brief detail about major childhood psychiatric disorders, related signs and symptoms and intervention

1. PLLAVI GUPTA, M. Phil., Mob: +91 98399
56104
Common Emotional and
Behavioural Disorders in Childhood
and Adolescence

2. About Me
 A Therapist, a Counselor, a Trainer, a Mother
and a Learner
 Presently running a centre called “AANGAN –
Building Life Skills Together” to provide
Psychosocial & Counseling Services
 Headed Department of child and adolescent
psychiatry for 3 years at Deva Institute
 10 yrs of experience in curative service
(assessment, therapies, Rehabilitation and
counseling) with persons suffering from
emotional and behavioural problems at Deva
Institute and Deva Foundation.

3. What will we discuss today?

4.  Disorders of Social
Interaction
 Autism
 Aspergers Syndrome
 Internalizing Disorders
 Anxiety Disorders
 Depression
 Trauma Responses
 Externalizing
Disorders
 Attention Deficit
Hyperactivity Disorder
 Conduct Disorder
 Appetite Disorders
 Eating Disorder
 Substance Abuse
 Self-Harming Behavior
 Intellectual
Disorders
 Learning Disability
 Early onset major
mental illness
 Schizophrenia
 Bipolar Disorder

5. Objectives
 Upon completion of this presentation,
the students will:
Acknowledge unique variations in
presenting psychiatric symptoms in
child and adolescent age group
Be aware of the use of multimodal
treatment focusing psychosocial
interventions in children and
adolescents

6. The presentation is not focused to
help you to make diagnosis but
definitely to identify disorders
around your environment and
provide them genuine way to right
intervention.

7.  What is there in PPT you will get it for sure as I
am going to share this PPT with you all…
 What is not there in PPT - examples and
experience which I am going to share today in
coming few hours.
SO PLEASE LISTEN, PARTICIPATE AND FOCUS
ON YOUR UNDERSTANDING

8. Before we start
QUIZ

9. Q 1
 Being mentally healthy includes:
A. having a mind that feels good and works well
B. Feeling excitement and happy always from
inside
C. not being sick
D. Healthy Thinking pattern leading to emotional
stability which further determines the socially
accepted behaviour with individual freedom.

10. Q 2
Mental illness in childhood
become alright automatically
after a person has reached
adulthood.
A. True
B. False

11. Q 3
Children with a mental illness
will always be ill and never be
fine.
A. True
B. False

12. Q 4
We label a child with disorder only
when disturbance is there in:
A. Socioccupational functioning
B. For specific time period
C. Emotions/behaviour
D. all of the above

13. Q 5
 If a child who is physically sick goes to
see a paediatrician, a child who has a
mental health problem, their parents see
a
A. Neurologist
B. Psychiatrist
C. Neurosurgeon
D. Pediatrician
E. None

14. Q 6
 What causes mental illness in
children?
A. diet
B. catching it from someone else
C. Vaccination
D. Multiple reasons – neurological,
environmental, psycho-social,
etc

15. Q 7
 Another way to talk about mental illness
in children is to say
A. Stubborn and “badmash” child
B. Neurodevelopmental disorders
C. Disordered mentality
D. Parenting faults

16. Q 8
Any children diagnose with mental
disorder, will need to get admitted in
hospital.
A. True
B. False

17. Q 9
 What does the term "diagnosis" mean?
A. to have a feeling that you know what is
wrong
B. to meet with your medical doctor who
gives you a prescription for medication
C. to meet with a mental health
professional and he or she gives what
you are experiencing a name
D. to be told you have a mental illness
E. all of the above

18. Q 10
 If a person with a mental illness or
mental health challenge experiences
"stigma", what does that mean?
A. People must be calling crazy, pagal
etc
B. People feeling shame of their child’s
illness
C. People believe that this is due to
black magic
D. Treatment is impossible for mental
illness

19. NORMAL vs. NOT NORMAL

20. Normal child development
What is growth and development ?
Process of growing to maturity.
Refers to process of biological and
psychological changes in human being
between birth and end of adolescence as the
individual progresses from dependency to
increasing autonomy.

21. What is the rationale behind the
knowledge of normal developmental
process ?
 For the better understanding of childhood
psychiatry.
 To identify whether the observed emotional, social,
or intellectual functioning is abnormal as it has to
be compared with the corresponding normal range
for the age group.

22. Distinct areas of development
 Physical
 Cognitive
 Social
 Emotional
 Moral
 psychosexual

23. Age related developmental periods
newborn (ages 0–1 month)
infant (ages 1 month – 1 year)
toddler (ages 1–3 years)
preschooler (ages 4–6 years)
school-aged child (ages 6–10 years)
adolescent (ages 11–19)

24. Cognitive development
Includes capacity to learn,
remember, recognise, solve
problems and organize the
environment.
• Newborn-learns to suck
• 8-12 mths-plays peek-a-boo
• 2yrs - knows animal sounds,
names objects
• 3yrs – knows colors
• 5-6yrs - understands humor
• 7-11yrs - think logically,
personal sense of right and
wrong

25. Social development
Learn to develop sense of
themselves so that they can
think and relate their
experiences in other situation.
 Infant- recognizes care giver,
shows stranger anxiety
 2yrs- may separate from care
giver
 3-6 yrs – curiosity about sex
 6-12 yrs – rules of the games
are key, separation of the sexes,
demonstrating competence is
key.

