A screening study provides. Ultrasound screening examination. Screening study during pregnancy. What affects screening results?

Screening is a comprehensive examination that will show the state of fetal development at a certain moment. Based on the screening results, the doctor observing the woman draws conclusions about the course of pregnancy and, if necessary, prescribes more detailed examinations or consultations in specialized centers.

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Screening and ultrasound: what's the difference?

The word “screening” comes from the English word screen - “to sift, filter, select.” In medicine, the term is used to refer to safe research on large populations. Prenatal (antenatal) screening allows you to determine the degree of risk of congenital pathologies of the fetus. Initially, such a diagnostic system was created in order to identify women who may experience complications during pregnancy, distribute them into various groups, and then provide them with planned examinations, observations and assistance.

Women often mistake ultrasound diagnostics for screening in a broad sense. But ultrasound is called screening because it is carried out as part of this study and is an integral part of it. The whole complex includes:

• Biochemical blood test for certain hormones and other serum markers. In a woman’s blood, the levels of several hormones are determined, which are indicators of a successful pregnancy and appropriate fetal development. A biochemical blood test is taken twice (double test and triple test): from the 11th to the 14th week and from the 16th to the 20th week. The results make it possible to recognize fetal development abnormalities as early as possible and identify genetic abnormalities.
• An ultrasound examination is carried out three times during pregnancy: at 12–14 weeks, at 21–24 weeks and at 30–34 weeks. Three procedures are mandatory, but there may be more if the doctor deems it necessary. The third screening ultrasound is performed with Doppler ultrasound, which makes it possible to assess whether blood circulation in the uterus and placenta is normal, and what is the condition of the blood flow in the vessels of the unborn child.
• Infectious diseases research. At 10-12 weeks, when a woman registers with the antenatal clinic, and at 30 weeks, the doctor will take a smear of discharge from the vagina and cervical canal. In the first and third trimester, you will need to take blood tests for syphilis, HIV, hepatitis B and hepatitis C. In the first trimester, you need to be tested for TORCH infections (the abbreviation stands for the English names of infections: toxoplasmosis, rubella, cytomegalovirus, herpes virus and others).

Prenatal screening consists of several stages in order to provide medical professionals and the expectant mother with the necessary information about the dynamic development of the fetus. This is one of the safest and most accessible diagnostic tools: the procedures do not affect the course of pregnancy, as they are carried out without intervention in the uterine cavity.

At the antenatal clinic, a pregnant woman fills out a questionnaire, where she indicates the data necessary to calculate the risks of intrauterine developmental defects. Once analyzes and studies are ready, all information is entered into a special computer program, where risks are calculated. There is an age-related risk for pathology, biochemical indicators, and diseases. The presence of a high risk does not mean one hundred percent presence of a defect in the fetus. During pregnancy, the woman will be under closer attention from specialists and will undergo a number of additional consultations and examinations.

Screening stages

In early pregnancy (from the 11th to the 14th week), biochemical screening makes it possible to identify genetic abnormalities and severe congenital diseases of the fetus. The test determines the amount of two substances significant for pregnancy in a woman’s blood:

1. 1. Human chorionic gonadotropin (hCG);
2. 2. Plasma protein associated with pregnancy A (PAPP-A).

HCG is a hormone produced by one of the components of a fertilized egg. After implantation to the wall of the uterus, it stimulates the development of the placenta, preparing the woman’s immunity to accept the fetus. By comparing hCG levels at different stages of pregnancy, the doctor will promptly identify deviations:

• If an elevated level of the hormone is detected, then diabetes mellitus in the pregnant woman and Down syndrome in the child can be suspected.
• If the level of hCG is low, this may signal an ectopic pregnancy, threatened miscarriage, delayed fetal development, or placental insufficiency.

PAPP-A is a protein essential for the development of the placenta. If there is a decrease in its level in the blood over time, this indicates the risk of chromosomal abnormalities of the fetus or the threat of miscarriage. In cases where indicators deviate from the norm, additional examinations of the pregnant woman are necessary.



An ultrasound examination is aimed at assessing the vital activity of the embryo, determining its location and comparing its size with norms. Ultrasound at this stage allows you to name the date of birth with an accuracy of 1-2 days, thereby establishing the duration of pregnancy, as well as assessing the risk of miscarriage or premature birth:

• The optimal period for completion is the period from the 12th to the 13th week. At the 12th week, the length of the embryo is 6–7 cm, weight is about 10 grams; A pulse with a frequency of 100–160 beats per minute is also heard.
• Ultrasound at this stage allows you to name the date of birth with an accuracy of 1-2 days, thereby establishing the duration of pregnancy, as well as assessing the risk of miscarriage or premature birth.
• At the first ultrasound, the specialist needs to determine whether the fetus is located outside the uterus, whether placental abruption is observed, or whether there is a disruption in the formation of individual parts or the entire body of the unborn child. It is at an early stage that it is revealed how many embryos are in the uterus. If a multiple pregnancy is not detected early, serious problems may arise later.
• One of the most important indicators for ultrasound is the thickness of the cervical fold. The cervical spine of the fetus is covered with soft tissue. The space between the outer surface of these tissues and the inner surface of the skin of the neck is called the cervical fold. There is an accumulation of fluid here, and the greater its thickness is visible, the more likely the presence of pathology. More accurately, the degree of risk can be calculated by considering this indicator in conjunction with data from other surveys.
• Ultrasound also evaluates the visualization of the nasal bone. If the length of the nasal bone is less than the norm established for a given period, then this may be a sign of chromosomal abnormalities.

Medical professionals examine the results of biochemical tests and ultrasound together. The woman's age and medical history are taken into account. If, based on the results of tests and ultrasound, a high degree of risk of pathologies such as Down syndrome, neural tube defects, Edwards syndrome, Patau syndrome, etc. is determined, the woman is sent for a consultation to a medical genetic center, where additional examinations may be recommended. Based on these data, the issue of further bearing the child will be decided. However, not all abnormalities in fetal development may be detected at the first screening.



Second screening

In the second trimester (weeks 16–20), a screening examination excludes malformations of the heart, kidneys, lungs, brain, limbs, and bone tissue. The triple biochemical test is again aimed at calculating the risks of having a child with genetic pathology and congenital diseases (spina bifida, anencephaly, etc.). The woman takes a blood test for alpha fetoprotein (AFP), free estriol and a second test for hCG. Alpha-fetoprotein is a protein that is produced in the baby's liver; it protects the fetus from the action of the mother's immune system. Free estriol is a hormone whose level in the blood increases in proportion to the duration of pregnancy. In the normal state, its content is minimal.

Ultrasound is performed in two-dimensional or three-dimensional mode:

• Usually a two-dimensional ultrasound is performed to get an idea of ​​the structure of the internal organs of the unborn child.
• Three-dimensional ultrasound is done as prescribed by a doctor and is used to detect surface defects.
• The specialist assesses the amount of amniotic fluid and the condition of the placenta, which provides information about the uteroplacental blood flow.

During the second ultrasound screening, women are very often asked to record an image of the unborn child for the family archive and name its gender. It is usually possible to determine the sex: the size of the fetus already allows the specialist to examine its basic anatomy. But it should be remembered that this is not the main purpose of ultrasound in the second trimester.

If, as a result of the first and second screening studies, the indicators deviate significantly from the norm, then there is a high risk that pathology will develop. This is a reason to prescribe additional research and consult a genetic specialist.



Third screening

The focus of ultrasound in the third trimester (30–34th week) is fetal biometry (head size, abdominal circumference, femur length are measured) and assessment of the condition and functions of the placenta. The doctor needs to establish whether the child’s weight corresponds to the norms for a given period of pregnancy, determine how proportionate and harmonious the development of the fetus is, clarify the features of the physical condition of the fetus, and identify the entanglement of the umbilical cord, if present. In the case of placental insufficiency, a manifestation of intrauterine growth retardation is likely, which must be treated. The doctor will prescribe medications aimed at normalizing metabolic processes and supporting the vital functions of the fetus. It is possible that intrauterine developmental defects may be detected at this stage. Based on the results, doctors will be able to prepare for the birth of the child and provide him with medical care immediately after birth.



For a woman, fetal Doppler testing does not feel different from a standard ultrasound. This test identifies defects in the child's heart and blood vessels and shows whether the child is suffering from a lack of oxygen (hypoxia). If so, the doctor will be able to determine where the blood flow is being disrupted: in the uterus, placenta or umbilical cord. In this case, the woman is prescribed appropriate treatment. After treatment, the woman must undergo control Doppler testing, which will show the results of therapy.

Microscopic examination of vaginal and cervical discharge and blood tests for infections can suggest whether the baby is likely to become infected during childbirth.

Concerning questions about the safety of ultrasound

Every woman preparing to become a mother worries whether the tests prescribed by the doctor will harm the health of the unborn baby. And if women treat taking blood from a vein as an unpleasant, but familiar and harmless procedure, then ultrasound diagnostics has its supporters and opponents. Many people consider ultrasound dangerous to health and pass on myths about the dangers of this study.

Ultrasound is one of the safe diagnostic methods. You can undergo these studies without fear, even if they are prescribed more than once, since ultrasound waves do not have harmful effects, unlike X-ray radiation. Ultrasound is based on the principle of echolocation. Specially tuned sensors emit ultrasonic vibrations, which are reflected from the object under study and received back by the same sensors. A computer program analyzes the information received and displays an image of the organ being studied on the monitor. Many are afraid that the frequency of 20 Hz, at which the ultrasound machine sensor operates, stimulates the growth of cancer cells, in other words, it can provoke the development of oncological pathology even in a healthy body. To date, there is no substantiated evidence for this theory, although many studies have been (and are still being conducted) on the topic of the harmlessness or harm of ultrasound. The harmlessness of ultrasound is confirmed by scientists and well-known medical specialists in the field of oncology. Ultrasound waves do not have a pathogenic effect on tissues, including the skin. Dermatitis, pigmentation disorders, redness, peeling and other skin changes were not recorded after ultrasound.



Some women insist on refusing ultrasound examination. In this case, you must refuse it in writing in the gynecologist's office. Even if a woman believes that the risk of fetal development pathologies is minimal, it is still recommended to undergo biochemical tests and get a consultation at a medical genetic center.

You should not refuse ultrasound as part of prenatal screening if one or more factors occur:

• pregnant woman over 35 years of age: the risk of complications increases with age;
• the woman has had (especially in the first trimester) hepatitis, rubella, chickenpox, and is a carrier of the herpes virus;
• sinusitis, otitis, pneumonia or other serious bacterial disease in a woman during pregnancy;
• the woman took medications prohibited during pregnancy;
• the woman has had more than two miscarriages or had previous pregnancies with unfavorable outcomes;
• a child from previous pregnancies was born with pathology or developmental defects;
• one of the parents was exposed to ionizing radiation;
• one of the future parents had children with pathologies.

