of psychological development due to testing on "scale for detection of alexithymia" and taking measures to eliminate alexithymia.

1 cl, 1 tbl, 3 ex

Description

The invention relates to medicine, specifically to psychiatry, and can be used in the diagnosis of alexithymia in adolescents with disorders of psychological development.

Alexithymia is a reduced ability or difficulty verbalizing emotional states and feelings. To measure alexithymia, the Toronto Alexithymia Scale - Toronto Alexithymia Scale TAS-26 [1], adapted in Russian at the Scientific Research Institute named after Ankylosing spondylitis [2]. Despite the satisfactory psychometric properties of TAS-26, its authors later revealed a number of drawbacks, for example, items on reducing the ability to imagine were poorly correlated with the total score and were influenced by “social desirability”. In the early 1990s, this scale was revised and improved [3, 4] into the 20-point Toronto alexithymia scale TAS-20, which is currently validated and is actively used by clinicians to quantify alexithymia [5]. The TAS-20 scale includes a description of three factors that reflect the main components of alexithymia: difficulties in identifying feelings, difficulties in describing feelings, and an outwardly oriented (external) type of thinking; however, when interpreting the test results, the developers of the Russian version of TAS-20 strongly recommended relying only on the total score and not using factor scales as independent indicators.

The literature describes the experience of determining alexithymia in children and adolescents using the TAS-20 scale [6-10].

This method of determining alexithymia is the closest to the claimed technical essence and the achieved result and is selected as a prototype to the achieved result.

The disadvantage of this scale is the difficulty of its use in children with intellectual disabilities, which are noted in disorders of psychological development in children with severe hearing and visual impairments. When trying to use the Russian-language versions of the TAS-20 scale in adolescents with intellectual disabilities, difficulties in understanding the wording due to the psychological characteristics of adolescents (insufficiently developed abstract thinking, reduced vocabulary, insufficiently formed arbitrary components of higher mental functions, low level of social competence) were noted.

The objective of the invention is to provide a method for detecting alexithymia in adolescents with sensory impairment, accompanied by disorders of psychological development.

The problem is solved by modifying the traditional presentation of this scale while maintaining the semantic meaning of the wording while ensuring their understanding by children with intellectual disabilities. They also determine the minimum number of questions - 16, sufficient to identify alexithymic traits and signs, the ability to evaluate answers according to the degree of clinical significance from 1 to 3 points and in accordance with the sum of the results, the following groups are distinguished - “norm”, risk groups, group with alexithymic manifestations. When compiling the scale, the proportions of the inclusion of questions are preserved, reflecting the three components of alexithymia: difficulties in identifying feelings (questions 1, 3, 6, 7, 8, 15), difficulties in describing feelings (questions 2, 4, 10, 11, 14) and outwardly oriented type of thinking (questions 5, 9, 12, 13, 16).

The proposed scale is affordable for adolescents of this category, does not require a significant amount of time, prolonged tension of the organ of vision, can be used to conduct psychological and clinical studies in a correctional school.

The scale for detecting alexithymia in adolescents with sensory impairment, accompanied by disorders of psychological development, contains an instruction and a key.

Instructions: Indicate your age and name. Choose one of the options - “disagree”, “agree”, “neither one nor the other”.

The key to the proposed alexithymia scale.

Scoring:

1) the answers to questions 1, 2, 3, 6, 7, 10, 11, 12, 13, 14, 16 are evaluated as follows:

“Disagree” - is estimated at 1 point,

"Neither one nor the other" - 2 points,

“I agree” - 3 points.

2) the answers to questions 4, 5, 8, 9, 15 are evaluated on the contrary,

“Disagree” - estimated at 3 points,

"Neither one nor the other" - 2 points,

“I agree” - 1 point.

The sum of the points obtained as a result of addition on all counts is the final indicator of “alexithymicity”. The results can be distributed in the range from 16 to 48 points.

Interpretation of the alexithymia scale:

29 points and above corresponds to the “alexithymic” profile (indicates the presence of alexithymic manifestations).

23-28 points - a risk group.

22 points and below - the absence of alexithymic manifestations (normal).

