One of the most common reasons for visiting a pediatric neurologist is a delay in the child’s speech development. How is a child’s speech formed? At what age should you start communicating with your baby? What are the causes of speech delay? Which doctor should I see? What examinations are carried out? How is the treatment carried out? These questions were answered by Evgenia Ivanovna Novyachkova, neurologist, epileptologist, functional diagnostics doctor at the SM-Doctor clinic for children and adolescents in Maryina Roshcha.
How is a child’s speech formed?
The process of forming a child’s speech begins in the first months after birth, so it is necessary to start communicating and speaking with the child already at this age.
Let's look at the main stages of child speech development. At 1.5-2 months, the baby begins to hum, that is, the child begins to pronounce individual sounds. Their range is quite diverse. There are even sounds that are not used in the parents' native language. Over time, they disappear and remain, only those that the child hears from the speech of adults near him. This is why it is so important to communicate and talk with the child already at this age. From 6-7 months, as a rule, babbling appears and the first syllables are formed.
At the age of 1 year, a healthy child can usually pronounce from 2 to 10 words.
At 2 years of age, with normal child development, he begins to speak simple phrases consisting of two words, and his vocabulary can reach 200 words.
At 3 years old, phrases of 3-4 words appear in the child’s speech, and his vocabulary is 300-800 words.
From the age of 4, a child can already use detailed sentences, including all parts of speech.
The active ingredient of the drug Cogitum is a synthetic analogue of the second most common molecule in the brain, N-acetylaspartate (NAA), which is the potassium salt of acetylaminosuccinate (salt of acetylaminosuccinic acid). The drug is often mistakenly confused with succinic acid, from which it differs in the presence of acetate and amine groups. Thus, the chemical formula of succinic acid is C4H6O, and the drug Cogitum is C6H9NO5. NAA is a derivative of aspartic acid, a non-essential (nonessential) amino acid synthesized in the body from asparagine. Aspartic acid is an endogenous biospecific compound that is found predominantly in the tissues of the central nervous system (CNS) [1–4]. NAA differs from aspartic acid by an additional acetate group.
As has been shown in a number of studies [4–6], the nervous system-specific NAA metabolite is synthesized from aspartate and acetyl coenzyme A in the mitochondria of neurons and, apparently, is a key link in various biochemical metabolic reactions in the central nervous system. The important role of NAA in the regulation of osmotic processes in the brain and axonoglial signaling was one of the first to be proven [6, 7]. Subsequently, the participation of NAA in the formation of pyrimidine bases, the metabolism of nitrogenous substances and the synthesis of urea, participation in transamination reactions, and the transformation of carbohydrates into glucose (with subsequent creation of glycogen reserves) was discovered [7]. During the early development of the central nervous system, in the postnatal period, there is an increase in the production of NAA in neurons, while the expression of lipogenic enzymes in oligodendrocytes increases, including the NAA-cleaving enzyme aspartoacyclase (ASPA) [7, 8]. An important discovery was the discovery of a mutation in the ASPA
with a genetically determined disease of young children - Canavan disease, which leads to fatal leukodystrophy. NAA is transported from neurons into the cytoplasm of oligodendrocytes, where ASPA cleaves the acetate moiety for use in the synthesis of fatty acids and steroids. The resulting fatty acids and steroids are then used as building blocks for the synthesis of myelin lipids [9]. Once postnatal myelination is complete, NAA may continue to be involved in adult myelin lipid metabolism, but appears to have other functions, including a bioenergetic role in neuronal mitochondria [4, 10].
