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Childhood Psychiatric disorders


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Childhood Psychiatric Disorders usually first diagnosed in Infancy and Early Childhood

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Childhood Psychiatric disorders

  2. 2. Disorders usually First Diagnosed in Infancy, Childhood or Adolescence
  3. 3. Types •Mental Retardation •Learning Disorders •Motor Skills Disorders •Pervasive Developmental Disorders •Attention Deficit Hyperactive Disorders •Feeding and Eating disorders of infancy or early childhood •Tic disorders •Elimination Disorders •Other Disorders
  4. 4. Mental Retardation Sub average general intellectual functioning that is accompanied by significant limitations in adaptive functioning in at least two of the following skills areas, Communication, self care, home living, social-interpersonal skills, etc
  5. 5. Definition Definition: Mental Retardation refers to significantly sub-average general intellectual functioning, resulting in or associated with, concurrent impairments in adaptive behavior and manifested during the developmental period.
  6. 6. Levels of MR 1. Mild Mental Retardation 2. Moderate Mental Retardation 3. Severe Mental Retardation 4. Profound Mental Retardation
  7. 7. Mild level They can called as Educable Mentally Retarded (EMR) IQ range – 55 to 80 Capable of learning basic academic skills of reading, writing and arithmatic. Most children can learn vocational skills.
  8. 8. Moderate level They called as Trainable Mentally Retarded (TMR) IQ range – 35- to 60 They were usually not admitted in public schools. They can go to special schools. They need supervisory help. Special teaching and training on basic skills needed for day to day life.
  9. 9. Severe and profound level Severe level IQ – 20 to 35 Profound level IQ – below 20 These children usually referred below the TMR level as custodial Usually they remained at home or under some residential facilities
  10. 10. MR
  11. 11. Learning Disorders Reading Disorder: (Dyslexia) Mathematical Disorder: (Dyscalculia) Writing Disorder: (Dysgraphia)
  12. 12. Motor Skills Disorders • Developmental Coordination disorder • Impairment in the development of motor coordination • Not due to general medical condition (Cerebral Palsy, Muscular Dystrophy) • Marked delays in achieving motor milestones (Walking, crawling, sitting), dropping things, clumsiness, poor performance in sports.
  13. 13. Communication disorders
  14. 14. Expressive Language Disorder The difficulties with expressive language interfere with academic or occupational achievement or with social communication
  15. 15. Phonological Disorder Failure to use developmentally expected speech soundsthat are appropriate for the individuals age and dialect Errors in sound production, substitutions of one sound for another (Use T for K), omissions of sounds
  16. 16. Stuttering • Disturbance in the normal fluency and time patterning of speech that is inappropriate for the individual’s age. • Frequent repetitions/ prolongations of sounds or syllables • Interjections • Broken words (pauses within a word) • Audible/silent blocking • Circumlocutions(word substitutions to avoid problematic words) • Words produced with an excess of physical tension • Monosyllabic whole word repetitions (I-I-I-I- see
  17. 17. Pervasive Developmental Disorders • Impairment in several areas of development • Reciprocal social interaction skills • Communication skills • Presence of stereotyped behavior/interests/activities • The qualitative impairments that defines these conditions are distintly deviant relative to the individual’s developmental level or mental age
  18. 18. Types of PDD 1. Autistic Disorder 2. Rett’s Disorder 3. Childhood Disintegrative 4. Asperger’s Disorder
  19. 19. Autistic Disorder • Onset prior to age 3 years • More frequent in males/boys • Average or above average intelligence with uneven cognitive skills
  20. 20. Symptoms • Qualitative impairment in social interaction • Qualitative impairments in communication • Restricted repetitive and stereotyped pattern of behaviours, interests and activities
  21. 21. Causes • Genetic • Prenatal environment • Perinatal environment • Postnatal environment
  22. 22. Mirror writing
  23. 23. Rett’s Syndrome • Rett syndrome is a rare genetic neurological and developmental disorder that affects the way the brain develops, causing a progressive inability to use muscles for eye and body movements and speech. It occurs almost exclusively in girls. • Discovered in the first two years of life • Is a genetic disorder. Mutation in a particular gene on the X chromosome.
