This document provides an overview of the classification of childhood and adolescent psychopathology. It discusses: 1) The early lack of a formal classification system and the inclusion of childhood disorders in the first DSM in 1952 which only included two disorders. 2) The more detailed classification system provided by the Group for the Advancement of Psychiatry in 1966 which broadened understanding of childhood disorders. 3) Common disorders like ADHD, oppositional defiant disorder, conduct disorder, anxiety disorders, depression, and symptom disorders like enuresis and encopresis. 4) Etiological factors, symptoms, prevalence, comorbidities, and treatment approaches for these disorders. 5) The

1. Psychopathology
CLASSIFICATIONOF CHILDHOOD AND
ADOLESCENCE DISORDER
PRESENTEDBY
KARTHIKAK T
ST.MARYSCOLLEGETHRISSUR

2. • Until 1950s no formal specific system was available for classifying
the emotional or behavioural problem of children and adolescents.
• In 1952, the first formal psychiatric, nomen clature (DSM I) was
published and childhood disorders were included. This system was
limited and include only two childhood disorders ; childhood
schizophrenia and adjustment reaction of childhood.
• In 1966; the group for the advancement of the psychiatry provided
a classification system for children that was detailed and
comprehensive.

3. • Thus in 1968 DSM II several additional category were added.
• Clinicians and researchers attempting to broaden understanding
of childhood psychopathology.
• Many childhood disorders such as autism, learning disabilities
and school phobia have no counter part in adult psychology.
• The early system ignore that the fact in childhood disorders
environmental factors play in the important role in the expression
symptom ie., symptoms are highly influenced by families
acceptance or rejection of the behaviour.

4. Attention Deficit Hyperactivity Disorder
( Hyperkinetic Disorder)
• Often refers to as hyper activity characterised by difficulty that interfere
with effective task oriented behavior.
• In childhood, impulsivity exaggerated motor activity and difficulty in
sustaining attention.
• Children with ADHD are highly distractable and often fail to follow
instruction or response to demand placed on them.
Low IQ
Socially intrusive and immature
Difficult in neurological testing
Poor academic
Generally have social problem because of impulsivity and hyperactivity.

5. Hyperactivity children do not obey rules
 Causal factors
• Remain unclear
Biological factors
Genetic inheritance
Psychological factors
Temperament, learning
Enviornmental and social factors

6. Treatment
• Meditation ( retalin, amphetamine, pemoline, Strattera, adoral)
• Psychological intervention
• Family therapy
• Positive reinforcement
• Behavioral therapy
• Selective reinforcement
• Social based behavioral intervention

7. OPPOSITIONALDEFIANT DISORDER ANDCONDUCT DISORDER
• This disorder involves child or adolescence relationship to social
norms and rules of conduct.
• aggressive and antisocial behavior is the focus.
• Oppositional defiant disorder is usually by about age 8 and
conduct disorder by 9.
• Both involves misleads that may or may not against law.
• Juvenile delinquency is the legal term used to refers to the
violation of the law commited by the minors.

8. Clinical factors
• An important precursor of the antisocial behavior seen in the
children who develop conduct disorder is often what is now called
oppositional deviant disorder (ODD).
• The essential features is a recurrent pattern of negativistic defiant,
disobedient and hostile behavior toward authority figure. That
persist for at least 6 month
• This disorder seen in boys more than girls.
• The risk factors for both include family discord, socioeconomic
disadvantage and antisocial behavior in the parent.

9. Anxiety and Depression disorders
• Anxiety producing events and experience of traumatic events can
cause predispose children develop anxiety disorder.
• Children and vulnerable to fear and uncertainty and can get in
generalized panic disorder just as adult do.
• Children with anxiety disorder our extreme entire behavior than
though experiencing normal anxiety. They are characterized by
over sensitivity unrealistic fears shyness, limpidity, and pervasive
feeling of inadequacy , sleep disturbances and fear of cool.
• They attempt to competent with their fears by becoming overly
dependent on others for support and help.

10. • Anxiety disorders are often comorbid with depressive disorder.
Prevalence is about 5-10%.
SEPERATION ANXIETY DISORDER
• Most common of childhood anxiety disorder occur in 2-4 % of children.
• Children with this disorder exhibits un realistic fear, over sensitivity, self-
consciousness, nightmare and chronic anxiety.
• Lack of self confidence are apprehensive in new situation and tend to be
immature of their age
• Parents describes this children as shy, nervous, sensitive easily
discouraged, worried and overly dependent.

