It can be argued that the methodology of the PMPK activity in its foundations in a fairly perfect and promising form was laid down by domestic scientists at the beginning of the 20th century. Many outstanding teachers and doctors who dealt with the problems of “difficult childhood” approved and put into practice an interdisciplinary approach, regardless of interdepartmental barriers.

In the first half of the 20th century, the terms “difficult children” or “difficult childhood” were widely used in relation to children with developmental disabilities. At the same time, V.P. Kashchenko introduced the expression “defective children” into scientific vocabulary, which was used in Russian literature until the early 1990s. This category included mainly children with various developmental anomalies, most often due to organic defects. Almost simultaneously with the term “defective children” V.P. Kashchenko also began to use the term “exceptional children”, expanding the concept of “defective children” and paying special attention to anomalies associated with adverse social conditions with a primary normal psychosomatic constitution.

In the 30s L.S. Vygotsky began to include gifted children among the so-called “exceptional children”. And although the term “exceptional children” did not take root in domestic defectological and related psychological, medical and pedagogical literature, all these children, including gifted (“child prodigies”), one way or another fell into the field of vision of institutions and specialists working with children with disabilities. developmental disabilities.

In the early 90s, against the backdrop of well-known socio-economic and political events taking place in our country, the vocabulary of the scientific fields we are considering began to be replenished with foreign terminology: “children with disabilities”, “children with special needs”, “children with special educational needs”, etc. These literal translations of the corresponding terms in Russian do not sound very harmonious and have different accents that do not accurately reflect the characteristics of the children in question. Ultimately, over the past decade in our country, the term “children with developmental disabilities” has become the most commonly used, which was widely used in the 60-80s 2 .

In Russia at the end of the 19th — the first half of the 20th century, such representatives of pedagogy and medicine as K.D. Ushinsky, V.P. Kashchenko, V.M. Bekhterev, V.G. Rossolimo,
L.S. Vygotsky and others scientifically substantiated a holistic approach to the child. The concept of “pedology” was an attempt at synthesis in the approach to “difficult childhood”. Pedology was considered as a science about a “holistic” child: not just about upbringing and education, not just about treatment and rehabilitation, but about the development forecast for a particular child with an individual constitutional genetic structure and personality dynamics in specific social conditions.

Consolidation and development in the works of L.S. Vygotsky’s conceptions reflecting integral significant “units” of a child’s development are still not fully understood by either scientists or practitioners. The concept of “zone of proximal development” is most widely used, including by members of the PMPK. Less realized is such an important concept as the “social situation of development”, which was previously designated by G.I. Rossolimo, V.P. Kashchenko, G.V. Murashev’s term “social profile”.

After the Decree of the All-Union Communist Party of Bolsheviks of 1936 “On pedological perversions in the system of the People’s Commissariat for Education”, the science of childhood, in particular “difficult childhood”, was thrown back, and practice went along the path of mechanically combining medical and pedagogical approaches to children with developmental disabilities, with involvement, in the most severe cases, departments of legal and social security of the population.

It cannot be denied that the joint work of specialists from different profiles and departments mutually enriched each of them and could not but contribute to the mutual penetration into the subject of related science. However, a really holistic approach could be implemented mainly only in central research institutes working on the problems of “difficult childhood” (in particular, in Moscow – the Research Institute of Defectology of the Academy of Medical Sciences of the USSR, the Research Institute of Psychiatry of the USSR Ministry of Health, in Leningrad – the Research Institute named after V.M. Bekhterev and etc.).

At the same time, the structure of these institutes and their constituent laboratories can be considered as a model for organizing the activities of modern practical institutions working with children with developmental disabilities. In the 1920s, V.P. Kashchenko wrote that institutions for “exceptional” children are, first of all, “medical and pedagogical institutions (institutes). This feature indicates that here the association of the forces of the doctor and the teacher should be sharply manifested.

Using the example of the laboratories of the Research Institute of Defectology of the Academy of Pedagogical Sciences of the USSR, which existed until the early 1990s and preserved the continuity of the most important domestic scientific and practical approaches to “difficult childhood”, we can consider the most effective model for working with such children.

Laboratories were profiled to study a specific developmental deviation (defect or anomaly) in children – mentally retarded, blind, deaf, etc. Each such deviation was in the field of view of teachers, psychologists, physicians, and other specialists – they all worked in direct interaction with each other. In practice, at the stage of diagnosis and development of recommendations, each laboratory worked as a medical and pedagogical commission (MPC) or in cooperation with the MPC, and then – at the stage of implementing recommendations in relation to the most difficult children – as a practical medical and pedagogical institution, with the provision and psychological and social assistance.