New technologies for studying the neurophysiological and neurochemical mechanisms of brain activity (functional EEG, MRI spectroscopy, cognitive spectroscopy), molecular genetic research methods have revealed new characteristics of NAA and its role in processes at the microstructural and molecular levels. Thus, NAA itself does not directly participate in glutamatergic neuronal transmission, but, being a direct precursor of the neurotransmitter N-acetylaspartyl glutamate, the most concentrated neuropeptide in the human brain, plays an important role in neurotransmission processes [4, 11]. Among the new methods of intravital brain imaging, proton H-MRS, more often called magnetic resonance spectroscopy (MRS) in domestic medicine, is of great importance, which provides non-invasive quantitative determination of neurochemical substances and their metabolites in certain areas of the central nervous system. Numerous studies using MRS have established the diagnostic value of the NAA proton signal as an indicator of neuronal dysfunction [12–15]. Reduced NAA levels detected by MRS may be an extremely valuable marker of brain damage after stroke or hypoxia [15]. Outcome predictions based on NAA and lactate levels on MRS have been found to be quite accurate for cerebral ischemia, stroke [15–19] and neonatal hypoxia [20, 21]. Further studies showed that NAA as a marker in neuroimaging methods of neuropsychological assessments and scales makes it possible to study individual changes in cognitive abilities with methodological accuracy [22, 23]. These studies suggest that NAA may play a key role as a marker in MRS to assess neuronal integrity, number, and functionality.
In light of these data, the results of the work presented in the review by N.V. are of great interest. Baimeeva and I.I. Miroshnichenko [24]. They showed that Alzheimer's disease, Parkinson's disease, schizophrenia, multiple sclerosis and Canavan disease are characterized by different concentrations of NAA and N-acetylaspartate in brain tissue. This supports the view that NAA and N-acetylaspartate can be considered markers of some forms of mental and neurological diseases. This is also evidenced by the facts of changes in NAA content in certain parts of the brain in response to drug therapy [25]. Studies regarding the connection between NAA and cognitive abilities in both healthy individuals and patients with intellectual disabilities deserve special attention [26].
Studies related to the study of the role of NAA/N-acetylaspartate in gliomas are considered very promising in oncology [27]. The pronounced protective properties of aspartic acid (including neuroprotective and hepatoprotective effects), as well as its ability to reduce the negative consequences of radiation on the body, also attract attention [28]. Aspartic acid also has a pronounced immunomodulatory effect (stimulates the formation of antibodies and immunoglobulin); plays an important role in the process of transferring genetic information (participates in the processes of RNA and DNA synthesis). By participating in a number of metabolic reactions, including the above-mentioned process of glycogen accumulation in tissues, it helps to increase physical endurance [6, 29].
Based on modern ideas about the properties and functions of NAA in the central nervous system, we can draw a conclusion about the therapeutic capabilities of the drug Cogitum, which does not differ in chemical and therapeutic properties from NAA1. In Russia and neighboring countries, the drug Cogitum, which belongs to the pharmacological group “General tonics and adaptogens”2, has been widely used since the mid-90s of the last century in neurology, including children’s, as well as in pediatrics, psychiatry, rehabilitation science [30—35]. In the author’s classification of neuroprotectors, nootropics and neurometabolites, I.S. Zozuli et al. [30] Cogitum belongs to the subgroup “Drugs with a combined mechanism of action (correction of energy metabolism)”.
The clinical data obtained to date indicate that the drug has a nootropic, vegetative-stabilizing, thymoleptic effect; it also eliminates emotional disturbances, normalizes sleep, and increases performance. By activating the process of mental activity, increasing concentration, stability and attention span, improving memory, Cogitum acts as a corrector of impaired cognitive functions. In addition, it has antiasthenic, antidepressant and psychostimulating properties. The brain-specific adaptogenic effect of Cogitum is very important, associated with an increase in the resistance of nerve cells to damaging influences of various natures. By increasing the body's energy potential, it increases physical endurance. Observations of the use of Cogitum for various diseases reflected in the existing literature [34-44] showed that it is advisable to prescribe it for somatogenic asthenic conditions, after traumatic brain injury (TBI), general infections and neuroinfections in chronic fatigue syndrome, autonomic dysfunction syndrome, chronic headache pain of tension, during intense physical or intellectual stress [34, 35]. In addition, in pediatric psychoneurology, the drug is actively used for delayed motor and psycho-speech development, the consequences of perinatal cerebral ischemia, cerebral palsy, and hydrocephalus [32, 33]. Cogitum has proven effective in the treatment of children and adolescents with vegetative dystonia syndrome [36], as well as in the complex therapy of epilepsy in children [37]. Cogitum has been noted to be effective in asthenic conditions of various origins [35, 38, 39], mental retardation of varying degrees, post-traumatic stress disorder, attention deficit hyperactivity disorder (ADHD) [40, 41]. There is reason to believe that the drug in question can also be successfully used for schizophrenia and autism spectrum disorders in childhood [42–44].