How to prepare for screening tests

Blood is drawn for biochemical studies from a vein. This is done both in the antenatal clinic and in a specialized laboratory. Take the test on an empty stomach. It is recommended to have dinner before 19:00 the night before. A large and late dinner, as well as breakfast, can provoke changes in indicators. It is recommended to ask your doctor in advance whether you should follow a certain diet before taking the test or whether you can eat your usual food. The doctor will ask you to exclude foods containing glucose from your diet on the eve of the test. These are grapes, pears, melons, figs, honey, sugar, candies and other sweets, white bread, cereals, and legumes. In the morning you can drink still water.

You should not donate blood after physical activity, physiotherapeutic procedures, X-ray examination, or intravenous administration of medications. Tablets that need to be taken in the morning can be taken.

Preparing for an ultrasound for screening is also simple. The first ultrasound is performed both transvaginally (through the vagina) and abdominally (through the anterior wall of the abdomen). Before the procedure, if possible, it is advisable to perform hygiene procedures - take a shower and wash yourself. If the diagnosis is performed abdominally, then it is necessary to come to the procedure with a full bladder. To do this, you need to drink two glasses of plain water half an hour before the test. If the specialist then needs to continue the examination transvaginally, the woman will be asked to go to the toilet first.



At the second stage of screening, an ultrasound scan is performed abdominally, but there is no need to drink water: amniotic fluid is sufficient to study the condition of the fetus. At the third stage, the examination is carried out through the abdomen; no preparation is needed.

Often both blood sampling and ultrasound examination are performed on the same day.

Reliability of results

Based on the results of comprehensive studies, the obstetrician-gynecologist draws conclusions about the course of pregnancy, the state of health of the woman and the fetus and, if necessary, corrects deviations in a timely manner. However, screening results cannot be 100% accurate. The effectiveness of using the ultrasound examination method in diagnosing congenital anomalies is 70–80%.

There is a possibility that the result will be false positive, which will give cause for alarm, additional examinations, and unnecessary stress for the woman. A false negative result will prevent you from paying special attention to the course of pregnancy. Experts note that sometimes we encounter situations where the pathological process develops too quickly and does not allow a diagnosis to be made in time. An example is the case of a transient intrauterine infection in late pregnancy, which led to changes in the internal organs of the fetus that are incompatible with life.

In case of multiple pregnancies, screening is currently not informative, since a sufficient number of women have not yet been studied, which would allow the results to be interpreted correctly. Indicators developed for singleton pregnancies will not be reliable in this case.



If no obvious pathology is detected, but the examination results place the woman in a high-risk group, then she will have to decide on the advisability of further pregnancy. If a decision is made to terminate the pregnancy, doing it in the early stages is much safer for the woman’s health. Not everyone finds this method ethical. Every year in Russia two thousand children are born with Down syndrome. According to the Moscow Center for Curative Pedagogy, this figure is not seriously decreasing, but it is not increasing either, which speaks in favor of the information content of prenatal screening, especially during pregnancy up to 12 weeks.

Most medical professionals believe that the opportunity should be taken to identify emerging pathology as early as possible. If a malformation is discovered during examinations, in many cases specially selected tactics for managing pregnancy and childbirth can minimize the identified complications. If a chromosomal abnormality is diagnosed, then it is impossible to influence the situation with medication. Parents will try to get as much information as possible and prepare mentally for the birth of a potentially unhealthy child. Each pregnant woman decides for herself whether she wants to be sufficiently informed about the health of her unborn child. Statistically, the decision is usually made in favor of surveys.

The Center for Immunology and Reproduction has been successfully working for many years prenatal screening program. Our specialists are invited to give lectures at specialized conferences and in other clinics. Our laboratory receives consistently good marks in the quality control system. Specially trained specialists carry out risk calculations.

What is prenatal diagnosis?

The word "prenatal" means "before birth." Therefore, the term “prenatal diagnosis” means any studies that make it possible to clarify the condition of the intrauterine fetus. Since human life begins at the moment of conception, various health problems can occur not only after birth, but also before birth. Problems can be different:

• fairly harmless, which the fetus can handle on its own,
• more serious when timely medical care will preserve the health and life of the intrauterine patient,
• severe enough that modern medicine cannot cope with.

To determine the health status of the intrauterine fetus, prenatal diagnostic methods are used, which include ultrasound, cardiotocography, various biochemical studies, etc. All these methods have different capabilities and limitations. Some methods are quite safe, such as ultrasound. Some carry some risk to the fetus, such as amniocentesis (sample of amniotic fluid) or chorionic villus sampling.

It is clear that prenatal diagnostic methods associated with the risk of pregnancy complications should be used only when there are compelling indications for their use. In order to narrow as much as possible the circle of patients in need of invasive (i.e., associated with intervention in the body) methods of prenatal diagnosis, the selection is used risk groups development of certain problems in the intrauterine fetus.

What are risk groups?

Risk groups are those groups of patients among whom the likelihood of detecting a particular pregnancy pathology is higher than in the entire population (among all women in a given region). There are risk groups for the development of miscarriage, gestosis (late toxicosis), various complications during childbirth, etc. If a woman, as a result of an examination, is found to be at risk for a particular pathology, this does not mean that this pathology will necessarily develop. This only means that this patient is more likely to develop one or another type of pathology than other women. Thus, the risk group is not identical to the diagnosis. A woman may be at risk, but there may not be any problems during pregnancy. And vice versa, a woman may not be at risk, but she may have a problem. The diagnosis means that this or that pathological condition has already been discovered in this patient.

Why are risk groups needed?

Knowing that the patient is in one or another risk group helps the doctor correctly plan the management of pregnancy and childbirth. Identification of risk groups makes it possible to protect patients who are not included in risk groups from unnecessary medical interventions, and vice versa, it allows us to justify the prescription of certain procedures or studies for patients included in risk groups.

What is screening?

The word screening means "sifting." In medicine, screening means conducting simple and safe studies on large groups of the population in order to identify groups at risk of developing a particular pathology. Prenatal screening refers to studies carried out on pregnant women to identify groups at risk of pregnancy complications. A special case of prenatal screening is screening to identify groups at risk of developing congenital defects in the fetus. Screening does not allow identifying all women who may have one or another problem, but it makes it possible to identify a relatively small group of patients, within which the majority of people with this type of pathology will be concentrated.

Why is screening for fetal defects necessary?

Some types of congenital defects in the fetus are quite common, for example, Down syndrome (trisomy 21 pair of chromosomes or trisomy 21) - in one case in 600 - 800 newborns. This disease, like some other congenital diseases, occurs at the time of conception or in the earliest stages of fetal development and can be diagnosed quite early in pregnancy using invasive prenatal diagnostic methods (chorionic villus sampling and amniocentesis). However, such methods are associated with the risk of a number of pregnancy complications: miscarriage, the development of a conflict regarding the Rh factor and blood group, infection of the fetus, the development of hearing loss in the child, etc. In particular, the risk of developing a miscarriage after such studies is 1:200. Therefore, these studies should be prescribed only to women at high risk. Risk groups include women over 35 and especially over 40, as well as patients who have given birth to children with developmental defects in the past. However, children with Down syndrome can be born to very young women. Screening methods - completely safe studies carried out at certain stages of pregnancy - make it possible with a very high degree of probability to identify groups of women at risk of Down syndrome who may be indicated for chorionic villus sampling or amniocentesis. Women who are not at risk do not need additional invasive examinations. Detection of an increased risk of developing fetal defects using screening methods is not a diagnosis. The diagnosis can be made or rejected with additional tests.

What types of birth defects are screened for?

• Down syndrome (trisomy of the twenty-first pair of chromosomes)
• Edwards syndrome (trisomy eighteenth pair)
• Neural tube defects (spina bifida and anencephaly)
• Smith-Lemli-Opitz syndrome
• Corneille de Lange syndrome

What types of tests are performed to screen for the risk of birth defects in the fetus?

By types of research highlight:

• Biochemical screening: blood test for various indicators
• Ultrasound screening: identifying signs of developmental abnormalities using ultrasound.
• Combined screening: a combination of biochemical and ultrasound screening.

The general trend in the development of prenatal screening is the desire to receive reliable information about the risk of developing certain disorders as early as possible in pregnancy. It turned out that combined screening at the end of the first trimester of pregnancy (10-13 weeks) makes it possible to approach the effectiveness of classical biochemical screening in the second trimester of pregnancy.

Ultrasound screening, used for mathematical processing of the risks of fetal abnormalities, is carried out only once: at the end of the first trimester of pregnancy.

Concerning biochemical screening, then the set of indicators will be different at different stages of pregnancy. During pregnancy 10-13 weeks the following indicators are checked:

• free β-subunit of human chorionic hormone (free β-hCG)
• PAPP-A (pregnancy associated plasma protein A), pregnancy-associated plasma protein A

A calculation of the risk of measuring fetal anomalies based on the measurement of these indicators is called double biochemical test in the first trimester of pregnancy.

Using a double test in the first trimester, the risk of detection in the fetus is calculated Down syndrome (T21) And Edwards syndrome (T18), trisomy on chromosome 13 (Patau syndrome), triploidy of maternal origin, Shereshevsky-Turner syndrome without dropsy. The risk of neural tube defects cannot be calculated using a double test, since the key indicator for determining this risk is α-fetoprotein, which begins to be determined only from the second trimester of pregnancy.

Special computer programs make it possible to calculate the combined risk of fetal developmental anomalies, taking into account biochemical indicators determined in a double test in the first trimester and the results of an ultrasound scan done at 10-13 weeks of pregnancy. This test is called combined with TVP double test in the first trimester of pregnancy or triple test in the first trimester of pregnancy. The risk calculations obtained using the combined dual test are much more accurate than risk calculations based on biochemical parameters alone or on ultrasound alone.

If test results in the first trimester indicate that the fetus is at risk for chromosomal abnormalities, the patient may be tested to exclude the diagnosis of chromosomal abnormalities. chorionic villus biopsy.

During pregnancy 14 - 20 weeks by last menstruation ( recommended time frame: 16-18 weeks) the following biochemical parameters are determined:

• α-fetoprotein (AFP)
• Inhibin A

Based on these indicators, the following risks are calculated:

• Down syndrome (trisomy 21)
• Edwards syndrome (trisomy 18)
• neural tube defects (spina bifida and anencephaly).
• Risk of trisomy 13 (Patau syndrome)
• Triploidy of maternal origin
• Shereshevsky-Turner syndrome without hydrops
• Smith-Lemli-Opitz syndrome
• Corneille de Lange syndrome

This test is called quadruple test in the second trimester of pregnancy or quadruple biochemical screening in the second trimester of pregnancy. A truncated version of the test is the so-called triple or double tests of the second trimester, which includes 2 or indicators: hCG or free β-hCG subunit, AFP, free estriol. It is clear that the accuracy of the second trimester double or double test is lower than the accuracy of the second trimester quadruple test.