New in the invention is the minimum number of questions - 16, the assessment of answers according to the degree of clinical significance in points and the specification of the assessment of the proposed answer options, as well as the value of the total score of 23-28 to determine the risk of alexithymia and above 29 points - the definition of alexithymic traits.

Thus, the proposed scale has clinical significance, consisting in a quantitative representation of the severity of such a phenomenon as alexithymia, consisting of a combination of certain symptoms.

Distinctive features showed in the inventive combination of new properties that are not explicitly derived from the prior art in this field and are not obvious to a specialist. An identical set of features was not found in the patent and medical literature. Proposed as an invention, the method can be used to diagnose alexithymia in adolescents with disorders of psychological development, students of correctional schools.

Based on the foregoing, the present invention meets the conditions of patentability "Novelty", "Inventive step" and "Industrial applicability".

The invention will be clear from the following description:

The present invention has been tested for 50 students of special (correctional) educational institutions aged 12-16 years, of which 25 are hearing impaired (sensorineural hearing loss stage III-IV), 25 are visually impaired (congenital anomalies of the organ of vision). All students have concomitant disorders of psychological development (F83), are trained according to the corrective program of the VII form, and they are satisfactory. A clinical examination of adolescents in the study group revealed no neurotic, affective, or behavioral disorders. The study was conducted individually, which was determined by the specifics of the defect in this category. The proposed scale made it possible to determine with great accuracy the presence or risk of alexithymia in adolescents with sensory health capabilities.

According to the results of screening, the presence of alexithymia in 32% of students (16 people) and the presence of risk of alexithymia in 38% (19 people) were revealed. The diagnosed manifestations of alexithymia (risk group and clinical group) determined the nature and extent of psychotherapeutic, psychocorrectional and psycho-educational measures.

Example 1. Kostya, 13 years old, bilateral sensorineural hearing loss, IV degree, violation of psychological development F 83.

I agreed with the statements: “I often don’t understand how I feel” - 3 points, “I find it difficult to understand how I feel inside” - 3 points, “I find it difficult to say how I feel about people” - 3 points, “I prefer to watch funny television programs, not films that talk about other people's problems "- 3 points," I find it difficult to say how I feel, even to my best friend "- 3 points. I did not agree with the statements: “I often dream of the future” - 3 points, “it is important for me to understand how I feel” - 3 points, “when I pay, I always know why” - 3 points.

The option “neither one nor the other” was chosen when answering the questions “I have sensations in the body that are not even clear to doctors” - 2 points, “I can easily say what I feel” - 2 points, “sometimes I can’t find words to say what I feel ”- 2 points,“ they tell me that I should talk more about how I feel ”- 2 points and“ know how to solve problems is more important than understanding the causes of these problems ”- 2 points .

I didn’t agree with the statements: “when I’m upset, I don’t know whether I’m sad, or scared, or I’m angry” - 1 point, “I prefer to talk with people about business and not about feelings” - 1 point, agreed with the statement “when I have a problem, I want to know why this happened” - 1 point.

The total score was 37, which corresponds to the group with clinically expressed alexithymic manifestations.

From the anamnesis: the third child of seven children. The older brother and one of the younger sisters are also hard of hearing. Early development - with a lag in speech, motor functions. Father is a construction worker, mother is a housewife. Parents do not speak fingerprints and gestures; they formally and monosyllabic communicate with their son. They visit the sect Jehovah's Witnesses, and try to introduce children to this. At school, situations arose repeatedly when a boy asked or forced classmates to bring him sweets, juices, money. At the time of the examination in the classroom, there was a conflict situation - Kostya and his younger sister, studying in the same class, regularly offend a classmate - name-calling, pushing, taking away or spoiling her things. The girl is very worried, constantly crying, refuses to attend school. Attempts by the class teacher, psychologist and parents of the girl to draw Bones attention to the emotional state and feelings of the girl do not cause a response. Appeal to Kostya's parents also did not produce an effect - they did not express sadness about the behavior of their son and sympathy for a classmate.

