i am just trying to essay child related psychiatric problems in community. At child age there have many problems and its converted into changing behavior of child towards the community. so the child problem its create the child behavior.
This is seminar presented as part of academics in my department. Please comment on the content, so that i can improve myself. If the content is good, kindly like it.
This is seminar presented as part of academics in my department. Please comment on the content, so that i can improve myself. If the content is good, kindly like it.
Classification
Mild, moderate, severe and profound mental retardation
Mental retardation F70-F79
F70- mild mental retardation
F71- moderate mental retardation
F72- severe mental retardation
F73- profound mental retardation
F78- other mental retardation
F79- unspecified mental retardation
Definition
Significantly subaverage general intellectual functioning, associated with significant deficit or impairment in adaptive functioning, which manifests during the developmental period - American association (1983)
Intellectual functioning – Result of standardized Intelligence Tests
Subaverage – Below 70 IQ
Adaptive behavior – Ability to meet the responsibilities of social, personal, occupational and interpersonal areas of life according to his age and socio cultural background
Developmental Period – Below 18 years
Genetic Causes
Perinatal Causes
Acquired Physical Disorders in childhood
Socio cultural causes
Psychiatric disorders
Mild MR
Commonest type
Accounts for 85 – 90% of all cases
Minimal retardation in sensory - motor areas
They can progress up to VI standard
They can achieve vocational skills
They can achieve social self-sufficiency
They can develop social and communication skills
But they have deficits in cognitive function like poor ability for abstraction and egocentric thinking
Moderate MR
Accounts for 10% of all cases
They have poor social awareness during early years
Communication skills develop very slowly in these individuals
They drop out of school after 2nd Grade
They can be trained to perform semi skilled or unskilled work under supervision
Even mild stress can destabilize them
Severe MR
Recognized early in life
Significantly delayed developmental mile stones
Absent or markedly delayed speech or communication skills
Self care (ADL) can be taught
They can perform very simple tasks under supervision
They require a great amount of assistance for living
They require a structured environment
Profound MR
Accounts for 1-2% of all cases
Often associated with physical disorders
Marked delay in developmental milestones
They need nursing care or life support
Usually cared in a residential setting
Diagnosis
History collection from Parents and Care Takers
Physical Examination
Neurological examination
Assessing milestones development
Investigations
Urine and blood examination for metabolic disorders
Culture for cytogenic and biochemical studies
Amniocentesis in infant chromosomal disorders
Chorionic villi sampling
Hearing and speech evaluation
EEG, especially seizures present
CT scan or MRI brain (Tuberous sclerosis)
Thyroid function test (Cretinism)
Psychological Tests
Stanford Binet Intelligence Test
Wechsler Intelligence Scale for Children (WISC)
Prevention
Primary
Secondary
Tertiary
Complications
Seizures
Cerebral palsy
Sensory deficit
Communication disorders (speech and language)
Neuron degenerative disorders
Psychiatric illnesses
Care
Team approach
Fostering (bring up)
Boarding school / residential care
Special education
Abnormal Psychology: Neurodevelopmental DisodersElla Mae Ayen
Group of conditions with onset in the developmental period.
Disorders typically manifest early in development.
often before the child enter grade school
characterized by developmental deficits that produce impairments of personal, social, academic or occupational functioning.
Running head INTELLECTUAL DISABILITIES1Intellectual Disabilit.docxcharisellington63520
Running head: INTELLECTUAL DISABILITIES 1
Intellectual Disabilities 6
Intellectual Disabilities
Introduction
Intellectual disability in lay man terms would be the disability to perform intelligent functioning of the human brain. The performance of everyday social and practical skills requires intellectual functioning and adaptive behaviour which are in-built abilities in most normal human beings. The ones who possess intellectual disability are often limited by their intellectual functioning and adaptive behaviour skills. This disability is generally spotted in individuals before they reach the age of 18 (Intellectual Disability (n.d.)).
Now we read more into the two parts of intellectual disability: intellectual functioning and adaptive behaviour.
· Intellectual functioning: In lay man terms, intellectual functioning is more commonly known as intelligence which largely helps in learning, reasoning, problem solving, mental capacity, etc. This is also known as IQ or the intelligence quotient and generally a score of 70 or 75 indicates a limitation in intellectual functioning. Basically, intellectual functioning part helps an individual to learn something, reason, make decisions and solve problems.
