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