26. Emotional development
Recognition and use of their
emotions appropriately.
 2 mths - social smile
 1-3yrs - likes attention
 3-5yrs - shows sensitivity to
criticism
 5-7 yrs – can express feelings
 >7 yrs – can react to feelings of
others and are more aware of
other’s feeling

27. Moral development
Learning concept of right and
wrong
 4-7 yrs - self control develops,
guilt appears
 7-11 yrs – feels empathy
 Early teens - peers considered
in principles

28. Psychosexual development
Process of learning to view themselves and others in terms of
gender.
 12-18 months: can differentiate play; girls like dolls
 2-3 yrs: child can label self, picture, other children’s sex
using clothes, toys, hair etc.
 3-6 yr: same sex peers favored
 6-11 yrs: heterosexual play
 >12 yrs: sexual activity begins

29. UNDERSTANDING
“NOT NORMAL”

30. Understanding when its not
normal
 Anything which is:
 Delayed more than
expected milestones
 Increased Dependence on
others
 Requiring support for things
which can be done
independently
 Interfering day to day life
like studies, play, peer
relations etc
 Seems things are going out

31. American Academy of Neurology
Warning Signs
 Any child with any of the following five symptoms
should be evaluated:
1. No babbling by 12 months.
2. No gesturing, pointing, or waving goodbye by 12
months.
3. No single words by 16 months.
4. No two words spoken together spontaneously by
24 months
5. Any loss of previously acquired language or
social skills at any time.

32. CHILD MENTAL HEALTH –
The Major Concerns
 Worldwide 10-20% of children and adolescents
experience mental disorders.
 One in 5 children (birth to 18) has a diagnosable
mental disorder.
 One in 10 youth have serious mental health
problems that are severe enough to impair how
they function at home, in school, or in the
community.
World Health Report (2000)

33. CHILD MENTAL HEALTH
The Major Concerns
 The onset of major mental illness may
occur as early as 7 to 11 years old (Kessler,
et. al. 2005).
 Roughly half of all lifetime mental health
disorders start by the mid teens (Kessler,
et. al. 2007).
 Studies from India revealed the prevalence
rates of childhood disorders range between
6 -15 % in 0-16 yrs. (Srinath et al, 2005)

34. Time : 5 MINUTES maximum
ACTIVITY

35. Tear one page form your
notebook
Write your name, college,
academic session and date
Write the name of one
disorder of childhood you
think is most common and

36. CHILDHOOD PSYCHIATRIC
DISORDERS

37. Classification of childhood psychiatric
disorders – ICD 10
 Mental retardation F70 - F79
 Disorders of psychological development F80- F89
 Speech disorders
 Learning disorders
 Motor disorders
 PDD: Autism
 Behavioural and emotional disorders with onset usually occurring
in childhood and adolescence F90- F98
 ADHD
 Conduct
 Emotional disorders
 Tics

38. Classification of childhood psychiatric
disorders – DSM V
• Neurodevelopmental disorders
– Intellectual disability
– Communication disorders
– Autism spectrum disorders
– ADHD
– Learning disorders
– Motor disorders
• Disruptive mood dysregulation disorder
• Anxiety disorders
– Separation anxiety disorder
– Selective mutism
– Specific phobia
• OCD – trichotillomania, excoriation
• Trauma and stressor related disorders – Reactive attachment disorders,
Disinhibited Social Engagement Disorder, PTSD for 6 years and below
• Feeding and eating disorders – pica, rumination disorder, Avoidant food intake
disorder, Anorexia nervosa, bulimia nervosa,
• Elimination disorders
• Disruptive, impulse control and conduct disorders – ODD, IED, CD

39. We will discuss in detail
Autism Spectrum Disorders
ADHD
Learning disorders
Disruptive, impulse control
and conduct disorders –
ODD, IED, CD

40. Symptoms in two core areas:
A. deficits in social communication & social
interaction
B. restricted repetitive behaviors, interests, &
activities

41. The History of Autism
 Autistic children were historically believed to be
schizophrenic
 In 1943 Leo Kanner (Hopkins) described 11 cases of
what he termed “early infantile autism,” noting ways
in which it was distinctive from
psychosis/schizophrenia
 Kanner’s (unfortunate) choice of the word “autism”
was meant to convey the unusual self-centered
quality of these children (following Bleuler)
 Although many of Kanner’s observations have
lasted, his speculations about certain aspects of the
illness (e.g., normal IQ, lack of association with
other medical conditions, poor parenting/education)

42. Historical Myths about Autism
 Children with autism never make eye contact, show
affection, or smile
 Inside a child with autism is a normal child (or
genius) waiting to emerge
 Children with autism don’t speak, but they could if
they wanted to
 Children with autism don’t relate to peers & adults
and don’t want friends
 Children with autism are manipulative & selfish
 Autism is an emotional disorder
 Autism can be outgrown; or progress means a child
is not autistic

43. What Should We Know About
Autism
 Autism is a biological disorder with multiple
etiologies
 No single cause, no single cure
 No biological marker
 No evidence of parenting defects or
emotionally induced autism (e.g., the
“refrigerator mother”)
 Currently, the view is that some factor(s) act
through one or more mechanism to produced
a final common pathway of CNS insult that
results in the behavioral syndrome of autism