  24. 24. Symptoms • A slowing of head growth is one of the first events in Rett syndrome • Problems with muscles and coordination • The child loses any purposeful use of her hands • stops talking and develops extreme social anxiety and withdrawal or disinterest in other people.
  25. 25. Rett’s Syndrome
  26. 26. Childhood Disintegrative • Childhood disintegrative disorder is also known as Heller's syndrome. It's a very rare condition in which children develop normally until at least two years of age, but then demonstrate a severe loss of social, communication and other skills. • Childhood disintegrative disorder is part of a larger category called autism spectrum disorder. • Develop normally through age 3 or 4
  27. 27. Childhood Disintegrative A child who is affected loses: • Communication skills • Nonverbal behaviors • Skills they had already learned
  28. 28. Symptoms • Delay or lack of spoken language • Impairment in nonverbal behaviors • Inability to start or maintain a conversation • Lack of play • Loss of bowel and bladder control • Loss of language or communication skills • Loss of motor skills • Loss of social skills • Problems forming relationships with other children and family members
  29. 29. Asperger’s Disorder • Children with Asperger's syndrome typically function better than do those with autism • Children with Asperger's syndrome generally have normal intelligence and near- normal language development • They may develop problems communicating as they get older. • Asperger's syndrome was named for the Austrian doctor, Hans Asperger, who first described the disorder in 1944.
  30. 30. Symptoms • Problems with social skills • Eccentric or repetitive behaviors • Unusual preoccupations or rituals – Ex: getting dressed in a specific order • Communication difficulties • Limited range of interests • Coordination problems • Skilled or talented
  31. 31. Asperger’s Syndrome
  32. 32. Attention Deficit Hyperactive Disorder (ADHD)
  33. 33. Case study Lisa's son Jack had always been a handful. Even as a preschooler, he would tear through the house like a tornado, shouting, roughhousing, and climbing the furniture. No toy or activity ever held his interest for more than a few minutes and he would often dart off without warning, seemingly unaware of the dangers of a busy street or a crowded mall. It was exhausting to parent Jack, but Lisa hadn't been too concerned back then. Boys will be boys, she figured. But at age 8, he was no easier to handle. It was a struggle to get Jack to settle down long enough to complete even the simplest tasks, from chores to homework. When his teacher's comments about his inattention and disruptive behavior in class became too frequent to ignore.
  34. 34. ADHD • ADHD is a common behavioral disorder that affects about 10% of school-age children. • Boys are about three times more likely than girls to be diagnosed with it, though it's not yet understood why.
  35. 35. ADHD • Of course, all kids (especially younger ones) act this way at times, particularly when they're anxious or excited. • But the difference with ADHD is that symptoms are present over a longer period of time and happen in different settings.
  36. 36. What is ADHD? • ADHD is a neuro developmental disorder affecting both children and adults. • It is described as a “persistent” or on-going pattern of inattention and/or hyperactivity- impulsivity that gets in the way of daily life or typical development. Individuals with ADHD may also have difficulties with maintaining attention, executive function (or the brain’s ability to begin an activity, organize itself and manage tasks) and working memory.
  37. 37. ADHD-Subtypes • ADHD broken down into three subtypes, each with its own pattern of behaviors, 1. an inattentive type 2. a hyperactive-impulsive type 3. a combined type
  38. 38. an inattentive type • trouble paying attention to details or a tendency to make careless errors in schoolwork or other activities • difficulty staying focused on tasks or play activities • apparent listening problems • difficulty following instructions • problems with organization • avoidance or dislike of tasks that require mental effort • tendency to lose things like toys, notebooks, or homework • distractibility • forgetfulness in daily activities
  39. 39. a hyperactive-impulsive type • fidgeting or squirming • difficulty remaining seated • excessive running or climbing • difficulty playing quietly • always seeming to be "on the go" • excessive talking • blurting out answers before hearing the full question • difficulty waiting for a turn or in line • problems with interrupting or intruding
  40. 40. a combined type • a combination of the other two type, is the most common
  41. 41. Treating ADHD • ADHD can't be cured, but it can be successfully managed. • ADHD is best treated with a combination of medicine and behavior therapy. • It's important for parents to actively participate in their child's treatment plan, parent education is also an important part of ADHD management.
