Scientific and Practical Center for Pediatric Psychoneurology. Children's psychoneurological department, Sukhareva Center for Child Psychiatry

Rabotnikova T.P., Ch. specialist in children's speech therapy, Department of Health, Moscow; Trebuleva V.N., Art. speech therapist, children's psychiatric hospital No. 6, Moscow

Moscow Children's Psychiatric Hospital No. 6 is the oldest children's psychiatric hospital in Russia. In 1917, in the old buildings of the modern hospital, a hospital for epileptics was opened, which in 1930 was reorganized into the children's psychiatric department of the hospital named after. P.P. Kashchenko. Three years later, a clinical department arose on its basis, in which, under the leadership of G.E. Sukhareva developed the foundations of the theory and practice of a new branch of medical knowledge - child psychiatry. In 1934, with the active participation of a prominent health care organizer E.A. Osipova created the Scientific and Methodological Center for Child Psychoneurology, which laid the foundations for organizing differentiated step-up psychiatric care with an extensive network of children's psychoneurological institutions in the system of the Ministry of Health, Education and Social Welfare. To improve the quality of diagnosis and care for children and adolescents with neuropsychiatric diseases, in 1962 the Scientific and Methodological Center was merged with the children's psychiatric hospital of the hospital named after. Kashchenko. At first, this association was called the City Psychoneurological Dispensary for Children and Adolescents with an inpatient facility, and was later renamed the Moscow City Children's Psychiatric Hospital No. 6.
Currently, Children's Hospital No. 6 provides highly qualified assistance to young Muscovites, introduces new methods of diagnosis and treatment, provides organizational and methodological management of children's and adolescent psychiatric institutions, and is the basis for specialization and advanced training of doctors, speech-language pathologists, nursing staff of psychiatric and psychoneurological institutions.
Children's Psychiatric Hospital No. 6 consists of a dispensary and diagnostic department; hospital; other departments, which include a medical-genetic complex, an outpatient clinic for forensic psychiatric examination, and a day speech therapy hospital for stuttering preschoolers.
The dispensary department performs advisory, organizational and methodological functions. Advisory assistance is provided to sick children and adolescents aged from
1 year to 17 years of age on referrals from child and adolescent psychiatrists in out-of-hospital institutions. Visits are conducted by psychiatrists, speech therapists, defectologists, and psychologists. Its structure also includes related specialists - a neurologist, an ophthalmologist, an otolaryngologist, a pediatrician, and specialists in functional diagnostics.
The task of the dispensary department is to centrally staff all inpatient departments, specialized sanatoriums, and medical and educational urban institutions with a psychoneurological profile. City commissions function on its basis - the central medical-pedagogical and adoption commissions.
The organizational and methodological department, which is part of the structure of the dispensary department, provides practical and methodological assistance to all speech therapists working in the healthcare system. Every week, the department's methodologists travel to specialized institutions and clinics to provide on-site assistance in examining children and determining methods and forms of work with them.
There is a permanent section of children's speech therapists within the organizational and methodological department. Its meetings are held once a month. They discuss organizational issues, exchange experience, get acquainted with the methods and forms of work of specialists from various children's institutions, and the most current decisions of the Health Committee directly related to speech therapy and defectology work. For speech therapists in the city, a methodological room has been opened at the dispensary department, where more than a hundred works of speech therapists working in specialized children's institutions have been collected. Many of these works, according to reviewers, are of practical value.
In order to improve the qualifications of city specialists, the organizational and methodological department organizes lecture series at the Department of Child and Adolescent Psychiatry, Psychotherapy and Medical Psychology of the Russian Medical Academy of Postgraduate Education (RMAPO). This department pays great attention to establishing close contacts with speech therapists in educational institutions, holding joint meetings and conferences both at the city level and in districts.
On the basis of Children's Hospital No. 6 there is a comprehensive school-laboratory No. 196. 20% of sick children are involved in classes here. The rest of the children who do not have the opportunity to attend school are taught by its teachers in the departments.
Children's Hospital No. 6, as a center for the treatment and rehabilitation of children with neuropsychiatric disorders, pays great attention to the issues of training medical and teaching personnel. The successful solution of this task is facilitated by close contacts with research institutes - the Department of Child and Adolescent Psychiatry, Psychotherapy and Medical Psychology of the Russian Medical Academy of Postgraduate Education, the Department of Psychiatry of the N.I. Pirogov Russian State Medical University, the psychological faculties of Moscow universities, the defectology faculties of Moscow State Pedagogical University and the Open Correspondence University.