Another option for biochemical prenatal screening is biochemical risk screening for neural tube defects only in the second trimester of pregnancy. In this case, only one biochemical marker is determined: α-fetoprotein

At what stage of pregnancy is second trimester screening performed?

At 14 - 20 weeks of pregnancy. The optimal period is 16 - 18 weeks of pregnancy.

What is the quadruple test in the second trimester of pregnancy?

The main option for biochemical screening of the second trimester in the Center is the so-called quadruple or quadruple test, when the determination of inhibin A is added to the determination of the three above indicators.

Ultrasound screening in the first trimester of pregnancy.

In the first trimester of pregnancy, the main measurement used in calculating risks is the width of the cervical translucency (English “nuchal translucency” (NT)”, French “clarté nuchale”). In Russian medical usage, this term is often translated as “neck space” (TVP) or “cervical fold”. Cervical translucency, nuchal translucency and cervical fold are complete synonyms that can be found in various medical texts and mean the same thing.

Cervical translucency - definition

• Cervical transparency is what the accumulation of subcutaneous fluid on the back of the fetal neck looks like during ultrasound examination in the first trimester of pregnancy.
• The term cervical translucency is used regardless of whether it is septated or whether it is limited to the cervical region or surrounds the entire fetus
• The frequency of chromosomal and other abnormalities is related primarily to the width of the transparency, and not to how it looks overall
• During the second trimester, the transparency usually resolves, but in some cases it can develop into either cervical edema or cystic hygromas with or without generalized edema.

Cervical translucency measurement

Gestation period and coccygeal-parietal size

The optimal period of pregnancy for measuring PB is from 11 weeks to 13 weeks 6 days. The minimum KTR size is 45 mm, the maximum is 84 mm.

There are two reasons for choosing 11 weeks as the earliest time to measure PN:

1. Screening requires the ability to perform chorionic villus sampling before the time when this study may be complicated by amputation of fetal limbs.
2. On the other hand, many gross fetal defects can be detected only after 11 weeks of pregnancy.

• A diagnosis of omphalocele is possible only after 12 weeks.
• Diagnosis of anencephaly is possible only after 11 weeks of pregnancy, since only from this period ultrasound signs of ossification of the fetal skull appear.
• Assessment of the four chambers of the heart and large vessels is possible only after 10 weeks of pregnancy.
• The bladder is visible in 50% of healthy fetuses at 10 weeks, in 80% at 11 weeks, and in all fetuses at 12 weeks.

Image and measurement

To measure SB, the ultrasonic device must have a high resolution with a video loop function and calibrators that can measure the size with an accuracy of tenths of a millimeter. PB can be measured using an abdominal probe in 95% of cases; in cases where this is not possible, a vaginal probe should be used.

When measuring HF, only the head and upper part of the fetal chest should be included in the picture. The magnification should be at its maximum, so that a slight shift of the markers results in a change in measurement of no more than 0.1 mm. When enlarging a picture, before or after capturing the image, it is important to reduce the gain. This avoids measurement errors when the marker falls into a blurred area and thus the size of the BL will be underestimated.

A good sagittal section should be obtained, the same quality as when measuring CTE. The measurement should be made in the neutral position of the fetal head: extension of the head can increase the TVP value by 0.6 mm, flexion of the head can decrease the value by 0.4 mm.

It is important not to confuse the fetal skin and the amnion, since at this stage of pregnancy both formations look like thin membranes. If in doubt, you should wait until the fetus moves and moves away from the amnion. An alternative method is to ask the pregnant woman to cough or lightly tap the pregnant woman's abdominal wall.

The greatest perpendicular distance between the internal contours of the cervical transparency is measured (see figure below). Measurements are taken three times, the largest size value is used for calculation. In 5-10% of cases, the umbilical cord is found entangled around the fetal neck, which can significantly complicate measurement. In such cases, 2 measurements are used: above and below the umbilical cord entanglement site, and the average of these two measurements is used to calculate the risks.

Standards for ultrasound scanning at the end of the first trimester of pregnancy are being developed by the England-based Fetal Medicine Foundation (FMF). In the CIR group of companies, ultrasound is performed according to the FMF protocol.

Additional ultrasound signs of risk for Down syndrome

Recently, in addition to the measurement of spinal cord, the following ultrasound signs have been used to diagnose Down syndrome at the end of the first trimester of pregnancy:

• Nasal bone definition. At the end of the first trimester, the nasal bone not defined using ultrasound in 60-70% of fetuses with Down syndrome and only 2% of healthy fetuses.
• Assessment of blood flow in the Arantium (venous) duct. Abnormalities in the waveform of blood flow in the duct of arantia are found in 80% of fetuses with Down syndrome and only in 5% of chromosomally normal fetuses
• Reduction in the size of the maxillary bone
• Enlarged bladder (“megacystitis”)
• Moderate tachycardia in the fetus

The shape of blood flow in the Arantium duct during Doppler measurements. Top: normal; bottom: with trisomy 21.

Not just Down syndrome!

During an ultrasound scan at the end of the first trimester, fetal contour assessment also helps identify the following fetal abnormalities:

• Exencephaly - anencephaly
• Cystic hygroma (swelling at the level of the neck and back of the fetus), in more than half of cases is caused by chromosomal abnormalities
• Omphalocele and gastroschisis. The diagnosis of omphalocele can be made only after 12 weeks of pregnancy, since before this period a physiological umbilical hernia, which is often detected, has no clinical significance
• Single umbilical artery (in a large percentage of cases combined with chromosomal abnormalities in the fetus)

How are risks calculated?

Special software is used to calculate risks. Simply determining the level of indicators in the blood is not enough to decide whether the risk of developmental abnormalities is increased or not. The software must be certified for use for prenatal screening purposes. At the first stage of computer calculation, the indicator numbers obtained during laboratory diagnostics are converted into the so-called MoM (multiple of median, multiple of the median), characterizing the degree of deviation of a particular indicator from the median. At the next stage of calculation, the MoM is adjusted for various factors (the woman’s body weight, race, the presence of certain diseases, smoking, multiple pregnancies, etc.). The result is the so-called adjusted MoM. In the third calculation step, the adjusted MoMs are used to calculate the risks. The software is specially configured for the methods used in the laboratory for determining indicators and reagents. It is not acceptable to calculate risks using tests done in another laboratory. The most accurate calculation of the risk of fetal abnormalities is when using data from an ultrasound examination performed at 10-13 weeks of pregnancy.

What is MoM?

MoM is an English abbreviation of the term “multiple of median”, which means “multiple of the median”. This is a coefficient showing the degree of deviation of the value of a particular prenatal screening indicator from the average value for the gestational age (median). MoM is calculated using the following formula:

MoM = [Value of the indicator in the patient’s blood serum] / [Value of the median indicator for the gestational age]

Because the indicator value and median have the same units, the MoM value has no units. If the patient’s MoM value is close to one, then the value of the indicator is close to the population average, if it is above one, it is above the population average, if it is below one, it is below the population average. With congenital fetal defects, there may be statistically significant deviations of MoM markers. However, pure MoMs are almost never used in calculating the risk of fetal anomalies. The fact is that in the presence of a number of factors, the average MoM values ​​deviate from the average in the population. Such factors include the patient’s body weight, smoking, race, pregnancy as a result of IVF, etc. Therefore, after obtaining MoM values, the risk calculation program makes adjustments for all these factors, resulting in the so-called “corrected MoM value”, which used in risk calculation formulas. Therefore, in the conclusion forms based on the analysis results, next to the absolute values ​​of the indicators, the corrected MoM values ​​for each indicator are indicated.

Typical MoM profiles in pregnancy pathologies

With various fetal anomalies, MoM values ​​are combined deviated from the norm. Such combinations of MoM deviations are called MoM profiles for a particular pathology. The tables below show typical MoM profiles at different stages of pregnancy.

Typical MoM Profiles - First Trimester

Typical MoM Profiles - Second Trimester

Indications for prenatal screening of the 1st and 2nd trimester for the risk of fetal anomalies

Prenatal screening is currently recommended for all pregnant women. An order of the Ministry of Health of the Russian Federation of 2000 obliges antenatal clinics to conduct biochemical prenatal screening for all pregnant patients in the second trimester of pregnancy for two indicators (AFP and hCG).

Order No. 457 of December 28, 2000 “On improving prenatal diagnostics in the prevention of hereditary and congenital diseases in children”:

“At 16-20 weeks, blood should be taken from all pregnant women to conduct research on at least two serum markers (AFP, hCG)”

The importance of monitoring congenital diseases on an ongoing basis in Moscow is also discussed in the resolution of the Moscow government on the establishment of the city program “Children's Health” for 2003-2005.

“It is advisable to begin in Moscow genetic monitoring of congenital malformations of newborns, prenatal screening for Down syndrome and neural tube defects”

On the other hand, prenatal screening should be a purely voluntary matter. In most Western countries, it is the physician's responsibility to inform the patient about the possibility of such tests and about the purposes, possibilities and limitations of prenatal screening. The patient herself decides whether to have tests done or not. The CIR group of companies shares the same point of view. The main problem is that there is no treatment for the detected abnormalities. If the presence of anomalies is confirmed, the married couple is faced with a choice: terminate the pregnancy or continue it. This is not an easy choice.

What is Edwards syndrome?

This is a condition caused by the presence of an extra 18th chromosome in the karyotype (trisomy 18). The syndrome is characterized by gross physical abnormalities and mental retardation. This is a lethal condition: 50% of sick children die in the first 2 months of life, 95% - during the first year of life. Girls are affected 3-4 times more often than boys. The incidence in the population ranges from 1 case in 6,000 births to 1 case in 10,000 births (about 10 times less common than Down syndrome).

What is the free β-subunit of hCG?

The molecules of a number of hormones of the pituitary gland and placenta (thyroid-stimulating hormone (TSH), follicle-stimulating hormone (FSH), luteinizing hormone (LH) and human chorionic hormone (hCG)) have a similar structure and consist of α and β subunits. The alpha subunits of these hormones are very similar and the main differences between the hormones lie in the structure of the beta subunits. LH and hCG are very similar not only in the structure of the α-subunits, but also in the structure of the β-subunits. This is why they are hormones with the same effect. During pregnancy, LH production by the pituitary gland drops to almost zero, and hCG concentrations are very high. The placenta produces very large amounts of hCG, and although this hormone mainly enters the bloodstream in assembled form (a dimeric molecule consisting of both subunits), the free (not associated with the α-subunit) β-subunit of hCG also enters the bloodstream in small quantities. Its concentration in the blood is many times lower than the concentration of total hCG, but this indicator can more reliably indicate the risk of problems in the intrauterine fetus in the early stages of pregnancy. Determination of the free β-subunit of hCG in the blood is also important for the diagnosis of trophoblastic disease (hydatidiform mole and chorionepithelioma), some testicular tumors in men, and monitoring the success of in vitro fertilization procedures.