In a clinical examination, mental status is qualified by the underdevelopment of the intellectual-mnestic sphere and speech means in a child with bilateral sensorineural hearing loss. Answers verbal questions in monosyllables, written ones - with sentences of 2-3 words, with agramatisms. The amount of knowledge about the environment is reduced, mainly limited by the household level. He is trained according to the program of the VII form, copes with the program. The mood is calm, even. The conversation is somewhat tense. Steady attention, well concentrates on the proposed tasks. When observing a child both in the examination situation and in everyday life (educational activities, communication with peers), external “seriousness”, the formal nature of communication, the absence of external manifestations of emotional states — joy, sadness (if there is reason for the subjects emotions), the boy practically does not smile and does not laugh. The class teacher and teacher also noted the child’s reduced emotionality, lack of activity in discussing situations related to feelings, personal attitudes to events or people.

A psychological examination determined the average level of anxiety (on the SMAS scale), the presence of interpersonal problems, feelings of loneliness (on the scale of depression M. Kovak).

The results of testing on the alexithymia scale correspond to clinical manifestations. The revealed features determined the volume of psychotherapeutic, psychocorrectional and psycho-educational measures. Individual psychotherapeutic classes included a discussion of school situations, in which attention was focused on the feelings and manifestations of emotions of both their own and those of their peers when interacting with them. Group psychotherapy included participation in a training at which problematic situations of relationships were played. An effective complementary tool for the implementation of psychotherapeutic tasks was art therapy. A discussion was held with teachers and a school psychologist about the essence of alexithymia, recommendations were given on teaching the skills of determining emotions and feelings in oneself and others (in literature lessons, in extracurricular reading, talking, discussing emerging conflict situations) and raising the skills for describing emotions. Parents were consulted, they were recommended to discuss emotional reactions in the family, pay more attention to their son, express love and acceptance of the child (verbally, tactfully, using gestures), help in organizing leisure activities and choosing a hobby, a hobby.

Example 2. Eugene, 14 years old, bilateral sensorineural hearing loss of III-IV degree, violation of psychological development F 83.

I agreed with the statement “I prefer to watch funny television programs, rather than films that talk about other people's problems” - 3 points.

The option “neither one nor the other” was chosen when answering the questions: “I often don’t understand how I feel” - 2 points, “I find it difficult to say what I feel inside” - 2 points, “when I have a problem, I want to know why this happened ”- 2 points,“ when I'm upset, I don’t know whether I’m sad, or scared, or I’m angry ”- 2 points,“ sometimes I can’t find words to say what I feel "- 2 points," it is important for me to understand how I feel "- 2 points," I prefer to talk with people about business and not about feelings "- 2 points," knowing how to solve problems is more important than understanding pr The values for these problems "- 2 points.

I didn’t agree with the statements: “I have sensations in the body that are not even clear to doctors” - 1 point, “it’s hard for me to say how I feel about people” - 1 point, “I am told that I should talk more about what I feel ”- 1 point,“ it’s hard for me to say what I feel, even to my best friend ”- 1 point. I agreed with the statements: “I can easily say how I feel” - 1 point, “I often dream of the future” - 1 point, “when I pay, I always know why” - 1 point.

The total score was 26, which corresponds to the risk group for alexithymia.

From the anamnesis: the eldest of two children in the family, the younger brother and mother are also hearing impaired. My father works as an installer, my mother is a junior teacher in a correctional kindergarten. Relations between parents are tense, conflicting, upbringing is controversial - the father is tough, demanding, unemotional, often raises his voice for his wife and children; mother is soft, compliant, accepting, while interacting with her daughter, she tries to understand the emotional state of the child, is actively interested in the life of children.

In a clinical examination, mental status is characterized by moderate underdevelopment of the intellectual-mnestic sphere in a child with bilateral sensorineural hearing loss. Phrase speech, without agramatisms, with some pronunciation defects. The amount of knowledge about the environment is approaching the lower limit of the age norm. He is trained according to the program of the VII form, he copes with the program well. The mood is calm, even. He actively participates in the conversation, talks about himself. Steady attention, well concentrates on the proposed tasks. Likes drawing. Actively involved in the activities of the school creative team (reads poetry, participates in stage productions), won prizes in competitions. Non-conflict, however, at school is kept apart, has no friends among peers, it is often the subject of ridicule (because of appearance). When observing in a situation of examination and in everyday life (educational activities, communication with peers) it gives the impression of an executive, closed, uncommunicative and unemotional.