44. • Persistent deficits in social
communication and social interaction
across multiple contexts
• Deficits in social emotional reciprocity
(e.g. reduced sharing of emotions,
affect or interests)
• Deficits in non verbal communicative
behaviours used for social interaction
(e.g eye contact, lack of facial
expressions, nonverbal
communications)
• Deficits in developing maintaining
Understanding ASD

45.  Restricted repetitive patterns of behaviors, interests, &
activities
• Stereotyped or repetitive motor movements, use of objects
or speech (e.g. idiosyncratic phrases, simple motor
stereotypes, etc)
• Insistence on sameness inflexible adherence to routines or
ritualized patterns of verbal & non verbal behaviour (e.g.
need to take same route, same food daily etc.)
• Highly restricted fixated interests that are abnormal in
intensity of focus (e.g. strong attachment to unusual
objects)
• Hypo-hyper activity to sensory inputs (e.g. adverse
response to specific sounds or textures, apparent
indifference to pain and temperature, visual fascination for
something)
Understanding ASD

47. Severity specifiers:
• Based on social communication
impairments and restricted,
repetitive behavior patterns.
• Severity Levels:
Level 1. Requiring Support
Level 2. Requiring Substantial
Support
Level 3. Requiring Very Substantial
Autism Spectrum Disorder

48. • Childhood autism
• Atypical autism
• Asperger’s syndrome
• Childhood disintegrative disorder,
• Pervasive developmental disorder
NOS
ASD includes

49. Current Research into Etiology
Abnormalities in the genome
Chromosome 15q11-q13 is implicated
based upon twin & family studies (re:
PWS & Angelman)
Mechanisms underlying the expression
of these abnormalities during brain
development
Resulting structural and functional
abnormalities in the brain

50. Medical Assessment of the Autistic
Child
 History & Physical
Hearing & Visual screening
Speech & Language Evaluation
Occupational and Physical Therapy
Evaluations
 Growth Milestones (e.g., head circumference)
 Imaging (?)
CT or MRI to identify Tuberous Sclerosis,
leukodystrophy, etc.
 EEG (?)
 Psychoeducational Testing

51. How is Autism Diagnosed?
Psychological Tools
 AIIMS Modified INDT ASD Tool
 Autism Diagnostic Observation Schedule
(ADOS; Lord et al)
 Autism Diagnostic Interview-Revised (ADI-R;
Rutter et al)
 Social Communication Questionnaire (SCQ;
Rutter et al)
 Childhood Autism Rating Scale (CARS; Schopler
et al)
 Clinical judgment plays a HUGE role
 What are the dangers of this?
 Potential differential diagnoses (type of
language/communication disorder, OCD, anxiety
disorder)

52. Checklist for Autism in Toddlers
CHAT involves a 5-item checklist for
PCPs and a 9-item checklist for parents
Recommended at 18-month pediatric
evaluation
On the PCP CHAT, children who fail
items #2, 3,& 4 are at risk of autism and
warrant further evaluation
On the Parent’s CHAT, items #5 & 7 are
the most important

53. PCP’s CHAT
1. Look for sustained eye-contact.
2. Get child’s attention; then point out an interesting
object in the room. The typical child should look
to where the physician points.
3. Ask the child to point out something in the room
(e.g., “show me the light”). The absence of
pointing by 18-months is a cardinal sign of PDD.
4. Show the child a doll and a cup and ask, “Can you
give the baby some juice?” An autistic child will
have difficulty engaging in pretend play.
5. Ask the child to build a tower of 3 blocks. (The
purpose of this task is to assess social
interaction).

54. Parent’s CHAT
1. Does your child enjoy being swung or
bounced on your knee?
2. Does your child take interest in other
children?
3. Does your child like climbing on things
such as stairs?
4. Does your child play peek-a-boo or
hide-and-seek?
5. Does your child ever pretend?
6. Does your child ever use his index

55. Parent’s CHAT (continued)
7. Does your child ever use your index
finger to point and indicate an interest
in something?
8. Can your child play appropriately with
small toys without just mouthing,
fiddling, or dropping them?
9. Does your child ever bring objects to
you to show you something?

56. Benefits of Early Diagnosis
Treatment and
intervention
effectiveness
Skill acquisition
exposure

57. Types of
Treatments/Interventions
Interpersonal Relationship
Intervnetions and Treatments
Skill-Based Interventions and
Treatment
Cognitive Interventions and
Treatment
Physiological/Biological/Neurologica
l Interventions and Treatment
Other Interventions, Treatments

58. Interpersonal Relationship
 Social-affective interpretation of ASD
 Need for people with ASD to express
attachments to others appropriately
 Seek to facilitate affect, attachment,
bonding, sense of relatedness
Holding Therapy (not recommended)
Developmental, Individual-Difference
Relationship Based Model (Floortime;
www.icdl.com)

59. Skill-Based
 Most common methods used by schools
 Intent is to develop and support
functional demonstration of specific
skills rather than to facilitate bonding
 Target specific skills to teach to improve
functioning in specific areas
 Picture Exchange Communication System
(PECS)
 Facilitated Communication (not
recommended)
 Assistive Technology
 Applied Behavior Analysis (Scientifically
Based Practice)