Which indicator: total hCG or free hCG β-subunit is preferable to use in the second trimester triple test?

Using the free β-hCG subunit assay rather than the total hCG assay provides a more accurate estimate of the risk of Down syndrome, but classic statistical calculations of the risk of Edwards syndrome in a population have used maternal total hCG levels. No such calculations have been made for the hCG β subunit. Therefore, a choice must be made between a more accurate calculation of the risk of Down syndrome (in the case of the β-subunit) and the possibility of calculating the risk of Edwards syndrome (in the case of total hCG). Let us remember that in the first trimester, only the free β-subunit of hCG, but not total hCG, is used to calculate the risk of Edwards syndrome. Edwards syndrome is characterized by low numbers of all 3 indicators of the triple test, so in such cases, both versions of the triple test can be done (with total hCG and with the free β-subunit).

What is PAPP-A?

Pregnancy-associated plasma protein-A (PAPP-A) was first described in 1974 as a high-molecular-weight protein fraction in the blood serum of women in late pregnancy. It turned out to be a large zinc-containing metaloglycoprotein with a molecular weight of about 800 kDa. During pregnancy, PAPP-A is produced by syncytiotrophoblast (tissue that is the outer layer of the placenta) and extravillous cytotrophoblast (islets of fetal cells in the thickness of the uterine mucosa) and enters the mother's bloodstream

The biological significance of this protein is not fully understood. It has been shown to bind heparin and is an inhibitor of granulocyte elastase (an enzyme induced by inflammation), so PAPP-A is believed to modulate the maternal immune response and is one of the factors that ensures the development and survival of the placenta. In addition, it was found to be a protease that cleaves insulin-like growth factor binding protein 4. There are serious reasons to believe that PAPP-A is one of the factors of paracrine regulation not only in the placenta, but also in some other tissues, in particular in atherosclerotic plaques. It is proposed to use this marker as one of the risk factors for coronary heart disease.

Concentrations of PAPP-A in maternal blood continuously increase with increasing gestational age. The greatest increase in this indicator is observed at the end of pregnancy.

Over the past 15 years, PAPP-A has been studied as one of three risk markers for trisomy 21 (Down syndrome) (together with free hCG β-subunit and nuchal translucency thickness). It turned out that the level of this marker at the end of the first trimester of pregnancy (8-14 weeks) is significantly reduced if the fetus has trisomy 21 or trisomy 18 (Edwards syndrome). The uniqueness of this indicator is that its significance as a marker of Down syndrome disappears after 14 weeks of pregnancy. In the second trimester, its levels in maternal blood in the presence of trisomy 21 in the fetus do not differ from those in pregnant women with a healthy fetus. If we consider PAPP-A as an isolated risk marker for Down syndrome in the first trimester of pregnancy, its determination at 8-9 weeks would be most significant. However, free hCG β-subunit is a stable risk marker for Down syndrome at 10–18 weeks, i.e., later than PAPP-A. Therefore, the optimal time for donating blood for a double test in the first trimester of pregnancy is 10-12 weeks.

The combination of measuring PAPP-A levels with determining the concentration of the free β-subunit of hCG in the blood and determining TVP using ultrasound at the end of the first trimester of pregnancy can identify up to 90% of women at risk of developing Down syndrome in the older age group (after 35 years). The probability of false positive results is about 5%.

In addition to prenatal screening for the risk of Down syndrome and Edwards syndrome, in obstetrics the PAPP-A determination is also used for the following types of pathology:

• Threat of miscarriage and stopping the development of pregnancy in the short term
• Cornelia de Lange syndrome.

Risk diagnosis stoppage of fetal development in early pregnancy was the historically first clinical application of PAPP-A determination in blood serum, proposed in the early 1980s. It has been shown that women with low levels of PAPP-A in early pregnancy are at risk of subsequent pregnancy loss and severe forms of late toxicosis. Therefore, it is recommended to determine this indicator at 7-8 weeks for women with a history of severe pregnancy complications.

Cornelia de Lange syndrome is a rare form of congenital malformations of the fetus, found in 1 case in 40,000 births. The syndrome is characterized by mental and physical retardation, heart and limb defects, and characteristic facial features. It has been shown that in this condition, PAPP-A levels in the blood at 20-35 weeks are significantly lower than normal. A study by Aitken's group in 1999 showed that this marker could be used to screen for Cornelia de Lange syndrome in the second trimester of pregnancy, since levels in such pregnant women were on average 5 times lower than normal.

The reagents used to determine PAPP-A and the free β-subunit of hCG are orders of magnitude more expensive than the reagents used for most hormonal parameters, making this test a more expensive test compared to the determination of most reproductive hormones.

What is α-fetoprotein?

It is a fetal glycoprotein produced first in the yolk sac and then in the liver and gastrointestinal tract of the fetus. This is a transport protein in the fetal blood that binds a number of different factors (bilirubin, fatty acids, steroid hormones). It is a dual regulator of intrauterine fetal growth. In an adult, AFP does not perform any known functions, although it can increase in the blood in liver diseases (cirrhosis, hepatitis) and in some tumors (hepatocellular carcinoma and germinal carcinoma). In the mother's blood, the level of AFP gradually increases with increasing pregnancy and reaches a maximum at 30 weeks. The level of AFP in the mother's blood increases with neural tube defects in the fetus and with multiple pregnancies, and decreases with Down syndrome and Edwards syndrome.

What is free estriol?

Estriol is synthesized in the placenta from 16α-hydroxy-dehydroepiantrosterone sulfate supplied from the fetus. The main source of estriol precursors is the fetal adrenal glands. Estriol is the main estrogenic hormone of pregnancy and ensures the growth of the uterus and the preparation of the mammary glands for lactation.

90% of estriol after 20 weeks of pregnancy is formed from fetal DEA-S. The high release of DHEA-S from the fetal adrenal gland is associated with low 3β-hydroxysteroid dehydrogenase activity in the fetus. A protective mechanism that protects the fetus from excess androgenic activity is the rapid conjugation of steroids with sulfate. The fetus produces more than 200 mg of DHEA-S per day, 10 times more than the mother. In the mother's liver, estriol quickly undergoes conjugation with acids, mainly hyaluronic acid, and is thus inactivated. The most accurate method for determining fetal adrenal activity is to determine the level of free (unconjugated) estriol.

Free estriol levels gradually increase as pregnancy progresses and in the third trimester of pregnancy can be used to diagnose fetal well-being. If the condition of the fetus worsens in the third trimester of pregnancy, a sharp drop in the level of free estriol may be observed. Free estriol levels are often reduced in Down syndrome and Edwards syndrome. Taking dexamethasone, prednisolone or metipred during pregnancy suppresses the function of the fetal adrenal glands, so the level of free estriol in such patients often decreases (reduced estriol intake from the fetus). When taking antibiotics, the rate of estriol conjugation in the mother's liver increases and the reabsorption of conjugates from the intestine decreases, so the level of estriol also decreases, but due to the acceleration of its inactivation in the mother's body. For accurate interpretation of the triple test data, it is very important that the patient indicate a complete list of medications taken or taken during pregnancy with doses and timing of use.

Algorithm for prenatal screening in the first and second trimester of pregnancy.

1. Calculate the duration of pregnancy, preferably after consultation with a doctor or with the help of a consultant.

First trimester screening has its own characteristics. It is carried out between 10 and 13 weeks of pregnancy and is quite strictly limited in terms of timing. If you donate blood too early or too late, if you make a mistake in calculating the gestational age at the time of donating blood, the accuracy of the calculation will sharply decrease. Pregnancy dates in obstetrics are usually calculated based on the first day of the last menstruation, although conception occurs on the day of ovulation, that is, with a 28-day cycle - 2 weeks after the first day of menstruation. Therefore, periods of 10 - 13 weeks on the day of menstruation correspond to 8 - 11 weeks on conception.

To calculate the gestational age, we recommend using the obstetric calendar posted on our website. Difficulties in calculating the timing of pregnancy can occur with an irregular menstrual cycle, with pregnancy occurring shortly after birth, with a cycle that deviates from 28 days by more than a week. Therefore, it is best to trust the professionals and consult a doctor to calculate the timing of pregnancy, perform an ultrasound and donate blood.

2. We do an ultrasound.

The next step should be an ultrasound scan between 10 and 13 weeks of pregnancy. Data from this study will be used by the risk calculation program in both the first and second trimester. It is necessary to begin the examination with an ultrasound, since during the examination problems with the development of pregnancy may be revealed (for example, a stop or delay in development), multiple pregnancies, and the timing of conception will be calculated quite accurately. The doctor performing the ultrasound will help the patient calculate the timing of blood donation for biochemical screening. If the ultrasound turns out to be done too early in the pregnancy, then perhaps the doctor recommends repeating the study after some time.

To calculate risks, the following data from the ultrasound report will be used: date of ultrasound, coccygeal-parietal dimension (CPR) and nuchal translucency thickness (NTT) (English abbreviations CRL and NT, respectively), as well as visualization of the nasal bones.

3. Donate blood.

Having the results of the ultrasound and knowing the exact stage of pregnancy, you can come to donate blood. Blood collection for analysis for prenatal screening in the CIR group of companies is carried out daily, including weekends. On weekdays, blood collection is carried out from 7:45 to 21:00, on weekends and holidays: from 8:45 to 17:00. Blood is drawn 3-4 hours after the last meal.

During pregnancy 14 - 20 weeks after the last menstruation (recommended periods: 16-18 weeks), the following biochemical indicators are determined:

• Total hCG or free β-subunit of hCG
• α-fetoprotein (AFP)
• Free (unconjugated) estriol
• Inhibin A

4. We get the result.

Now you need to get the analysis results. The turnaround time for prenatal screening analysis results in the CIR group of companies is one business day (except for the quadruple test). This means that tests taken from Monday to Friday will be ready on the same day, and tests taken from Saturday to Sunday will be ready on Monday.

Conclusions based on the results of the study are issued to the patient in Russian.