Despite a fairly large number of studies on the use of Cogitum in child neurology and psychiatry, the spectrum of its therapeutic activity, taking into account the characteristics of neurological and psychopathological symptoms in individual diseases, remains insufficiently studied. This served as the basis for generalizing the observations we have accumulated regarding the influence of Cogitum on cognitive functions and asthenic disorders in neurological and psychiatric pathologies of various origins in children based on the use of methods of clinical, neurological, psychopathological and pathopsychological analysis.
The work was carried out at the Department of Child Psychiatry of the Russian Medical Academy of Continuing Professional Education and in the Department of Child Psychiatry of the Scientific Center for Mental Health in 2010-2019.
This article presents the results of observations of four groups of children aged 5-15 years. The 1st group included 12 patients with a diagnosis of “closed traumatic brain injury (CTBI)”, the 2nd group included 12 patients with a diagnosis of psychospeech development delay (DSRD), the 3rd group included 10 people with a diagnosis of hyperkinetic disorder", the 4th group consisted of 11 patients diagnosed with schizotypal disorder. We assessed changes in cognitive indicators and the severity of asthenic disorders during therapy with Cogitum, which was prescribed 250 mg 2 times a day for 30 days. An analysis of the effectiveness of the drug was carried out and presented sequentially in each group.
The work complies with the ethical principles of the Declaration of Helsinki of the World Medical Association and the Rules of Clinical Practice in the Russian Federation.
Before starting the study, informed consent was obtained from parents for examination and drug administration, as well as approval from the local ethics committee of the institution.
Application of Cogitum in patients with consequences of head injury
The basis for prescribing Cogitum in the early period after traumatic brain injury was the results of MRS studies [45], which showed a decrease in the level of NAA in TBI, as well as the establishment of the main damaging mechanism in concussion - a violation of the integrity of neuronal axons.
The study included 12 children (8 boys and 4 girls) aged 10 to 13 years (average age 11.3 years) who had suffered a head injury, with complaints of headaches, fatigue, irritability, learning difficulties, memory loss, inattention. . When solving the assigned problems, a VAS scale was used to assess pain syndrome; in order to objectify cognitive impairments, a series of computer programs were used: “Arithmetic calculations” to determine the speed and accuracy of simple arithmetic operations, to study visual memory “Memory for numbers and letters” and tests “Red -black tables"
Table 1. Dynamics of indicators of psychophysiological processes in children after traumatic brain injury and “Attention to the arrangement of numbers” from the test computer system (TCS) “Psychomat” before and after taking the drug Cogitum.
Examination after the end of treatment showed an improvement in the general somatic condition. In the neurological status, 86% of children retained scattered neurological signs in the form of horizontal nystagmus, asymmetry and revitalization of tendon reflexes, and mild coordination disorders. The severity of symptoms of autonomic dysfunction decreased significantly. In the mental state, noticeable positive dynamics were also noted: mood leveled out, irritability decreased, academic performance and memory improved, and headaches decreased. The average VAS score at the beginning of the study was 7.4 points, after the study - 6.1 points. In 27% of children, headaches stopped.
Analysis of the results of psychometric tests of the TCS “Psychomat” in children after a concussion during the first examination before treatment showed worse indicators compared to normative ones. After a course of treatment with Cogitum, a significant improvement in visual and auditory-verbal memory was noted, the ability to concentrate improved, and the volume and distribution of attention expanded. The results obtained are presented in table. 1.
Among the side effects, it should be noted that during the 1st week of therapy, increased irritability, tearfulness, hyperactivity, and sleep disorders occurred in 2 children, which required reducing the dose of the drug to 250 mg/day.
Thus, based on the results obtained, we can recommend the use of Cogitum at a dose of 250-500 mg 2 times a day for 30 days, both immediately after a concussion and in repeated courses with an interval of 3-6 months.