· Adaptive behaviour – These skills are required to deal with day-to-day life and the activities that we engage in every day. This involves communicating with other individuals, analysing the behaviour of others and respond accordingly. The limitations of adaptive behaviour can also be screened by standardized tests which comprises three basic skill types:
· Conceptual skills – this involves language, education, money, time and number concepts along with self direction
· Social skills – this involves interpersonal skills, social responsibility, self-esteem, gullibility, social problem solving, the ability to follow rules and to avoid being victimized
· Practical skills – this involves the daily activities, occupational skills, healthcare, travel, routines, usage of money and telephone usage
Hence in order to determine the intellectual disability of an individual, the above mentioned characteristics need to be kept in mind (Definition of Intellectual Disability, ( n.d.)).
Symptoms and causes of intellectual disability
There are various symptoms of intellectual disability that could go unnoticed for years till it becomes very evident. Sometimes it is noticeable during infancy and sometimes may remain dormant until the child reaches school going age and then the degree of disability starts to deteriorate and then show major symptoms. “The symptoms are as follows:
· Rolling over, sitting up, crawling or walking late
· Talking late or having trouble with talking
· Slow to master things like potty training, dressing, and feeding himself or herself
· Difficulty remembering things
· Inability to connect actions with consequences
· Behaviour problems such as explosive tantrums
· Difficulty with proble.
It discuss on what is mental retardation, what is mental retardation, Causes for Mental Retardation, Medical Classification, Educational Classification, Psychological Classification(IQ basis), Causes of MR, PREVENTION OF MENTAL RETARDATION, Provisions and Educational Facilities for Persons Suffering from MR, Teaching-Learning Materials (TLM) for Persons with MR
This is topic to know that the group therapy in short in psychology. actually is the therapy we are using to mental stability and develop good kind of behaveviour.
so I am just try to explain the various types of mental illness. In the psychiatry the mental illness is the big challenge to find out the cause behind that and solve the problem. Today the depression cases is very common in society, so i am just introducing the Mental Illness. I hope its essay to understand and if any query plz comments.
Thanq so much.
Dear students its a simple presentation of substance abuse or alcoholic withdrawal and treatment. the substance abuse its a common problem of Young generations today, so health prevention and what is the cause of substance abuse in day today life. its only knowledge purpose.
The code and Ethics is the very important for nursing practice. The various problem and crisis are create during practice so for support to right situation.
Dear students i am just trying to explain the equipment and supply of material in hospital easy way. Its really helpful for studding and those who are studding to hospital supply.
Dear students we many times problems with Advance research theory application so i am just explain by my PPT slides to help the students and application of theories.
CRITICAL PATHWAY FOR NURSING ADMINISTRATION.VIKRANT KULTHE
Respected,
all Administration and Nursing Management student its very helpful for a critical planing and critical care plan for the patients those who are hospitalize. The critical pathway means a plan of care to the patients or plan for project. I hope its helpful for all student.
thanking you!!!!!!!
the lecture method is a most perfect method to essay understand the topic. the lecture method is the usually to used in education and demonstration, its help to modify the difficult information in essay.
