This document provides information on various topics in child psychiatry. It discusses child development, behavioral and emotional disorders that usually onset in childhood/adolescence, nocturnal enuresis, nocturnal encopresis, attention deficit hyperactivity disorder (ADHD), autism, and stammering. It defines each condition and covers epidemiology, etiology, clinical features, diagnosis, management, course and prognosis. The document is a reference for child psychiatric conditions.

2. CHILDCHILD
PSYCHIATRYPSYCHIATRY

3. IntroductionIntroduction
A.A. 1 Child is a developing being1 Child is a developing being
2. Child is a dependent being2. Child is a dependent being

4. B.B. Child as a symbol of relationshipChild as a symbol of relationship
problemsproblems
i. Child-parent relationshipi. Child-parent relationship
ii. Relationship between theii. Relationship between the
parentsparents
C. Source of historyC. Source of history
i. Childi. Child
ii. Parentii. Parent
iii. Teachersiii. Teachers

5. Behavioral & EmotionalBehavioral & Emotional
Disorders With OnsetDisorders With Onset
Usually OccurringUsually Occurring
Childhood & AdolescenceChildhood & Adolescence
1.1. Hyperkinetic DisordersHyperkinetic Disorders
2. Conduct Disorders2. Conduct Disorders
3. Mixed Disorders of Conduct and3. Mixed Disorders of Conduct and
EmotionsEmotions
4. Emotional Disorders with onset4. Emotional Disorders with onset
specific to Childhoodspecific to Childhood

6. 5. Disorders of Social Functioning5. Disorders of Social Functioning
with onset specific to Childhood andwith onset specific to Childhood and
AdolescenceAdolescence
6. Tic Disorders6. Tic Disorders
7. Other Behavioral and Emotional7. Other Behavioral and Emotional
DisordersDisorders
8. Unspecified Mental Disorders8. Unspecified Mental Disorders

7. Nocturnal EnuresisNocturnal Enuresis
 DefinitionDefinition
 Causes/PsychopathologyCauses/Psychopathology
 SymptomatologySymptomatology
 InvestigationsInvestigations
 Management:Management:
i. Drugsi. Drugs
ii. Behavior Therapyii. Behavior Therapy

8. Nocturnal EncopresisNocturnal Encopresis
 DefinitionDefinition
 Causes/PsychopathologyCauses/Psychopathology
 SymptomatologySymptomatology
 InvestigationsInvestigations
 ManagementManagement
i.i. DrugsDrugs
ii.ii. Behavior TherapyBehavior Therapy

9. ATTENTION DEFICITATTENTION DEFICIT
HYPERACTIVITY DISORDERHYPERACTIVITY DISORDER
(ADHD)(ADHD)
(HYPERKINETIC DISORDERS)(HYPERKINETIC DISORDERS)

10. EPIDEMIOLOGYEPIDEMIOLOGY
 Early onset usually before age of 6Early onset usually before age of 6
but more noticeable once thebut more noticeable once the
child starts schoolchild starts school
 Several times more frequent inSeveral times more frequent in
boys than girls 3 – 5 x moreboys than girls 3 – 5 x more
 More in first born boysMore in first born boys

11. 
Incidence reported 2 – 20% ofIncidence reported 2 – 20% of
grade school children ,grade school children ,
conservative figure 3-5 % ofconservative figure 3-5 % of
prepubertal elementary schoolprepubertal elementary school
children.children.

12. ETIOLOGYETIOLOGY

13.  GENETIC FACTORSGENETIC FACTORS

14.  DEVELOPMENTALDEVELOPMENTAL
FACTORSFACTORS

15.  NEUROCHEMICALNEUROCHEMICAL
FACTORSFACTORS

16. CARDINAL FEATURESCARDINAL FEATURES
 Impaired attentionImpaired attention

17.  OVEROVER
ACTIVITYACTIVITY

18. Associated FeaturesAssociated Features
 DisinhibitionDisinhibition
 RecklessnessRecklessness
 Impulsive flouting of social rulesImpulsive flouting of social rules
 Prone to accidentProne to accident
 Secondary:Secondary:
dissocial behaviordissocial behavior
low self esteemlow self esteem

19.  Pervasive over situationsPervasive over situations
(at least 2 situations)(at least 2 situations)
 Persistence over timePersistence over time
 Interference with social activitiesInterference with social activities

20. DiagnosisDiagnosis
 Rate and deviation inRate and deviation in
developmentdevelopment
 School history and teacher’sSchool history and teacher’s
reportreport

21.  relations with siblingsrelations with siblings
 mental state:mental state:
distractibilitydistractibility
perseverationperseveration

22. Differential DiagnosisDifferential Diagnosis
 NormalityNormality
 AnxietyAnxiety
 DepressionDepression
 Bipolar affective disorder (mania)Bipolar affective disorder (mania)

23.  Conduct disorderConduct disorder
 Pervasive developmental disorderPervasive developmental disorder
 Learning disordersLearning disorders
 EpilepsyEpilepsy

24. MANAGEMENTMANAGEMENT

25. PharmacologicalPharmacological
 CNS StimulantsCNS Stimulants
 TricyclicTricyclic
AntidepressantsAntidepressants
 AntipsychoticsAntipsychotics
 Selective Serotonin ReuptakeSelective Serotonin Reuptake
Inhibitors (SSRI)Inhibitors (SSRI)

26. PSYCHOLOGICALPSYCHOLOGICAL
 IndividualIndividual
PsychotherapyPsychotherapy
 Behavior ModificationBehavior Modification
 Reward & PunishmentReward & Punishment

27. Parental Counseling- To UseParental Counseling- To Use
Behavioral InterventionsBehavioral Interventions
Group Therapy:Group Therapy:

28. COURSE ANDCOURSE AND
PROGNOSISPROGNOSIS

29. AUTISMAUTISM

30. AUTISMAUTISM
 Abnormal and/or impairedAbnormal and/or impaired
development.development.
 Manifest before the age of 3Manifest before the age of 3
years.years.
 Abnormal functioning in allAbnormal functioning in all
three areas.three areas.

