brief summary for medical personnel about common child psych disorders

1. DR/KHALID ALHARBY 1 بسم الله الرحمن الرحيم CHILD PSYCHIATRY Dr. KHALID AL-HARBY MBBS,SBFM,ABFM

5. breath holding.

6. Sleep problems.

8. Specific developmental disorders.

12. School performance. Family history: separations from and illness of parents. Quality of relations with parents and siblings. Personal history of the child. - Pregnancy - Birth - Development - Past illness and injury - Attendance and attainments at school The presenting problem. Nature, severity, frequency. Situations in which it occurs. Factors which make it worse or better

13. DR/KHALID ALHARBY 7 Principle observations of a child’s behavior & emotional state Appearance. Activity level. Mood. Rapport with the interviewer. Relationship with parents. Habits, mannerisms

14. DR/KHALID ALHARBY 8 Interviewing other informants Teachers social workers.

15. DR/KHALID ALHARBY 9 Indications for In-patient Care Severe behavioral disorder. For observation. To separate the child. To observe relationship with mother

16. DR/KHALID ALHARBY 10 Temper Tantrum Temper tantrums range from whining and crying to screaming, kicking, hitting, and breath-holding. Equal in girls and boys, age: 1-3 y. Even the most good-natured toddlers has an occasional temper tantrum (normal development) Tantrum Tactics: Keep cool ( do not complicate the problem with your own frustrations) Assess the situation Take the child to a quite, secluded place to calm down

17. DR/KHALID ALHARBY 11 Breath holding spells (BHS) a benign, involuntary recurring condition of childhood in which anger or pain produce crying that culminates in noiseless expiration and apnea. 5% of all children ageing (6m-6y) Most common in 12-18 months Boys and girls are affected equally + ve family history is found in 25% One of the nonepileptic paroxysmal disorders of childhood 2 types: cyanotic, and pallid DD: epileptic seizures, syncope, benign paroxysmal vertigo, cataplexy, central or obstructive apnea

19. Spontaneous resolution in the vast majority of children by the age of 5-6 years

21. DR/KHALID ALHARBY 14 NIGHTMARES AND NIGHT TERRORS

22. DR/KHALID ALHARBY 15 Nightmares Awakening from REM sleep (which constitute <25 % in children above age of 6 years and adults) to full consciousness with recall of unpleasant dreams. Common in children 5 - 6 yrs. of age. Stimulated by frightening experience during the day.(If frequent:  day time anxiety). Rx. - causes of anxiety. - Re assurance .

23. DR/KHALID ALHARBY 16 Night terrors Awakening from stage 3 or 4 of NREM sleep (usually 90 min. after going to sleep). Terrified, confused, and cry for 5-30min. No recall of dream.(and at morning no recall of the episode) Settle slowly in few minutes & return to normal calm sleep. Not persisting to adult life. Occur in 5-15% of children 4-6 y. (though they can appear in babies as young as 9 m) Rx: Not specific (? Awake him shortly before the usual time of terror).

24. DR/KHALID ALHARBY 17 Sleep walking(somnambulism) Walk as if he is awake.(for few minutes). ? Anxious, not answering questions. Difficult to awaken him, but easy to “drive” Occurs usually during deep NREM sleep <stage 3 or stage 4 sleep> (early part of the night). Age 5 - 12 yrs. (at least once in 15% of them). Rx: - Non specific - Reassurance  Mild: parents should maintain a consistent approach & set color limits to the child’s behavior. - Close doors and windows - Avoid dangerous objects – hypnosis may be helpful - benzodiazepines

25. DR/KHALID ALHARBY 18

26. DR/KHALID ALHARBY 19 Food Refusal Brief periods are common in pre-school. Rx: - ignorance. - don’t offer the child special food. - don’t force him to eat.

28. Clay

29. Chalk

30. Cigarette ashes

31. Sand

32. Paint

33. Plaster

34. Gravel

35. Rocks

37. DR/KHALID ALHARBY 22 Pica Not an eating disorder Physiological theory: eating clay or dirt helps relieve nausea, control diarrhea, increase salivation, remove toxins, and alter odor or taste perception. Psychological theory: a behavioral response to stress, a habit disorder, or a manifestation of oral fixation Rx: - Modify stress - keep away - reassure: with aging.

38. DR/KHALID ALHARBY 23 School Refusal The child may be Psychologically unable to attend school even though he wishes to do so. C/P: - sudden refusal to attend school (complete) - gradually increasing reluctant to leave home. - somatic complaint. (Only on School days). Causes: - separation anxiety (normally at age 18-24 months when separated from caregiver but may persists). - bullying by other children or failure in class. - marital problems between parents, or illness of a family member

39. DR/KHALID ALHARBY 24 School Refusal Prevention: Toddlers and preschoolers can benefit from structured experiences with other adults. Inform the child calmly that the parent will return and the child is to stay. Then leave quickly. A firm, caring and quick separation is better. Prognosis: most of them eventually return to school. Rx: Modify stress circumstances: helping the child to relax, develop better coping skills, using a contract,….. Treat the underlying cause .

40. DR/KHALID ALHARBY 25 Hyper kinetic Syndrome (ADHD) 1/3 of children are described as overactive by their parents and 1/5 of school children by their teachers. Incidence in USA is 3-7% A developmental condition of inattention and distractibility with or without hyperactivity. C/P: ( it should start before the age of 7 years). - Extreme restlessness - Impulsiveness - Sustained motor activity - Poor attention - Learning difficulties - Temper and aggressive. Etiology: not related to food (e.g. sugar) - Genetic - Social - Lead intoxication - intrauterine exposure to Food additives

41. DR/KHALID ALHARBY 26 Hyper kinetic Syndrome (ADHD) Prognosis:   ê age.  usually ceases by puberty  associated learning difficulties are less likely to improve.  antisocial behavior has the worst prognosis. Rx:  Stimulant drugs e.g. Methylphenidate ? Paradoxical effect. No addiction by those children !!  Family and social support.

42. DR/KHALID ALHARBY 27 CONDUCT DISORDER

45. DR/KHALID ALHARBY 30 JUVENILE DELINQUENCY It is considered because some have conduct disorder. Most common about 15-16 yrs. of age, male > female. Causes: 1. Low social class, poverty,poor housing and poor education. 2. Poor parenting and shared attitudes to the law Rx: - improve family environment - educate the child: - improve skills -  harmful peer group influences

46. DR/KHALID ALHARBY 31 AUTISM Rare. C/P:  inability to relate  speech and language disorder.  resistant to change.  odd behavior and mannerism.  seizures (in adolescence) Etiology: unknown ? Genetic  cognitive abnormalities   thinking and language.  no rule for abnormal parenting

47. DR/KHALID ALHARBY 32 AUTISM Prognosis: about 50% acquire some useful speech but may continue to show emotional coldness and odd behavior. 10 - 20% can attend ordinary school and later obtain work. 10 - 20% need specialschool. 60 - 80% are unable to lead an independent life.

48. DR/KHALID ALHARBY 33 شكرا لحضوركم