Application of Cogitum for correction of delayed psychospeech development in preschool children
Mental retardation is usually diagnosed between the ages of 2 and 7 years. The instructions for medical use of the drug Cogitum state that “there are no clinical data” on its use in children under 7 years of age.
However, the results of experimental studies using proton MR spectroscopy of the brain of children with developmental delays older than 2 years (average age 5 years) show a decrease in the NAA/creatinine (Cr) ratio in the frontal ( p
<0.001) and parieto-occipital (
p
<0.017) regions in white matter compared with age-matched control subjects [46]. The data obtained indirectly indicate a violation of myelination and development of neurons and their dendrites in these areas of the brain and provide grounds for prescribing Cogitum to preschool children, especially since in recent years there have been reports of positive experience of its use in preschool children with neurological and mental disorders [32, 33, 41]. An open study of the use of Cogitum was conducted in 12 children with PVD of early school age - 5-7 years (average age 6.4 years). The main cause of PVRD was the consequences of perinatal damage: cerebral ischemia (8 children) and infectious-hypoxic factors (4 children). Memory impairments, difficulties of inclusion in the learning process, low speed of comprehension, distractibility, and delayed speech development came to the fore.
The dynamics of cognitive and speech functions were monitored using check tables in which the results of tasks for understanding and using speech, the level of active vocabulary, the communicative function of speech, the use of personal pronouns, the formation of concepts (shape, color, counting) and generalizations, and spatial representations were recorded. To determine the level of intelligence, we used the Wechsler test (modified version), a test for simple analogies, and story pictures.
To objectify the dynamics of attention and memory indicators, psychological methods and tests were used, which are presented in Table. 2.
Table 2. Indicators of attention and memory before and after therapy with Cogitum in children with SPR
After the course of treatment, the parents of the examined children noted a significant expansion of their active vocabulary, improvement in attention and inclusion in the learning process, and behavior. Our data confirm the effectiveness of Cogitum for delayed mental and speech development, including sensorimotor alalia in children.
Application of Cogitum in the treatment of hyperkinetic disorder in children
It is known that hyperkinetic disorder, or ADHD, is directly related to disturbances in the inhibitory system, which is accompanied by deficits in the function of behavioral control. ADHD is often based on residual phenomena of early organic damage to the central nervous system of various origins, including perinatal lesions, consequences of a previous head injury, and neuroinfection. Therefore, some researchers [40, 41] emphasize the need to include cerebroprotectors, including Cogitum, in the treatment regimen for ADHD.
10 children (all boys) diagnosed with hyperkinetic disorder, aged 8 to 11 years, were examined in an outpatient setting. The diagnosis was made based on ICD-10 criteria. To objectify the changes, we used a scale for assessing symptoms of hyperactive attention disorder (ADHD), based on the ICD-10 diagnostic criteria (version for educators and teachers of children aged 6 to 12 years). The scale includes subscales: cognitive problems associated with attention impairment; hyperactivity; impulsivity [47].
During the examination of children with ADHD to study attention and memory, the Toulouse-Pieron test was used to measure the speed and accuracy of completing tasks. The study of auditory-verbal memory was carried out according to the method of A.R. Luria “Memorizing 10 words”, which allows you to study memory processes such as memorization, preservation and reproduction, as well as assess the activity and voluntariness of attention, memorization, preservation, reproduction, fatigue. Children with hyperkinetic disorder were examined twice: before the start of treatment and after its completion (day 30).
During therapy with Cogitum, a positive dynamics in the speed of performing the Toulouse-Pieron test was noted. Before treatment in children 8-9 years old, the speed was 16-17 s, and after the course of therapy - 21-30 s with a norm of 33-41 s; in older children (10-12 years old) the speed increased from 16-23 to 24-28 s with a norm of 26-36 s.
The accuracy of the Toulouse-Pieron test in the subjects before treatment was slightly lower than the age norm - 0.87-0.89 in children 8-9 years old (norm 0.92) and 0.89-0.91 in children 10-12 years old (norm 0.93-0.95). After treatment, accuracy also remained below normal, but positive dynamics were noted: 0.90 (8-9 years), 0.92 (10-12 years).
