1. Emotional disorders:
Depression in young people and at different
development periods
What is the main cause of depression among
the youth?
Many factors increase the risk of developing or
triggering teen depression, including: Having
issues that negatively impact self-esteem, such
as obesity, peer problems, long-term bullying
or academic problems. Having been the victim
or witness of violence, such as physical or
sexual abuse.
2. DEPRESSION IN YOUNG PEOPLE AND
AT DIFFERENT DEVELOPMENTAL
PERIODS
• Depression affects children and adolescents in
a number of areas of functioning (Oster &
Montgomery, 1995)
• 1. Mood: children show feelings of sadness
that are more exaggerated and persistent; also
show irritability, guilt, shame and
oversensitivity to criticism
3. • 2. Behaviour: children show increased
restlessness and agitation, reduced activity,
slowed speech and excessive crying; these
behaviours are a change from usual behaviour,
persist and interfere with everyday
functioning; reduction in social contact;
express sadness through aggressive or
negative acts (verbal sarcasm, in adolescents:
drug or alcohol abuse)
4. 3. Changes in attitude: children experience
worthlessness and low self-esteem; feel
inadequate; worries and fears dominate;
feel the future is bleak; risk for suicide
increases.
5. • 4. Thinking: preoccupied with inner thoughts
and tensions; self-focus and self-critical;
thought slows down; pessimistic about the
future; difficulty concentrating, remembering,
making decisions; blame themselves for bad
outcome
6. • 5. Physical changes: Disruptions in eating and
sleeping: weight loss and early morning'or frequent
awakening: physical complaints such as head ache,
stomach ache, nausea and loss of energy.
Primary features of depression are the same as in
adults, though children may express symptoms
differently and through behavior; look sad and
unhappy, show withdrawal or irritability, spend
time alone and activities that were once fun bring
no pleasure, argumentative, moody and tearful;
also aggressive.
7. Depression at different developmental
periods:
The ways in which child‘ express and
experience depression is related to their
physical, emotional and cognitive
development: an infant may be passive and
non-responsive, a preschooler may appear
withdrawn and inhibited; a school-age child
may be argumentative and combative and a
teenager may express feelings of guilt and
hopelessness.
8. No 1 pattern fits all children;
depression in children below the age of 7 is diffuse and
less easily identified.
We know the least about depression in infants, Spitz
spoke of "anaclitic depression" in which infants raised
in an emotionally cold institution showed symptoms of
weeping, withdrawal, apathy, weight loss, sleep
disturbance, over all decline in development and
sometimes death. Spitz attributed this to a lack of
"mothering" and inability to form an attachment.
Similar symptoms in infants who failed to thrive
because of a severely disturbed family environment in
which the mother was depressed, psychologically
unavailable or physically abusive.
9. Preschool children who are depressed appear
somber and tearful; lack exuberance and
enthusiasm in play; show clinginess and whining
behaviour, fear separation; are irritable, have
negative and self-destructive verbalization and
physical complaints such as stomach aches.
In addition to the symptoms of preschoolers,
children between the ages 6-12 show irritability,
cisruptive behavior, temper tantrums,
combativeness, argumentativeness; also weight
loss, difficulty concentrating, head achie, sleep
disturbance; also academic problems, peer
problems, suicide threats.
10. In addition to the problems of preschoolers and
school age children, preteens (9-12) show self-blame,
low self-esteem, sadness and inhibition, inability to
sleep or excessive sleep, disturbance in eating.
Teenagers who are depressed show irritability, loss of
feelings of pleasure or interest, declining academic
performance, negative body image, low self-esteem,
fatigue and energy loss, difficulty tolerating routines,
physical symptoms and illness, restiessness,
loneliness, self-blame, guilt and suicidal thoughts and
attempts.
12. AUTISM
• Leo Kanner, a child psychiatrist, in 1943
first coined the term “autism”.
• 11 children described who demonstrated :
a profound lack of social engagement, failed
to use language to communicate, had an
obsessive need for sameness.
• But, faulty postulation that autism occurs
due to difficulties in the parent‐child
relationship.
13. AUTISM: NEURODEVELOPMENTAL
DISORDER
• Autism is now recognized as a neuro
developmental disorder &
neurobehavioral’ disorder.
• Autism occurs due to underlying
disorder of brain development.