  42. 42. Feeding and Eating Disorders of Infancy or Early Childhood
  43. 43. Feeding and Eating Disorders of Infancy or Early Childhood • If a child loses a lot of weight suddenly or is small for their age and doesn't seem to growing normally, it may be a sign that a feeding or eating disorder is present. • When malnutrition is not caused by a medical problem, it is referred to as a feeding disorder of infancy or early childhood.
  44. 44. Types • Pica • Rumination Disorder • Feeding Disorder Of Early Childhood
  45. 45. Pica • Pica is a disorder that occurs when children persistently eat one or more non-food substances over the course of at least one month. • Pica may result in serious medical problems, such as intestinal blockage, poisoning, parasitic infection, and sometimes death. • Younger children with Pica frequently eat paint, plaster, string, hair, or cloth. • older children with Pica tend to eat animal droppings, sand, insects, leaves, or pebbles. • Adolescents affected by the disorder often consume clay or soil substances.
  46. 46. Rumination Disorder • Children with Rumination Disorder repeatedly regurgitate and spit out or re-chew their food following eating. • This disorder usually develops in infants or young children. It must last for at least one month before the diagnosis can be made. Children with Rumination Disorder do not show nausea, retching, or disgust associated with their rumination behavior, and do not have associated gastrointestinal problems that can account for the behavior.
  47. 47. Feeding Disorder Of Early Childhood • A Feeding Disorder of Early Childhood is diagnosed when a child does not eat adequately and maintain proper nutrition. This disorder, sometimes referred to as "Failure to Thrive" leads to weight loss or to difficulties maintaining normal weight.
  48. 48. Tic disorders • The body moves repeatedly, quickly, suddenly and uncontrollably • Any parts of the body- face, shoulders, hands or legs • Involuntary, sudden, recurrent, stereotyped motor movements or vocalizations that are rapid and not rhythmic. • It is irresistable • Begin in childhood • Ex for Motor Tics: eye blinking, nose twitching, tooth clicking, sticking out the tongue, hand clapping • Ex for Vocal Tics: grunting, sniffing, barking, throat clearing
  49. 49. Diagnostic Criteria • The presence of one or mote tics either motor or vocal – but not both • The tics occur many times a day, either daily or intermittently, during a period of more than a year and without any tic free period of 3 or more consecutive months. • The tics cause marked distress or significant impairment in one or more important areas of functioning, such as social or occupational • The symptoms began before age 18 • The tics are not due to the direct effects of some chemical substances or some general medical condition • The person has never met the criteria for Tourette’s Disorder
  50. 50. Tourette’s Syndrome • Is one type of tic disorder • Begins as early as age 2 • Cause significant social and functional difficulties for children • More in boys than girls
  51. 51. Diagnostic Criteria • Both multiple motor and one or more vocal tics have been identified at sometime during the disorder, although it is not necessary for them to occur in the same period. • The tics occur many times a day and nearly everyday or they occur intermittently, for a period of more than a year and without any tic free period of 3 or more consecutive months. • The tics cause marked distress or significant impairment in one or more important areas of functioning, such as social or occupational • The symptoms began before age 18 • The tics are not due to the direct effects of some chemical substances or some general medical condition.
  52. 52. Elimination Disorders • 2 types – Non-organic Enuresis – Non-organic Encopresis
  53. 53. Non-organic Enuresis • Enuresis is repetitive voiding of urine, either during the day or night, at inappropriate places. • Enuresis is diagnosed only after 5 years of age • Enuresis can be either of: – Primary type, where bladder control has never been achieved or – Secondary type, where enuresis emerges after a period of bladder control.