60. Cognitive
 Teaching individuals with ASD to monitor
their own behavior and performance
 Shift control from others to the
individuals
 Connection between thoughts, feelings
and behavior
Social Stories
Social Decision Making Strategies
LEAP (Scientifically Based Practice)

61. Physiological/ Biological/
Neurological
 Address the neurological dysfunctions or problems
thought to exist at the core of ASD
 Alter way in which neurological system processes
information, the manner in which information is
received, chemistry and processes associated with
sensations, perceptions and emotions
 Irlen Lenses (limited support)
 Sensory integration (promising practice)
 Auditory Integration Training (limited support)
 Pharmacology (promising practice)

62. Let’s Identify Autism Spectrum
Disorders

64. Symptoms Domain:
1. Inattention
2. Hyperactivity/ Impulsivity
ATTENTION DEFICIT HYPERACTIVE
DISORDERS

65. Attention-Deficit
Hyperactivity Disorder
 ADHD is a neurodevelopmental disorder of
childhood that is characterized by
developmentally inappropriate levels of:
 Hyperactivity
 Impulsivity
 Inattention

66. Inattention
1. Often fails to give close attention to
details or makes careless mistakes
2. Often has difficulties sustaining
attention in tasks or play activities
3. Often does not seem to listen when
spoken to directly
4. Often does not follow through on
instructions and fails to finish
homework, chores, or duties in the
workplace

67. Inattention
5. Often has difficulty organizing tasks
and activities
6. Often avoids, dislikes, or is reluctant to
engage in tasks that require sustained
mental effort
7. Often loses things necessary for tasks
or activities
8. Is often easily distracted by extraneous
stimuli.
9. Is often forgetful in daily activities

68. More on Inattention
 “Attentional" problems may be most
obvious on specific types of
attentional tasks:
sustained attention: responding to
tasks, being vigilant
situations requiring the child to
attend over time to dull, boring,
and repetitive tasks

69. Hyperactivity
Often fidgets with hands or feet,
squirms in seat
Often leaves seat in classroom or in
other situations in which remaining
seated is expected
Often runs about or climbs
excessively in situations in which it
is inappropriate
Often has difficulty playing or
engaging in leisure activities quietly

70. Hyperactivity
 Is often "on the go" or often acts as if "driven
by a motor”
 Often talks excessively when inappropriate
to the situation
 6 or more of hyperactive and/or impulsive
symptoms required for diagnosis

71. More on Hyperactivity
 Children with ADHD are more active,
restless, and fidgety than normal children
during the day and during sleep
 There are different types of hyperactivity:
 Gross Motor Activity
 Restless/Squirmy
 Verbal hyperactivity
 Hyperactivity often varies according to
situation
 Degree of hyperactivity may vary with age

72. Impulsivity
Often blurts out answers
before questions have been
completed
Often has difficulty awaiting
turn
Often interrupts or intrudes
on others

73. • At least 6 symptoms in one domain
required (adults: 5 symptoms)
• Six symptoms of hyperactivity
and impulsivity are required for
diagnosis
• Onset prior to age 12
Attention-Deficit
Hyperactivity Disorder

75. ADHD SPECIFIERS
1. Combined
presentation
2. Predominantly
inattentive
presentation
3. Predominantly
hyperactive/impulsi
ve presentation
Mild
Moderat
e
Severe

76. ADHD: Prevalence
 3-9% of the elementary school population
 more often in males than females, with
the sex ratio being about 3:1 to 9:1
 most common disorders of childhood
accounting for a large number of referrals
to pediatricians, family physicians and
child mental health professionals

77. ADHD Etiology
 No specific etiologies have been
identified.
 Some associated conditions are
perinatal injuries, malnutrition and
substance exposure
 Heterogeneous, with many causes
 Factors include genetic,
prenatal/perinatal factors (maternal
smoking and alcohol use), neurotoxins
(such as lead)
 Psychosocial stressors can, at times,

78. ADHD Risk Factors
Maternal cigarette use
Maternal alcohol use
Unusually long or short labor
Prenatal infections
Minor physical anomalies

79. Impairment in ADHD
Social Impairment – What does it
look like?
Academic Impairment – Long term
outcomes for children with ADHD
not so good
Family Impairment
Occupational Impairment
Driving Impairment

80. ADHD Across the Lifespan
ADHD is a chronic disorder
60%-80% of children continue to
meet diagnostic criteria in
Adolescence
50%-70% of children will continue
to meet diagnostic criteria in
Adulthood
ADHD in childhood is different from

81. Presentation of ADHD in
Adolescence
Gross motor activity tends to
disappear
Predominance of Inattention,
Restlessness (rather than
hyperactivity) and impulsivity
What is a developmentally
appropriate level of impulsivity
in adolescence?

82. Onto Assessment and Diagnosis!
Interview
Behavioural Observation
Parents Report
Conners’ Parent Rating scale the
“Gold Standard” form
Behaviour Assessment System for
Children
Teacher’s report
Conners’ Teacher Rating Scale

83. CPRS
 Items are rated on a four-point scale from
“Not at all true” to “Very much true”
 87 questions
 Each question is part of one or more
subscales
 The parents’ rating on a given question
corresponds to a number 0-3
 You sum the numbers for that scale
 You plot subscale sums on the profile chart
 Scores in the red area are indicative of
greater problems

84. Psychosocial Treatments
 Parent Training
 Social Skills Training
 Cognitive Behavioral Treatments
 Psychotherapy for comorbid conditions
 Psycho-educational Interventions
 Classroom strategies and modifications
 Parent Education and Empowerment
NEED FOR MULTIMODAL TREATMENT!