The results of testing on the alexithymia scale correspond to clinical manifestations. The revealed features determined the volume of psychocorrectional and psycho-educational measures. The girl was invited to participate in group correctional training, the purpose of which was to expand the scope of the manifestation of emotions and activation of emotional vocabulary. A conversation was held with teachers and a school psychologist about the essence of alexithymia, recommendations were given on teaching the skills of determining emotions and feelings in oneself and others (in literature lessons, in extracurricular reading, talking, discussing emerging conflict situations) and in developing skills for describing emotions. Only my mother responded to the invitation to receive an appointment; a supportive psychotherapeutic conversation was held with her. It is recommended to express love and acceptance of the daughter, taking into account her growing up (in words, tactile, with gestures), appeal to a family therapist for help in resolving interpersonal problems between parents.

Example 3. Roma, 13 years old, congenital anomaly of the organ of vision, atrophy of the optic nerve disc OS, myopia of mild OD; violation of psychological development F 83.

I chose the option “neither one nor the other” when answering the questions: “it is important for me to understand how I feel” - 2 points, “I prefer to talk with people about business and not about feelings” - 2 points, “I prefer to watch funny television programs and not films that talk about other people's problems "- 2 points," knowing how to solve problems is more important than understanding the causes of these problems "- 2 points.

I agreed with the statements: “I can easily say how I feel” - 1 point, “when I have a problem, I want to know why it happened” - 1 point, “I often dream about the future” - 1 point, “when I pay I always know why ”- 1 point.

I didn’t agree with the statements: “I often don’t understand how I feel” - 1 point, “it’s hard for me to say what I feel inside” - 1 point, “I have sensations in the body that are not clear even to doctors” - 1 point, “When I’m upset, I don’t know whether I’m sad, or scared, or I’m angry” - 1 point, “sometimes I can’t find words to say how I feel” - 1 point, “it’s hard for me to say how I feel about people ”- 1 point,“ they tell me that I should talk more about how I feel ”- 1 point,“ it’s hard for me to say how I feel, even to my best friend ”- 1 point.

The total score was 20, which indicates the absence of alexithymic manifestations.

From the anamnesis: lives with mom, older sister and grandmother. Parents divorced when the child was 1 year old, the father does not support relations with the family. Mom - a nurse, by nature is kind, calm, pays much attention to the development and education of her son.

In a clinical examination, the mental status is qualified by the underdevelopment of the intellectual-mnestic sphere in a child with a VAR of the organ of vision. Phrase speech, without agramatisms. The amount of knowledge about the environment is approaching the lower limit of the age norm. He is trained according to the program of the VII form, he copes with the program well. The mood is calm, even. He actively participates in the conversation, talks about himself, his own feelings and attitude to different situations (how he was in the hospital when he was offended by a high school student, how he likes to cook food for his mother at home). Steady attention, well concentrates on the proposed tasks. Likes to listen to stories about animals, the world around him, chatting with friends. He speaks warmly of mom, sister, grandmother. At school lessons, he is attentive, efficient, rarely independently takes initiative. Calm, not conflicting, has friends among classmates and housemates.

Psychological examination determined the average level of anxiety (on the SMAS scale), low level of depression (on the M. Kovak scale).

The test results on the proposed alexithymia scale correspond to clinical manifestations - the absence of alexithymic features.

The method proposed as an invention has been tested on 50 patients and allows for screening of adolescents with sensory impairments with psychological development disorders, to determine groups according to the level of alexithymic manifestations and to conduct preventive psychotherapeutic, psychocorrectional and psycho-educational measures.

LITERATURE

1. Taylor G.J., Ryan D.P., Bagby R.M. Toward the development of a new self-report alexithymia scale // Psychotherapy and Psychosomatics. 1985.V. 44. P. 191-199.

2. Eresko DB, Isurina G.L., Kaydanovskaya EB, Karvasarsky B.D., Karpova E.B., Korepanova T.G., Krylova G.S., Tarhan A.U., Chekhlaty E. I., Shifrin V.B. Alexithymia and methods for its determination in borderline psychosomatic disorders A manual for psychologists and doctors // St. Petersburg: Printing House SPbNIPNI im. V.M. Ankylosing spondylitis., 2005, 25 p.