At the first examination of auditory-verbal memory, at the third presentation, not a single child reproduced 9-10 words, 63% of children repeated a smaller number of words (8-7), the rest - less than 6 words. All the children had “extra” words that they got stuck on. This indicates a lack of concentration and disinhibition. 8 (66.7%) children reproduced fewer words, which may indicate fatigue or impaired attention. The volume of auditory short-term memory before the examination was 5±1 words, and long-term memory was 4±2 words (a volume of 7±2 words is considered the norm).
After treatment with Cogitum, children with ADHD showed an increase in the volume of auditory-verbal memory, both short-term and long-term, and fatigue decreased. During the clinical assessment of the patients' condition, no adverse events were recorded in any case during treatment with Cogitum. A positive effect of Cogitum therapy on the severity of concomitant disorders was noted: regression of tics was observed in 3 patients, tension headaches in 2, and falling asleep improved in 2 children.
In our study, there was no statistically significant improvement in the clinical manifestations of ADHD, but at a trend level, improvements were noted in the areas of attention and impulsivity. The positive effect of Cogitum on the cognitive sphere, including indicators of executive control, concentration of directed and distributed attention, and auditory-verbal memory, is achieved after just 1 month of pharmacotherapy. These initial positive changes can serve as the basis for achieving significant clinical results and overcoming impairments typical for ADHD in various areas of activity, as well as in socio-psychological adaptation during long-term drug therapy and providing comprehensive interdisciplinary care to patients with ADHD.
Application of Cogitum in complex therapy of schizotypal disorder in children
Changes in the concentration of NAA in certain parts of the brain, including the prefrontal cortex, in diseases of the schizophrenia spectrum have been noted in numerous studies [48–52]. There is an assumption that early signs of schizophrenia are most associated with a decrease in NAA and NAA/Cr levels [48] and this indicator can be used as a marker of predisposition to the development of schizophrenia. One of the important prognosis-determining symptoms that often foreshadow the development of the schizophrenic process is cognitive deficit in patients with schizophrenia spectrum diseases, including schizotypal disorder, in which impairments of voluntary attention, decreased auditory-verbal memory, and attention are described [52, 53]. No less important from the point of view of the severity of the condition is the presence in the clinical picture of schizotypal disorder in children of various psychomotor disorders (tics, grimacing, hyperkinesis, motor stereotypies, changes in muscle tone, disturbances in the movements of the eyeballs) and neurological symptoms, among which dysregulation and integration predominate movements, various extrapyramidal disorders [54]. The most common symptom complexes in all variants of schizotypal disorder are the asthenic circle, which, according to a number of researchers, may represent an independent psychopathological category within the asthenic defect [55].
11 outpatients were examined with a diagnosis of schizotypal disorder, of which 4 patients had a neurosis-like form, 4 patients had a psychopathic-like form, and 3 patients had a schizotypal personality disorder. At the time of Cogitum’s prescription, the condition was defined as therapeutic remission, the patients received maintenance therapy. Depending on the leading psychopathological symptoms, patients received rispolept up to 2 mg/day, alimemazine up to 15 mg/day, neuleptil up to 15 mg/day, trihexyphenidyl, and antidepressants from the SSRI group.
The clinical picture was determined by asthenic disorders, deficit disorders in the intellectual sphere of procedural genesis, manifested by mild dissociated mental retardation, decreased ability to acquire and retain skills, increased distractibility, hyperdynamic disorders, impaired concentration and memory. Therapy did not change 2 weeks before the start of treatment with Cogitum.
Before the start of therapy, immediately after the end and 2 weeks after the end of therapy with Cogitum, a comprehensive pathopsychological examination of all patients was carried out using a psychological-educational test (PET), as well as a set of specially selected methods used in pathopsychology to assess cognitive functions. The PEP scales assessed the level of development of intellectual, motor and social skills: imitation, gross motor perception, fine motor skills, verbal cognitive functions and executive cognitive functions. Auditory verbal memorization was assessed using the “10 words” method, attention - using Schulte tables and the Kogan method.