85. Educational Interventions
Special Education Services for
existing learning problems
Classroom accommodations
Classroom behavior
modification programs

86. Learning Disorders

87. Who is a Student with a Learning Disability?
A student with a Learning Disability is a student
with learning abilities who:
 falls within the range of intellectual ability from
average to superior intelligence;
 is able to learn (including tertiary level subjects);
 has disabilities in one or more of the academic
skills of reading, writing, spelling or mathematics;
and
 is able to progress in their learning by navigating
around their learning difficulties.

88. Understanding LD
 Preschool signs and symptoms
 Problems pronouncing words
 Trouble finding the right word
 Difficulty rhyming
 Trouble learning the alphabet, numbers, colors,
shapes, days of the week
 Difficulty following directions or learning routines
 Difficulty controlling crayons, pencils, and scissors or
coloring within the lines
 Trouble with buttons, zippers, snaps, learning to tie
shoes

89. Understanding LD
 Ages 5-9 signs and symptoms
 Trouble learning the connection between letters
and sounds
 Unable to blend sounds to make words
 Confuses basic words when reading
 Consistently misspells words and makes
frequent reading errors
 Trouble learning basic math concepts
 Difficulty telling time and remembering
sequences
 Slow to learn new skills

90. Understanding LD
 Ages 10-13 signs and symptoms
 Difficulty with reading comprehension or math skills
 Trouble with open-ended test questions and word
problems
 Dislikes reading and writing; avoids reading aloud
 Spells the same word differently in a single
document
 Poor organizational skills (bedroom, homework, desk
is messy and disorganized)
 Trouble following classroom discussions and
expressing thoughts aloud
 Poor handwriting

91. Associated Features
Demoralization, low self-esteem, and
deficits in social skills are common
Children with LDs are not as socially
competent as peers and have more
difficulty understanding affective states
in complex/ambiguous situations
School drop-out rate for children with
LDs is nearly 40%

92. Prevalence
Range from 2 – 10%
Estimated to include 5% of
American children
Approximately 50% of children
receiving special services at
school are LD

93. Etiology
left brain (temporal lobe)
abnormalities, chromosomes 6,15,
role of viral infections, complications
in pregnancy, neonatal life,
epilepsy, CP.
deficit in occipital lobe area,
cognitive, emotional, educational
and SE factors.

94. TYPES
Learning disabilities in reading
(dyslexia)
Learning disabilities in math
(dyscalculia)
Learning disabilities in writing
(dysgraphia)
Learning disabilities in motor skills
(dyspraxia)
Learning disabilities in language

95. Learning Disabilities in reading
(Dyslexia)
 There are two types of learning disabilities in reading. Basic
reading problems occur when there is difficulty understanding
the relationship between sounds, letters, and words. Reading
comprehension problems occur when there is an inability to
grasp the meaning of words, phrases, and paragraphs.
 Signs of reading difficulty include problems with:
 letter and word recognition
 understanding words and ideas
 reading speed and fluency
 general vocabulary skills
 letter and word recognition
 understanding words and ideas
 reading speed and fluency
 general vocabulary skills

96. Learning disabilities in math
(dyscalculia)
 A child’s ability to do math will be affected
differently by a language learning disability, or a
visual disorder or a difficulty with sequencing,
memory or organization.
 A child with a math–based learning disorder may
struggle with memorization and organization of
numbers, operation signs, and number “facts”
(like 5+5=10 or 5x5=25).
 Children with math learning disorders might also
have trouble with counting principles (such as
counting by 2s or counting by 5s) or have
difficulty telling time.

97. Learning disabilities in writing
(dysgraphia)
Learning disabilities in writing can
involve the physical act of writing or
the mental activity of
comprehending and synthesizing
information.
Basic writing disorder refers to
physical difficulty forming words and
letters.
Expressive writing disability

98. Learning disabilities in writing
(dysgraphia)
 Symptoms of a written language learning
disability revolve around the act of writing.
They include problems with:
neatness and consistency of writing
accurately copying letters and words
spelling consistency
writing organization and coherence
neatness and consistency of writing
accurately copying letters and words
spelling consistency

99. Learning disabilities in motor
skills (dyspraxia)
 Motor difficulty refers to problems with movement
and coordination whether it is with fine motor skills
(cutting, writing) or gross motor skills (running,
jumping).
 A motor disability is sometimes referred to as an
“output” activity meaning that it relates to the
output of information from the brain. In order to
run, jump, write or cut something, the brain must
be able to communicate with the necessary limbs
to complete the action.
 Signs that your child might have a motor
coordination disability include problems with

100. Learning disabilities in language
(aphasia/dysphasia)
 Language and communication learning disabilities
involve the ability to understand or produce
spoken language.
 Language is also considered an output activity
because it requires organizing thoughts in the
brain and calling upon the right words to verbally
explain something or communicate with someone
else.
 Signs of a language-based learning disorder
involve problems with verbal language skills, such
as the ability to retell a story and the fluency of
speech, as well as the ability to understand the

101. ASSESSMENT
 Woodcock Johnson Psychoeducation
Battery, Peabody Individual Achievement
Test
 Keymath diagnostic arithmetic test
 Intelligence assessment
 Indian tool- NIMHANS Battery for LD

102. Assessment limitations
 IQ tests correlate with & predict school
achievement; a measure of academic
intelligence
 IQ tests are relatively stable but not
unchanging (stability increases with age)
 Heredity and environment influence IQ scores
 No test is free from cultural influences
 IQ is a score on a test – it is descriptive, not
explanatory
 IQ fails to measure many factors – creativity,
perseverance & discipline, social ability, etc.

