4. Must be familiar with normal development and
remember what is normal for one age may be a
problem for another
◦ Example: Tantrum Behavior
2 year old ~ normal and expected behavior
12 year old ~ not expected within normal development
Confidentiality directly related to age of
child/adolescent
◦ Young child ~ all information shared with caretaker
◦ Adolescent ~ try to establish privacy agreement between
caretaker and adolescent with understanding of what
must be shared (significant danger to self and/or others,
abuse)
4
5. Motor Skills Disorders
This is also called developmental
coordination disorders
Its essential characteristic is a marked
impairment in the development of motor
coordination
It is characterized by imprecise or clumsy
gross motor skill
5
6. Communication Disorders
This category includes disorders of speech & language
They include:
1. Expressive language disorder:
the child skills in vocabulary ,the use of correct sentences ,the
production of complex sentences & the recall of words are
below the expected level for his or her age & intelligence
2 . Mixed receptive –expressive language disorder:
child is impaired in both understanding and expressing language
3 . Phonological disorder:
it is manifested by inappropriate or poor sound production
4 . Stuttering or Stammering:
disturbance in the fluency and time patterning of speech that is
inappropriate for the patient’s age
6
7. Pervasive developmental disorders
These disorders are severe ,pervasive
impairment in developmental areas ,such as
social interaction & communication ,or
stereotyped behavior ,interests and activities
The impairments are deviant in comparison
to a person’s mental or developmental level
These disorders include:
7. Autistic disorder
8. Rett’s disorder
9. Childhood disintegrative disorder
10. Asperger’s disorder
7
8. Autistic disorder
Sometimes called “childhood autism,
early infantile autism, Kanner’s
autism”
Prevalence is 0.02-0.05 %
In most cases it starts before the age of
36 months( 3 years)
It is more frequent in boys
The etiology of autistic disorder is not
clear but there is more reliance on 8
9. Clinical features
2. Impairment in social interaction: lacking social smile, fail to
show the usual relatedness to their parents and other
people, abnormal eye contact, …
4. Disturbance of communication &language
6. Stereotyped behavior :the activities &play are rigid
,repetitive & monotonous. Ritualistic and compulsive
phenomena are common
8. Unstability of mood
10. Abnormal response to sensory stimuli( either exaggerated
or decreased)
12. Other behavioral symptoms hyperkinesis or
hypokinesis ,aggressive behavior ,temper tantrums, self
injurious behavior
9
10. Prognosis is generally unfavorable
The patient needs a complicated care
which include:
4. Educational therapy
6. Behavioral therapy
8. Pharmacotherapy: no specific therapy is
available. It can be only symptomatic
like anti-obsessive, antipsychotic and
antiepileptic 10
11. In the absence of specific treatment,
management has 6 main aspects:
Management of abnormal behavior
Education and social services
Speech and language therapy ,occupational
therapy, dietary advice…
Treat medical conditions (e.g. epilepsy ,GIT
problems)
Help for families
Pharmacotherapy :symptom management
(e.g. antipsychotic for stereotypes ),SSRI for
compulsive and self harming behaviors and
depression, and anxiety
11
12. (Aspergers Syndrome( AS
A syndrome first described by Hans Asperger’s in 1944
,and sometimes called autistic psychopath ,is
characterized by:-
The child develops normally until about the third year
when they begin to lack warmth in relationships, and
speak in monotonous stilted ways
Severe persistent impairment in social interactions
,repetitive behavior patterns, and restricted interests
IQ and language are normal or in some cases, superior
Motor mannerisms such as hand and finger twisting, or
whole body movements
12
13. They are often clumsy and eccentric
They are more interested in others than
autistic children
The disorder is more common in boys than
girls
A family history of autism may be present
The cause of AS is unknown
It differ from autism in that there is no general
delay or retardation of cognitive development
or language
They are solitary, and embark on and spend
much time in narrow interests
13
14. (Attention Deficit / Hyperactivity Disorder (ADHD
This disorder is common ,appears more often in boys
than in girls and causes disruption in school and at
home
It is characterized by:
4. Features of hyperactivity: age-inappropriate
hyperactivity which is mostly purposeless & intolerable
causing a lot of disturbance
5. Poor attention span
6. Impulsivity
These symptoms should be present for at least 6
months before the diagnosis is made
The symptoms should be present in more than one
setting ( home, school, work)
And should be severe enough to cause significant
impairment
14
15. 3%-7% of children suffer from ADHD
