This document provides information on several childhood psychiatric disorders and conditions. It discusses mental retardation and the different classifications based on IQ. It also covers pervasive developmental disorders like autism and Asperger's disorder. Learning disorders and disruptive disorders like oppositional defiant disorder and conduct disorder are explained. The document also summarizes attention deficit hyperactivity disorder, movement disorders, encopresis, enuresis, and toilet training.

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CHILDHOOD DISORDERS

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Goals
• Understanding how symptoms of psychiatric
disorders differ in children and adolescents
 Psychiatric disorders:
 Mood
 Anxiety
 Psychotic
 Disorders first usually diagnosed in Infancy.
Childhood and Adolescence
 Eating disorders

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Mental Retardation
 Defined as intellectual functioning with an IQ less than 70
 Also need delays in two or more adaptive areas
 Self care
 Communication
 Testing:
 Vineland Adaptive Behavior Scales-measure of personal and social
skills
 Weschler-compares individual test performance to normative of age
group
 WISC or Stanford-Binet- intelligence test

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Mental Retardation

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Mental Retardation
Mild
• 50-55 to 70-85 IQ
 85% of MR
population
 Academic level- 6th
grade
 Holds job, makes
change

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Mental Retardation
Moderate
 35-40 to 50-55 IQ
 10% of MR
population
 Academic level-2nd
grade
 Makes small change
Severe
 20-25 to 35-40 IQ
 4% of MR population
 Academic level-
below 1st
 Can use coin
machines

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Mental Retardation
Profound
 20-25 and below IQ
 1% of MR population
 Academic level-
BELOW 1st
 Dependent on others

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–Most common INHERITED cause of mental
retardation-Fragile X
–Most common GENETIC cause of mental retardation-
Down syndrome

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Treatment Considerations
 Family is coping with loss of “ideal” child
 Grief and loss issues
 Appropriate placement.
 School setting, day care, group homes, sheltered workshop and
respite care
 Specific problems responsive to medications
 Seizures Disorders
 Affective Disorders
 ADHD
 Aggression

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Pervasive Developmental Disorders
Autism Asperger Rett PDDNOS ChildhoodDisintegrativeDisorder
PDD

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Pervasive Developmental Disorders
• Autism-delays or
abnormal functioning in:
• Social interaction
• Language and Social
Communication
• Repetitive and
stereotyped patterns of
behavior
• Prevalence:2-5 cases per
10,000 children.
• Sex Ratio:3-4 times more
common in boys.

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AUSTISTIC DISORDER
Diagnostic Criteria: (cont)
• Marked lack of awareness of others’ feelings
• No or abnormal comfort-seeking
• No or impaired imitation.
• No or abnormal social play.
• Gross deficits in making friendships
• Impaired non-verbal behavior (e.g. eye contact, body
postures)
A. Qualitative Impairment in Reciprocal Social
Interaction.

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AUTISTIC DISORDER
Diagnostic Criteria: (cont)
• Delay or lack of spoken language
• Impaired ability to initiate or maintain
conversation
• Stereotypic, repetitive or idiosyncratic use of
language
• Impaired ability to converse with others
B. Impaired Verbal and Nonverbal Communication

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AUTISTIC DISORDER
Diagnostic Criteria: (cont)
• Stereotyped or repetitive body movements
(e.g. hand flapping)
• Inability to tolerate change, with insistence
on routines
• Narrow interests
• Unusual attachments to objects
• Preoccupation with object parts
C. Restricted Repertoire of Activities

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Etiology of Autism
 Psychological theories have not been confirmed
 Not caused by bad parenting
 “Common final pathway” --
i.e., association with a variety of disorders:
-Congenital rubella & - Genetic disorders, including
other infections Fragile X
- Postnatal infection. - Metabolic disorders
• Approximately 70% have mental retardation
• Approximately 30% have seizures

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Interventions in Autism
Presently: No curative treatment.
Symptomatic approaches.
Mainstay: Structured behavioral and
educational programs.
Medications: To control seizures,
hyperactivity, severe
aggression, or mood disorders.
Investigational: Reciprocal communication
training

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Asperger’s Disorder
 “High functioning autism”
 Stereotypic, repetitive mannerisms
 Lack of interactive play/communication
 Loss of communication skills
 No delays in language and cognitive development
Derek Preuss obsesses over game
shows, a typical symptom of a child with
the disorder. (ABCNEWS.com)

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Retts Disorder
 Normal growth for the first few months
 Deceleration of head growth between 4-8 months
 Truncal incoordination
 Lack of purposeful and movements
 Disorder of females
 Similar criteria as PDD

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Childhood Disintegrative Disorder
 Normal development for at least two years after
birth
 Clinically significant loss of previously acquired
skills (before age 10 years): in 2 or more of the
following areas:
 Language
 Social skills or adaptive behavior
 Bowel or bladder control
 Play
 Motor skills

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PDD NOS
When there is no severe and pervasive
impairment in the development of reciprocal
social interaction, or communication skills, or
when stereotyped behaviors and activities are
present but the criteria are not met for a
specific pervasive developmental disorder.