103. Practically What Should We Do In The Case Of
Diagnosing A Learning Disability
 Some practical guidelines follows in order to
diagnose a child with a suspected learning disability:
 Clinical Interview
 Ecological Assessment
 Parent Interview
 Teacher Interview
 Review of Cumulative Reports and Records
 Intelligence Testing
 Achievement Testing
 Perceptual Testing
 Curriculum-Based Assessment
 Portfolio Assessment

104. MANAGEMENT
 Direct instruction on various components
of reading- letter sound, syllables, words.
Programmes like Merill progamme can be
used.
 Teaching Maths concepts with continuous
practice helps. Project MATH multimedia
program used.
 Direct practice in spelling and sentence
writing
 Parental counseling

105. Strategies to Overcome the Behavioural
Problems among Children with Learning Disability
 Observe carefully
 To begin with create situations which enhance the
possibilities for application of a particular skill or set of skills.
 To develop ability to organize the child
 The child should be made realized that there is pleasure in
accepting the responsibility and carryout it successfully
 The social skills like cooperation and tactfulness can be
developed through group activities and social situations
 Development of cognitive skills, academic skills and social
skills need not be achieved in isolation.
 The routine activities can be made use of for the development
of various abilities.
 Suitable adaptations can be made in the traditional games
and plays.

106. GUIDELINES FOR HELPING CHILDREN WITH LD: BETTER
UNDERSTANDING TO MEET THEIR CHALLENGES
 Encourage children to ask for help when something is difficult.
 Be careful not to explain the disorder or disability in a way that
suggest they are incapable of something.
 Remember to point out individuals as models who have
overcome their challenges.
 Answer child’s questions at the appropriate developmental
level.
 Involve child in support groups or create the opportunity for
child to meet other children with similar challenges.
 Be sensitive to child’s emotional state.
 Anticipation some of negative experiences that children may
have and help them learn how to responds.
 Help them to know how, when ,and whom they can go to if
they need help.
 Be aware of situations that are a challenge for child and try
never to become frustrated, anger, or disappointed.
 Establish realistic expectations

107. “Taare Zameen Par” a movie to
understand LD – features,
signs, symptoms, interventions,
etc

109. ODD, IED, CD
Disruptive, impulse control and
conduct disorders

110. Understanding of these disorders
These disorders include conditions
involving problems in the self
control of emotions and behaviour.
These problems are manifested in
behaviours that violate the rights of
others (aggression, destruction of
property) and that bring the
individual into significant conflict
with societal norms.

111. Types
 Oppositional defiant disorder
 Angry mood, argumentative behaviour,
vindictiveness
 Intermittent Explosive Disorder (Generally disorder
of adulthood)
 Recurrent behavioural outbursts representing
failure to control aggressive impulses like verbal
aggression, destruction of property, etc.
 Conduct Disorder
 Repetitive & persistent pattern of behaviour in
which basic rights of others and societal rules are
violated (aggression to people and animals,

112. Etiology
 Temperamental
high level of emotional reactivity, poor
frustration tolerance
Difficult uncontrolled temperament during
infancy
 Environmental
harsh, neglectful, inconsistent child
rearing practices, parental rejection
Exposure to physical and emotional
trauma

113. Prevalence
 Prevalence is 1-11 % with an average
prevalence of
Oppositional Defiant Disorder - 3.3 %
IED – 2.7 %
Conduct Disorder – 4 %
Affects 12% of boys and 7% of girls
-Most frequent reason for psychiatric
hospital admissions for children and
adolescents

115. Interventions
 Parent Training
 Parent Management Training
 Parent–child interaction therapy (PCIT)
 Contingency Management Programs
 CBT - cognitive Behavior Therapy
 DBT – Dialectical Behaviour Therapy
 Social Skills Training
 Multisystematic Treatment - family-based
intensive therapeutic approach
 Multimodal Community Treatment
 Wilderness therapy

116. DISCUSSIONS & Feedback

117. CASE STUDIES

118. Which picture explains poor eye
contact in Autism best

119. सत्यम तकरीबन १ साल में दौड़ने लगा | घर में पड़े हर
स्विच या घड़ी उसे बहुत पसंद थे | उसे लेकर उसके पुर्जे
तक िो दांत से नोच कर देखता था कक क्या है? इन कामों
में िो घंटो एक चीज़ के पीछे बीता देता पर खाना खखलाना,
नहलाना, टीिी देखना, कोई ककताब देखना ये सब बहुत
मुस्ककल से हो पाते और र्जरुरत से ज्यादा समय लग र्जाता
| उसके माता पपता को लगता है की उसे कोई बात
समझाना असंभि है और िो हर बात अनसुनी कर रहा है |
वकू ल में डालने के बाद भी उसकी बहुत शिकायत आती है |

