MHN

1. CHILDHOOD PSYCHIATRIC DISORDERS

2. Childhood Psychiatric Disorder
• Disorders usually first diagnosed in infancy, childhood or
adolescence.
• Child psychiatry is concerned with the assessment and treatment of
children’s emotional and behavioral problems.
• Psychological disturbances in childhood is most usefully defined
as an abnormality in at least one of the three areas: emotions,
behavior or relationships.

3. Contd.
• Psychiatric disorders among children are described as serious
changes in the way children typically learn, behave, or handle their
emotions, which cause distress and problems getting through the
day.

4. Prevalence
• Worldwide 10-20% of children and adolescents experience mental
disorders.
• Half of all mental illnesses begin by the age of 14 and three-
quarters by mid-20s.
• Neuropsychiatric conditions are the leading cause of disability in
young people in all regions.

5. Types
• Intellectual disability (Mental
Retardation)
• Attention Deficit Hyperactive
Disorders
• Emotional disorders
- Separation anxiety
- School Phobia
• Other behavioral and emotional
disorders
- Enuresis, encopresis, pica
• Sleep disorder
- Nightmares, night terror

6. Mental Retardation (F70 – F79)
• Mental retardation is a condition of arrested or incomplete
development of the mind, which is especially characterized by
impairment of skills manifested during the developmental period,
which contribute to the overall level of intelligence, i.e. cognitive,
language, motor, and social abilities.

7. Classification
Mild IQ
Ranges from
50-70
Moderate IQ
Ranges from
35-50
Severe IQ
Ranges from
20-35
Profound IQ
Ranges
below 20

8. Classification
• F70 Mild mental retardation
• F71 Moderate mental retardation
• F72 Severe mental retardation
• F73 Profound mental retardation
• F78 Other mental retardation
• F79 Unspecified mental retardation

9. Mild Mental Retardation
IQ range from 50 – 70
• Individuals in this group can often live on their own with
community support
• These individuals have minimum retardation in sensory – motor
areas
• They can be called as Educable Mentally Retarded (EMR)
• Capable of learning basic academic skills of reading, writing and
arithmetic.

10. Moderate Mental retardation
ID range from 35 – 50
• They are challenged academically and often are not able to achieve
academically above a second to third grade level.
• They can go to special schools.
• As adults, persons with moderate mental retardation may be able
to perform semiskilled work under appropriate supervision.

11. Severe Mental Retardation
IQ range from 20-35
• Individuals in this category can often master the most basic skills
of living, such as cleaning and dressing themselves.
• Is often recognized early in life with poor motor development &
absent or markedly delayed speech & communication skills.

12. Profound Mental Retardation
IQ range below 20
• Individuals at this level can often develop basic communication
and self-care skills.
• Most individuals with profound mental retardation have
identifiable causes for their condition.

13. Etiology
1. Genetic Factors
 ChromosomalAbnormalities: Down’s syndrome. Fragile X
syndrome, Turner’s syndrome, Klinefelter’s syndrome
 Inborn errors of metabolism involving in amino – acids
(phenylketonuria)
 Cranial malformation ; hydrocephaly, microcephaly
 Gross disease of brain – neurofibromatosis, epilepsy

14. Contd.
2. Prenatal factors
 Infection: rubella, syphilis, herpes simplex, toxoplasmosis
 Endocrine disorders: hypothyroidism, hypo – parathyroidism, diabetes
mellitus
 Physical damage and disorders – injury, hypoxia, radiation, hypertension,
anemia
 Intoxication – certain drugs, substance abuse
 Placental dysfunction – toxemia in pregnancy, placenta previa, cord prolapse,
nutritional growth retardation

15. Contd.
3. Perinatal factors
 Birth asphyxia
 Prolonged or difficult birth
 Prematurity
 Kernicterus
 Instrumental delivery

16. Contd.
4. Postnatal factors
 Infection: Encephalitis, Measles, Meningitis, Septicemia
 Accidents
 Lead poisoning

17. Contd.
5. Environmental and sociocultural factors
 Cultural deprivation
 Child abuse
 Low socioeconomic status
 Inadequate caretakers

18. Signs and Symptoms
• Failure to achieve developmental milestones
• Deficiency in cognitive functioning such as inability to follow
commands or directions
• Failure to achieve intellectual developmental markers
• Reduced ability to learn or to meet academic demands
• Expressive or receptive language

19. Contd.
• Psychomotor skill deficits
• Difficulty performing self-esteem
• Irritability when frustrated or upset
• Depression or labile moods
• Acting-out behavior
• Persistence of infantile behavior
• Lack of curiosity.

20. Diagnosis
• History collection from parents & caretakers
• Physical examination
• Neurological examination
• Assessing milestones development

21. Contd.
• Investigations
- Urine & blood examination for metabolic disorders
- Culture for cytogenic & biochemical studies
- Amniocentesis in infant chromosomal disorders
- chorionic villi sampling
- Hearing & speech evaluation

22. Contd.
• EEG, especially if seizure are present
• CT scan or MRI brain, for example, in tuberous sclerosis
• Thyroid function tests when cretinism is suspected
• Psychological tests like Stanford Binet Intelligence Scale &
Wechsler Intelligence Scale for Children’s (WISC), for
categorizing the child’s level of disability.

23. Management
• Behavior management
• Environmental supervision
• Monitoring the child’s development needs & problems.
• Programs that maximize speech, language, cognitive,
psychomotor, social, self-care, & occupational skills.
• Ongoing evaluation for overlapping psychiatric disorders, such as
depression, bipolar disorder, &ADHD.

