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Infantilism: genital, psychological, social
Last reviewed: 21.04.2022
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In medicine, the term infantilism (exactly translated from Latin infantia means “infancy”) is one of the developmental disorders in which adults and children have physical or physiological parameters that are clearly inappropriate for their age, mental or behavioral characteristics. [1]
Epidemiology
According to statistics, physical retardation due to a lack of hormones accounts for almost 10% of the total number of growth disorders and infantilism.
The approximate prevalence of congenital hypogonadism in the population is 1:10 thousand, Shereshevsky-Turner syndrome - in one of 2-5 thousand women; Kalman syndrome in boys -1:8 thousand, in girls - 1:40 thousand; Klinefelter's syndrome is detected in one of 650-800 newborn boys.
And the frequency of congenital hypothyroidism is estimated at one case in 3600-4500 infants.
Causes of the infantilism
Experts associate the main causes of infantilism with a lag or certain deviations in the development of a child, adolescent or adult.
Normally, during physical interaction with the environment, a set of inherited reflexes of infants develops into more coordinated actions, and by the age of one and a half, the child tries to solve physical problems meaningfully, has stable attachments, shows interest and is able to adequately express his emotions.
However, in physical development, the formation of cognitive, emotional, intellectual abilities, there may be delays that cause a discrepancy between the age norms known in pediatrics - infantilism in children.
The etiology of this immaturity, including in adulthood, is considered, depending on its form, as a syndrome of infantilism.
So, physiological or physical infantilism, classified by the ICD-10 to the section of symptoms, signs and deviations from the norm - as the absence of the expected normal physiological development in children and adults (with code R62.5), may occur:
- due to placental insufficiency during childbearing (leading to fetal hypoxia and ontogenesis disorders);
- in the presence of malformations of intrauterine development (in particular, the hypothalamic-pituitary region of the brain and thyroid gland - with neuroendocrine disorders);
- with insufficient secretion of growth hormone somatotropin (STH);
- due to genetic abnormalities (including the hormone-producing anterior pituitary gland);
- as a result of hereditary mitochondrial diseases .
And infantilism and mental retardation can be associated with both perinatal encephalopathy and neuroendocrine and / or chromosomal syndromes. [2]
Risk factors
Risk factors for lagging or deviations in the development of a child, leading to one or another type of infantilism, are considered to be:
- constitutional and genetic predisposition;
- deficiency of hormones that provide metabolism and processes of embryonic ontogenesis;
- teratogenic effects on the fetus of toxic substances or drugs taken during pregnancy, as well as birth trauma, fraught with swelling of the brain of the newborn;
- anomalies of intrauterine development and congenital malformations;
- fraught with complications of infectious diseases suffered at an early age;
- psychotraumatic impact (maltreatment in childhood, death of the father or mother of the child);
- psychosocial factors, including pedagogical and / or socio-psychological neglect, increased demands of parents and vice versa - parental overprotection. Permissiveness, whim indulgence, etc.
Child psychologists see a serious threat of infantilization of normally developed children and adolescents in the craze for computer games and the replacement of live communication with peers by virtual contacts in social networks.
Pathogenesis
The mechanism of developmental disorders in case of insufficiency of growth hormone produced by the anterior pituitary gland is associated with a decrease in a number of other growth factors and a violation of the entire biochemical chain for ensuring the processes of protein synthesis, glucose metabolism, and the production of hormones (gonadotropic, thyrotropic, adrenocorticotropic).
The presence of congenital hypothyroidism leads to a deficiency of thyroid hormones, which also causes a delay in the development of most body systems, including the central nervous system.
The pathogenesis of some conditions leading to certain forms of infantilism is discussed in publications:
Symptoms of the infantilism
With somatotropin deficiency, physical infantilism is manifested by age-inappropriate body proportions (narrow chest, thin bones and weak muscles), underdevelopment of some organs and delayed puberty.
In children with congenital hypothyroidism, the first signs of physical infantilism are also manifested by growth retardation and bone age disorders.
Despite the clinical heterogeneity, the symptoms and most characteristic signs of mental infantilism (which can be distinguished only from the onset of primary school or early adolescence) include age-inappropriate behavior with increased impressionability and moodiness, superficial judgments and fantasizing, inability to concentrate and make decisions, egocentrism with simultaneous dependence on the actions and opinions of others.
Manifestations of intellectual infantilism are violations of attention, perception and concentration; inertia of thinking, fixation on one thought (perseveration) and difficulty in switching the thought process.
Children with neurotic infantilism are timid and impressionable, very attached to their mother and not inclined to show independence. Signs of emotional immaturity of a person, first of all, are considered impulsiveness, inability to control their emotions and their inadequate manifestation (children often cry for insignificant reasons, take offense at the fair remarks of elders, get angry and throw tantrums), as well as inability to understand the feelings of other people.