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Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
Adv. biopharm. APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMSAkankshaAshtankar
MIP 201T & MPH 202T
ADVANCED BIOPHARMACEUTICS & PHARMACOKINETICS : UNIT 5
APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMS By - AKANKSHA ASHTANKAR
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
2. Normal child development
• Divided into four major areas:
1. Motor behaviour
2. Adaptive behaviour
3. Language
4. Personal and social behaviour
• In addition to these milestones, other
developmental parameters are:
Height, weight, activity level and general health
4/21/2020 MR. VIKRANT KULTHE 2
3. Intellectual development
• Acc. to Jean Piaget’s developmental theory:
Sensory-motor stage: from birth – 2 yrs of age
1. actions related to sucking, orality and
assimilation of objects
2. ability to think of only one thought at a time
3. Inanimate objects given human qualities
4. Out of sight means ceasing to exist
4/21/2020 MR. VIKRANT KULTHE 3
4. Intellectual development
• Concrete thinking stage: 2-7 yrs
1. Egocentric thought with a unique logic of its
own, involving a limited point of view and
lacking introspection
2. Inability to generalise from specific events and
to specify from general events
4/21/2020 MR. VIKRANT KULTHE 4
5. Intellectual development
• Abstract or conceptual thinking stage: 7-11
yrs
1. Ability to focus on several aspects of a
problem at a time
2. Thought process is flexible & reversible
3. Ability of abstraction, & to find similarities
and differences among specific objects
4/21/2020 MR. VIKRANT KULTHE 5
6. Intellectual development
• Adolescent thinking or formal operational
stage: 11yrs and life-long
1. Ability to imagine possibilities inherent in a
situation, thus making the thought
comprehensive
2. Ability to develop complete abstract
hypotheses and test them
4/21/2020 MR. VIKRANT KULTHE 6
7. Intellectual development
• By the end of adolescence, the individual’s
intellectual structures are completely
developed , although learning and
intellectual growth continues
4/21/2020 MR. VIKRANT KULTHE 7
8. Classification in child psychiatry
• Mental retardation
• Specific developmental disorders
• Pervasive developmental disorders
• Hyperkinetic disorders
• Conduct disorders
• Tic disorders
• Enuresis and encopresis
• Speech disorders
• Habit disorders
• Other disorders
4/21/2020 MR. VIKRANT KULTHE 8
9. Mental retardation
• 1-3% of general population
• Called learning disability
• Definition:
Significantly sub-average general intellectual
functioning associated with significant deficit
or impairment in adaptive functioning, which
manifests during developmental period
(before 18 years of age).
4/21/2020 MR. VIKRANT KULTHE 9
10. Mental retardation
• On standardised intelligence tests, 2 SD’s
below mean, i.e. IQ below 70
• Adaptive behaviour is person’s ability to meet
responsibilities of social, personal,
occupational and interpersonal areas of life
acc. to his age and socio-cultural and
educational background.
• Adaptive behaviour is measured by clinical
interview and standardised assessment scales.
4/21/2020 MR. VIKRANT KULTHE 10
11. Mental retardation
• IQ score alone cannot be taken as a measure of
one’s intelligence and there has to be deficit in
adaptive behaviour too.
• Intelligence Quotient = mental age
chronological age
Mental retardation levels:
– Mild: 50-70
– Moderate: 35-50
– Severe: 20-35
– Profound: < 20
4/21/2020 MR. VIKRANT KULTHE 11
12. Mild mental retardation
• Commonest type, 85-90% cases, called educable
• Diagnosis made later
• Pre-school period, almost normal development,
with very little deficit
• Often progress up to 6th grade
• Can achieve vocational and social self-sufficiency
with a little support
• Supervised care needed only in stressful
conditions or in presence of an associated
disease
4/21/2020 MR. VIKRANT KULTHE 12
13. Moderate mental retardation
• About 10 %
• Previously called trainable but can be educated to
some extent
• In the early years can learn to speak
• Drop out of school after 2nd grade
• Poor social awareness
• Can be trained to support themselves by
performing semi-skilled or unskilled work under
supervision
• Mild stress enough to destabilise them
4/21/2020 MR. VIKRANT KULTHE 13
14. Severe mental retardation
• Often recognised early, with poor motor
development ( significantly delayed
milestones)
• Absent or markedly delayed speech and other
communication skills
• Elementary training in personal health care
possible, sometimes can be taught to talk.
• Can perform only simple tasks under
supervision, called dependent.
4/21/2020 MR. VIKRANT KULTHE 14
15. Profound mental retardation
• About 1-2%
• Associated with physical disorders, which
contribute to the retardation
• Markedly delayed developmental milestones
• Need nursing or life-support under carefully
planned and structured environment.