Table. Explanations of terms and abbreviations

Report date	Date of computer processing of results
Gestational age	Weeks + days
Date of ultrasound	Date of ultrasound. Usually does not coincide with the date of blood donation.
Fruit	Number of fruits. 1 - singleton pregnancy; 2 - twins; 3 - triplets
ECO	Pregnancy resulted from IVF
KTR	Coccygeal-parietal size determined during ultrasound
MoM	Multiple of median, the degree of deviation of the result from the average for a given period of pregnancy
Accor. MoM	Adjusted MoM. MoM value after correction for body weight, age, race, number of fetuses, presence of diabetes, smoking, infertility treatment using IVF.
NT	Thickness of the collar space (nuchal translucency). Synonym: neck fold. Various reporting options may provide either absolute values ​​in mm or degree of deviation from the median (MoM)
Age risk	Average statistical risk for this age group. No factors other than age are taken into account.
Tr. 21	Trisomy 21, Down syndrome
Tr. 18	Trisomy 18, Edwards syndrome
Biochemical risk	Risk of fetal anomalies after computer processing of blood test data without taking into account ultrasound data
Combined risk	The risk of fetal anomalies after computer processing of blood test data taking into account ultrasound data. The most accurate indicator of risk level.
fb-HCG	Free β-subunit of hCG
DPM	Date of last menstruation
AFP	α-fetoprotein
HCG	General hCG (human chorionic gonadotropin)
uE3	Free estriol (unconjugated estriol)
+NT	The calculation was carried out taking into account ultrasound data
mIU/ml	mIU/ml
ng/ml	ng/ml
IU/ml	IU/ml

Additional Information.

Information for patients: Please note that if you plan to undergo prenatal screening in the CIR group of companies, then ultrasound data performed in other institutions will be taken into account only if there is a special agreement between the CIR group of companies and these institutions.

Information for doctors

Dear Colleagues! In accordance with Order of the Ministry of Health No. 457 and Decree of the Moscow Government No. 572, the CIR group of companies provides services to other medical institutions for prenatal screening for the risk of chromosomal abnormalities. You can invite our employees to come to you with a lecture on this program. To refer a patient for screening, the attending physician must fill out a special referral. The patient can come to donate blood on her own, but it is also possible to have blood taken at other institutions with subsequent delivery to our laboratory, including by our courier. If you want to receive the results of double, triple and quadruple tests of the first and second trimesters of pregnancy, combined with ultrasound data, the patient must come to us for an ultrasound, or we must sign a special agreement with your institution and include your ultrasound specialists in the program, but only after our expert in functional diagnostics will visit your institution and become familiar with the quality of the equipment and the qualifications of the specialists.

It is carried out with a group of children and is aimed at identifying children who have one or another group of characteristics, assesses the constancy of certain psychological properties in a given group of children.

2. In-depth psychological diagnostics , which is carried out after identifying children who have any developmental disabilities and need additional developmental or correctional work, i.e., special psychological assistance. Typically conducted individually or in small groups.

3. Dynamic examination , with the help of which the dynamics of development, the effectiveness of training, developmental and/or correctional measures are traced. It can be carried out several times during one correction course.

4. Final diagnostics . The purpose of this type of diagnosis is to assess the child’s condition upon completion of the course of correctional work.

PRINCIPLES OF DIAGNOSTICS

When conducting any type of diagnosis, a teacher-psychologist of a preschool educational institution must adhere to the following principles:

– complexity and versatility in the study of a child, the desire for maximum consideration in assessing the development of all his significant characteristics;

– study of children in activities and relationships, through activities and relationships;

– pedagogical orientation: study, diagnosis not as an end in itself, but as a means that determines the direction of correctional assistance to the child in overcoming his problems;

– participation in the study and assessment of the child’s development of all those involved in his destiny and interested parties (parents, educators, teachers);

To ensure that the diagnostic results are not distorted, the educational psychologist needs to take into account:

– physical development and condition of the child;

– psychophysiological characteristics of his age;

– dynamics of physical development (history);

– state of hearing, vision;

– features of the development of the motor sphere;

– disorders of general motor skills (general tension or lethargy, imprecision of movements; paralysis, paresis, the presence of their residual effects);

– coordination of movements (features of gait, gestures, difficulties when necessary to maintain balance, difficulties in regulating the pace of movements, the presence of hyperkinesis, synkinesis, obsessive movements);

– characteristics of performance (fatigue, exhaustion, absent-mindedness, satiety, switchability, perseverance, pace of work; an increase in the number of errors towards the end of the lesson or during monotonous activities; complaints of headaches).

METHODS OF PSYCHOLOGICAL RESEARCH

Research methods can be considered based on four main positions:

a) non-experimental psychological methods;

b) diagnostic methods;

c) experimental methods;

d) formative methods.

Currently, a large number of diagnostic methods have been developed, but not all of them are applicable to preschool children. The most acceptable are: observation, conversation, experiment, survey.

Non-experimental methods:

Observation is one of the most commonly used research methods. Observation can be used as an independent method, but usually it is organically included in other research methods, such as conversation, study of products of activity, various types of experiment, etc.

Observation and self-observation is the purposeful, organized perception and registration of an object and is the oldest psychological method.

Observation can be carried out directly or using observation devices and means of recording results. These include: audio, photo and video equipment, special surveillance cards, etc.

The observation results can be recorded during the observation process or delayed.

Observation is an indispensable method if it is necessary to study natural behavior without outside interference in a situation, when it is necessary to obtain a holistic picture of what is happening and reflect the behavior of individuals in its entirety. Observation can act as an independent procedure and be considered as a method included in the experimentation process. The results of observing subjects as they perform an experimental task are the most important additional information for the researcher.

Questionnaire , like observation, is one of the most common research methods in psychology. Questionnaire surveys are usually conducted using observational data, which (along with data obtained through other research methods) is used to construct questionnaires.

There are three main types of questionnaires used in psychology:

- These are questionnaires composed of direct questions and aimed at identifying the perceived qualities of the subjects.

These are scale questionnaires; When answering questions on scale questionnaires, the subject must not only choose the most correct of the ready-made answers, but analyze (evaluate in points) the correctness of the proposed answers.

Conversation - one of the methods for studying human behavior, since in other natural sciences communication between the subject and object of research is impossible. A dialogue between two people, during which one person reveals the psychological characteristics of the other, is called the conversation method. A conversation can also be conducted with a group, when the teacher asks questions to the whole group and makes sure that the answers include the opinions of all group members, and not just the most active ones.

The conversation can be both more standardized and freer. In the first case, the conversation is conducted according to a strictly regulated program, with a strict sequence of presentation, clearly recording answers and processing the results with relative ease.

In the second case, the content of the question is not planned in advance. Communication flows more freely and wider, but this complicates the organization, conduct of the conversation and processing of the results. This form places very high demands on the teacher.

There are also intermediate forms of conversation that try to combine the positive qualities of both of these types.

When preparing for a conversation, preliminary work is very important.

1. The leader of the conversation must carefully think through all aspects of the problem he is going to talk about, select those facts that he may need. A clear statement of the purpose of the conversation helps to formulate clear questions and avoid random ones.

2. He must determine in what order he will raise topics or ask questions.

3. It is important to choose the right place and time for conversation. It is necessary that there are no people nearby whose presence could confuse, or, even worse, affect the sincerity of the interlocutor.

When conducting a conversation, especially a free one, you should adhere to the following recommendations:

1. Communication should begin with a topic that is pleasant to the interlocutor, so that he will willingly start talking.

2. Questions that may be unpleasant for the interlocutor or cause a feeling of testing should not be concentrated in one place, they should be evenly distributed throughout the conversation.

3. The question should provoke discussion and development of thought.

4. Questions should take into account the age and individual characteristics of the interlocutor.

5. Sincere interest and respect for the opinion of the interlocutor, a friendly attitude in conversation, the desire to convince rather than force an agreement, attention, sympathy and participation are no less important than the ability to speak convincingly and reasonedly. Modest and correct behavior inspires trust.

6. The teacher must be attentive and flexible in conversation, preferring indirect questions to direct ones, which are sometimes unpleasant for the interlocutor. Reluctance to answer a question should be respected, even if it means that important information for the study is missed. If the question is very important, then during the conversation you can ask it again in a different wording.

7. From the point of view of the effectiveness of the conversation, it is better to ask several small questions than one large one.

8. In a conversation with students, indirect questions should be widely used. It is with their help that the teacher can obtain the information he is interested in about the hidden aspects of a child’s life, about unconscious motives of behavior, and ideals.

9. In no case should you express yourself in a drab, banal or incorrect manner, thus trying to get closer to the level of your interlocutor - this is shocking.

10. For greater reliability of the results of the conversation, the most important questions should be repeated in various forms and thereby control previous answers, supplement, and remove uncertainty.

11. You should not abuse the patience and time of your interlocutor. The conversation should not last more than 30-40 minutes.

The undoubted advantages of the conversation include:

Having contact with the interlocutor, the ability to take into account his responses, evaluate his behavior, attitude to the content of the conversation, and ask additional, clarifying questions. The conversation can be purely individual, flexible, and maximally adapted to the student.

An oral response takes less time than a written one.

The number of unanswered questions is noticeably reduced (compared to written methods).

Students take questions more seriously.

At the same time, it should be taken into account that in a conversation we do not receive an objective fact, but a person’s opinion. It may happen that he arbitrarily or involuntarily distorts the real state of affairs. In addition, the pupil, for example, often prefers to say what is expected of him.

Questionnaire.

The questionnaire belongs to the most proven, practiced and mastered methods. But this diagnosis has one common negative feature. It is exploited when the teacher does not take the trouble to creatively select methods for a specific pedagogical goal, and with the help of a questionnaire they try to find out from the children themselves what the measure of their upbringing is. Therefore, teachers often resort to simultaneous surveys of parents and children, and also take into account their own assessment.

The criterion for evaluating the questionnaire is the measure of detecting the child’s directed interest, his desires, aspirations, doubts and, ultimately, personal problems in life, as well as the measure of spiritual help for the child: when the questionnaire, being a diagnosis, helps children understand themselves in the world and gives rise to their positive activity, opening up for them a new aspect of life or a new value object.

Monographic method. This research method cannot be implemented in any one technique. It is a synthetic method and is specified in a combination of a wide variety of non-experimental (and sometimes experimental) techniques. The monographic method is used, as a rule, for a deep, thorough study of age and individual characteristics.

Diagnostic methods.

Diagnostic research methods include various tests, i.e. methods that allow the researcher to give a quantitative qualification to the phenomenon being studied, as well as various methods of qualitative diagnostics, with the help of which, for example, different levels of development of the psychological properties and characteristics of the subjects are identified.

Test – a standardized task, the result of which allows you to measure the psychological characteristics of the subject. Thus, the purpose of the test study is to test and diagnose certain psychological characteristics of a person, and its result is a quantitative indicator correlated with previously established relevant norms and standards.

The difference between diagnostic methods and non-experimental methods is that they not only describe the phenomenon being studied, but also give this phenomenon a quantitative or qualitative qualification and measure it.

Methodology for carrying out diagnostic work.

The pedagogical examination is aimed at determining the level of assimilation of program material by preschool children. The survey can be carried out both for the program as a whole, and for a section or subsection. Based on the data obtained, conclusions are drawn, a work strategy is built, strengths and weaknesses are identified, technologies for achieving the desired result, forms and methods for eliminating shortcomings are developed. The pedagogical examination is aimed at identifying the level of program material, achieving high results in its assimilation, correcting the forms, methods and methods of teaching students, and the effectiveness of using pedagogical technologies.

