This document provides information on several childhood psychiatric disorders and conditions. It discusses mental retardation and the different classifications based on IQ. It also covers pervasive developmental disorders like autism and Asperger's disorder. Learning disorders and disruptive disorders like oppositional defiant disorder and conduct disorder are explained. The document also summarizes attention deficit hyperactivity disorder, movement disorders, encopresis, enuresis, and toilet training.
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Goals
• Understanding how symptoms of psychiatric
disorders differ in children and adolescents
Psychiatric disorders:
Mood
Anxiety
Psychotic
Disorders first usually diagnosed in Infancy.
Childhood and Adolescence
Eating disorders
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Mental Retardation
Defined as intellectual functioning with an IQ less than 70
Also need delays in two or more adaptive areas
Self care
Communication
Testing:
Vineland Adaptive Behavior Scales-measure of personal and social
skills
Weschler-compares individual test performance to normative of age
group
WISC or Stanford-Binet- intelligence test
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Mental Retardation
Mild
• 50-55 to 70-85 IQ
85% of MR
population
Academic level- 6th
grade
Holds job, makes
change
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Mental Retardation
Moderate
35-40 to 50-55 IQ
10% of MR
population
Academic level-2nd
grade
Makes small change
Severe
20-25 to 35-40 IQ
4% of MR population
Academic level-
below 1st
Can use coin
machines
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Mental Retardation
Profound
20-25 and below IQ
1% of MR population
Academic level-
BELOW 1st
Dependent on others
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–Most common INHERITED cause of mental
retardation-Fragile X
–Most common GENETIC cause of mental retardation-
Down syndrome
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Treatment Considerations
Family is coping with loss of “ideal” child
Grief and loss issues
Appropriate placement.
School setting, day care, group homes, sheltered workshop and
respite care
Specific problems responsive to medications
Seizures Disorders
Affective Disorders
ADHD
Aggression
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Pervasive Developmental Disorders
• Autism-delays or
abnormal functioning in:
• Social interaction
• Language and Social
Communication
• Repetitive and
stereotyped patterns of
behavior
• Prevalence:2-5 cases per
10,000 children.
• Sex Ratio:3-4 times more
common in boys.
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AUSTISTIC DISORDER
Diagnostic Criteria: (cont)
• Marked lack of awareness of others’ feelings
• No or abnormal comfort-seeking
• No or impaired imitation.
• No or abnormal social play.
• Gross deficits in making friendships
• Impaired non-verbal behavior (e.g. eye contact, body
postures)
A. Qualitative Impairment in Reciprocal Social
Interaction.
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AUTISTIC DISORDER
Diagnostic Criteria: (cont)
• Delay or lack of spoken language
• Impaired ability to initiate or maintain
conversation
• Stereotypic, repetitive or idiosyncratic use of
language
• Impaired ability to converse with others
B. Impaired Verbal and Nonverbal Communication
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AUTISTIC DISORDER
Diagnostic Criteria: (cont)
• Stereotyped or repetitive body movements
(e.g. hand flapping)
• Inability to tolerate change, with insistence
on routines
• Narrow interests
• Unusual attachments to objects
• Preoccupation with object parts
C. Restricted Repertoire of Activities
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Etiology of Autism
Psychological theories have not been confirmed
Not caused by bad parenting
“Common final pathway” --
i.e., association with a variety of disorders:
-Congenital rubella & - Genetic disorders, including
other infections Fragile X
- Postnatal infection. - Metabolic disorders
• Approximately 70% have mental retardation
• Approximately 30% have seizures
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Interventions in Autism
Presently: No curative treatment.
Symptomatic approaches.
Mainstay: Structured behavioral and
educational programs.
Medications: To control seizures,
hyperactivity, severe
aggression, or mood disorders.
Investigational: Reciprocal communication
training
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Asperger’s Disorder
“High functioning autism”
Stereotypic, repetitive mannerisms
Lack of interactive play/communication
Loss of communication skills
No delays in language and cognitive development
Derek Preuss obsesses over game
shows, a typical symptom of a child with
the disorder. (ABCNEWS.com)
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Retts Disorder
Normal growth for the first few months
Deceleration of head growth between 4-8 months
Truncal incoordination
Lack of purposeful and movements
Disorder of females
Similar criteria as PDD
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Childhood Disintegrative Disorder
Normal development for at least two years after
birth
Clinically significant loss of previously acquired
skills (before age 10 years): in 2 or more of the
following areas:
Language
Social skills or adaptive behavior
Bowel or bladder control
Play
Motor skills
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PDD NOS
When there is no severe and pervasive
impairment in the development of reciprocal
social interaction, or communication skills, or
when stereotyped behaviors and activities are
present but the criteria are not met for a
specific pervasive developmental disorder.