3. Bagby M., Parker J.D.A., Taylor G.J. The twenty-item Toronto Alexithymia Scale-I. Item selection and cross-validation of the factor structure // J. Psychosom. Res. 1994. Vol. 38. P. 23-31.

4. Bagby R.M., Taylor G.J., Parker J.D.A. The twenty-item Toronto Alexithymia Scale: Convergent, discriminant, and concurrent validity // J. Psychosom. Res. 1994. Vol. 38. P. 33-40.

5. Starostina EG, Taylor GD, Quilti LK, Bobrov A.E., Moshnyaga E.N., Puzyreva N.V., Bobrova M.A., Ivashkina M.G., Krivchikova M.N., Shavrikova E.P., Bagby PM Toronto scale of alexithymia (20 points): validation of the Russian version on a sample of therapeutic patients // Social and Clinical Psychiatry 2010 No. 4, pp. 31-38.

6. Rieffe S., Oosterveld P., Terwogt M.M. An alexithymia questionnaire for children: Factorial and concurrent validation results // Personality and Individual Differences Volume 40, Issue 1, January 2006, Pages 123-133.

7. Joukamaa M., Taanila A., Miettunen J., Karvonen J.T., M. Koskinen, Veijola J. Epidemiology of alexithymia among adolescents // Journal of Psychosomatic Research 63 (2007) 373-376.

8. Kelina M.Yu., Meshkova T.A. Alexithymia and its relationship with food installations in a non-clinical population of adolescent and adolescent girls [Electronic resource] // Clinical and special psychology. 2012. No2. URL: http://psyjournals.ru/psyclin/2012/n2/52628.shtml (accessed: 02/13/2015).

9. Gatta M., Facca I., Colombo E., Svanellini L., Montagnese S. Alexithymia, Psychopathology and Alcohol Misuse in Adolescence: A Population Based Study on 3556 Teenagers Sami Schiff2 Neuroscience & Medicine, 2014, 5, 60-71.

10. Scimeca G., Bruno A., Cava L., Pandolfo G., Muscatello MRA, Zoccali R. The Relationship between Alexithymia, Anxiety, Depression, and Internet Addiction Severity in a Sample of Italian High School Students // The Scientific World Journal Volume 2014 (2014), Article ID 504376, 8 pages http://dx.doi.org/10.1155/2014/504376.

Claims (1)

A method for detecting alexithymia for subsequent correction in adolescents with sensory impairment accompanied by disorders of psychological development, which consists in using the screening “Scales for detecting alexithymia in adolescents with sensory impairment accompanied by disorders of psychological development”, which is contained in the description, characterized in that the responses are evaluated by degree clinical significance from 1 to 3 points and summarized, according to the component of the scale "difficulty in identifying feelings" is estimated at three points the presence of a sign in answers to questions about the lack of understanding of one’s feelings, the presence of “bodily sensations not even understood by a doctor”, difficulties in determining feelings in a situation of “when I’m upset”, difficulties in verbalizing them and lack of habit of dreaming about the future and difficulty in determining the reason “why I cry” ; according to the component of the scale, “difficulties in describing feelings” assess three points as the presence of difficulties in defining one’s inner feelings, the need to verbalize one’s feelings and attitudes towards other people, especially relatives, and difficulties in determining one’s feelings; according to the “externally-oriented type of thinking” component of the scale, the presence of the sign “preference to talk about deeds rather than feelings”, preference to watch humorous programs, rather than “films about other people's problems”, agree with the statement “know ways to solve problems” are evaluated at three points more important than understanding their causes ”, if you do not want to know the cause of the problem and understand your feelings; two points evaluate the answers "neither one nor the other" to all questions; one point is the agreement with the statements “I dream about the future”, “when I cry, I always know the reason”, “I can easily say how I feel”, “I want to know the reason for my problem”, “it is important to understand my feelings”; and at values of the sum of points 22 and lower, the norm is determined without alexithymic manifestations, with values of the sum of points 23-28, the risk group is determined and psychocorrectional and psycho-educational measures are carried out, with values of the sum of scores 29 and higher, alexithymia is determined and psychotherapeutic, psychocorrectional and psycho-educational measures are carried out.