4/21/2020 MR. VIKRANT KULTHE 15
16. aetiology
• Genetic ( probably in 5% cases)
i. Chromosomal abnormalities:
down’s syndrome, fragile X syndrome, Turner’s
syndrome, Klinefelter’s syndrome
ii. Inborn errors of metabolism: involving
a. a.: phenylketoneuria, homocystinuria,
lipids: Tay-Sachs disease, Gaucher’s disease
purines: Lesch Nyhan Syndrome
iii. Single gene disorders:
tuberous sclerosis, neurofibromatosis
iv. Cranial anomalies: microcephaly
4/21/2020 MR. VIKRANT KULTHE 16
17. Aetiology
• Peri-natal causes: probably 10% of cases
i. Infections- rubella, syphilis, toxoplasmosis,
CMV, herpes
ii. Prematurity
iii. Birth trauma
iv. Hypoxia
v. IUGR
vi. Kernicterus
vii. Placental abnormalities
viii.Drugs during 1st trimester
4/21/2020 MR. VIKRANT KULTHE 17
18. Aetiology
• Acquired physical disorders in childhood: 2-5 %
i. Infections, esp. Encephelopathies
ii. Cretinism
iii. Trauma
iv. Lead poisoning
v. Cerebral palsy
• Socio-cultural causes: probably in 15%
deprivation of socio-cultural stimulation
• Psychiatric disorders: 1-2 %
PDD- infantile autism, childhood onset
schizophrenia
4/21/2020 MR. VIKRANT KULTHE 18
19. Diagnosis
• History
• General physical examination
• Detailed neurological examination
• Mental status examination
• Investigations:
i. Routine investigations
ii. Urine test for phenylketonuria, maple syrup
urine disease
iii. EEG, esp. In presence of seizures
iv. Blood levels, for inborn errors of metabolism
4/21/2020 MR. VIKRANT KULTHE 19
20. Diagnosis
v. Chromosomal studies, e.g. In Down’s syndrome,
prenatal and post-natal
vi. CT scan or MRI scan, e.g. In tuberous sclerosis,
focal seizures, anomalies of skull configuration,
severe or profound MR without apparent cause,
toxoplasmosis
vii. TFT’s
viii.LFT’s
ix. Psychological tests: Seguin form board test,
Stanford- Binet test, WISC, Raven’s progressive
matrices, VSMS for adaptive behaviour4/21/2020 MR. VIKRANT KULTHE 20
21. Differential diagnosis
• Deaf and dumb
• Deprived children with inadequate social
stimulation
• Isolated speech defects
• Psychiatric disorders
• Systemic disorders- with physical debilitation
• epilepsy
4/21/2020 MR. VIKRANT KULTHE 21
22. Management
Primary prevention:
– improvement of socio-economic conditions,
prevent malnutrition
– Education of lay people about individuals with
MR
– Medical measures to prevent perinatal
infections, trauma, excessive use of medicines,
diseases of pregnancy
– Universal immunisation of children
– Facilitating research to study causes of MR
– Genetic counselling of at-risk parents
4/21/2020 MR. VIKRANT KULTHE 22
23. Management
• Secondary prevention:
– Early detection and treatment of preventable
causes e.g. Phenylketonuria, hypothyroidism
– Early detection of handicaps in sensory, motor or
behavioural areas with early remedial measures
and treatment
– Early treatment of correctable disorders, e.g.
Infections, skull configuration anomalies
– Early diagnosis
– Avoid segregation or discrimination
4/21/2020 MR. VIKRANT KULTHE 23
24. Management
• Tertiary prevention
– Adequate treatment of psychological and
behavioural problems
– Behaviour modification using positive and
negative reinforcement
– Rehabilitation in vocational, physical, and social
areas
– Parental counselling to lessen levels of stress,
increasing adaptational skills
– Institutionalisation or residential care
4/21/2020 MR. VIKRANT KULTHE 24
25. Management
• Legislation: persons with disability act 1995
envisages mandatory support for prevention,
early detection, education, employment, and
other facilities for the welfare of people with
disabilities and esp. MR
this act provides for affirmative action and
non-discrimination of persons with disabilities
4/21/2020 MR. VIKRANT KULTHE 25
26. Specific developmental disorder
• Ch/b inadequate development in usually one
specific area of functioning
• May be scholastic skills, speech and language,
and motor skills
• May include reading, language, arithmetic or
mathematics, articulation or co-ordination
• Sometimes more than one disorder is present
• Either cause impairment in academic
functioning or in daily activities
4/21/2020 MR. VIKRANT KULTHE 26
27. Specific reading disorder
• Called “dyslexia” or developmental reading
disorder
• Serious delay in learning to read
• May include omissions, distortions, or
substitutions of words, long hesitations,
reversal of words, or simply slow reading
• Writing and spelling are also affected