31.  Social Interaction.Social Interaction.
 Communication.Communication.
 Restricted, RepetitiveRestricted, Repetitive
Behavior.Behavior.

32. EPIDEMIOLOGYEPIDEMIOLOGY
 Prevalence:- 2-5 cases perPrevalence:- 2-5 cases per
10,000 children under age of10,000 children under age of
12.12.
 Before age of 36 months.Before age of 36 months.
 3 – 5 x more common in boys.3 – 5 x more common in boys.
 Equally prevalent in all socialEqually prevalent in all social
strata.strata.

33. ETIOLOGYETIOLOGY

34. NEUROLOGICAL &NEUROLOGICAL &
BIOLOGICALBIOLOGICAL
FACTORS:FACTORS:
 Complication ofComplication of
pregnancy in firstpregnancy in first
trimester.trimester.
 4 – 32% have increase4 – 32% have increase
brain volume,brain volume,
temporal lobe damage.temporal lobe damage.

35. GENETICGENETIC
FACTORSFACTORS::
 2 – 4% of siblings2 – 4% of siblings
of children withof children with
autism also haveautism also have
autism.autism.
 50 x higher rate50 x higher rate
than in generalthan in general
population.population.

36. BIOCHEMICAL FACTORSBIOCHEMICAL FACTORS ::
Increase plasma serotoninIncrease plasma serotonin

37. CLINICAL FEATURESCLINICAL FEATURES

38. Qualitative Impairment InQualitative Impairment In
Social InteractionSocial Interaction

39. Disturbances OfDisturbances Of
Communication &Communication &
LanguageLanguage

40. Restricted, Repetitive &Restricted, Repetitive &
Stereotyped, Pattern OfStereotyped, Pattern Of
Behavior, Interests &Behavior, Interests &
ActivitiesActivities

41. ASSOCIATED FEATURES:ASSOCIATED FEATURES:
 Hyper KinesisHyper Kinesis
 Aggressiveness & TemperAggressiveness & Temper
TantrumsTantrums
 Self Injurious BehaviorSelf Injurious Behavior
 Sleeping & EatingSleeping & Eating
DisturbancesDisturbances
 Intellectual FunctioningIntellectual Functioning
40% - IQ < 5040% - IQ < 50

42. DIFFERENTIAL DIAGNOSISDIFFERENTIAL DIAGNOSIS
 SchizophreniaSchizophrenia
 Mental Retardation &Mental Retardation &
Behavioral SymptomsBehavioral Symptoms
 Developmental Disorders ofDevelopmental Disorders of
Receptive LanguageReceptive Language

43. MANAGEMENTMANAGEMENT

44. TREATMENT GOALSTREATMENT GOALS
 Increase socially acceptableIncrease socially acceptable
behavior.behavior.
 Reduce odd behavior.Reduce odd behavior.
 Develop verbal & non verbalDevelop verbal & non verbal
communication.communication.

45.  Behavior reinforcementBehavior reinforcement
 Family counseling & supportFamily counseling & support
 Educational & behavioralEducational & behavioral
methodsmethods

46. PHARMACOLOGICALPHARMACOLOGICAL
TREATMENTTREATMENT
for associatedfor associated
symptoms e.g.symptoms e.g.
 aggression,aggression,
 severe tempersevere temper
tantrums,tantrums,
 hyperactivity.hyperactivity.

47. COURSE & PROGNOSISCOURSE & PROGNOSIS

48. STAMMERINGSTAMMERING
(STUTTERING)(STUTTERING)

49. Speech characterized bySpeech characterized by
frequent repetition orfrequent repetition or
prolongation of sounds orprolongation of sounds or
syllables or words or by frequentsyllables or words or by frequent
hesitation or pauses that disrupthesitation or pauses that disrupt
the rhythmic flow of speech.the rhythmic flow of speech.

50. EPIDEMIOLOGYEPIDEMIOLOGY ::
 1% in general population.1% in general population.
 Most common in young children.Most common in young children.
 3 – 4 times more common in males.3 – 4 times more common in males.
 More in families with historyMore in families with history
of stuttering.of stuttering.
 Appears mostly between 18Appears mostly between 18
months – 9 years.months – 9 years.

51. ETIOLOGYETIOLOGY::
 UnknownUnknown
 Psychological FactorsPsychological Factors
 Organic CauseOrganic Cause
 Learned BehaviorLearned Behavior

52. CLINICAL FEATURESCLINICAL FEATURES ::
 Vivid fearful anticipation ofVivid fearful anticipation of
stuttering.stuttering.
 Avoid situations requiringAvoid situations requiring
speech.speech.
 Word substitution.Word substitution.
 Frustration, anxiety, depression.Frustration, anxiety, depression.

53. DIFFERENTIALDIFFERENTIAL
DIAGNOSISDIAGNOSIS::
 Normal Speech DysfluencyNormal Speech Dysfluency
 ClutteringCluttering

54. TREATMENTTREATMENT::
 Breathing Exercise,Breathing Exercise,
Relaxation TechniqueRelaxation Technique
 Speech Therapy.Speech Therapy.
 PsychotherapyPsychotherapy
 Family Therapy If Needed.Family Therapy If Needed.

55. COURSE AND PROGNOSISCOURSE AND PROGNOSIS