All 11 patients showed positive dynamics in the cognitive sphere after treatment - cognitive activity, attention, speech improved, and manifestations of mental retardation decreased. The results of the assessment using the Schulte method showed a reduction in the time spent on tasks, and an improvement in workability and concentration was noted. When using Kogan's technique, we also observed a reduction in the time spent by subjects on completing a task for combining a number of signs, a decrease in the number of errors, which, apparently, is also associated with an improvement in voluntary regulation of activity and concentration of attention and is an indicator of a reduction in asthenic symptoms. Positive dynamics were observed in relation to the volume of immediate auditory-verbal memorization and delayed reproduction.
In this group of patients, mental status remained generally stable. It should be noted that in 2 of 11 patients, after 6 days of taking Cogitum, psychopathic-like disorders intensified in the form of dysphoric reactions, protest, and verbal aggression, which did not require discontinuation of the drug. In other cases, no increase in psychopathological symptoms was noted.
A comprehensive study has shown the effectiveness of treatment with Cogitum in combination with basic therapy with neuroleptics in patients with schizotypal disorder without exacerbation. As it turned out, Cogitum has the greatest impact on such cognitive functions as attention - concentration improves; workability, distribution, stability and switchability; immediate (short-term) and delayed (long-term) memory - the volume of immediate auditory-verbal memory and delayed reproduction improves; thinking - there is an improvement in productivity and quality in methods that require subject-content analysis. Our study did not reveal any increase in the severity of psychopathological disorders.
The observations presented in this article allow us to positively assess the effectiveness of the drug Cogitum. Many fundamental questions of the operation of Cogitum also require theoretical development.
Thus, analysis of the results of experimental and diagnostic studies, according to the literature, indicates the important role of NAA in the metabolism and functions of the central nervous system; its increasing diagnostic role in nervous and mental diseases using MRS is noted. Our own observations allow us to positively evaluate the effectiveness of the drug Cogitum in relation to cognitive functions and asthenic manifestations in children with nervous system diseases of a wide variety of genesis and clinical manifestations (consequences of traumatic brain injury, mental and speech development disorders, ADHD, schizotypal disorder). The results of our own research have shown that the therapeutic activity of Cogitum is aimed primarily at reducing asthenic manifestations and improving cognitive abilities by activating the metabolism of nerve cells and increasing energy balance. The results obtained are important for expanding recommendations for the practical use of Cogitum in child neurology, psychiatry, and pediatrics. However, questions concerning the place of this drug in the complex treatment of psychoneurological disorders and the possibility of its combination with other drugs, especially taking into account drug interactions, require special study.
The authors declare no conflict of interest.
The authors declare no conflicts of interest.
Information about authors
Goryunova A.V.
— e-mail; https://orcid.org/0000-0002-9774-6575
Shevchenko Yu.S.
— e-mail; https://orcid.org/0000-0003-1968-5823
Goryunov A.V.
— e-mail; https://orcid.org/0000-0002-2851-8843
How to quote:
Goryunova A.V., Shevchenko Yu.S., Goryunov A.V. Cogitum in child neurology and psychiatry (experience of practical application). Journal of Neurology and Psychiatry. S.S. Korsakov
. 2019;119(7, issue 2):58-66. https://doi.org/10.17116/jnevro201911907258
Corresponding author:
Goryunova Anna Viktorovna — e-mail
Instructions for use of the drug Cogitum for medical use. 2006, P N01 1377/01−020811.
Register of Medicines in Russia (RLS) 2000
Causes of delayed speech development in a child
As a rule, parents pay attention to the fact that the child lags behind his peers in speech development, closer to 3 years. This is a fairly common problem, which is one of the most common reasons for visiting a pediatric neurologist. And the sooner a specialist examines the child and identifies the cause, the better it will be, since delayed speech development may indicate serious pathologies that require immediate treatment.