4/21/2020 MR. VIKRANT KULTHE 27
28. Specific arithmetic disorder
• Called developmental arithmetic disorder or “
dyscalculia”
• May include failure to understand simple
mathematical concepts, recognise
mathematical signs or numerical symbols,
difficulty in carrying out mathematical
manipulations and difficulty in learning
mathematical tables
4/21/2020 MR. VIKRANT KULTHE 28
29. Specific developmental disorder of speech and language
• Called communication disorder or dysphasia
• 3 main types:
– Phonological disorder: dyslalia
includes severe articulation errors, speech
sounds or phonemes are omitted, distorted or
substituted
– Expressive language disorder: below par ability
to use expressive language
4/21/2020 MR. VIKRANT KULTHE 29
30. Specific developmental disorder of speech and language
restricted vocabulary, difficulty in selecting words
and immature grammatical usage. Cluttering of
speech may also be present
– Receptive language disorder; often presents as a
receptive- expressive disorder
ch/by below par understanding of language,
failure to respond to simple instructions
4/21/2020 MR. VIKRANT KULTHE 30
31. Specific developmental disorder of motor function
• Called motor skills disorder, developmental
co-ordination disorder, clumsy child syndrome
or motor dyspraxia
• Ch/by poor co-ordination in daily activities of
life like dressing, walking, feeding, playing
• Inability to perform fine or gross motor skills
4/21/2020 MR. VIKRANT KULTHE 31
32. Treatment
• Based on learning theory principles and
behaviour therapy
- use of special remedial teaching focussing on
underlying deficit
• Treatment of co-morbid emotional problems
• Parental education and counselling
4/21/2020 MR. VIKRANT KULTHE 32
33. Pervasive developmental disorder
• Infantile autism 1st described by Leo Kanner in
1943
• Described as autistic disorder, childhood
autism, childhood psychosis, pseudo- defective
psychosis
• M > F, 3-4 : 1
• Prevalence- 0.4- 0.5 / 1000
• Onset before 2 ½ yrs.
4/21/2020 MR. VIKRANT KULTHE 33
34. Pervasive developmental disorder
• Clinical features:
• Autism- marked impairment in reciprocal
social and interpersonal interaction
- absent social smile
- lack of eye-to-eye contact
- lack of awareness of others’ existence or
feelings, treats people as furniture
4/21/2020 MR. VIKRANT KULTHE 34
35. Pervasive developmental disorder
– lack of attachment to parents and absence of
separation anxiety
– no or abnormal social play, solitary games
– marked impairment in making friends
– lack of imitative behaviour
– absence of fear in presence of danger
4/21/2020 MR. VIKRANT KULTHE 35
36. Pervasive developmental disorder
• Marked impairment in language and non-verbal
communication:
- lack of verbal or facial response to sounds or
voices
- absence of communicating sounds e.g. Babbling
- absent or delayed speech
- abnormal speech patterns and content.
Presence of echolalia, perseveration, poor
articulation, pro-nominal reversal (I-you)
- rote memory is usually good
- impaired abstract thinking4/21/2020 MR. VIKRANT KULTHE 36
37. Pervasive developmental disorder
• Abnormal behavioural characteristics:
- mannerisms
- stereotyped behaviours like head-banging,
body spinning, rocking, clapping etc.
- Ritualistic and compulsive behaviour
- resistance to even slightest change in
environment
- attachment to inanimate objects
- hyperkinesis4/21/2020 MR. VIKRANT KULTHE 37
38. Pervasive developmental disorder
• Mental retardation:
- only 25% have IQ >70
- about 50% have moderate to profound MR
• Other features:
- Many children enjoy music
- Idiot savant syndrome: certain islets of
precocity or splinter function may remain. E.g.
Prodigious rote memory or calculating ability
and musical ability
- Epilepsy common in children with IQ < 50
4/21/2020 MR. VIKRANT KULTHE 38
41. Other Pervasive developmental disorders
• Childhood psychosis- includes autism,
schizophrenia, mood disorders, organic
psychiatric disorders
• Asperger’s syndrome: autism without any
delay in language or cognitive development,
high functioning autism. M > F, 8:1
4/21/2020 MR. VIKRANT KULTHE 41
42. Other Pervasive developmental disorders
• Rett’s syndrome: reported only in girls.
Apparently normal growth f/by deceleration
of head growth between 5- 30 months. Loss of
purposive hand movements and acquired fine
motor skills, subsequent stereotypic hand
movements. Severe mental handicap follows.