120. विीटी एक पांच साल का बच्ची है र्जो प्ले वकू ल में र्जाती
है | उसे बालों के स्क्लप्स बहुत ज्यादा पसंद है और िो ददन
भर उनके साथ खेलती है | उसके मााँ के अलािा कोई उसके
स्क्लप्स को छू ने या लेने की कोशिि करता है तो िो
चचल्लाने लगती है | एक ददन िो वकू ल गई और िहााँ
उसकी टीचर ने उससे बात िुरू करने के शलए उसके
स्क्लप्स को उससे मांग शलया | िो कु छ बोले बबना िहां से
र्जा कर बेंच पर बैठी और स्क्लप्स को बालों से नोच कर
खेलने लगी | टीचर की सॉरी बोलने पर उसे कोई फकक नहीं
पड़ा और िो खुद में व्यवत रही | अगले ददन उसने वकू ल
आते िक़्त बहुत ददक्कत की र्जैस चचल्लाना सामान तोड़ना
इत्यादद |

121. देि एक बहुत ही प्यारा हंसमुख बच्चा है | बातें बनाना
बड़ी बड़ी बातें करना और अपनी बातों से लोगो को खुि
करने में िो बहुत अच्छा है | पर र्जबसे िह वकू ल र्जा
रहा है उसके पढाई को लेकर काफी शिकायतें आ रही है
| डायनासौर में उसकी पििेष रूचच है और िो वकू ल में
रह रह कर टीचर से उसी के बारे में बात करना चाहता
है | टीचर र्जब बात नहीं सुनती तो िो उन्हें धक्का दे
देता है, उनके मना करने पर िो और भागम भाग
करता है | उसने कई बार टीचर के सामान को भी
नुकसान पहुंचा ददया है र्जैसे पेन, चवमा आदद | साथ
ही ये भी शिकायत आ रही है कक बच्चों के खूबसूरत
इरेज़र पेंशसल आदद गायब हो रहे हैं | घर में िो
बबलकु ल ऐसा है है और माता पपता को यह बबलकु ल
यकीन नहीं हो रहा |

122. बहुत ददनों से एक बच्चा अपनी मााँ से कह रहा है मााँ मुझे
वकू ल नहीं र्जाना | मेरा वके दटंग में मन लगता है बस िही
करना है | तो मााँ को क्या करना चादहए ?
A. वकू ल से नाम हटा कर बस वके दटंग की ट्रेननंग के शलए
भेर्जना चादहए
B. वके दटंग िूर्ज फ़ें क कर वकू ल में भेर्जते रहना चादहए
C. समझा बुझा कर दोनों करिाना चादहए
D. एक बार और र्जानकारी इकठ्ठा करने का प्रयास करना
चादहए
र्जानकारी के बाद पता चलता है कक बच्चे को LD है तो क्या
करना चादहए?

123. एक ददन देि अपने मााँ के साथ उनके फ्रें ड के यहााँ
गया | िहां उसने उनके यहााँ मछली की
एक्िेररयम देखी | िह उसे देख कर बहुत उत्सुक
हुआ | एक ददन देि की मााँ घर लौटी तो उन्होंने
पाया कक एक्िेररयम में ६ की र्जगह पांच ही
मछशलयां है | उन्होंने देि को बहुत मारा परन्तु
उसने अंत तक नहीं बोला कक उसने मछली के
साथ क्या ककया?
यह घटना ककस बीमारी की और संके त करता है |

124. Other childhood related Psychiatric
Disorders

125. 125
NEURODEVELOPMENTAL
DISORDERS
DSM V- intellectual disability
ICD 11 - intellectual developmental disorder
ICD 10 – mental retardation

126. Understanding IDD
 Deficits in intellectual functions/ mental abilities
such as reasoning, problem solving, abstract
thinking etc
 Deficits in everyday adaptive functions that result
in failure to meet developmental and socio cultural
standards for personal independence and social
responsibility. Such as communication, social
participation, independent livings etc.
 Onset of deficits in intellectual period

127. Impairment in domains of:
 Conceptual Domain : memory, langauge,
reading, writing, math reasoning, acquisition
of practical knowledge, problem solving,
judgment
 Social domain: Awareness of others thoughts,
feelings, experiences, empathy, interpersonal
communication skills, friendship abilities social
judgment
 Practical domain: personal care, schooling,
job responsibilities, money management, self
management of behaviour etc.

128. General Information
Severity and Specifiers
Mild (IQ 50 – 69)
Moderate (IQ 35 – 49)
Severe (IQ 20-34)
Profound (Below 20)
Prevalence approx 6 per 1000

129. 129
NEURODEVELOPMENTAL
DISORDERS
DSM V- COMMUNICTAION DISORDERS
ICD 10 – SPECIFIC DEVELOPMENTAL DISORDERS OF
SPEECH AND LANGUAGE

130. Understanding Communication
Disorders
 Deficits in speech, language and communication
 Speech is expressive production of sounds and
includes an individuals articulation, fluency, voice
and resonance quality
 Language includes form, function and use of a
conventional system of symbols
 Communication is any verbal or non verbal
behaviour that influences others’ behaviours,
ideas or attitudes.