ADHD is diagnosed approximately three
times more often in boys than in girls
As many as half of those with ADHD also
have other mental disorders
Over half of the children diagnosed with
ADHD carry the disorder into adulthood
A large number of adults who were never
diagnosed as a child show clear symptoms
of ADHD 15
16. The symptoms of ADHD are present since the
early childhood (before the age of 7 years)
The causes of ADHD are unknown ,but the
disorder is predictably associated with a variety
of other disorders that affect the brain function
,such as learning disorders
The suggested contributory factors to ADHD
include prenatal toxic exposure, prematurity,
and prenatal mechanical insult to the fetal
nervous system
Food additives ,colorings, preservatives, and
sugar have been suggested as possible causes
There is evidence for a genetic cause
16
17. Symptoms of Inattention
must have 6 or more
1. Often fails to give close attention to details or makes careless
mistakes in schoolwork, work, or other activities
3. Often has difficulty sustaining attention in tasks or play
activities
5. Often does not seem to listen when spoken to directly
7. Often does not follow through on instructions and fails to
finish school-work, chores, or duties in the workplace (not
oppositional)
17
18. 5. Often has difficulty organizing tasks and activities
6. Often avoids, dislikes, or is reluctant to engage in
tasks that require a sustained mental effort
7. Often loses things necessary for tasks or activities
8. Often easily distracted by extraneous stimuli
9.Often forgetful in daily activities
18
19. Symptoms of Hyperactivity-Impulsivity
Must have 6 or more
Hyperactivity
1. Often fidgets with hands or feet or squirms in seat
2. Often leaves seat in classroom or in other situations in
which remaining seated is expected
3. Often runs about or climbs excessively in situations in
which it is inappropriate (adolescents ~ may be subjective
feelings of restlessness)
4. Often has difficulty playing or engaging in leisure activities
quietly
5. Often “on the go” or often acts as if “driven by a motor”
6. Often talks excessively
19
20. Impulsivity
2. Often blurts out answers before
questions have been completed
3. Often has difficulty awaiting turn
4. Often interrupts or intrudes on others
20
21. Treatment of ADHD
1. Pharmacotherapy:
a. CNS stimulants: dextroamphetamine,
methylphenidate, and pemoline
b. Antidepressants
Psychotherapy :
which include behavioral therapy , education
of parents and teachers
21
22. Disruptive behavior disorders
There are two types:
2. Oppositional defiant disorder:
described as a recurrent pattern of negativistic,
defiant, disobedient, and hostile behaviors
toward authority figures
5. Conduct disorder:
A repetitive & persistent pattern of behavior in
which the basic rights of others or major age-
appropriate societal norms or rules are
violated 22
23. Elimination Disorders
1. Enuresis :
The repeated voiding of urine into clothes or
bed ,whether, the voiding is involuntary or
intentional .The behavior must occur twice
weekly for at least 3 months or must cause
clinically significant distress or impairment
socially or academically. The child’s age must
be at least 5 years
Encopresis:
Passing feces into inappropriate places whether
the passage is involuntary or intentional. The
pattern must be present for at least 3 months ;
the child’s age must be at least 4 years 23
24. Separation Anxiety Disorder
Defined as an excessive anxiety about separation
from home or from those to whom the child is
attached
This disorder must last for at least 4 weeks
Must begin before age of 18 years
Must cause significant distress or impairment
Separation anxiety requires the presence of at
least three symptoms related to excessive worry
about separation from the major attachment
figures 24
25. The worries may take the form of refusal to
go to school( school phobia, school refusal),
fears & distress upon separation ,repeated
complaints of such physical symptoms like
headaches & stomach aches when separation
is anticipated and night mares related to
separation issues
The disorder is common and onset may occur
during preschool years but is most common in
7-8 years old
Prevalence is 3-4% of all school children
It occurs equally in males and females
Treatment : behavioral therapy
25
26. Pediatric Psychopharmacology
:Summary
Substantial Empirical Evidence Currently Supports
◦ Stimulants for ADHD
◦ SSRI’s for OCD
Well Designed Trials support
◦ Risperidone for aggression and self-injurious
behaviors in autism
◦ Fluvoxamine for Childhood Anxiety Disorders
◦ Fluoxetine for Moderate – Severe Major
Depression
26
27. Pediatric Psychotherapy
:Summary
Best Evidence for;
◦ CBT (cognitive behavioral therapy) for Depression,
Anxiety
◦ CBT/Behavioral Strategies for Conduct Problems
◦ Parent Training for Conduct Problems
◦ MST (multi systemic treatment) for Conduct
Problems
27