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04/09/16 JStar 1
CHILDHOOD DISORDERS
04/09/16 JStar 2
Goals
• Understanding how symptoms of psychiatric
disorders differ in children and adolescents
 Psychiat...
04/09/16 JStar 3
Mental Retardation
 Defined as intellectual functioning with an IQ less than 70
 Also need delays in tw...
04/09/16 JStar 4
Mental Retardation
04/09/16 JStar 5
Mental Retardation
Mild
• 50-55 to 70-85 IQ
 85% of MR
population
 Academic level- 6th
grade
 Holds jo...
04/09/16 JStar 6
Mental Retardation
Moderate
 35-40 to 50-55 IQ
 10% of MR
population
 Academic level-2nd
grade
 Makes...
04/09/16 JStar 7
Mental Retardation
Profound
 20-25 and below IQ
 1% of MR population
 Academic level-
BELOW 1st
 Depe...
04/09/16 JStar 8
–Most common INHERITED cause of mental
retardation-Fragile X
–Most common GENETIC cause of mental retarda...
04/09/16 JStar 9
Treatment Considerations
 Family is coping with loss of “ideal” child
 Grief and loss issues
 Appropri...
04/09/16 JStar 10
04/09/16 JStar 11
Pervasive Developmental Disorders
Autism Asperger Rett PDDNOS ChildhoodDisintegrativeDisorder
PDD
04/09/16 JStar 12
Pervasive Developmental Disorders
• Autism-delays or
abnormal functioning in:
• Social interaction
• Lan...
04/09/16 JStar 13
AUSTISTIC DISORDER
Diagnostic Criteria: (cont)
• Marked lack of awareness of others’ feelings
• No or ab...
04/09/16 JStar 14
AUTISTIC DISORDER
Diagnostic Criteria: (cont)
• Delay or lack of spoken language
• Impaired ability to i...
04/09/16 JStar 15
AUTISTIC DISORDER
Diagnostic Criteria: (cont)
• Stereotyped or repetitive body movements
(e.g. hand flap...
04/09/16 JStar 16
Etiology of Autism
 Psychological theories have not been confirmed
 Not caused by bad parenting
 “Com...
04/09/16 JStar 17
Interventions in Autism
Presently: No curative treatment.
Symptomatic approaches.
Mainstay: Structured b...
04/09/16 JStar 18
Asperger’s Disorder
 “High functioning autism”
 Stereotypic, repetitive mannerisms
 Lack of interacti...
04/09/16 JStar 19
Retts Disorder
 Normal growth for the first few months
 Deceleration of head growth between 4-8 months...
04/09/16 JStar 20
Childhood Disintegrative Disorder
 Normal development for at least two years after
birth
 Clinically s...
04/09/16 JStar 21
PDD NOS
When there is no severe and pervasive
impairment in the development of reciprocal
social interac...
04/09/16 JStar 22
Pervasive Developmental Disorders
04/09/16 JStar 23
Learning Disorders
Definition
 Skills in a specific academic area are greatly
below those expected for ...
04/09/16 JStar 24
Learning, Motor Skills &
Communication Disorders
Types:
- Reading Disorder
- Mathematics Disorder
- Diso...
04/09/16 JStar 25
Learning Disorders
Course/Prognosis
 Diagnosed in grade
school, but not outgrown
 Complications includ...
04/09/16 JStar 26
Learning Disorders
Diagnosis
 Academic testing
 Speech and language
skills testing
 Motor testing
 C...
04/09/16 JStar 27
Disruptive Disorders in Children
04/09/16 JStar 28
Oppositional Defiant Disorder
A pattern of negativistic, hostile and defiant behavior
lasting greater th...
04/09/16 JStar 29
Oppositional Defiant Disorder
(ODD)
 Prevalence-3-10%
 Male to female -2-3:1
 Outcome-in one study,
4...
04/09/16 JStar 30
Oppositional Defiant Disorder
http://www.hsc.wvu.edu/aap/aap-car/videos.htm
04/09/16 JStar 31
Conduct Disorder
(CD)
 Aggression toward
people or animals
 Deceitfulness or
Theft
 Destruction of
pr...
04/09/16 JStar 32
Conduct Disorder
(CD)
 Prevalence-1.5-3.4%
 Boys greatly outnumber
girls (3-5:1)
 Comorbid ADHD in
50...
04/09/16 JStar 33
Conduct Disorder
“You left your D__M care in the driveway again!”
04/09/16 JStar 34
Conduct Disorder
http://www.hsc.wvu.edu/aap/aap-car/videos.htm
04/09/16 JStar 35
04/09/16 JStar 36
Movement Disorders
Chorea
 Chorea-Continuous, unsustained, rapid, abrupt and
random contractions
 Caus...
04/09/16 JStar 37
Movement Disorders
• Tic-sudden, rapid, recurrent, nonrhythmic,
sterotyped motor movement or vocalizatio...
04/09/16 JStar 38
Movement Disorders
http://www.wemove.org/ts_ssv1.0.html
04/09/16 JStar 39
Attention Deficit Hyperactivity Disorder
 Symptoms for at least six
months to a degree that it
is malad...