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Pervasive Developmental Disorders

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Learning Disorders
Definition
 Skills in a specific academic area are greatly
below those expected for age or IQ and academic
level
 Must cause academic or adaptive defect

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Learning, Motor Skills &
Communication Disorders
Types:
- Reading Disorder
- Mathematics Disorder
- Disorder of Written Expression
- Developmental Coordination Disorder
- Expressive Language Disorder
- Mixed Receptive-Expressive Language Disorder
- Phonological Disorder
- Stuttering

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Learning Disorders
Course/Prognosis
 Diagnosed in grade
school, but not outgrown
 Complications include:
 low self-esteem
 school dropout
 low frustration tolerance
 Academic achievement
associated with language
skills

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Learning Disorders
Diagnosis
 Academic testing
 Speech and language
skills testing
 Motor testing
 Cognitive testing
 Observation of the
child in the classroom
Treatment
 Multidisciplinary plan
 Tx for specific
developmental disorders
in public schools is
mandated by law
 Included least restrictive
environment and
Individual Educational
Plan

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Disruptive Disorders in Children

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Oppositional Defiant Disorder
A pattern of negativistic, hostile and defiant behavior
lasting greater than 6 months of which you have 4
or more of the following:
 Loses temper
 Argues with adults
 Actively defies or refuses to comply with rules
 Often deliberately annoys people
 Blames others for his/her mistakes
 Often touchy or easily annoyed with others
 Often angry and resentful
 Often spiteful or vindictive

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Oppositional Defiant Disorder
(ODD)
 Prevalence-3-10%
 Male to female -2-3:1
 Outcome-in one study,
44% of 7-12 year old
boys with ODD
developed into CD
 Evaluation-Look for
comorbid ADHD,
depression, anxiety
&LD/MR

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Oppositional Defiant Disorder
http://www.hsc.wvu.edu/aap/aap-car/videos.htm

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Conduct Disorder
(CD)
 Aggression toward
people or animals
 Deceitfulness or
Theft
 Destruction of
property
 Serious violation
of rules

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Conduct Disorder
(CD)
 Prevalence-1.5-3.4%
 Boys greatly outnumber
girls (3-5:1)
 Comorbid ADHD in
50%, common to have
LD
 Course-remits by
adulthood in 2/3. Others
become Antisocial
Personality Disorder

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Conduct Disorder
“You left your D__M care in the driveway again!”

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Conduct Disorder
http://www.hsc.wvu.edu/aap/aap-car/videos.htm

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Movement Disorders
Chorea
 Chorea-Continuous, unsustained, rapid, abrupt and
random contractions
 Causes of chorea-metabolic disorders, medication
induced, Syndenham chorea, metabolic disorders,
nutritional disorders, SLE, CNS abnormalities
 Etiology of Syndenham chorea-Group A hemolytic
streptococcal infection
 Clinical features of Syndenham chorea-irritability,
emotional lability and abnormal choreiform movements
 Treatment of Syndenham chorea-PCN prophylaxis x 10
years, cardiac screening, antipsychotic (severe cases)

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Movement Disorders
• Tic-sudden, rapid, recurrent, nonrhythmic,
sterotyped motor movement or vocalization
• Tourette’s syndrome-motor and vocal tics for
greater than one year
• Tourette’s Disorder-1/1000 boys & /10000 girls
 Onset of Tourette’s- ages 7-14 years (rarely
postpubertal)
 Tourette syndrome is associated with LD, ADHD
and OCD

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Movement Disorders
http://www.wemove.org/ts_ssv1.0.html

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Attention Deficit Hyperactivity Disorder
 Symptoms for at least six
months to a degree that it
is maladaptive and
INCONSISTENT with
developmental level
 Some symptoms present
prior to age 7 years
 Two or more settings

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Attention Deficit Hyperactivity Disorder
 Inattention
 Poor organization
 Does not seem to listen
when spoken to
 Loses objects
 Easily distracted
 Forgetful in daily
activities
 Hyperactivity/Impulsivit
y
 Fidget
 Leaves seat often
 Runs or climbs
excessively
 Always “on the go”
 Talks excessively
 Blurts out answers
 Can’t wait turn,
interrupts others

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Attention Deficit Hyperactivity Disorder
 Attention deficit disorder can occur WITH
and WITHOUT hyperactivity
 Hyperactivity is more common in boys
than girls
 ADHD is difficult to diagnose in the early
years (age 4-6)

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Attention Deficit Hyperactivity Disorder
Medical Causes of hyperactivity and/or attention problems
• Birth complications-hypoxia, toxemia
• Fragile X Syndrome, PKU, resistance to
thyroid hormone
• Brain injury-trauma or infection
• Lead poisoning

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Attention Deficit Hyperactivity Disorder
 ADHD can be a lifetime disorder with 30-50% having
symptoms as adults
 Learning Disabilities are frequently seen in children with
ADHD
 Behavior in a pediatrician’s office does NOT reflect the
situation at home or in school
 Long term outcome dependent on substance abuse, CD

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Attention Deficit Hyperactivity Disorder
 Stimulant medications improve attention in
normal individuals as well as children with
ADHD
 Medication alone is usually not sufficient for the
treatment of ADHD
 It is of upmost importance to communicate with
the ADHD/LD child’s teacher
 Mentally retarded children with symptoms of
hyperactivity and short attention may respond to
medication in different manner

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Toilet training
 Toilet training
 Begins 18-30 months
 Most children control urination by day at 2.5 years
and at night by 3.5-4 years
 Factors that effect refusal include:
 early training
 excess parent-child conflict
 constipation
 Prerequisites:
 bowel and bladder regularity
 sphincter control
 psychological ability to delay
 desire to please adults

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Enuresis
 Primary vs secondary enuresis
 Nocturnal vs. diurnal
 DIURNAL enuresis after
continence is achieved should
prompt evaluation
 Family history of enuresis
 Laboratory studies are
unlikely to be positive unless
other clinical findings are
present
 Treatment with medications
and behavioral plan

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Encopresis
Encopresis
 High association between
encopresis and enuresis
 Medical therapy,
behavioral modification
and counseling results in
the greatest success in the
treatment of encopresis

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Our Time is up!