  54. 54. Non-organic Encopresis • Encopresis is repetitive passage of faeces at inappropriate time and/or place, after bowel control is physiologically possible. It is not due to the presence of any organic cause, which is called as faecal incontinence. • Encopresis can be either of: – Primary type, where toilet training has never been achieved or – Secondary type, where encopresis emerges after a period of faecal continence.
  55. 55. Other Disorders • Oppositional Defiant Disorder • Conduct Disorder • Separation Anxiety Disorder • Childhood Schizophrenia • PTSD in Childhood • OCD in Childhood • Depression in Childhood • Elective (Selective) Mutism • Habit Disorder
  56. 56. Oppositional Defiant Disorder • Child/adolescent behave in negativistic, defiant, disobedient and hostile ways towards authority figures • If this behavior is severe enough to interfere with the child’s functioning and relationship with others then the child may be ODD
  57. 57. Diagnostic Criteria • A pattern that includes negativistic, defiant, disobedient and hostile behavior that lasts at least 6 months and includes the frequent occurrence of at least 4 of the following behaviors during that period (more frequently • lose temper • Argues with adults • Actively defies or refuses to comply with adults’ rules or requests • Deliberately annoys others • Blames others for own mistakes or misbehaviors • Is easily annoyed by others, touchy • Is angry and resentful • Is spiteful or vindictive • These behavior cause clinically significant impairment in social, academic or work related functioning • These behavior do not occur exclusively as part of a psychotic disorder or mood disorder • Criteria are not met for conduct disorder or if 18 years or older for antisocial personality disorder.
  58. 58. Conduct Disorder • Is often more serious in their consequences than ODD because of the violation of important societal norms and disregard of the rights of others • Persistent behavior – include aggressive actions that cause or threaten harm to people or animals • Non aggressive conduct that causes property damage, major deceitfulness or theft and • Serious rule violations.
  59. 59. Diagnostic Criteria • Three or more of these behavioural criteria must have been present in the last 12 months and at least one in the past 6 months • Aggression – toward people – bullying, intimidation, use of weapons, physical cruelty, forced sexual activity, mugging, purse snatching and aggression toward animal. • Destruction of property including fire setting, and other deliberate property destruction • Deceitfulness or theft including breaking into a building or a car, conning others to obtain goods, stealing items of value • Serious rule violation including staying out at night without parents’ permission before age 13, running away from home, school truancy before 13 • These behavior do not occur exclusively as part of a psychotic disorder or mood disorder • Criteria are not met for conduct disorder or if 18 years or older for antisocial personality disorder.
  60. 60. Separation Anxiety Disorder • Separation anxiety is normal in very young children (those between 8 and 14 months old). Kids often go through a phase when they are "clingy" and afraid of unfamiliar people and places. When this fear occurs in a child over age 6 years, is excessive, and lasts longer than four weeks, the child may have separation anxiety disorder. • Separation anxiety disorder is a condition in which a child becomes fearful and nervous when away from home or separated from a loved one - - usually a parent or other caregiver -- to whom the child is attached.