04/09/16 JStar 40
Attention Deficit Hyperactivity Disorder
 Inattention
 Poor organization
 Does not seem to listen
whe...
04/09/16 JStar 41
Attention Deficit Hyperactivity Disorder
 Attention deficit disorder can occur WITH
and WITHOUT hyperac...
04/09/16 JStar 42
Attention Deficit Hyperactivity Disorder
Medical Causes of hyperactivity and/or attention problems
• Bir...
04/09/16 JStar 43
Attention Deficit Hyperactivity Disorder
 ADHD can be a lifetime disorder with 30-50% having
symptoms a...
04/09/16 JStar 44
Attention Deficit Hyperactivity Disorder
 Stimulant medications improve attention in
normal individuals...
04/09/16 JStar 45
Toilet training
 Toilet training
 Begins 18-30 months
 Most children control urination by day at 2.5 ...
04/09/16 JStar 46
Enuresis
 Primary vs secondary enuresis
 Nocturnal vs. diurnal
 DIURNAL enuresis after
continence is ...
04/09/16 JStar 47
Encopresis
Encopresis
 High association between
encopresis and enuresis
 Medical therapy,
behavioral m...
04/09/16 JStar 48
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Childhood psychiatry disorders

  1. 1. 04/09/16 JStar 1 CHILDHOOD DISORDERS
  2. 2. 04/09/16 JStar 2 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
  3. 3. 04/09/16 JStar 3 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
  4. 4. 04/09/16 JStar 4 Mental Retardation
  5. 5. 04/09/16 JStar 5 Mental Retardation Mild • 50-55 to 70-85 IQ  85% of MR population  Academic level- 6th grade  Holds job, makes change
  6. 6. 04/09/16 JStar 6 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
  7. 7. 04/09/16 JStar 7 Mental Retardation Profound  20-25 and below IQ  1% of MR population  Academic level- BELOW 1st  Dependent on others
  8. 8. 04/09/16 JStar 8 –Most common INHERITED cause of mental retardation-Fragile X –Most common GENETIC cause of mental retardation- Down syndrome
  9. 9. 04/09/16 JStar 9 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
  10. 10. 04/09/16 JStar 10
  11. 11. 04/09/16 JStar 11 Pervasive Developmental Disorders Autism Asperger Rett PDDNOS ChildhoodDisintegrativeDisorder PDD
  12. 12. 04/09/16 JStar 12 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.
  13. 13. 04/09/16 JStar 13 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.
  14. 14. 04/09/16 JStar 14 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
  15. 15. 04/09/16 JStar 15 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
  16. 16. 04/09/16 JStar 16 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
  17. 17. 04/09/16 JStar 17 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
  18. 18. 04/09/16 JStar 18 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)
  19. 19. 04/09/16 JStar 19 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
  20. 20. 04/09/16 JStar 20 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
  21. 21. 04/09/16 JStar 21 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.
  22. 22. 04/09/16 JStar 22 Pervasive Developmental Disorders
  23. 23. 04/09/16 JStar 23 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
  24. 24. 04/09/16 JStar 24 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
  25. 25. 04/09/16 JStar 25 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
  26. 26. 04/09/16 JStar 26 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
  27. 27. 04/09/16 JStar 27 Disruptive Disorders in Children
  28. 28. 04/09/16 JStar 28 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
  29. 29. 04/09/16 JStar 29 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
  30. 30. 04/09/16 JStar 30 Oppositional Defiant Disorder http://www.hsc.wvu.edu/aap/aap-car/videos.htm
  31. 31. 04/09/16 JStar 31 Conduct Disorder (CD)  Aggression toward people or animals  Deceitfulness or Theft  Destruction of property  Serious violation of rules
  32. 32. 04/09/16 JStar 32 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
  33. 33. 04/09/16 JStar 33 Conduct Disorder “You left your D__M care in the driveway again!”
  34. 34. 04/09/16 JStar 34 Conduct Disorder http://www.hsc.wvu.edu/aap/aap-car/videos.htm
  35. 35. 04/09/16 JStar 35
  36. 36. 04/09/16 JStar 36 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)
  37. 37. 04/09/16 JStar 37 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
  38. 38. 04/09/16 JStar 38 Movement Disorders http://www.wemove.org/ts_ssv1.0.html
  39. 39. 04/09/16 JStar 39 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
  40. 40. 04/09/16 JStar 40 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
  41. 41. 04/09/16 JStar 41 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)
  42. 42. 04/09/16 JStar 42 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
  43. 43. 04/09/16 JStar 43 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
  44. 44. 04/09/16 JStar 44 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
  45. 45. 04/09/16 JStar 45 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
  46. 46. 04/09/16 JStar 46 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
  47. 47. 04/09/16 JStar 47 Encopresis Encopresis  High association between encopresis and enuresis  Medical therapy, behavioral modification and counseling results in the greatest success in the treatment of encopresis
  48. 48. 04/09/16 JStar 48 Our Time is up!
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Childhood psychiatry disorders

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