Such multifaceted activities were carried out in the laboratory for the clinical and genetic study of abnormal children, which included a medical and pedagogical commission of all-Union significance, and experimental groups were created at the laboratory for children with one or another similar structure of “deviating development”. The Laboratory for Clinical and Genetic Study of Abnormal Children of the Research Institute of Defectology (including the MPC) closely cooperated with the Moscow City MPC, which worked on the basis of the Children’s City Psychoneurological Hospital No. 6 (PNB No. 6), which also served children from different regions of the Soviet Union.

The uniqueness of these two IPCs was in the scientific and practical nature of the activities of the specialists working in them. PNB No. 6 was the practical and experimental base of the Research Institute of Psychiatry of the Ministry of Health of the USSR, at present – the Research Institute of Psychiatry of the Ministry of Health of the Russian Federation. Various departments and laboratories of the Research Institute of Psychiatry are now located directly at the departments of the hospital. The hospital has a school that has accumulated exceptional experience in working with children with various developmental disabilities.

At the Research Institute of Defectology, there were also experimental schools and groups that made it possible to formulate and solve the problems of scientific research in diagnostically complex, dynamically unclear conflict cases, when confronted with undifferentiated forms of deviations in the development of children, with undeveloped methods of teaching, educating, treating, psychological and social support for such children.

The uniqueness of the model of cooperation between the two IPCs, as well as the departments and laboratories of the Research Institute of Defectology and the Research Institute of Psychiatry, which was already in force, but somewhat disordered in the last decade, was the practical implementation of the ideas, forms and methods of work proposed by the above-mentioned leading methodologists. Almost a century has passed since they wrote their main works on the problem of interest to us, but only now we are approaching the implementation of their ideas in the most systematized form, in particular in the conditions of PMPK, directly close to the population.

The contradiction we identified at the beginning of the introduction in the methodological substantiation of the activities of the PMPK lies in the discrepancy between a holistic approach to a child with developmental disabilities and those “departmental” attempts to qualify the condition and development of these children, which are clothed in the form of clinical diagnoses. According to legal requirements, the conclusion of the PMPK must comply with the instructions for the selection of children in special (correctional) educational institutions. The instructions also provide a list of clinical diagnoses. A clinical diagnosis as a conclusion of the PMPK makes sense only if it is backed by an appropriate psychological, pedagogical and medical and social technology for the development of the child.

Modern practice of working with children with developmental disabilities shows that the clinical classification of diseases cannot fully correspond to the psychological and pedagogical understanding of the characteristics of a child’s development. The International Classification of Diseases of the Tenth Revision (ICD-10), in terms of children with developmental disabilities, approaches the needs of education (upbringing, training, development) of children only at the phenomenological level. Domestic tradition involves the use in pedagogical practice of a deep “clinical” type of thinking based on an understanding of the causes, mechanisms, structure and dynamics of a child’s development. When focusing on the ICD-10, many achievements of Russian science and practice of working with children with developmental disabilities are lost. It is no coincidence that on the agenda, especially in the last decade, there is the question of developing a new systematization or classification of types, types, forms of deviant development, adequate precisely for the purpose and objectives of the PMPK.

Moving along the path of a holistic scientific and practical approach to children, including those with developmental disabilities, puts forward the requirement for its equally holistic reflection in the terminological apparatus.

Otherwise, practitioners may have perplexed questions, for example, a teacher: “What is the significance of the diagnosis of schizophrenia for the education of this child?”

Attempts to combine in a defectologist or pedologist a doctor and a teacher or a psychologist and a doctor were really and in the most perfect form embodied only at the level of outstanding scientists who were at the same time virtuoso practitioners. Of course, there are ordinary practices that have reached perfection. But until now, the mechanism for achieving such perfection has been the knowledge of several scientific fields (medicine, pedagogy, psychology) separately, and then combining them as practical experience is accumulated into a “synthesis”. Such a “synthesis” was carried out as a skillful and quick translation into at least three parallel languages: pedagogical, psychological, clinical.

Modern requirements for working with children with developmental disabilities are the development and implementation of such technologies , which take into account (in a condensed form) the psychological, pedagogical and medical and social parameters of the life and development of children. PMPK recommendations should form the basis for the development of new technologies or the use of existing “off the shelf” technologies. Their meaning is not just sending a child to one or another special (correctional) educational institution with appropriate standard programs, but determining the way of life and means of development and self-realization of this particular child.