Pedagogical examination is carried out twice a year: for the first half of the year - January, for the second in May (possibly the third at the beginning of the school year) Examination in all sections of the program, except for special ones (musical and physical) is carried out by teachers, the administration is present during the examination, helps with permission controversial issues, a re-examination is carried out (if necessary).

The results of the survey are discussed at a joint meeting, the reasons for the insufficiently high level of mastery of program material for each task, subsection, and section by each child are identified, and further actions of teachers in working with students are outlined. The compiled analytical report is read out to the pedagogical council.

Diagnostics is of great importance for the targeted and effective implementation of the educational process. It allows, through control (monitoring) and correction of the entire system of education and training and its components, to improve the process of education, training and development of children.

Stages of organizing diagnostic work.

Defining goals and setting tasks, developing methodological recommendations for conducting pedagogical diagnostics.

Development of criteria for assessing levels of mastery of program material.

Development of tasks for examining pupils.

Development of a plan for conducting a diagnostic examination.

Preparation of material for diagnostics.

Development of a table-matrix “Results of a pedagogical survey”

Filling out a diagram of the dynamics of individual assimilation of program material by each student (in comparison for two half-years).

Based on the obtained data, compilation of an analytical report on the assimilation of program material for this section.

The educational institution issues an order “On conducting pedagogical diagnostics,” which specifies the goals, responsibilities, and timing.

At the end of the diagnostic examination and summing up, an order “On the results of pedagogical diagnostics” is issued, which reflects the results, conclusions, recommendations, responsible persons, and deadlines for eliminating deficiencies.

Specifics of psychological and pedagogical diagnostics of junior schoolchildren.

What is he like, a junior schoolchild who faces a difficult path of learning new things under the guidance of a teacher, whose interest in learning the teacher has to awaken?

Junior school age is a stage of child development that corresponds to the period of study in primary school. The chronological boundaries of this age vary in different countries and in different historical conditions. These boundaries can be conditionally defined in the range from 6-7 to 10-11 years; their clarification depends on the officially accepted terms of primary education.

The admission of a child to school poses a number of tasks for the institution during the period of work with primary schoolchildren:

identify the level of his readiness for schooling and the individual characteristics of his activities, communication, behavior, mental processes that will need to be taken into account during training;

if possible, compensate for possible gaps and increase school readiness, thereby preventing school maladjustment;

plan the strategy and tactics of teaching the future student, taking into account his individual capabilities.

Solving these problems requires a deep study of the psychological characteristics of modern schoolchildren, who come to school with different “baggage”, representing the totality of psychological new formations of the previous age stage - preschool childhood.

Each age stage is characterized by a special position of the child in the system of relations accepted in a given society. In accordance with this, the lives of children of different ages are filled with specific content: special relationships with people around them and special activities leading to a given stage of development. I would like to note that L.S. Vygotsky identified the following types of leading activity:

infants – direct emotional communication;

early childhood – manipulative activities;

preschoolers - play activities;

younger schoolchildren - educational activities;

teenagers – socially recognized and socially approved activities;

high school students – educational and professional activities.

Entering school radically changes the nature of a child's life. From the first days of school, the main contradiction arises - between the ever-growing demands placed on the child’s personality, his attention, memory, thinking, speech, and the current level of development. This contradiction is the driving force of development in a primary school student. As demands increase, the level of mental development rises to their level.

Primary school age is a qualitatively unique stage of child development. The development of higher mental functions and personality as a whole occurs within the framework of the leading activity at this stage (educational - according to the periodization of D.B. Elkonin), replacing in this capacity the play activity, which acted as the leading one in preschool age. The inclusion of a child in educational activities marks the beginning of a restructuring of all mental processes and functions.

Of course, it is not immediately that younger schoolchildren develop the correct attitude towards learning. They don’t yet understand why they need to study. But it soon turns out that learning is work that requires volitional efforts, mobilization of attention, intellectual activity, and self-restraint. If the child is not used to this, then he becomes disappointed and has a negative attitude towards learning. In order to prevent this from happening, the teacher must instill in the child the idea that learning is not a holiday, not a game, but serious, intense work, but very interesting, since it will allow you to learn a lot of new, entertaining, important, necessary things. It is important that the organization of educational work itself reinforces the teacher’s words.

Initially, he develops an interest in the process of learning activity itself without realizing its significance. Only after interest in the results of one’s educational work has arisen, interest in the content of educational activities and in the acquisition of knowledge is formed. This foundation is a fertile ground for the formation in a primary school student of motives for learning of a high social order, associated with a truly responsible attitude to academic activities.

The formation of interest in the content of educational activities and the acquisition of knowledge is associated with schoolchildren experiencing a feeling of satisfaction from their achievements. And this feeling is reinforced by the approval and praise of the teacher, who emphasizes every, even the smallest success, the smallest progress forward. Younger schoolchildren experience a feeling of pride and a special uplift when the teacher praises them.

The great educational influence of the teacher on the younger ones is due to the fact that the teacher, from the very beginning of the children’s stay at school, becomes an indisputable authority for them. The authority of the teacher is the most important prerequisite for teaching and education in the elementary grades.

The functional improvement of the brain occurs - the analytical and systematic function of the cortex develops; The ratio of the processes of excitation and inhibition gradually changes: the process of inhibition becomes more and more strong, although the process of excitation still predominates, and younger schoolchildren are highly excitable and impulsive.

Educational activities in primary school stimulate, first of all, the development of mental processes of direct knowledge of the surrounding world - sensations and perceptions. Younger schoolchildren are distinguished by their sharpness and freshness of perception, a kind of contemplative curiosity.

The most characteristic feature of the perception of these students is its low differentiation, where they make inaccuracies and errors in differentiation when perceiving similar objects. The next feature of the perception of students at the beginning of primary school age is its close connection with the actions of the student. Perception at this level of mental development is associated with the child’s practical activities. For a child to perceive an object means to do something with it, change something in it, perform some actions, take it, touch it. A characteristic feature of students is a pronounced emotionality of perception.

In the process of learning, a restructuring of perception occurs, it rises to a higher level of development, and takes on the character of purposeful and controlled activity. During the learning process, perception deepens, becomes more analytical, differentiating, and takes on the character of organized observation.

Some age-related characteristics are inherent in the attention of primary school students. The main one is the weakness of voluntary attention. The possibilities of volitional regulation of attention and its management at the beginning of primary school age are limited. The voluntary attention of a primary school student requires so-called close motivation. If older students maintain voluntary attention even in the presence of distant motivation (they can force themselves to concentrate on uninteresting and difficult work for the sake of a result that is expected in the future), then a younger student can usually force himself to work concentratedly only in the presence of close motivation (prospects for getting an excellent mark, earn the teacher’s praise, do the best job, etc.).

Involuntary attention is developed much better at primary school age. Everything new, unexpected, bright, interesting naturally attracts the attention of students, without any effort on their part.

Age-related characteristics of memory in primary school age develop under the influence of training. The role and specific weight of verbal-logical, semantic memorization increases and the ability to consciously manage one’s memory and regulate its manifestations develops. Due to the age-related relative predominance of the activity of the first signaling system, visual-figurative memory is more developed in younger schoolchildren than verbal-logical memory. They remember better, faster and more firmly retain specific information, events, persons, objects, facts in their memory than definitions, descriptions, explanations. Younger schoolchildren are prone to rote memorization without awareness of the semantic connections within the memorized material.

The main trend in the development of imagination in primary school age is the improvement of the recreating imagination. It is associated with the representation of what was previously perceived or the creation of images in accordance with a given description, diagram, drawing, etc. The recreating imagination is improved due to an increasingly correct and complete reflection of reality. Creative imagination as the creation of new images, associated with the transformation, processing of impressions of past experience, combining them into new combinations, also develops.

Under the influence of learning, a gradual transition occurs from knowledge of the external side of phenomena to knowledge of their essence. Thinking begins to reflect the essential properties and characteristics of objects and phenomena, which makes it possible to make the first generalizations, the first conclusions, draw the first analogies, and build elementary conclusions. On this basis, the child gradually begins to form elementary scientific concepts.

Analytical-synthetic activity at the beginning of primary school age is still very elementary; it is mainly at the stage of visual and effective analysis, based on the direct perception of objects.

Primary school age is the age of quite noticeable personality formation. It is characterized by new relationships with adults and peers, inclusion in a whole system of teams, inclusion in a new type of activity - teaching, which makes a number of serious demands on the student. All this has a decisive impact on the formation and consolidation of a new system of relationships towards people, the team, learning and related responsibilities, forms character, will, expands the range of interests, and develops abilities.

At primary school age, the foundation of moral behavior is laid, moral norms and rules of behavior are learned, and the social orientation of the individual begins to take shape. The character of younger schoolchildren differs in some ways. First of all, they are impulsive - they tend to act immediately under the influence of immediate impulses, promptings, without thinking or weighing all the circumstances, for random reasons. The reason is the need for active external discharge with age-related weakness of volitional regulation of behavior.

An age-related feature is also a general lack of will: a junior schoolchild does not yet have much experience in long-term struggle for an intended goal, overcoming difficulties and obstacles. He may give up if he fails, lose faith in his strengths and impossibilities. Capriciousness and stubbornness are often observed. The usual reason for them is shortcomings in family upbringing. The child was accustomed to the fact that all his desires and demands were satisfied; he did not see refusal in anything. Capriciousness and stubbornness are a peculiar form of a child’s protest against the strict demands that the school makes on him, against the need to sacrifice what he wants for the sake of what he needs.

Younger schoolchildren are very emotional. Emotionality is reflected, firstly, in the fact that their mental activity is usually colored by emotions. Everything that children observe, think about, and do evokes in them an emotionally charged attitude. Secondly, younger schoolchildren do not know how to restrain their feelings or control their external manifestation; they are very spontaneous and frank in expressing joy. Grief, sadness, fear, pleasure or displeasure. Thirdly, emotionality is expressed in their great emotional instability, frequent mood swings, a tendency to affect, short-term and violent manifestations of joy, grief, anger, fear. Over the years, the ability to regulate one’s feelings and restrain their unwanted manifestations develops more and more.

Primary school age provides great opportunities for developing collectivist relationships. Over the course of several years, with proper upbringing, a junior schoolchild accumulates the experience of collective activity that is important for his further development—activity in the team and for the team. Children’s participation in public, collective affairs helps foster collectivism. It is here that the child acquires the main experience of collective social activity.

Norm, types of norm.

Norm - in a number of sciences about living organisms, including humans (medicine, biology, as well as sociology, etc.) is considered as a certain reference point, standard, standard - for comparison with other options for the state of a living object (objects) (which can be considered as deviation, pathology).

A rule of law is a generally binding, formally defined rule of behavior, established or sanctioned by the state, ensured by its force, establishing the rights and obligations of participants in social relations and being a criterion for assessing behavior, both lawful and unlawful.

