PSYCHIATRIC DISORDERS PSYCHIATRIC DISORDERS IN CHILDHOOD AND IN CHILDHOOD AND
ADOLESCENCEADOLESCENCE
Robert L. Hendren, D.O.Professor of Psychiatry and
PediatricsUMDNJ-RWJMS
Developmental Model of Psychopathology
2 4-5 6-7 12 14 21
0
Autism SchizoidReactiveAttachmentSeparationAnxiety
ODDConductDisorder
TourettesPDDMentalRetardationAnxiety
ODDADHDSeparationAnxietyOveranxious
ConductDisorder
EatingDisorderSchizophreniaDepression
EatingDisorderIdentityDisorder
6MOS
Mental Retardation Retardation
• Mild (50-55 to 70)• Moderate (35-40 to 50-55)• Severe (20-25 to 35-40)• Profound (<20-25)
Etiology Etiology Unknown 30-40%Genetic 5%Prenatal 30%Perinatal medical conditions
and complications -15%Environmental influences 15 -
20%
Learning, Motor Skills, Communication Disorders
Reading disorder 7-9% Mathematics disorder Disorder of Written Expression 2-8% Developmental Coordination Disorder 6% Expressive Language Disorder 3-10% Mixed Receptive - Expressive Language Disorder
3-10% Phonological Disorder 5-10% Stuttering
Autistic DisorderAutistic Disorder
•Reciprocal interaction
•Communication
•Stereotypes
•Brain changes
Pervasive Developmental Pervasive Developmental DisordersDisorders
Asperger’s DisorderRett’s DisorderChildhood Disintegrative
DisorderPDD NOS
Elimination DisordersElimination Disorders
Encopresis Enuresis
Concept of Impulse Control Disorder
Common etiology
Diagnostic overlapCo-morbidity
Attention Deficit Hyperactivity Attention Deficit Hyperactivity DisorderDisorder
Over vs. under diagnosis controversy
Subtypes include inattentive, impulsive/hyperactive and combined
Similar life cycle except hyperactivity and co-morbidity
ADHD PrevalenceADHD Prevalence
•3 - 5% school-aged children•Boys more than girls, but may be under-diagnosed in girls
ADHD Biologic EtiologyADHD Biologic EtiologyGenetic riskPrenatal stress and toxinsFrontal lobe, basal ganglia and RAS implicatedNorepinepherine - inattentionSerotonin - impulsivity
ADHD Psychosocial ADHD Psychosocial EtiologyEtiology
Poor social relatednessPeer/Authority rejectionGoodness of fit
ADHD AssessmentADHD Assessment
Context and developmentLife cycle issuesFamily issues
Rule out medical causes
Rating Scales - ADHDRating Scales - ADHD
ConnorsAcTERSContinuous PerformanceWender Utah Rating Scale for
retrospective diagnosis
Alternative Diagnoses
SchizophreniaPTSDBipolar Disorder
ADHD Co-morbidityADHD Co-morbidity
DepressionTics and TourettesConduct DisorderSubstance Use DisorderLearning Disability
ADHD OutcomeADHD Outcome
Normal 15%Continued Problems 50%Significant pathology 25%Substance abuse
Conduct DisorderConduct DisorderRepetitive persistent pattern of
violation
Childhood vs. adolescent onset9% males; 2% femalesCo-morbidity
CD - Biologic EtiologyCD - Biologic Etiology
Temperament
Genetics
Serotonin
•Developmental instability
CD - Psychosocial CD - Psychosocial EtiologyEtiology
•Cognitive factors
•Family factors
•Peer group
•SES
•Culture
“You left your goddam car in the driveway again!”
Oppositional Defiant Oppositional Defiant DisorderDisorder
Recurrent pattern greater than 6 months
Evident by age 8Non-aggressive grow out
Substance Use DisorderSubstance Use Disorder
Prevalence
Co-morbidity
Type I/Type II