Symptoms of genital infantilism in men were named above, and in adolescent girls and women, three degrees of genital infantilism are distinguished:
- infantilism of the 1st degree - with a rudimentary state of the uterus and amenorrhea (absence of menstruation) ;
- infantilism of the 2nd degree - with a diameter of the body of the uterus not more than 30 mm and irregular, meager and painful menstruation;
- infantilism of the 3rd degree - with a slightly reduced uterus and almost normal, but often painful periods.
Forms
In addition to the already named physical, there are a number of other types or forms of infantilism, and each of them has its own reasons - obvious or hidden.
With a delay in general development (physical, mental and mental), psychophysical infantilism is determined. Depending on the degree of lag in the development of the child and the characteristics of its manifestations, they distinguish: harmonic infantilism (if physical and mental development lags behind proportionally and its manifestations do not go beyond the emotional-volitional sphere) and disharmonic infantilism, which is a specific disorder of personality development with psychopathic behavioral deviations.
Developmental delay against the background of systemic diseases of internal organs and pathologies of general metabolism can be defined as somatic infantilism or somatogenic infantilism. For example, with congenital hypothyroidism , as well as an extreme degree of thyroid dysfunction - myxedema , many metabolic processes in the body are disturbed, which negatively affect its development. [3]This also applies to patients with monogenic juvenile MODY diabetes . [4]
In such cases, such a definition as organic infantilism can also be used, although some experts use this term if the cause of infantilism lies in damage to brain structures and dysfunction of the central nervous system.
It should be noted that genetic infantilism can be determined only in cases where a child's developmental delay is etiologically associated with a hereditary disease or one of the congenital syndromes of functional disorders of the pituitary gland or adrenal cortex.
By the way, the term intestinal infantilism, referring to the beginning of the 20th century, is outdated and is not used, since this pathology, associated with increased sensitivity of the intestinal mucosa to alpha-gliadin, the gluten (gluten) protein of cereals, is called celiac disease (gluten enteropathy) . [5]
Motor or motor infantilism is a delay in the development of fine motor skills and may be due to: minimal brain dysfunction - with diffuse alteration of the brain or its frontal lobes during pregnancy and childbirth; prolonged oxygen starvation of the fetal brain; significant prematurity of infants; congenital synaptic inhibition of the motor and premotor cortex of the cerebral hemispheres. Fine motor skills are also underdeveloped in children with attention deficit hyperactivity disorder .
Read also - Brain dysfunction in adults and children
Genital infantilism means the underdevelopment of the external genital organs (genitals), and sexual or sexual infantilism means a delay or lack of sexual development / maturation. These disorders affect the reproductive system of women and men.
Genital infantilism is considered synonymous with hypogonadism : hypogonadotropic - with a primary deficiency of gonadoliberin (gonadotropin-releasing hormone, GnRH) or pituitary - when violations of the prenatal development of the pituitary gland lead to insufficient secretion of the same GnRH. [6]
The reproductive organs of the fetus develop from the 4-5th to the 20th week of pregnancy. The so-called baby uterus - uterine infantilism or gonadal infantilism in women - is the result of congenital anomalies due to gene mutations. Violations of the intrauterine formation of the organs of the reproductive system, leading to uterine aplasia (often with vaginal hypoplasia), are fully manifested in Mayer-Rokitansky-Kuster-Hauser syndrome - due to violations of the transformation of the embryonic Müllerian ducts.
Underdevelopment of the uterus is characteristic of Swyer's syndrome and adrenogenital syndrome - deficiency of the enzyme 17-alpha-hydroxylase (which is necessary for the biosynthesis of sex steroids).
Cervical infantilism, that is, infantilism of the cervix, is observed in violations of the development of the female genital tract - agenesia of the cervix, which is most often combined with congenital absence of the vagina and an underdeveloped (or absent) uterus. Among the main causative factors, various teratogenic effects on the fetus and gene mutations (in particular, those responsible for the synthesis of the 21-hydroxylase enzyme) are noted.
Pituitary ovarian infantilism is the result of isolated hypogonadotropic ovarian hypofunction . It is also detected in all girls with a partial absence of one X chromosome - Shereshevsky-Turner syndrome . With this syndrome, in addition to gonadal dysgenesis, puberty is delayed, and sexual infantilism, as in Kalman syndrome , is a consequence of hypothalamic-pituitary dysfunction and deficiency of GnRH, FSH (follicle-stimulating hormone) and LH (luteotropin). [7]
Read more: Malformations of the vagina and uterus
Sexual infantilism in men is associated with dysontogenesis (underdevelopment) of the genitals. So, the presence of micropenis , as well as testicular aplasia, are caused either by hypoplasia of Leydig cells - endocrinocytes of the interstitial tissue of the testicles, or by Klinefelter 's syndrome - partial insensitivity to male sex hormones (androgens). Hypogonadism and chromosomal abnormalities in Noonan syndrome also lead to violations of the sexual development of men at an early embryonic stage .
