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CHILDHOOD DISORDERS

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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

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Mental RetardationMild

• 50-55 to 70-85 IQ 85% of MR

population Academic level- 6th

grade Holds job, makes

change

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Mental RetardationModerate

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 RetardationProfound

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 Asperger R ett PD D N O S C hi ld ho od D isin teg ra tiv e D iso rd e r

PD D

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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 DISORDERDiagnostic 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 DISORDERDiagnostic 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 DISORDERDiagnostic 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 AutismPresently: 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 NOSWhen 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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Pervasive Developmental Disorders

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Learning DisordersDefinition

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 DisordersCourse/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 DisordersDiagnosis

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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Disruptive Disorders in Children

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Oppositional Defiant DisorderA 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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Oppositional Defiant Disorder

http://www.hsc.wvu.edu/aap/aap-car/videos.htm

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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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Conduct Disorder

“You left your D__M care in the driveway again!”

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Conduct Disorder

http://www.hsc.wvu.edu/aap/aap-car/videos.htm

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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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Movement Disorders

http://www.wemove.org/ts_ssv1.0.html

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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/Impulsivity 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 DisorderMedical 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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EncopresisEncopresis

High association between encopresis and enuresis

Medical therapy, behavioral modification and counseling results in the greatest success in the treatment of encopresis

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Our Time is up!