24. Contd.
• Family therapy to help parents develop coping skills & deal with
guilt or anger.
• Early intervention programs for children younger than 3 with
mental retardation Provide day schools to train the child in basic
skills, such as bathing
• Medications –Associated behavioral and psychiatric disorders
only
• Multidisciplinary care

25. Some Do’s and Don’ts for parents
• Look at abilities rather than disabilities in the child.
• Notice successes and praise them, however small these may be.
• Try to learn the techniques of training and practice them.
• Remember that those with mental retardation are slow in learning
but they can still be taught with patience, persistence, and the
correct approach.

26. Contd.
• Find out about services that are available and utilize them.
• There is no need to feel ashamed about having a retarded child.
• There is no need to blame oneself or other family members for the
child's condition.
• Do not overprotect the child; as far as possible encourage them to
stand on their own feet.
• Do not waste money unnecessarily on dubious treatments, which
have not been proven.

27. Prevention
• Preconception
• During
gestation
• At delivery
• Childhood
Primary
Prevention
• Early detection and
treatment of
preventable disease
• Psychiatric treatment
for emotional and
behavioral difficulties
Secondary
Prevention
Rehabilitation
(vocational,
physical and
social areas)
Tertiary
Prevention

28. Attention Deficit Hyperactivity Disorders

29. Introduction
• ADHD is the most common neurobehavioral disorder of
childhood, among the most prevalent chronic health conditions
affecting school-aged children, and the most extensively studied
mental disorder of childhood.
• ADHD is characterized by inattention, including increased
distractibility and difficulty sustaining attention; poor impulse
control and decreased self- inhibitory capacity; and motor over
activity and motor restlessness.

30. Contd.
• Affected children commonly experience
 academic underachievement,
 problems with interpersonal relationships with family members
and peers,
 low self-esteem.
• ADHD often co-occurs with other emotional, behavioral,
language, and learning disorders

31. Epidemiology
• Amean worldwide prevalence ofADHD of ~2.2% overall (range:
0.1–8.1%) has been estimated in children and adolescents (aged
<18 years).
• A relatively common disorder, it occurs in about 3% of school age
children. Males are 6-8 times more often affected. The onset
occurs before the age of 7 years and a large majority of patients

32. In US

33. Etiology
1. Biological Influences
a. Genetic factors
 There is greater concordance in monozygotic than in dizygotic
twins.
 Siblings of hyperactive children have about twice the risk of
havingADHD
 First degree relatives

34. Contd.
b. Biochemical theory:
A deficit of dopamine and norepinephrine, this deficit
neurotransmitters is believed to lower the threshold for stimuli input.
2. Pre, peri and postnatal factors
 Prenatal toxic exposure, prenatal mechanical insult to the fetal
nervous system
 Prematurity, fetal distress, precipitated or prolonged labor,
perinatal asphyxia and lowAPGAR scores

35. Contd.
3. Postnatal infections, CNS abnormalities resulting from trauma
4. Environmental influences
 Environmental lead
 Food additive, coloring preservatives and sugar have also been
suggested as possible causes of hyperactive behavior but there is
no definite evidence

36. Contd.
5. Psychosocial factors
 Prolonged emotional deprivation
 Stressful psychic events
 Distribution of family equilibrium

37. Diagnosing ADHD: DSM - V
Persisted for at least 6 months to a degree that is inconsistent
with developmental level and that negatively impacts directly on
social and academic/occupational activities
Lacks attention to detail; makes careless mistakes.
Has difficulty sustaining attention
Doesn’t seem to listen.
Fails to follow through/fails to finish instructions or schoolwork.
Has difficulty organizing tasks.
Avoids tasks requiring mental effort.
Often loses items necessary for completing a task.
Easily distracted.
Is forgetful in daily activities.
Inattention
A1

38. Diagnosing ADHD: DSM - V
Persisted for at least 6 months to a degree that is inconsistent with
developmental level and that negatively impacts directly on social and
academic/occupational activities
Fidgets or squirms excessively
Leaves seat when inappropriate
Runs about/climbs extensively when inappropriate
Has difficulty playing quietly
Often “on the go” or “driven by a motor”
Talks excessively
Blurts out answers before question is finished
Cannot await turn
Interrupts or intrudes on others
Hyperactivity/
Impulsivity
A2

39. B. Several inattentive or hyperactive-impulsive symptoms were
present prior to age 12 years.
C. Several inattentive or hyperactive-impulsive symptoms are
present in two or more settings.
Diagnosing ADHD: DSM - V

40. Contd.
B. There must be clear evidence of clinically significant impairment
in social, academic, or occupational functioning.
C. Symptoms do not occur exclusively during the course of a
pervasive developmental disorder, schizophrenia, or other
psychotic disorder, and are not better accounted for by another
mental disorder (e.g., mood disorder, anxiety disorder,
dissociative disorder, personality disorder)

41. Contd.
• Specify whether:
Combined presentation: If both CriterionA1 (inattention) and CriterionA2
(hyperactivity- impulsivity) are met for the past 6 months.
Predominantly inattentive presentation: If Criterion A1 (inattention) is met
but Criterion A2 (hyperactivity-impulsivity) is not met for the past 6
months.
Predominantly hyperactive/impulsive presentation: If Criterion A2
(hyperactivity-impulsivity) is met and Criterion A1 (inattention) is not met
for the past 6 months.

42. Treatment
1. Medicine
- Stimulants medicine such as methylphenidate administered in a
divided dose of 50 – 60 mg/day
- Antidepressants such as desipramine have been effective
alternative agents in some children

43. Contd.
2.Behavior modification therapies, but psychotherapy is not the
mainstay therapy for this disorder.
3.Environmental engineering is of great benefit in this disorder,
because children with ADHD do not readily adapt to change or
function well in highly stimulating environments.