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Learning Disorders
Definition
Skills in a specific academic area are greatly
below those expected for age or IQ and academic
level
Must cause academic or adaptive defect
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Learning, Motor Skills &
Communication Disorders
Types:
- Reading Disorder
- Mathematics Disorder
- Disorder of Written Expression
- Developmental Coordination Disorder
- Expressive Language Disorder
- Mixed Receptive-Expressive Language Disorder
- Phonological Disorder
- Stuttering
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Learning Disorders
Course/Prognosis
Diagnosed in grade
school, but not outgrown
Complications include:
low self-esteem
school dropout
low frustration tolerance
Academic achievement
associated with language
skills
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Learning Disorders
Diagnosis
Academic testing
Speech and language
skills testing
Motor testing
Cognitive testing
Observation of the
child in the classroom
Treatment
Multidisciplinary plan
Tx for specific
developmental disorders
in public schools is
mandated by law
Included least restrictive
environment and
Individual Educational
Plan
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Oppositional Defiant Disorder
A pattern of negativistic, hostile and defiant behavior
lasting greater than 6 months of which you have 4
or more of the following:
Loses temper
Argues with adults
Actively defies or refuses to comply with rules
Often deliberately annoys people
Blames others for his/her mistakes
Often touchy or easily annoyed with others
Often angry and resentful
Often spiteful or vindictive
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Oppositional Defiant Disorder
(ODD)
Prevalence-3-10%
Male to female -2-3:1
Outcome-in one study,
44% of 7-12 year old
boys with ODD
developed into CD
Evaluation-Look for
comorbid ADHD,
depression, anxiety
&LD/MR
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Conduct Disorder
(CD)
Aggression toward
people or animals
Deceitfulness or
Theft
Destruction of
property
Serious violation
of rules
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Conduct Disorder
(CD)
Prevalence-1.5-3.4%
Boys greatly outnumber
girls (3-5:1)
Comorbid ADHD in
50%, common to have
LD
Course-remits by
adulthood in 2/3. Others
become Antisocial
Personality Disorder
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Movement Disorders
Chorea
Chorea-Continuous, unsustained, rapid, abrupt and
random contractions
Causes of chorea-metabolic disorders, medication
induced, Syndenham chorea, metabolic disorders,
nutritional disorders, SLE, CNS abnormalities
Etiology of Syndenham chorea-Group A hemolytic
streptococcal infection
Clinical features of Syndenham chorea-irritability,
emotional lability and abnormal choreiform movements
Treatment of Syndenham chorea-PCN prophylaxis x 10
years, cardiac screening, antipsychotic (severe cases)
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Movement Disorders
• Tic-sudden, rapid, recurrent, nonrhythmic,
sterotyped motor movement or vocalization
• Tourette’s syndrome-motor and vocal tics for
greater than one year
• Tourette’s Disorder-1/1000 boys & /10000 girls
Onset of Tourette’s- ages 7-14 years (rarely
postpubertal)
Tourette syndrome is associated with LD, ADHD
and OCD
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Attention Deficit Hyperactivity Disorder
Symptoms for at least six
months to a degree that it
is maladaptive and
INCONSISTENT with
developmental level
Some symptoms present
prior to age 7 years
Two or more settings
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Attention Deficit Hyperactivity Disorder
Inattention
Poor organization
Does not seem to listen
when spoken to
Loses objects
Easily distracted
Forgetful in daily
activities
Hyperactivity/Impulsivit
y
Fidget
Leaves seat often
Runs or climbs
excessively
Always “on the go”
Talks excessively
Blurts out answers
Can’t wait turn,
interrupts others
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Attention Deficit Hyperactivity Disorder
Attention deficit disorder can occur WITH
and WITHOUT hyperactivity
Hyperactivity is more common in boys
than girls
ADHD is difficult to diagnose in the early
years (age 4-6)
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Attention Deficit Hyperactivity Disorder
Medical Causes of hyperactivity and/or attention problems
• Birth complications-hypoxia, toxemia
• Fragile X Syndrome, PKU, resistance to
thyroid hormone
• Brain injury-trauma or infection
• Lead poisoning
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Attention Deficit Hyperactivity Disorder
ADHD can be a lifetime disorder with 30-50% having
symptoms as adults
Learning Disabilities are frequently seen in children with
ADHD
Behavior in a pediatrician’s office does NOT reflect the
situation at home or in school
Long term outcome dependent on substance abuse, CD
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Attention Deficit Hyperactivity Disorder
Stimulant medications improve attention in
normal individuals as well as children with
ADHD
Medication alone is usually not sufficient for the
treatment of ADHD
It is of upmost importance to communicate with
the ADHD/LD child’s teacher
Mentally retarded children with symptoms of
hyperactivity and short attention may respond to
medication in different manner
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Toilet training
Toilet training
Begins 18-30 months
Most children control urination by day at 2.5 years
and at night by 3.5-4 years
Factors that effect refusal include:
early training
excess parent-child conflict
constipation
Prerequisites:
bowel and bladder regularity
sphincter control
psychological ability to delay
desire to please adults
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Enuresis
Primary vs secondary enuresis
Nocturnal vs. diurnal
DIURNAL enuresis after
continence is achieved should
prompt evaluation
Family history of enuresis
Laboratory studies are
unlikely to be positive unless
other clinical findings are
present
Treatment with medications
and behavioral plan
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Encopresis
Encopresis
High association between
encopresis and enuresis
Medical therapy,
behavioral modification
and counseling results in
the greatest success in the
treatment of encopresis