Mental infantilism or psychoaffective immaturity is considered one of the types of psychotic disorders, in particular, asthenic psychopathy . Also, disharmonic mental infantilism in children and adults is often observed in cases of schizoid personality disorder and in schizophrenia. In children, there is an etiological connection with autistic disorder - Asperger's syndrome .
Psychological infantilism is often replaced by the phrase "adult child", and the peculiarity of such a person is manifested in the absence of self-control and self-regulation skills, willpower and responsibility. Almost identical to psychological personal infantilism is the immaturity of an individual in the emotional-volitional sphere, whose mental characteristics are manifested by emotional lability (instability), increased excitability and impulsivity, the presence of behavioral patterns and a lack of self-criticism, as well as difficulties with adaptation in a team or problems in personal relationships.
Intellectual infantilism is considered a mental disorder with cognitive abilities inappropriate for the age level. For more details, see - Mental retardation in children
Emotional infantilism is defined as when an older child or adult exhibits the emotions of a younger child, responds inappropriately (especially in a situation where there is no way to satisfy their desires), and is not able to understand their own feelings, as well as recognize and interpret the emotions of other people.
Neurotic infantilism develops as a psychopathological against the background of neurotic disorders and disorders in individuals with emotional and volitional immaturity.
Taking into account the predominant areas of manifestation of developmental disorders, some experts distinguish social infantilism, as well as legal infantilism. In the first case, this refers to a person's lack of interaction skills with others (family members, work colleagues, etc.) and unwillingness to fulfill the duties of adults. In the second case, adults - like children who oppose any restrictions - do not have an “internal brake”, that is, a clear idea of \u200b\u200bresponsibility for their actions and what they have no right to do. In an extreme form, this may seem like legal nihilism with an absolute rejection of legal norms as such.
Complications and consequences
Problems of fertility and reproductive function with the inability to become pregnant - complications and consequences of genital infantilism of 1-2 degrees in women.
With intellectual infantilism, there is a serious decrease in the school performance of children and adolescents.
Personal or psychological infantilism in a relationship jeopardizes any interpersonal and intra-family ties and social contacts. In addition to difficulties in adapting to the rules of society, adolescents with disharmonious mental infantilism have distorted the formation of personality and general motivation, and in adults, personality disorder can progress, anxiety-depressive states develop, and psychopathic behavior is aggravated.
Diagnostics of the infantilism
Clinical diagnosis of personal, mental and neurotic infantilism can cause certain difficulties in identifying specific disorders that underlie this deviation.
Based on the history, symptoms and diagnostic criteria, the psychiatrist conducts a test for infantilism, which includes a scale for assessing psychopathological symptoms (negative and positive), various psychophysical and behavioral tests, including the level of logical thinking, memory, reaction speed, etc..
When the parents go to the doctor about the lag in the development of the child, an X-ray of the hand is prescribed - to determine the bone age, as well as blood tests to determine the level of various hormones (STH, TSH, ACTH, etc.).
Laboratory studies are also necessary to diagnose developmental disorders of the organs of the reproductive system (underdevelopment of the genitals), as well as to clarify the history of syndromic abnormalities. Then an analysis is carried out for the karyotype, for the level of thyroid-stimulating, sex and other hormones in the blood.
Differential diagnosis
Differential diagnosis includes borderline personality disorder, mental retardation, Angelman syndrome, emotional disorders (including hyperthymia), and other types of neurocognitive pathologies.
More information in the materials:
Treatment of the infantilism
No doctor can accelerate physical, mental or psycho-emotional development, and infantilism of psychological and mental origin becomes a persistent personality characteristic.
What to do if the child is behind in development , the child psychologist will tell the parents. And how to get rid of infantilism, an experienced psychotherapist will advise , in whose arsenal there is such a method as cognitive behavioral therapy.
What therapeutic measures help to cope with the emotional instability of children and adults with infantilism, read in the publication - Increased emotional lability syndrome .
And the treatment of hypogonadism, functional disorders of the adrenal cortex, thyroid dysfunction or hypothalamic-pituitary dysfunction, etiologically associated with a violation of the development of the genitals and sexual development, consists in the appointment of long-term (often lifelong) hormone replacement therapy.
Prevention
Since genetically related diseases are responsible for almost half of the cases of moderate mental retardation and more than a third of cases of developmental delay, prevention may include genetic counseling when planning a pregnancy.
Forecast
Psychologists believe that proper upbringing can significantly improve the prognosis of harmonic infantilism in children. But the immaturity of the adult personality often shapes a lifestyle that is frivolous, carefree, and irresponsible.
Psychogenic pathological infantilism can lead to passive confrontation with society. And the inability to make independent decisions, the inability to think about one's actions and weigh their possible consequences makes a person an easy object for various manipulations, including criminal ones.