131. Types
Language disorder
Speech Articulation disorders/
Speech sound disorder
Childhood onset fluency disorder
(Stuttering)
Social pragmatic communication
disorder

132. Disruptive Mood Dysregulation
Disorder (DMDD)
 DMDD provides a diagnosis for children with
extreme behavioral dyscontrol but persistent,
rather than episodic, irritability
 This severe irritability has two prominent
clinical manifestations
Frequent temper outbursts
Persistently irritable mood present between

133. Failure to speak in specific
social situations (e.g., school,
with playmates) where speaking
is expected.
Duration: at least 1 month
The failure to speak is not due
to a lack of knowledge with the
spoken language required
Selective Mutism

134. Repeated pulling of one’s
own hair
Deleted DSM-IV’s Criterion B
& C (tension and
gratification).
Added: Repeated attempts to
decrease hair
Trichotillomania (Hair-Pulling
Disorder)
1
3

135. Repeated skin picking that
results in skin lesions
Most common areas: face, arms,
hands
Excoriation (Skin-Picking) Disorder
1
3

136.  It is a disorder of infancy or early
childhood
 Consistent pattern of inhibited
emotionally withdrawn behaviour
towards the caregiver
 Absent attachment between child and
care-giving adults and absence of
expected comfort and seeking and
response to comforting behaviours.
 Most common amongst children who are
Reactive Attachment Disorder

137. Pattern of behaviour that
involves culturally
inappropriate overly familiar
behaviour with strangers.
Only diagnosed after 9
months of age
Disinhibited Social
Engagement Disorder

138. • PTSD for Children 6 Years and
Under are identified as development
of characteristic symptoms like fear,
helplessness, horror etc after
exposed to one or more traumatic
events.
Specify:
• With dissociative symptoms
Post Traumatic Stress Disorder

139. Enuresis and Encopresis
Term derived from Greek
word – enourein-to void
urine
Enuresis is defined as the
involuntary or intentional
voiding of urine
 Encopresis is defined as
the involuntary or
intentional voiding of
fecus

140. Normal continence development
 normal process of continence
-achievement of night time bowel continence
-achievement of day time bowel continence
-achievement of day time bladder continence
-At last achievement of night time bladder
continence
 By three years 98% are dry in day and 78 % dry at
night. However other children may take as much as
13 to 14 years or more to acquire complete control.

141. Treatment
Behavior therapy
bell and pad method of conditioning
 external ultrasonic monitor attached to waist

142. Tics
Typically, brief clonic movements of
eyes, face, neck and shoulders
Most common: eye-blinking, facial
grimacing and head-jerking
Typically, vocal tics involve throat-
clearing, grunting or barking
Tics may be simple (brief) or complex
(elaborate)

143. Transient Tic Disorder
Single or multiple motor and/or
vocal tics, occurring many times
a day, nearly every day, for at
least 4 weeks, but no longer
than 12 months
Most transient tics are simple,
not complex, and do not usually
cause distress

144. Chronic Motor or Vocal Tic
Disorder
Single or multiple motor
or vocal tics that last
more than a year

145. Tourette’s Disorder
Multiple motor and one or more
vocal tics lasting at least 1 year,
many times a day, nearly every
day, without a tic-free period of
more than three consecutive
months

146. PANDAS
Pediatric Autoimmune
Neuropsychiatric Disorders
Associated with group A
Streptococcus
Infection may precipitate abrupt
onset of tics, compulsions,
emotional lability, episodic and
recurrent

147. Separation Anxiety Disorder
The most common anxiety
disorder of childhood
Most commonly occurs at age 7
or 8 years, but may occur in
adolescence
Developmentally inappropriate,
excessive worry concerning
separation from those to whom
the youngster is attached,

148. Separation Anxiety Criteria
 evidenced by at least three of the following:
 Recurrent and excessive distress when
separation from home or major attachment figures
occurs or is anticipated
 Persistent, excessive worry about losing, or
possible harm befalling, major attachment figures
 Persistent, excessive worry that an event will lead
to separation from a major attachment figure (e.g.,
getting lost or being kidnapped)
 Persistent reluctance or refusal to go to school or
elsewhere because of fear of separation

149. Separation Anxiety Criteria
Persistently, excessively fearful or reluctant
to be alone or without major attachment
figures at home or without significant adults
in other settings
Persistent reluctance or refusal to go to sleep
without being near a major attachment figure
or to sleep away from home
Repeated nightmares involving the theme of
separation
Repeated complaints of physical symptoms
(such as headaches, stomachaches, nausea,
or vomiting) when separation from major

150.  This proposed condition is limited to gaming and
does not include problems with general use of the
internet, online gambling, or use of social media or
smartphones. The proposed symptoms of internet
gaming disorder include:
 Preoccupation with gaming
 Withdrawal symptoms when gaming is taken
away or not possible (sadness, anxiety,
irritability)
 Tolerance, the need to spend more time gaming
to satisfy the urge
 Inability to reduce playing, unsuccessful attempts
Internet Gaming Disorders

151.  Giving up other activities, loss of interest
in previously enjoyed activities due to
gaming
 Continuing to game despite problems
 Deceiving family members or others
about the amount of time spent on
gaming
 The use of gaming to relieve negative
moods, such as guilt or hopelessness
 Risk, having jeopardized or lost a job or
Internet Gaming Disorders

152. THANK YOU