14. WHAT IS AUTISM ?
Autism is a complex neuro developmental
disorder characterized by:
•qualitative impairments in social
interaction,
•qualitative impairments in communication,
and
•restricted, repetitive, stereotyped patterns
of behavior, interests and activities.
15. SOME FACTS ABOUT AUTISM
Autism is NOT a single disorder.
• Autistic symptoms occur along a wide
spectrum.
• Sensory hypo sensitivities or hyper sensitivities
to the environment often noted.
• Symptoms may vary in the same autistic child
and change over time.
• No specific biological markers.
16. DIAGNOSIS OF AUTISM
• Diagnosis based entirely on clinical findings
. • Ascertain whether the child’s specific behaviors
meet the Diagnostic and Statistical Manual of
Mental Disorders ‐ V ‐Revised (DSM ‐V) criteria.
• Observe child in several settings as symptoms
may unfold over time.
17. DSM ‐ 5
Diagnostic and Statistical Manual of Mental Disorders, 5th
Edition (DSM ‐5) revisions − Autism spectrum disorders
• Includes autism, Asperger syndrome, PDD ‐NOS,
and child disintegrative disorder (CDD) −
Concentrates on required features
• Social/communication deficits
• Restricted, repetitive patterns of behavior,
interests, activities o Addition of sensory criteria −
Increases specificity while maintaining sensitivity
• Important to distinguish spectrum from non
‐spectrum developmental disabilities
• Improves stability of diagnosis
18. DSM‐5 CRITERIA: SOCIAL
COMMUNICATION
Persistent deficits in social communication and social
interaction across contexts, not accounted for by
general developmental delays, manifested by all of the
following:
– Deficits in social‐emotional reciprocity
– Deficits in nonverbal communicative behaviors
– Deficits in developing and maintaining relationships
appropriate to the developmental level
19. DSM‐5 CRITERIA: RESTRICTED/REPETITIVE
BEHAVIORS
Restricted, repetitive patterns of behavior,
interests, or activities as manifested by at least 2
of the following:
– Stereotyped or repetitive speech, motor
movements, or use of objects
– Excessive adherence to routines
– Highly restricted, fixated interests that are
abnormal in intensity or focus
– Hyper‐ or hypo‐reactivity to sensory input or
unusual sensory interests
20. DSM‐V CRITERIA
*Symptoms must be present in early
childhood.
*Symptoms together limit and impair
everyday functioning.
21. DSM‐IV‐R CRITERIA FOR DIAGNOSING
AUTISM
A.Impairment in social interactions (4 criteria)
1. Lacks eye‐to‐eye gaze, facial expression,
gestures while interacting
2. Fails to develop peer relationships
3. Does not share interests with others (e.g., no
bringing, or pointing out objects)
4. Lacks social or emotional reciprocity
22. DSM‐IV‐R CRITERIA FOR DIAGNOSING
AUTISM
B. Impairment in communication (4
criteria)
1. Has delayed development of
speech
2. Does not initiate or sustain
conversation
3. Has stereotyped and repetitive
language or idiosyncratic language
4. Lacks make‐believe play or social
imitative play
23. DSM‐IV‐R CRITERIA FOR DIAGNOSING
AUTISM
C. Repetitive behaviors and stereotyped behavior
patterns (4 criteria)
1. Has stereotyped, restricted patterns of interest,
abnormal in intensity or focus
2. Has inflexible adherence to specific,
non‐functional routines or rituals
3. Has stereotyped and repetitive motor
mannerisms (e.g., hand or finger flapping)
4. Has persistent preoccupation with parts of
objects
24. WHAT CAUSES AUTISM?
No one single unified theory can explain
etiology of autism.
• Structural MRI brain studies have detected,
though not consistently, increased volume of
the total brain and abnormalities in the
cerebellum, frontal lobe, and limbic system
(amygdala and hippocampus) in young
children with autism.
25. HOW EARLY CAN AUTISM BE DIAGNOSED?
• In first year of life: no clear discriminating
features.
• However, home videos of infants later diagnosed
to have autism have detected four autistic
behaviors viz. not pointing, not showing objects,
not looking at others, and failing to orient to name
being called.
• Abnormally accelerated rate of growth in head
size between 6 ‐14 months of age: an early warning
signal of risk for autism.
