The document discusses several childhood disorders categorized into 10 diagnostic subgroups. These include mental retardation, learning disorders, motor skills disorders, communication disorders, pervasive developmental disorders, attention deficit and disruptive behavior disorders, feeding and eating disorders of infancy and early childhood, tic disorders, elimination disorders, and other disorders of infancy, childhood, or adolescence. Specific disorders discussed in more depth include mental retardation, learning disorders, tic disorders, attention deficit hyperactivity disorder, conduct disorder, oppositional defiant disorder, separation anxiety disorder, autism, and Asperger's disorder. Causes, characteristics, prevalence, gender differences, treatments and prognoses are described for each.

1. Presentation onPresentation on
childhood disorderschildhood disorders
Presented by : Parul Prasher
mental health nursing dept

2. Disorders Usually 1Disorders Usually 1stst
DiagnosedDiagnosed
in Infancy, Childhood, &in Infancy, Childhood, &
AdolescenceAdolescence
Core Concept Of Diagnostic
Group:
Categorized by time of onset
Predominantly disorders of abnormal
development and maturation.
Emphasis of disorders is on the inability of
the individual to attain certain normal
developmental milestones and the
associated functions, capabilities, &
behaviors.

3. 10 DIAGNOSTIC SUBGROUPS10 DIAGNOSTIC SUBGROUPS
(DSM-IV-TR)(DSM-IV-TR)
1) Mental Retardation
2) Learning Disorders
3) Motor Skills Disorders
4) Communication Disorders
5) Pervasive Developmental Disorders
6) Attention Deficitand Disruptive Behavior Disorders
7) Feeding & Eating Disorders ofInfancy & Early Childhood
8) Tic Disorders
9) Elimination Disorders
10) Other Disorders ofInfancy, Childhood, or Adolescence

5. Mental RetardationMental Retardation
Characteristics:
IQ is significantly below average (<
70)
Accompanied by deficits in adaptive
functioning, e.g. communication,
self-care, home living,
social/interpersonal skills, use of
community resources, self-direction,
academic skills, work, leisure,
health, safety.

6. Onset and codingOnset and coding
 Onset before age 18 years
 Coding: coded on axis II
 Code based on degree of severity, reflecting level of
intellectual impairment:
◦ Mild Mental Retardation – IQ from 50-55
to 70
◦ Moderate Mental Retardation – IQ from
35-40 to 50-55
◦ Severe Mental Retardation – IQ from 20-
25 to 35-40
◦ Profound Mental Retardation – IQ below
20-25

7. Mental RetardationMental Retardation
 Prevalence: 1-3% of population; 90% are mild MR
 Course: chronic
 Prognosis: variable, depending on IQ & level of
impairment
 Gender differences: more prevalent for males (1.6 to
1); no gender differences for severe & profound MR
 Causes: genetic; chromosomal (Down syndrome,
Fragile X syndrome, Lesch-Nyhan syndrome);
environmental (deprivation, abuse, neglect); prenatal
(exposure to disease, alcohol, drugs, chemicals, poor
maternal nutrition); perinatal (difficulties during labor &
delivery); postnatal (malnutrition, infections, & head
injuries)
 Treatment: behavioral skills training; communication
training; supported living and employment;
mainstreaming

8. Causes and TreatmentCauses and Treatment
Causes: genetic; chromosomal (Down
syndrome, Fragile X syndrome, Lesch-
Nyhan syndrome); environmental
(deprivation, abuse, neglect); prenatal
(exposure to disease, alcohol, drugs,
chemicals, poor maternal nutrition);
perinatal (difficulties during labor &
delivery); postnatal (malnutrition,
infections, & head injuries)
Treatment: behavioral skills training;
communication training; supported living
and employment; mainstreaming

9. LEARNING DISORDERLEARNING DISORDER

11. Characteristics:
Inadequate development of specific
academic skills, such as reading,
writing, and math.
Specific academic skills are
substantially below expected for
age, intelligence, and education
Significantly interferes with aspects
of life requiring those skills.
Subtypes:
Reading Disorder
Mathematics Disorder
Disorder of Written Expression
Learning Disorder Not Otherwise
Specified

12. Prevalence:
◦ general population: 5-10%
◦ reading disorders: 5-15%
◦ math disorders: 6%
Racial: more common in black children
Negative outcomes: negative school
experiences; school drop-out; lower employment
rates; lower educational & career goals
Causes: genetics; structural & functional
differences in the brain
Treatment: educational interventions
(processing skills; cognitive skills; behavioral skills)