Social norms are understood as general rules and patterns, behavior of people in society, determined by social relations and resulting from the conscious activity of people. Social norms develop historically and naturally. In the process of their formation, refracted through social consciousness, they are then consolidated and reproduced in the relationships and acts necessary for society. To one degree or another, social norms are binding on those to whom they are addressed, and have a certain procedural form of implementation and mechanisms for their implementation.

There are various classifications of social norms. The most important thing is the division of social norms depending on the characteristics of their emergence and implementation. On this basis, five types of social norms are distinguished: moral norms, customary norms, corporate norms, religious norms and legal norms.

Moral norms are rules of behavior that are derived from people’s ideas about good and evil, justice and injustice, good and bad. The implementation of these norms is ensured by public opinion and the inner conviction of people.

Norms of customs are rules of behavior that have become habitual as a result of their repeated repetition. The implementation of customary norms is ensured by the force of habit. Customs with moral content are called mores. A variety of customs are traditions that express people’s desire to preserve certain ideas, values, and useful forms of behavior. Another type of customs are rituals that regulate the behavior of people in the everyday, family and religious spheres.

Corporate norms are the rules of conduct established by public organizations. Their implementation is ensured by the internal conviction of the members of these organizations, as well as by the public associations themselves.

Religious norms refer to the rules of conduct contained in various holy books or established by the church. The implementation of this type of social norms is ensured by the internal beliefs of people and the activities of the church.

Legal norms are rules of behavior established or sanctioned by the state; church norms are rights established or sanctioned by the state, and sometimes directly by the people, the implementation of which is ensured by the authority and coercive power of the state.

Different types of social norms did not appear simultaneously, but one after another, as needed.

With the development of society they became more and more complex.

Scientists suggest that the first type of social norms that arose in primitive society were rituals. A ritual is a rule of behavior in which the most important thing is the strictly predetermined form of its execution. The content of the ritual itself is not so important - it is its form that matters most. Rituals accompanied many events in the life of primitive people. We know about the existence of rituals for seeing off fellow tribesmen on a hunt, taking office as a leader, presenting gifts to leaders, etc. Somewhat later, rituals began to be distinguished in ritual actions. Rituals were rules of conduct that consisted of performing certain symbolic actions. Unlike rituals, they pursued certain ideological (educational) goals and had a deeper impact on the human psyche.

The next social norms to appear, which were an indicator of a new, higher stage of human development, were customs. Customs regulated almost all aspects of the life of primitive society.

Another type of social norms that arose in the primitive era were religious norms. Primitive man, aware of his weakness before the forces of nature, attributed divine power to the latter. Initially, the object of religious worship was a really existing object - a fetish. Then man began to worship some animal or plant - a totem, seeing in the latter his ancestor and protector. Then totemism was replaced by animism (from the Latin “anima” - soul), i.e., belief in spirits, soul or the universal spirituality of nature. Many scientists believe that it was animism that became the basis for the emergence of modern religions: over time, among supernatural beings, people identified several special ones - gods. This is how the first polytheistic (pagan) and then monotheistic religions appeared.

In parallel with the emergence of norms of customs and religion in primitive society, moral norms were also formed. It is impossible to determine the time of their occurrence. We can only say that morality appears along with human society and is one of the most important social regulators.

During the period of the emergence of the state, the first rules of law appeared.

Finally, the last to emerge are corporate norms.

All social norms have common features. They represent rules of conduct of a general nature, i.e., they are designed for repeated use, and operate continuously over time in relation to a personally indefinite circle of persons. In addition, social norms are characterized by such features as proceduralism and authorization. The procedural nature of social norms means the presence of a detailed regulated order (procedure) for their implementation. Authorization reflects the fact that each type of social norms has a specific mechanism for implementing their requirements.

Social norms define the boundaries of acceptable behavior of people in relation to the specific conditions of their life. As already mentioned above, compliance with these norms is usually ensured by the internal beliefs of people or by applying social rewards and social punishments to them in the form of so-called social sanctions.

Social sanction is usually understood as the reaction of society or a social group to the behavior of an individual in a socially significant situation. In terms of their content, sanctions can be positive (incentive) and negative (punitive). There are also formal sanctions (coming from official organizations) and informal sanctions (coming from unofficial organizations). Social sanctions play a key role in the system of social control, rewarding members of society for fulfilling social norms or punishing for deviation from the latter, that is, for deviance.

Deviant behavior is behavior that does not meet the requirements of social norms. Sometimes such deviations can be positive and lead to positive consequences. Thus, the famous sociologist E. Durkheim believed that deviation helps society gain a more complete understanding of the diversity of social norms, leads to their improvement, promotes social change, revealing alternatives to existing norms. However, in most cases, deviant behavior is spoken of as a negative social phenomenon that harms society. Moreover, in a narrow sense, deviant behavior means deviations that do not entail criminal punishment and are not crimes. The totality of an individual’s criminal actions has a special name in sociology - delinquent (literally criminal) behavior.

Based on the goals and direction of deviant behavior, destructive and asocial types are distinguished. The first type includes deviations that cause harm to the individual (alcoholism, suicide, drug addiction, etc.), the second type includes behavior that harms communities of people (violation of rules of conduct in public places, violation of labor discipline, etc.).

While exploring the causes of deviant behavior, sociologists drew attention to the fact that both deviant and delinquent behavior are widespread in societies experiencing a transformation of the social system. Moreover, in conditions of a general crisis of society, such behavior can acquire a total character.

The opposite of deviant behavior is conformist behavior (from the Latin conformis - similar, similar). Conformist is social behavior that corresponds to accepted norms and values ​​in society. Ultimately, the main task of regulatory regulation and social control is the reproduction of a conformist type of behavior in society.

.Psychological diagnosis: concept, types, functions.

Psychological diagnosis (diagnosis, from the Greek diagnosis - recognition) is the final result of a psychologist’s activity aimed at describing and clarifying the essence of individual psychological characteristics of a person in order to assess their current state, predict further development and develop recommendations determined by the task of a psychodiagnostic examination. The medical understanding of diagnosis, firmly linking it with illness, a deviation from the norm, was also reflected in the definition of this concept in psychology. In this understanding, a psychological diagnosis is always the identification of the hidden cause of the detected trouble. Such views (for example, in the works of S. Rosenzweig) lead to an undue narrowing of the subject of psychological diagnosis; everything that is associated with identifying and taking into account individual psychological differences in the norm falls out of it. Psychological diagnosis is not limited to a statement, but necessarily includes prediction and development of recommendations arising from the analysis of the entire set of data obtained during the examination in accordance with its objectives. The subject of psychological diagnosis is the establishment of individual psychological differences in both normal and pathological conditions. The most important element of a psychological diagnosis is the need to clarify in each individual case why these manifestations are found in the behavior of the subject, what their causes and consequences are.

Types of diagnosis: - Diagnosis that reveals the presence/absence of certain personality traits and qualities (presence/absence of accentuations). - A diagnosis that allows you to find the place of a subject or group according to the severity of certain qualities. = Carrying out comparisons within the surveyed sample, ranking, introducing indicators of high, medium and low levels of development of the studied characteristics by relating them to some criterion, standard (low, medium or high degree of risk readiness). Possible levels of diagnosis: 1) Symptomatic - statement of individual characteristics or symptoms, on the basis of which practical conclusions are drawn 2) Etiological - takes into account not only the presence of characteristics (symptoms), but also the reasons for their occurrence. 3) Typological – determines the place and meaning of the data obtained in the holistic picture of the child’s development.

1. Carrying out a diagnosis of activity, behavior, i.e. description, analysis and characterization of the behavioral characteristics of the subject.

2. Carrying out a diagnosis of the processes of regulation of activity or studying the mental processes through which activity is carried out.

3. Diagnosis of regulatory mechanisms, mechanisms of mental processes on which their course depends - diagnosis of systems of nervous connections.

4. Diagnosis of the genesis of regulatory mechanisms or the answer to the question of how and under what conditions the psyche of a given individual was formed.

In medicine there is such a thing as “screening”. Literally the word means 'sifting'. Find out what screening is and why it is done.

What is screening

Screening is a study of a population group with the aim of identifying pathologies and diseases in the early stages or possible risk.

For adults, screening is done to confirm or refute diagnoses such as cancer, diabetes, HIV, hepatitis, eye and cardiovascular diseases. Risk groups include certain age categories of people according to statistics on a specific disease.

Children, especially newborns, are checked for hearing, common abnormalities in the thyroid gland, liver, gastrointestinal tract, adrenal glands and enzyme deficiency.

Screening during pregnancy is called prenatal screening. This test detects defects in the fetus in the womb.

Genetic screening is done in the first trimester to see if the baby has Down or Edwards syndrome. In the second trimester, it is possible to examine the fetal neural tube.

Screening is not a definitive diagnosis. If the result is positive, the patient is referred for a detailed examination.

There are cases of false results. This leads to a delay in necessary treatment or, conversely, to unnecessary worries and waste of time and money.

Screening is not required. It is done with the consent of the patient.

Medical organizations conduct screening in such cases as:

1. High percentage of diseases among the population.
2. Research does not require large expenditures.
3. The disease is too dangerous.
4. Treatment in the early stages has a good effect.
5. The study has a small percentage of false results.
6. The disease in the initial stages is asymptomatic.

Thanks to screening, it is possible to detect serious diseases, which gives a chance for a timely and complete cure for the patient.

Screening: how it is done

Screening is a hardware or laboratory test on the basis of which the doctor makes a conclusion. The procedure sometimes consists of several analyzes and comparison of results.

Screening methods are:

• blood analysis;
• mammography;
• CT scan;
• colposcopy, etc.

Prenatal screening consists of collecting the woman's venous blood and intrauterine ultrasound of the fetus. It is recommended to carry out the procedures in one day.

The leading doctor prescribes examinations for pregnant women three times:

• from 11th to 13th week;
• from 20th to 24th;
• from 30th to 34th.

Examinations reveal abnormalities in fetal development. As a result, the woman, after consulting with the doctor, decides to continue or terminate the pregnancy and the method of delivery.

For children and adults, screening conclusions are often based on a blood test. Laboratory assistants examine DNA genes, the presence of antibodies, and the amount of organic compounds.

Instrumental screening includes:

• ultrasonography;
• electrocardiography;
• electroencephalography;
• radiography and others.

Preventive medical examinations, Mantoux reaction, tests - all these are screenings that reveal hidden diseases.

If the initial examination gives a positive result, be sure to undergo a more in-depth diagnosis.

Take screening seriously, because it is carried out to diagnose serious diseases.

As already indicated, psychodiagnostics of developmental disorders should be carried out in three stages:

1) screening diagnostics;

2) differential diagnosis;

3) in-depth psychological and pedagogical study of the child with the aim of developing an individual correction program.