4/21/2020 MR. VIKRANT KULTHE 42
43. Hyperkinetic disorder
• Attention deficit disorder
• 3% school children
• Occurs before the age of 7yrs.
• Four types- ADD with hyperactivity,
ADD without hyperactivity
residual type
with conduct disorder
4/21/2020 MR. VIKRANT KULTHE 43
44. Diagnosis
• Teacher’s school report (often most reliable)
• Parent’s report
• Clinical examination
• Mental retardation should be excluded
Aetiology:
Cause not known but supposedly minimal brain
damage
4/21/2020 MR. VIKRANT KULTHE 44
45. Course:
• Majority (80%) improve by puberty
• 20% persistent symptoms in adulthood
• Impulsivity and inattention likely to remain
Treatment:
Pharmacotherapy: stimulant medication, clonidine,
venlafaxine, lithium, imipramine, chlorpromazine
etc. Barbiturates contraindicated
Behaviour modification
Counselling and supportive psychotherapy
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46. Conduct disorder
• Ch/by persistent and significant pattern of
conduct in which the basic rights of others are
violated or rules of society are not followed
• Diagnosis is made when conduct is far in
excess of the routine mischief of children an d
adolescents
• onset usually before puberty
• 5-10 times common in males
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47. Clinical features
1. Frequent lying
2. Stealing or robbery
3. Running away from home and school
4. Physical violence like rape, fire- setting, assault,
use of weapons
5. Cruelty towards other people and animals
• Earlier called juvenile delinquents
• Unsocialised type more severe
• Chronic course, may progress to ASPD
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48. Clinical features
• High co-morbidity – secondary complications like
drug abuse, dependence, unwanted pregnancy,
syphilis, AIDS, criminal records, suicidal and homicidal
behaviour
• Treatment: usually difficult
placement in corrective institution
behavioural, educational and psychotherapeutic
medicines- anticonvulsants, stimulant medication (
for hyperactivity),antipsychotics
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49. Non-organic enuresis
• enuresis is repetitive voiding of urine, either
during the day or night, at inappropriate
places.
• Technically diagnosed only after 5 years of age
and at least after 4 years of mental age.
• Types: primary
secondary
• Majority are nocturnal bed-wetting only
• M > F, 2:14/21/2020 MR. VIKRANT KULTHE 49
50. Non-organic enuresis
• Aetiology: exact cause unknown
– 75% have 1st degree relative
– Psychosocial: emotional disturbances,
insecurity, sibling rivalry, death of a parent
– Organic cause, esp. In diurnal enuresis and
adolescent enuresis- worm infestation, spina
bifida, UTI, neurogenic bladder, DM, seizure
disorder
– Secondary enuresis- age of onset, 5-8 years.
Tends to remit spontaneously. 1% continues in
adulthood
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51. Non-organic enuresis
• Treatment:
– Restriction of fluid intake after 8 PM
– Bladder training during daytime, progressive
– Interruption of sleep before expected time of bed-
wetting. Child should be woken up and made
aware of passing of urine
– Conditioning devices like alarm setting off as soon
as urine touches the bed-sheet
– Supportive psychotherapy for the child and the
whole family
– Pharmacotherapy: TCA- imipramine
intranasal desmopressin
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52. Non-organic encopresis
• Repetitive passage of faeces at inappropriate
time and/or place, after bowel control is
physiologically possible.
• Normal toilet training between 2-3 yrs. of age
• Diagnosed after the age of 4 years.
• Types: primary
secondary- 4-8 years of age
• M > F , 3-4 : 1
• Bye 5 years, 1- 1.5% children encopretic
• Tends to remit spontaneously with age.
• 25% are also enuretic
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53. Non-organic encopresis
• Aetiology: factors implicated are-
– Inadequate, inconsistent toilet training
– Sibling rivalry
– Maturational lag
– Underlying hyperkinetic disorder
– Emotional disturbances
– Mental retardation
– Childhood schizophrenia
– Autistic disorder
• Organic cause should be ruled out.
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54. Non-organic encopresis
• Treatment:
– Best treatment is preventive
– Family environment should be warm and
understanding
– Emotional disturbances should be dealt with as
soon as noticed
– Behaviour therapy
– Psychotherapy, biofeedback and imipramine
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