13. TIC DISORDER

14. Tic Disorder: Tourette’sTic Disorder: Tourette’s
DisorderDisorder
Symptoms: characterized by multiple motor tics and
one or more vocal tics (involuntary, sudden, rapid,
nonrhythmic, stereotyped motor movements or
vocalizations), which occur many times a day, nearly
every day, or intermittently for more than a year.
Common motor tics: eye-blinking, eye-rolling,
spitting, flipping/twirling hair, rolling head around,
bending/jumping, skin picking, shrugging/jerking
shoulders, thrusting pelvic movements, tapping
fingers/feet
Common vocal tics: throat clearing, tongue-clicking,
whistling, grunting, humming, hoots, howls,
burps/belches, animal noises, repetition of one’s own
words, repetition of others’ words

15. Contd .Contd .
 Causes: genetic (32% have relatives with TD); abnormal
metabolism of 5HT & D; brain processing problem (basal
ganglia)
 Prevalence: decreases with age; 5-30 per 10,000 in
childhood; 1-2 per 10,000 in adulthood
 Gender: 2-5x as common for males
 Onset: as early as 2 yrs; average age of onset is 6-7 yrs;
typically develops by age 14
 Course: severity, frequency, and disruptiveness of sx
diminish during adolescence & adulthood
 Treatment: antipsychotics; antihypertensive
medications; SSRI’s; self-monitoring; relaxation training;
habit reversal

16. ADHDADHD

17. Attention Deficit/Hyperactivity DisorderAttention Deficit/Hyperactivity Disorder
Includes two major syndromes:
1) Inattention
2) Hyperactivity-Impulsivity
Syndromes may occur independently or
together, but usually some components of
each are present.
Symptoms begin before age 7
Symptoms cause some impairment in 2 or
more settings.

18. Inattention: 6+ of the following for 6+ months
 Often fails to give close attention to details
 Often makes careless mistakes in school, work,
etc.
 Often has difficulty sustaining attention
 Often doesn’t seem to listen when spoken to
directly
 Often doesn’t follow instructions
 Often fails to finish schoolwork, chores, or work
duties
 Has difficulty organizing tasks & activities
 Avoids or dislikes tasks requiring sustained mental
effort
 Often loses things
 Is easily distracted by extraneous stimuli
 Is forgetful in daily activities

19. Attention Deficit/Hyperactivity DisorderAttention Deficit/Hyperactivity Disorder
Hyperactivity-Impulsivity 6+ of following for 6+ months
Hyperactivity:
 Fidgets with hands or feet; squirms in seat
 Difficulty staying in seat
 Excessive running, climbing, or restlessness
 Difficulty playing or engaging in leisure activities quietly
 Often “on the go;” acts as if “driven by a motor”
 Often talks excessively
Impulsivity:
 Often blurts out statements
 Impatient; difficulty awaiting turn
 Often interrupts or intrudes on others

20. Attention Deficit/Hyperactivity DisorderAttention Deficit/Hyperactivity Disorder
 Subtypes:
◦ AD/HD, Predominantly Inattentive Type
◦ AD/HD, Predominantly Hyperactive-Impulsive Type
◦ AD/HD, Combined Type
◦ AD/HD, Not Otherwise Specified
 Onset: 3-4 years old
 Age: 68% have ongoing sx in adulthood; inattentive
subtype is more common in adolescents and adults
 Gender: ratios of males to females range from 2:1 to 9:1;
Combined and Hyperactive Subtypes are much more
common in males than females
 Prevalence: up to 3-7% of school-age children

21. ADHD: Associated FeaturesADHD: Associated Features
 Academic deficits
 School-related problems
 Peer rejection
 Low frustration tolerance
 Tantrums
 Poor self-esteem
 Mood swings
 Bossiness
 Stubbornness
 Accidents
 Driving difficulties – speeding, accidents

22. ADHD: Diagnostic ConsiderationsADHD: Diagnostic Considerations
 Difficulty of distinguishing normal activity from
hyperactivity and normal distractibility from attention
deficit distractibility.
 Need to evaluate behavior in terms of what’s normal for
others of same gender, age, developmental level, cultural
background.
 Behaviors must occur in multiple settings.
 Behaviors must cause clinically significant impairment.
 Symptoms must have been present and caused
impairment by age 7.
 Combined and Hyperactive Subtypes are less likely to be
missed.