The hospital's inpatient departments provide treatment for patients aged 3 to 18 years. The average duration of treatment is 58-78 bed days. There are three departments for preschool children (from 3 to 7 years old) and eight for school-age children. Two departments can be called narrow-profile; they mainly house children with speech disorders. There are 27 speech therapists working in inpatient departments. On average, they provide speech correction assistance to 1,700-1,800 children per year.
Since 1989, the position of senior speech therapist at the hospital has been occupied by V.N. Trebuleva. She provides practical and methodological guidance to the work of specialists in inpatient departments. A large place in her activities is occupied by organizing and conducting practical classes for students of defectology departments of Moscow universities. During the academic year, the hospital receives about 400 students, organizing and conducting practical classes with analysis and demonstration of the most interesting and revealing patients with speech disorders. The main burden in the practical training of speech therapists falls specifically on the speech departments of the hospital - No. 8 and 12.
Preschool department No. 8, opened in December 1962, was created on the initiative of psychoneurologist, candidate of medical sciences R.A. Belova-David, who led it for 17 years. For the last 20 years, the department has been headed by E.N. Karnaukhova. It is intended for children with severe forms of speech disorders of various origins. However, in the vast majority of children they were combined with mental retardation, mental retardation or mildly expressed disorders of personal development. From the very beginning of the department’s existence, its employees pursued the goal of not only practically helping children overcome their defect, but also to penetrate as deeply as possible into its essence and find the most adequate methods of elimination. In this regard, scientists such as A.R. were involved in the work. Luria, N.I. Zhinkin, G.E. Sukhareva, M.B. Eidinova, L.S. Tsvetkova, E.N. Pravdina-Vinarskaya, E.M. Mastyukova and others, as well as speech therapists A.G. Ippolitova, L.V. Melekhova, G.A. Kashe and others. For several years, Professor V.V. was a permanent consultant of the department. Kovalev. Currently, Doctor of Medical Sciences I.O. Kalacheva is conducting consultations there.
The staff of the department generously shared their experience with colleagues from other institutions in Moscow, the country and the world (Bulgaria, Mongolia), and prepared two collections for publication (Speech impairment in preschool children / Edited by R.A. Belova-David and B.M. Grinshpun. M., 1969; Speech impairment in preschoolers /Ed. R.A. Belova-David, 1972).
Much attention in the department is paid to the training of young specialists in practical classes with students of the defectology faculty of Moscow State Pedagogical University named after. IN AND. Lenin. Since 1989, speech therapists from department No. 8 regularly provide practical patronage to MGOPU students. The goal of practical classes conducted by speech therapists of the department E.G. Karitskaya, O.A. Lokshtanova, I.I. Kashirina, T.M. Paramonova, is to introduce students to complex speech disorders that occur in preschool children undergoing treatment in a psychiatric hospital. Students become familiar with such forms of speech disorders as stuttering, alalia, dysarthria, speech disorders in children with early childhood autism, as well as those with genetic pathology. Speech therapists examine children in the presence of students. As part of practical classes, students thus have a rare opportunity to observe the symptoms and features of the course of many speech disorders, participate in the formulation or clarification of speech therapy conclusions in complex diagnostic cases, together with speech therapists of the department, outline ways and methods for correcting existing speech disorders and assess the prospects for it corrections. They can also get acquainted in practice with the most interesting and often rare speech pathology, which is practically not found in educational institutions (Landau-Klefner syndrome, Elf-Williams syndrome, Kanner syndrome, Asperger syndrome, etc.). When working with such disorders, it is necessary to verify the diagnosis with the use of examination and correction methods that confirm one or another speech therapy conclusion: motor alalia and originality of speech with RDA; sensory alalia and originality of speech in RDA; stuttering and originality of speech with RDA; hearing loss and sensory alalia; oculo-dento-digital syndrome and rhinophony, etc.
Working with MGOPU students for many years, the department’s speech therapists note their high theoretical training, maturity and independence in decision-making, a decent level of professional discussions, a desire to see and learn as much as possible, tirelessness and a creative approach to solving diagnostic problems. Students treat the proposed topics of practical classes with great attention and curiosity, express their wishes, allowing the speech therapists of the department to modify and improve them.