Each stage has its own specific tasks and each stage is associated with a range of problems that characterize the state of modern psychodiagnostics.

The main objectives of screening diagnostics are the timely identification of children with various deviations and disorders of mental development in the population, including in the context of mass educational institutions, and an approximate determination of the range of psychological and pedagogical problems of child development.

In addition, screening diagnostics allows solving problems related to assessing the quality of teaching and raising children in an educational institution: identifying shortcomings in the educational process in a particular educational institution, as well as shortcomings of a particular program of teaching and raising children.

The problem of organizing and conducting screening diagnostics is currently being solved in different ways. In practice, there are several options. For example, teachers, faced with difficulties in teaching and raising a child in their work that are caused by some of his characteristics, ask the psychologist of the educational institution to evaluate these characteristics and develop appropriate recommendations for working with such a child.

In another case, parents turn to a psychologist with a request: to give an assessment of the behavioral characteristics or difficulties in raising a child and recommendations for conducting educational activities. It should be emphasized that there are much more such requests in relation to children of senior preschool age, since this age is considered as “preparatory” for school, and parents begin to notice that the child has certain psychological problems.

And finally, the identification of children with developmental problems can be carried out based on the results of a specially organized screening examination. The form of the screening examination can be individual or group. This approach best meets modern requirements for identifying children with developmental disorders, but, unfortunately, is used infrequently.

The set of techniques used for screening does not always meet the objectives of the screening study; the professional training of educational psychologists is usually insufficient to qualify a developmental disorder. Today, screening diagnostics “on request” remain the leading method, which does not make it possible to provide a comprehensive study of the characteristics of each child and provide psychological and pedagogical assistance to those children who need it. Thus, there are a number of problems that characterize the current state of screening diagnostics.

Despite the large number of different techniques used in examining children, there is a clear lack of scientifically based and tested diagnostic tools for use in screening examinations. This is especially true for screening examinations of children in the first 3 years of life.

When developing screening diagnostics, it is very difficult to develop a system of criteria by which it is possible to distinguish between children of early and preschool age with a normal rate of mental development and those in need of psychological, pedagogical and medical and social assistance.

An important problem when conducting a screening examination is the emotional state and personal characteristics of the subjects. Motivation for cooperation, reactions to success and failure, well-being, negative past experiences, etc. significantly affect the quality of task completion. This creates significant difficulties, since time limitations during a screening study may not provide the opportunity to obtain the necessary information.

Differential diagnostics is aimed at determining the type of impaired development; it is based on its results that the direction of the child’s education and its organizational forms are determined.

The tasks of differential diagnosis are as follows:

Distinguishing the degree and nature of disorders of the child’s mental, speech and emotional development;

Identification of primary and secondary violations and systematic analysis of the structure of the violation;

Assessment of the characteristics of mental development disorders in cases of visual, hearing, and musculoskeletal impairments;

Definition and justification of pedagogical forecast.

Based on these data, the type of educational institution, training program, and organization of the correctional pedagogical process are determined. Differential diagnosis is carried out by a psychological, medical and pedagogical commission. A group of specialists conducting diagnostics takes a comprehensive approach to studying a child with developmental problems. The decision based on the diagnostic results is made collectively. The work is structured according to a specific system, taking into account the individual characteristics of the child (the organization and content of PMPK activities are presented in detail in Chapter 8).

Currently, there is a range of problems associated with the differential diagnosis of developmental disorders.

It is known that similar psychological characteristics are observed in children with different types (categories) of developmental disorders. For example, deficiencies in speech development or reduced learning ability characterize almost all children with developmental disorders. Much less is known about the specific features that define each type of developmental disorder, which can serve as criteria for differential diagnosis (V.I. Lubovsky). This is due both to the patterns of abnormal development and to the fact that in special psychology today there is not enough scientific research of a comparative nature. The implementation of such scientific developments would significantly expand the possibilities of differential diagnosis.

Another problem is related to the practical activities of the PMPK. Today, many organizational issues have not been resolved, in particular the creation of a network of permanent diagnostic institutions, staffing issues, and a number of methodological and terminological problems.

Among the methodological problems, the problem of developing effective and reliable methods that make it possible to perform a qualitative and quantitative analysis of the results of a psychodiagnostic study of a child for the purpose of differential diagnosis should be especially highlighted.

Of the terminological problems, the most important is the problem of a clear distinction between psychological-pedagogical and medical terminology, determining the place of medical and psychological-pedagogical diagnosis in the activities of PMPK.

In-depth psychological and pedagogical study of children with developmental disorders aims to develop correction programs based on diagnostic results. Such study takes time and is carried out mainly in an educational and sometimes in a counseling institution. The specific tasks of such study, as a rule, are diverse and specific to different age stages. Among them are the following:

Identification of individual psychological and pedagogical characteristics of the child;

Development of individual correctional development and training programs;

Determining the conditions for raising a child, the specifics of intra-family relationships;

Help in situations with learning difficulties;

Professional counseling and vocational guidance for adolescents;

Solving social-emotional problems.

In solving these problems, a significant role is played by the combination of psychological diagnostic methods (experiments, tests, projective techniques) with specially organized observation and analysis of the products of educational activity and creativity of children and adolescents. It should be emphasized that until now, most specialists in the field of psychodiagnostics are focused mainly on assessing the level of intellectual and speech development of the child and on differentiating disorders. Experts successfully state the underdevelopment or absence of a particular function, but are not sufficiently focused on identifying positive potential, especially positive personal characteristics, on the basis of which it is possible to solve the child’s cognitive, speech, social and personal problems. But the effectiveness of the correctional pedagogical process is determined not only by the identification of negative factors, but primarily by the identification of intellectual and personal potential, on the basis of which it is possible to build a system of individual psychological and pedagogical support for the child. It should be noted that some of the problems posed have only just begun to be studied, for example, issues of professional diagnostics and professional counseling of adolescents with developmental disorders.

So, the most important tasks of psychological and pedagogical diagnosis of developmental disorders are:

Early detection of developmental disorders in children;

Determining the causes and nature of violations;

Determining the optimal pedagogical route for the child;

Identification of individual psychological characteristics of a child with developmental disorders;

Development of individual development and training programs

Principles of PPD.

One of the main ones is principle of humanity which consists in creating in time for each child the necessary conditions under which he can develop his abilities to the maximum. This principle obliges us to study the child deeply and carefully, to look for ways and means to overcome the difficulties encountered on his way. Only if all the necessary and possible measures of assistance provided to children in general education institutions do not produce positive results, the question of sending them to special institutions is raised.

The principle of determinism. According to this principle, external conditions do not strictly and unambiguously determine the essence of an object and the result of influence on it, but are refracted through internal ones. Any influence of one phenomenon on another, according to S.L. Rubinstein, is refracted through the internal properties of the phenomenon on which this influence is exerted. The result of this influence on a phenomenon or object depends not only on the phenomenon or body influencing it, but also on nature, on the own internal properties of the object or phenomenon on which this influence is exerted. Peering into human life, we see how mental phenomena are woven into its fabric, both as conditioned and as conditioning, as dependent on the conditions of life and as conditioning the behavior of people through which these conditions change.

The principle of the unity of consciousness and activity means the relationship and mutual influence of consciousness and activity. Consciousness guides activity, but it is in activity that it is formed. Consciousness can be studied indirectly through the child’s activities. The principle of an individual and personal approach means that the general laws of mental development manifest themselves in each child in a unique and unique way.

PPD principles: impartiality, complexity, systemic and dynamic approaches

Principle of impartiality. Obviously, a psychodiagnostician must know and understand well the syndromes that arise in various speech disorders. He must take into account the capabilities of the subject. What can be easily accomplished by a physically healthy stutterer may be an unbearable burden for a patient suffering from aphasia. These and some other circumstances favor the use of a certain examination scheme, which many experts are convinced of. The scheme allows us to achieve a certain unification of the examination and make it most adequate to the capabilities of the subject.

Mandatory principle of complexity studying children. This principle obliges us to take into account, during a joint discussion, the data obtained during the examination of the child by all specialists: doctors, defectologists, psychologists. In cases where the opinions of specialists differ, a re-examination of the child is prescribed. When solving the most difficult issues, the interests of the child must come first. It should be noted that adherence to this principle when studying children allows, even before the commission, to more accurately determine their condition and identify the causes of existing developmental deviations. Thus, the teacher can be the first to draw attention to the child’s increasing absent-mindedness, fatigue, tearfulness, etc. In turn, the doctor will help determine the causes of these changes and recommend the necessary remedies to eliminate them.

Comprehensive Study The development of a child’s psyche involves the discovery of deep internal causes and mechanisms of the occurrence of one or another deviation, carried out by a group of specialists (doctors, speech pathologists, speech therapist, psychologist, social teacher). Not only clinical and experimental psychological study of the child is used, but also other methods: analysis of medical and pedagogical documentation, observation of the child, socio-pedagogical examination, and in the most difficult cases - neurophysiological, neuropsychological and other examinations.

Systems approach Diagnosis of a child’s mental development is based on the idea of ​​the systemic structure of the psyche and involves an analysis of the results of the child’s mental activity at each of its stages. System analysis in the process of psychological and pedagogical diagnostics involves not only identifying individual disorders, but also establishing relationships between them and their hierarchy. It is very important that not only negative phenomena are identified, but also preserved functions and positive aspects of the personality, which will form the basis for corrective measures.

Dynamic approach The study of a child involves tracking the changes that occur in the process of his development, as well as taking into account his age-related characteristics. This is important when organizing a survey, choosing diagnostic tools and analyzing the results of the study. It is necessary to take into account the current state of the child, take into account age-related qualitative new formations and their timely implementation in various types of activities of the child. It is very important to take into account the age factor when carrying out diagnostic training, which is organized only within the limits of those tasks that are available to children of a given age. Identifying and taking into account the child’s potential capabilities- this principle is based on the theoretical position of L.S. Vygotsky about the zones of actual and proximal development of a child. The potential capabilities of a child in the form of a zone of proximal development determine the possibilities and pace of assimilation of new knowledge and skills. These possibilities are revealed in the process of cooperation between the child and the adult as the child learns new ways of acting.

Qualitative analysis of results Psychodiagnostic study of a child includes the following parameters:

Attitude to the examination situation and tasks;

Methods of orientation in task conditions and methods of completing tasks;

Compliance of the child’s actions with the conditions of the task, the nature of the experimental material and instructions;

Productive use of adult assistance;

Ability to perform a task by analogy;

Attitude to the results of one’s activities, criticality in assessing one’s achievements.

Qualitative analysis results of psychodiagnostics does not exclude quantitative assessment of the results of performing individual diagnostic tasks.

Unity of diagnostic and correctional helping children with developmental disorders. The tasks of correctional pedagogical work can be solved only on the basis of diagnostics, determination of prognoses of mental development and assessment of the child’s potential capabilities.