23. ADHD: Contributing FactorsADHD: Contributing Factors
Genetics: increased incidence of ADHD &
psychopathology in families & relatives
Prenatal factors: inadequate oxygen; drug
exposure; maternal smoking
Neurotransmitters: inadequate availability of
dopamine; NE, 5HT, GABA also implicated
Brain abnormalities: frontal cortex, basal
ganglia, & cerebellar vermis are smaller
Exposure to toxins: allergens, food additives
Parenting: negative attempts to control their
behavior; intrusive, over-bearing parenting

24. Attention Deficit/Hyperactivity DisorderAttention Deficit/Hyperactivity Disorder
Treatments:
Medication – stimulants, Strattera (SNRI),
Wellbutrin
Psychoeducation & bibliotherapy
Skills-based training – time management,
organizational skills, study skills, problem-
solving, social skills

26. CONDUCT DISORDERCONDUCT DISORDER

27. Conduct DisorderConduct Disorder
 Repetitive, persistent pattern of behavior in
which the basic rights of others or major
societal norms or rules are violated.
 3 or more of the following are present in the
past 12 months, and at least one of the
following is present in the past 6 months.
1) Aggression to people and animals
2) Destruction of property
3) Deceitfulness or theft
4) Serious violations of rules

28. Conduct DisorderConduct Disorder
1) Aggression to People and
Animals:
◦ Bullying, threats, intimidation
◦ Physical fights
◦ Use of weapons
◦ Physical cruelty to people
◦ Physical cruelty to animals
◦ Mugging, purse snatching, extortion,
armed robbery
◦ Forced sexual activity

29. Conduct DisorderConduct Disorder
2) Destruction of Property:
◦ Deliberate fire-setting
◦ Deliberate destruction of others’ property
3) Deceitfulness or Theft
◦ Breaking & entering
◦ Lying; conning
◦ Stealing; shoplifting; forgery
4) Serious Violations of Rules
◦ Breaking curfew prior to age 13
◦ School truancy prior to age 13
◦ Running away from home

30. Conduct DisorderConduct Disorder
Subtypes:
 Conduct Disorder, Childhood Onset – onset of at least
1 criterion prior to age 10
 Conduct Disorder, Adolescent Onset – absence of any
criteria prior to 10
 Conduct Disorder, Unspecified Onset – age of onset is
unknown
Specifiers:
 Mild – few, if any, conduct problems in excess of those
required to make dx; cause only minor harm to others
 Moderate – number of conduct problems and effect on
others are in the intermediate range
 Severe – many conduct problems in excess of those
required to make dx; cause considerable harm to others

31. Conduct DisorderConduct Disorder
 Etiology: genetics; decreased arousal; low levels of
5HT; neurological deficits
 Prevalence: 2-9% of nonclinical population; up to 1/3-
1/2 of child mental health referrals; 87-91% of
incarcerated juveniles
 Gender Differences: mostly males
 Onset: as early as preschool
 Prognosis: poor; 2/3rds of cases develop into
Antisocial Personality Disorder
 Treatment: parent management training; community-
based interventions (group homes, wilderness programs;
therapeutic boarding schools); CBT (social skills,
problem solving, cognitive restructuring)

33. Oppositional Defiant DisorderOppositional Defiant Disorder
 Pattern of negativistic, hostile, and defiant behavior for at
least 6 months.
 At least 4 of the following are present:
◦ Often loses temper
◦ Often argues with adults
◦ Often actively defies or refuses to comply with
adults’ requests or rules
◦ Often deliberately annoys others
◦ Often blames others for own mistakes or
misbehavior
◦ Is often touchy or easily annoyed by others
◦ Is often angry or resentful
◦ Is often spiteful or vindictive

34. Oppositional Defiant DisorderOppositional Defiant Disorder
 Prevalence: 1-6%
 Gender differences: more prevalent for males prior
to puberty; ratio evens out after puberty
 Prognosis: relatively persistent – some of the behaviors
persist into adulthood, others are outgrown; higher
divorce rate, employment difficulties, and drug/alcohol
abuse for those with ODD
 Causes: marital conflict; family discord; inconsistent
parenting; overly lenient or rigid parent; coercive or
aversive parent-child interactions; genetics
 Treatment: parent training; family therapy; behavioral
therapy (anger management, social skills training,
problem solving, frustration tolerance); cognitive
interventions to reduce negativity