However, the implementation of the recommendations of even the most highly qualified PMPK, involving the use of modern technologies, at the place of residence of the child is still often carried out by representatives of different departments and institutions in a fragmentary, inconsistent way, so that when solving specific (“departmental”) problems of the child, ignoring a holistic approach to it, specialists can get the effect of general social maladjustment of the child. For example, a child treated in a sanatorium of the healthcare system, returning to an educational institution, often “hangs in the air”, since for the sanatorium the fulfillment of the educational program by the child is not an urgent and leading goal. As a result, the inevitable pedagogical neglect makes it difficult for the child to adapt to the previous conditions, but at a new stage of their development. The inconsistency of many issues and the lack of continuity in the work of departments dealing with children’s problems still persist.

The methodological support of its activities remains important for the PMPK. Modern requirements for the examination of a child in the PMPK indicate two leading trends in the methodological support of the examination. The first of these involves equipping all PMPKs in Russia with a unified set of standardized experimental techniques, tests, and other methodological tools. The second trend is the highly professional use of these tools and their flexible individualized use in relation to each specific child.

It is possible that all children should be examined by a single minimum set of methods, which can be designated by analogy with educational programs as the “basic component” of examination in the conditions of PMPK. Such a “basic component” will allow for more efficient statistical processing and comparison of results within the child population across the country. Statistical data will make it possible to more clearly track the development needs of special education institutions and other institutions and departments that in one way or another satisfy the interests of children with developmental disabilities.

So, the choice of PMPK as an object of study and analysis for the optimal organization of its activities is due to the uniqueness of this structure and its importance in ensuring the life path of children and adolescents with developmental disabilities, as well as normally developing children who may experience exaggerated age or individual developmental characteristics. .

The significance of the PMPK is also due to one of its most important tasks: initiating the development of the education system in general and special education in particular, as well as applying to other departments with proposals to meet the needs of the education system. PMPK also initiates the development of unique unified interdisciplinary and interdepartmental technologies, which are the “key” of a holistic approach to the child. In this regard, the main prospects for the development of the PMPK system include:

– increasing the professionalism of each PMPK specialist of the relevant profile within their subject;

– the importance (for each PMPK specialist) of mastering the “interdisciplinary space” in the form of modern technologies for a holistic approach to the child, both in matters of the procedure for interacting with each other, with other institutions and departments, and in matters of direct diagnosis and correction of the child’s development;

– initiating the development and improvement of the education system, in particular the system of special education, in order to ensure the right of every child to receive education;

– initiation of the development of assistance from other institutions and departments accompanying the child’s education;

– formation of mechanisms for interaction between the PMPK and educational and other institutions and departments to which the PMPK sends the child or recommends seeking advice, etc.;

– determination of means and mechanisms for monitoring the dynamics of the child’s development and timely adjustment of recommendations.

So, from the foregoing, it follows that the legal framework for the activities of the PMPK currently remains imperfect. Additional time is required to create a legal framework, in particular: amendments to the Federal Law “On Education”, adoption of the Federal Law “On the Education of Persons with Disabilities (Special Education)” 3 , amendments to Government Decree No. 867 dated July 31, 1998 “On Approval of the Model Regulations on an Educational Institution for Children in Need of Psychological, Pedagogical and Medical and Social Assistance”, etc.

In the future, as the regulatory and legal support of the activities of the PMPK at the federal level, it is planned to unify the model presented in the manual in accordance with the legislation of the Russian Federation and isolate a common component for similar regions of the Russian Federation, which will allow it to be used as the basis for the development of the Model Regulation on the PMPK ( these issues are resolved in cooperation and in agreement with the Department of Special Education of the Ministry of Education of the Russian Federation, which, in turn, goes to other ministries and departments on this issue).

Under these conditions, the most acceptable way is to systematize the issues of organizing the activities of the PMPK, which is the purpose of this guide.

The following tasks have been put forward as priorities:

— systematization of mechanisms for the internal organization of the activities of the PMPK;

— systematization of the mechanisms of interaction between the structural components of the PMPK system;

— systematization of the mechanisms of interaction between the PMPK system and other institutions and departments.


An analysis of the history of the development of medical-pedagogical, and then psychological-medical-pedagogical commissions, an assessment of their current state shows that at present it is optimal to organize the PMPC as a structural unit of the PPMS center or as an independent PPMS center (diagnostics and counseling), profiled on performance of the functions of the PMPK .

Arguing this position, two categories of arguments can be cited:

– the first – arguments against other organizational and legal forms of the PMPK discussed earlier and currently being discussed;

– the second – arguments for PMPC as a structural unit of the PPMS center or as an independent PPMS center (diagnostics and counseling).

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