Difficulties in working with children who have mental illness motivate the speech therapist to present speech material using non-traditional methods. By introducing manual labor into speech therapy classes, moreover, by making manual activity the leading one, one can successfully develop, correct, and enrich the speech of children with developmental and health needs.

Starting to work as a speech therapist in the children's department of a psychiatric hospital, I encountered a number of difficulties: this is the heterogeneity of speech disorders, this is the lack of motivation to learn, this is a different intellectual level, this is the severity of the manifestation of mental illness, etc.

In the process of work, I discovered that you can approach these children through manual activity.

Manual labor has always been dominant in correctional educational institutions; it is also necessary for the development and correction of speech. It helps to establish contact and trust with the speech therapist; in group classes, it makes the group cohesive, and it motivates children to speak.

When making various crafts and toys from various materials, not only fine motor skills develop, which greatly suffers in children with disabilities, but also the vocabulary is enriched, coherent speech develops, dialogue speech improves, children learn to retell and answer in complete sentences to questions, correction of sound pronunciation is also possible; automation of sounds in speech is especially productive.

In the process of making certain things, children answer the speech therapist’s questions, and then talk in detail about what action they are performing at the moment, in what sequence they perform individual elements of the work, what material they use, etc.

In addition, attention improves, the child becomes calmer, more balanced, memory develops, horizons expand, logical and grammatical constructions (comparisons, sequence relations) become more accessible.

In the course of the work, several basic projects were developed, which became the basis; they are constantly updated taking into account age, individual characteristics, as well as the characteristics of the disease of children.

1. Project “Merry Matryonitsa”.

Working with threads and fabric is a child’s creative work, during which he creates useful, aesthetically significant objects and products for decorating everyday life and games. The main work is braiding braids, winding balls, tying knots, making pom-poms, and simple dolls.

This project is related to oral folk art, respectively, it is listening and retelling various fairy tales, singing Russian folk songs, dramatization games, table theater, finger theater with children playing fairy tales, learning nursery rhymes, jokes, ditties, solving riddles, explaining proverbs and sayings. Long-term planning has been developed for the project; the duration of the project is long-term.

2. Project “Paper Country”.

The basis is working with paper. Most often this is a collective work, correlated with a certain time of year, a holiday. Together with the children, large paintings are made from rolled paper, often multi-colored napkins. This type of work requires a lot of patience, perseverance, teamwork, and accuracy.

In this project, speech therapy work is built taking into account the topic of the work. For example: in preparation for the New Year, a thematic panel is made; accordingly, in the process of working as a speech therapist, such topics as “Winter”, “Wintering Birds”, “Winter Fun”, “New Year Traditions”, “Animals in Winter”, etc. will be worked out. A calendar-thematic plan with the main speech therapy tasks has been developed for the project; its duration is long-term.

3. Project “Macaronimania”.

The basis is working with different types of pasta. Children really like this type of work; it is more creative and individual. This project includes such types of work as stringing pasta on a cord (various beads), applique, painting pasta and finished crafts. The main topics are “Plants”, “Flowers”, “Vegetables”, “Fruits”, “Seasons”. When performing this type of work, the grammatical structure of speech is well developed. The project is also equipped with a thematic plan and is long-term.

All these projects are constantly updated and adjusted taking into account the characteristics and speech capabilities of children. Children are happy to go to classes, and their performance when using manual labor increases.

Kolesnikova T.V.,
speech therapist