38. Separation Anxiety DisorderSeparation Anxiety Disorder
At least 4 weeks of inappropriate or excessive anxiety
about separation from home or major attachment figures,
as evidenced by at least 3 of the following:
◦ excessive anxiety regarding separation
◦ excessive fears of losing major attachment figures
◦ nightmares involving the theme of separation
◦ refusal to go to school
◦ refusal to be alone or without major attachment
figures
◦ refusal to sleep away from home or attachment
figures
◦ repeated physical complaints when separation occurs
or is anticipated
Onset prior to age 18

39. Pervasive DevelopmentalPervasive Developmental
DisordersDisorders
Characterized by:
 A broad-based impairment or a loss of
functions expected for child’s age.
 Includes 3 components:
1) Impairment in social
interactions/relationships
2) Impairment in communication/language
3) Restricted, repetitive, and stereotyped
patterns of behavior, interests, and activities

41. Autistic DisorderAutistic Disorder
 Abnormal functioning in at least one of the
following areas, with onset prior to 3:
1) Social interaction
2) Language and communication
3) Symbolic, imaginative play
 Qualitative impairment in social interaction
and relationship development
 Qualitative impairment in communication,
language, and conversation skills
 Restricted, repetitive, stereotyped patterns of
behavior, interests, activities.

42. AutismAutism
 Mental retardation: 75-80%; 50% are profoundly or
severely MR; 25% are moderately MR; 25% borderline to
average IQ
 Gender differences: higher IQ – more prevalent among
males; IQ < 35 – more prevalent among females
 Prevalence: 1 in 500 births
 Onset: first apparent in infancy & toddlerhood
 Course: chronic; life-long impairment; 50% never acquire
speech
 Causes: abnormalities in brain structure and function (5HT
synthesis, cerebellum); genetics
 Treatments: intensive behavioral Tx focusing on improving
communication, social and daily living skills and reducing
problem behaviors; early intervention programs; applied
behavior analysis; parent training; mainstreaming for
education; community interventions (supportive living
arrangements & work settings)

45. Asperger’s DisorderAsperger’s Disorder
Qualitative impairment in social
interaction and relationship
development
Restricted, repetitive, and
stereotyped patterns of behavior,
interests, and activities
But lack any clinically significant
delay in language or cognitive
development

46. Asperger’s SyndromeAsperger’s Syndrome
What you see:
 Anxious, excessive desire for sameness
 Preoccupation with stereotyped, repetitive activities
 Obsess about objects
 Limited interests
 Can’t relate to others
 Can’t read emotions
 Can’t understand social cues
 Social isolation, socially inept
 Average IQ scores
 Motor clumsiness
 Poor coordination

47. Asperger’s SyndromeAsperger’s Syndrome
Gender: up to 4x as common for males
Prevalence: up to 5x as common as
Autism
Onset: later onset than Autism
Course: chronic, life-long
Etiology: genetics; brain abnormalities
(limbic system, 5HT & D systems, right
hemisphere)

48. Asperger’s Syndrome: TreatmentsAsperger’s Syndrome: Treatments
Behavioral treatments/skills building:
interventions targeting problem behaviors,
problem solving, social skills, communication
skills, empathy-building, daily living skills
School-based interventions: mainstreaming;
tutoring; special aides; multiple modalities for
presenting information
Psychotherapy to address accompanying
psychiatric disorders, such as depression and
anxiety
Medications: antidepressants, antipsychotics

50. Nurses Role In Management OfNurses Role In Management Of
Childhood DisorderChildhood Disorder

51.  Ensuring the child’s safety and that of others
Stop unsafe behavior.
 Provide close supervision
 Give clear directions about acceptable and
unacceptable behavior.
 Improved role performance
 Give positive feedback for meeting
expectations.
 Manage the environment (e.g., provide a quiet
place free of distractions for task completion).
 Simplifying instructions/directions
 Get child’s full attention.

52. Contd.Contd.

Break complex tasks into small steps.
 Allow breaks.
 Structured daily routine
 Establish a daily schedule.
 Minimize changes.
 Client/family education and support
 Listen to parent’s feelings and
frustrations.
 Improving role performance
 Simplifying instructions
 Promoting a structured daily routine
 Providing client and family education and
support