11. • Essential feature of this disorder is excessive anxiety about separation
from major attachment figure. May be death of closed one result.
• This children may experience other anxiety disorder such as OCD
Causal factors
• Genetic factors; particularly OCD
• Social factors
• Parental behavior and family stress in minority roles, culture etc
• Anxious children often manifest an unusual constitution sensitivity
that may raise the easily condition able by aversive stimuli

12. • They have harder time, calming down and generalization of surplus to their
reaction
• Modelling effect of an over protective and over anxious parents in different
or detached parent or rejecting parent.
• The role social environmental factors might play in the development of
anxiety disorder.
Treatment and outcome
• Biologically based treatment- psychopharmacological treatment is most
common. Efficient use of fluosetine
• Psychological treatment- behavior therapy anxious behavior, CBT.
• and assertive training, competency and desensitization to reduce

13. Child depression and bipolar disorder
• Childhood depression include behavior such as, withdrawal, crying,
avoidance of eye contact, physical complaints, poor appetite and
aggressive behavior.
• Somatic illness and childhood depression may have common more
etiological factor.
• Neuro-imagine technique are needed to explore the hormonal level and
in response in treatment.
Causal factor
• Biological factors- association between parental depression and behavior
and more problems in children. Other biological factors are also make
children to vulnerable to that problem.
• The factors are alcohol intake mother during pregnancy, prenatal
exposure etc

14. • Learning factors- are unculturable factors having important role
in childhood depressive disorder. Children who have experienced
past stressful events are susceptible to develop depression
• Negative parental behaviour or negative emotional state may
result depression
Treatment and outcome
• Anti depressant medication- use of fluoxetine
• psychological therapy, providing supportive emotional
environment

15. SYMPTOM DISODER
• Deal with elimination disorder(enuresis, encopresis, sleep walking and
typically involves a simple understanding symptom rather than a
pervasive maladaptive pattern.
• Functional enuresis: refers to the habitually discharge of urine usually at
night after the age of 5. it is described as bedwetting that is not
organically caused.
• Children primary enuresis have never be continent.
• Child have secondary function enuresis have been continent for al least
for a year but have regretted.
• Enuresis is result from a variety of organic condition, such as disturbed
cerebral control of bladder, side effect of medication. Other possible
factors are faulty learning immature, disturbed family interaction,
stressful events etc.

16. Treatment
• Anti depressants, hormone replacement, behavioral treatment etc.
ENCORPOSIS
• Describes a symptom disorder of children who have not learned
appropriate toileting for bowel movements after age of 44
• It is less common than enuresis. Few children report that didn’t
know when they need to have a bowel movement or work to shy to
use the bathrooms at School
• These children suffer from constipation
• Treatment involves both Medical and psychological aspects

17. Sleepwalking or somnambulism
• Onset of this disorder usually between the ages of 6 and 12 it is classified
broadly under sleep disorder
• The symptoms include repeated episodes in which a person leaves his or
her bed and a walk around without being conscious experience or
remembering it later
• They may engage in complex activities while sleepwalking eyes partially
or fully opened avoid obstacles respond to command take place during
NREM Sleep
• Causes
• Condition that arises subject from deep sleep memory and Impairment
• Treatment
• Behavioral therapy

18. Tic disorder
• It is a persistent intermittent muscle twitch or spam usually limited to a
localized muscle group. The term frequently used for blinking the eyes
twitching the mouth shrugging the shoulders twisting neck etc.
• Frequently occurs between age of 2 and 14
• Many people may not realise that they have tic
• Tourelle disorder
• Extreme tic disorder involving multiple motor and vocal patterns typically
involves uncontrollable head movements with accompanying sounds
• Prevalence is 0.6 %
• Treatments
• Suppressive drugs
• Behaviour intervention

19. ICD classification
• Infant and Juvenile psychiatry we have at our disposal 3classification.
• Two of them are ICD 10 and DSM IV are based on biomedical model.
• ICD is the classification of all diseases and and instrument of the WHO
• In ICD chapter 5 mental disorders have two sections specifically
dedicated to children disorders of psychological development and
behavioral and emotional disorder with onset usually occurring in
childhood
• In the first group we can find the pervasive disorder of development,
School learning and motor development. The second group comprises
hyperkinetic disorder behavioral disorder

20. DSM
• In the third version of DSM already exist in the term psychosis is
and reactional disorders which were a reference to
psychopathology had been removed
• Fourth version devotes a chapter to children entitled (disorders
usually first diagnosed in infancy childhood adolescence more
even it calm that there is no distribution between disorders
children and adults section 10 include mental retardation School
learning disorders motor communication and other child and
adolescent disorders

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