- exposure to unfavorable factors in the perinatal period (hypoxia, infection, metabolic disorders), as a result of which brain neurons were damaged;
- hereditary factors;
- autism spectrum disorder (the incidence of this pathology has increased significantly in the last decade); various genetic syndromes;
- congenital abnormalities of the brain structure;
- severe hydrocephalic syndrome;
- pedagogical neglect;
- hearing impairment (sensorineural hearing loss).
in some cases, the cause of delayed speech, and often mental development, may be epileptiform discharges in the cerebral cortex, which interfere with the normal development of the child. In this case, epileptic seizures may be absent or appear much later.
Indications for use
The main indications for the use of a medicinal solution with immune-strengthening and adaptogenic properties for adults and children are the following conditions:
- Increased fatigue due to light loads.
- Asthenia, accompanied by drowsiness and irritability.
The drug is prescribed as an adjuvant to patients taking antidepressants. Cogitum, the instructions focus on this, can be used to stabilize the condition of various neuropsychic disorders. The drug is in demand for complex therapy in the following cases:
- With affective lability, which is characterized by frequent and inexplicable mood changes.
- With intolerance to strong odors, which is often caused by various pathologies of the nervous system or stress.
- For insomnia and sleep disorders accompanied by nightmares.
- When self-control weakens, when a person loses the ability to control his actions under the influence of external factors.
- With increased excitability, which is associated with fatigue and is accompanied by headaches.
Treatment
Treatment tactics are selected based on a comprehensive examination.
For some, classes with a speech therapist will be enough. In other cases, medication treatment may be required, which is individually selected by a neurologist, sessions with a neuropsychologist, speech pathologist, as well as physiotherapeutic treatment. In most cases, this comprehensive approach produces positive results. “And in conclusion, a few words about pedagogical neglect. It would seem that in modern life there is no shortage of education, that pedagogical neglect is the lot of only socially disadvantaged families. In fact, there is currently a lack of communication between parents and children, people spend a lot of time watching TV, on gadgets and social networks, parents work a lot from home, physically being close to their children. As mentioned above, for normal psycho-speech development, a child needs “live” and emotionally friendly communication from the first month. He needs to hear speech and see the face and articulation of an adult, to feel encouragement and joy at his first successes in humming and babbling.
For the child’s full development, it is advisable not to turn on the TV in the background, minimize watching cartoons and playing with gadgets, read age-appropriate books to the child, develop fine motor skills and communicate more with your baby. It is important to be attentive to the health and development of your child at different stages of life, since it is easier and more effective to solve any problem at the very beginning.
Health and harmonious development to your children!”, Evgenia Ivanovna Novyachkova, a doctor at SM-Doctor in Maryina Roshcha, addressed the readers.
Published on the portal detstrana.ru
Description of the product
Cogitum is intended to stabilize the condition of patients of different ages with various malfunctions of the central nervous system. Acetylaminosuccinic acid, which is the active component in the medicinal solution, is a synthetic substitute for aspartic acid. This compound is found in the tissues of the central nervous system and is responsible for the formation of antibodies and immunoglobulins that help improve the body’s defense reactions.
When taking cogitum solution, reviews confirm this, physical endurance improves and excitation processes in the central nervous system are normalized. The drug has a general tonic and restorative effect. When used as a course, the product helps to cope with chronic fatigue and reduce the manifestations of depression.
Cogitum solution has a yellowish tint and a recognizable light banana aroma. You can buy it in 10 ml ampoules. They are made of dark glass and have a marking ring. Each ampoule contains 250 mg of active ingredient. One package contains 30 ampoules.
Contraindications and negative reactions
An absolute contraindication to the use of cogitum solution is hypersensitivity to its components. This means that you must carefully read the composition. Due to the fact that the drug has not been tested for effects on the fetus and newborn child, its use during pregnancy and lactation should be avoided.
The drug Cogitum does not put excessive stress on the kidneys or liver. Therefore, there is no need to adjust the dosage of the drug during treatment. Side effects when using it can be manifested by allergic reactions: skin itching, swelling, etc. In such cases, you should stop taking the drug.
There were no cases of overdose during treatment. There is also no information about the negative impact on human reactions, so there are no restrictions on driving vehicles.