  61. 61. Separation Anxiety Disorder • Following are some of the most common symptoms of separation anxiety disorder: • An unrealistic and lasting worry that something bad will happen to the parent or caregiver if the child leaves • An unrealistic and lasting worry that something bad will happen to the child if he or she leaves the caregiver • Refusal to go to school in order to stay with the caregiver • Refusal to go to sleep without the caregiver being nearby or to sleep away from home • Fear of being alone • Nightmares about being separated • Bed wetting • Complaints of physical symptoms, such as headaches and stomachaches, on school days • Repeated temper tantrums or pleading
  62. 62. Childhood Schizophrenia • Childhood schizophrenia is a severe brain disorder in which children interpret reality abnormally. • Signs and symptoms may vary, but they reflect an impaired ability to function. • It occurs early in life and has a profound impact on a child's behavior and development. And it requires lifelong treatment. • The earliest indications of childhood schizophrenia may include developmental problems, such as: – Language delays – Late or unusual crawling – Late walking – Other abnormal motor behaviors — for example, rocking or arm flapping
  63. 63. PTSD in Childhood • Children and teens could have PTSD if they have lived through an event that could have caused them or someone else to be killed or badly hurt. Such events include sexual or physical abuse or other violent crimes. Disasters such as floods, school shootings, car crashes, or fires might also cause PTSD. Other events that can cause PTSD are war, a friend's suicide, or seeing violence in the area they live. • Posttraumatic stress disorder, or PTSD, is diagnosed after a person experiences symptoms for at least one month following a traumatic event. The disorder is characterized by three main types of symptoms: – Re-experiencing the trauma through intrusive distressing recollections of the event, flashbacks, and nightmares. – Avoidance of places, people, and activities that are reminders of the trauma, and emotional numbness. – Increased arousal such as difficulty sleeping and concentrating, feeling jumpy, and being easily irritated and angered.
  64. 64. PTSD in Childhood • Diagnosis criteria that apply specifically to children younger than age six include the following: Exposure to actual or threatened death, serious injury, or sexual violation: – direct experience – witnessing the events as they occurred to others, especially primary caregivers (Note: Does not include events witnessed only in electronic media, television, movies, or pictures.) – learning that the traumatic events occurred to a parent or care giving figure
  65. 65. OCD in Childhood • Symptoms of childhood-onset OCD vary widely from child to child. Some common obsessions experienced by children and adolescents with OCD include: – exaggerated fears of contamination from contact with certain people, or everyday items such as clothing, shoes, or schoolbooks – excessive doubts that he/she has not locked the door, shut the window, turned off the lights, or turned off the stove or other household appliance – marked over-concern with the appearance of homework assignments – excessive worry about symettrical arrangement of everyday objects such as shoelaces, school books, clothes, or food – fears of accidentally harming a parent, sibling or friend – superstitious fears that something bad will happen if a seemingly unconnected behavior is done (or not done)
  66. 66. OCD in Childhood • Some common compulsions experienced by children and adolescents with OCD include: – Compulsive washing, bathing, or showering – Ritualized behaviors in which the child needs to touch body parts or perform bodily movements in a specific order or symmetrical fashion – Specific, repeated bedtime rituals that interfere with normal sleep – Compulsive repeating of certain words or prayers to ensure that bad things don’t occur – Compulsive reassurance-seeking from parents or teachers about not having caused harm – Avoidance of situations in which they think “something bad” might occur
  67. 67. Depression in Childhood • If the Child’s sadness becomes persistent, or if disruptive behavior that interferes with normal social activities, interests, schoolwork, or family life develops, it may indicate that he or she has a depressive illness.
  68. 68. Depression in Childhood • The signs and symptoms of childhood depression include: • Changes in appetite -- either increased appetite or decreased • Changes in sleep -- sleeplessness or excessive sleep • Continuous feelings of sadness or hopelessness • Difficulty concentrating • Fatigue and low energy • Feelings of worthlessness or guilt • Impaired thinking or concentration • Increased sensitivity to rejection • Irritability or anger • Physical complaints (such as stomachaches or headaches that do not respond to treatment • Reduced ability to function during events and activities at home or with friends, in school or during extracurricular activities, or when involved with hobbies or other interests • Social withdrawal • Thoughts of death or suicide • Vocal outbursts or crying
  69. 69. Elective (Selective) Mutism • Characterized by a marked, emotionally determined selectivity in speaking, such that the child demonstrates a language competence in some situations but fails to speak in other (definable) situations. The disorder is usually associated with marked personality features involving social anxiety, withdrawal, sensitivity, or resistance.
  70. 70. Habit Disorder • Habit disorder is the term used to describe several related disorders linked by the presence of repetitive and relatively stable behaviors that seem to occur beyond the awareness of the person performing the behavior. As with other disorders, these behaviors cause impairment and result in negative physical and/or social consequences. • Habit disorders includes thumb sucking, nail biting, hair pulling