Childhood Psychiatric disorders

CHILDHOOD DISORDERS

Disorders usually First Diagnosed in Infancy,

Childhood or Adolescence

Types

• Mental Retardation• Learning Disorders• Motor Skills Disorders• Pervasive Developmental Disorders• Attention Deficit Hyperactive Disorders• Feeding and Eating disorders of infancy or

early childhood• Tic disorders• Elimination Disorders• Other Disorders

Mental RetardationSub average general intellectual

functioning that is accompanied by significant limitations in adaptive functioning in at least two of the following skills areas,

Communication, self care, home living, social-interpersonal skills, etc

DefinitionDefinition:

Mental Retardation refers to significantly sub-average general intellectual functioning, resulting in or associated with, concurrent impairments in adaptive behavior and manifested during the developmental period.

Levels of MR

1. Mild Mental Retardation2. Moderate Mental Retardation3. Severe Mental Retardation4. Profound Mental Retardation

Mild levelThey can called as Educable

Mentally Retarded (EMR)IQ range – 55 to 80Capable of learning basic academic

skills of reading, writing and arithmatic.

Most children can learn vocational skills.

Moderate levelThey called as Trainable Mentally

Retarded (TMR) IQ range – 35- to 60They were usually not admitted in public

schools. They can go to special schools.They need supervisory help. Special teaching and training on basic

skills needed for day to day life.

Severe and profound levelSevere level IQ – 20 to 35Profound level IQ – below 20These children usually referred

below the TMR level as custodialUsually they remained at home or

under some residential facilities

MR

Learning DisordersReading Disorder: (Dyslexia)Mathematical Disorder: (Dyscalculia)Writing Disorder: (Dysgraphia)

Motor Skills Disorders• Developmental Coordination disorder• Impairment in the development of

motor coordination• Not due to general medical condition

(Cerebral Palsy, Muscular Dystrophy)• Marked delays in achieving motor

milestones (Walking, crawling, sitting), dropping things, clumsiness, poor performance in sports.

Communication disorders

Expressive Language Disorder

The difficulties with expressive language interfere with academic or occupational achievement or with social communication

Phonological DisorderFailure to use developmentally

expected speech soundsthat are appropriate for the individuals age and dialect

Errors in sound production, substitutions of one sound for another (Use T for K), omissions of sounds

Stuttering• Disturbance in the normal fluency and time

patterning of speech that is inappropriate for the individual’s age.

• Frequent repetitions/ prolongations of sounds or syllables

• Interjections• Broken words (pauses within a word)• Audible/silent blocking• Circumlocutions(word substitutions to avoid

problematic words)• Words produced with an excess of physical

tension• Monosyllabic whole word repetitions (I-I-I-I- see

him)

Pervasive Developmental Disorders

• Impairment in several areas of development

• Reciprocal social interaction skills• Communication skills• Presence of stereotyped

behavior/interests/activities• The qualitative impairments that

defines these conditions are distintly deviant relative to the individual’s developmental level or mental age

Types of PDD1. Autistic Disorder2. Rett’s Disorder3. Childhood Disintegrative4. Asperger’s Disorder

Autistic Disorder• Onset prior to age 3 years• More frequent in males/boys• Average or above average intelligence with

uneven cognitive skills

Symptoms• Qualitative impairment in social

interaction• Qualitative impairments in

communication• Restricted repetitive and

stereotyped pattern of behaviours, interests and activities

Causes• Genetic• Prenatal environment• Perinatal environment• Postnatal environment

Mirror writing

Rett’s Syndrome• Rett syndrome is a rare genetic

neurological and developmental disorder that affects the way the brain develops, causing a progressive inability to use muscles for eye and body movements and speech. It occurs almost exclusively in girls.

• Discovered in the first two years of life• Is a genetic disorder. Mutation in a

particular gene on the X chromosome.

Symptoms• A slowing of head growth is one of the

first events in Rett syndrome• Problems with muscles and coordination• The child loses any purposeful use of

her hands• stops talking and develops

extreme social anxiety and withdrawal or disinterest in other people.

Rett’s Syndrome

Childhood Disintegrative• Childhood disintegrative disorder is also

known as Heller's syndrome. It's a very rare condition in which children develop normally until at least two years of age, but then demonstrate a severe loss of social, communication and other skills.

• Childhood disintegrative disorder is part of a larger category called autism spectrum disorder. 

• Develop normally through age 3 or 4

Childhood DisintegrativeA child who is affected loses:• Communication skills• Nonverbal behaviors• Skills they had already learned

Symptoms• Delay or lack of spoken language• Impairment in nonverbal behaviors• Inability to start or maintain a conversation• Lack of play• Loss of bowel and bladder control• Loss of language or communication skills• Loss of motor skills• Loss of social skills• Problems forming relationships with other

children and family members

Asperger’s Disorder• Children with Asperger's syndrome typically

function better than do those with autism• Children with Asperger's syndrome generally

have normal intelligence and near-normal language development

• They may develop problems communicating as they get older.

• Asperger's syndrome was named for the Austrian doctor, Hans Asperger, who first described the disorder in 1944.

Symptoms• Problems with social skills• Eccentric or repetitive behaviors• Unusual preoccupations or rituals – Ex: getting dressed

in a specific order• Communication difficulties• Limited range of interests• Coordination problems• Skilled or talented

Asperger’s Syndrome

Attention Deficit Hyperactive Disorder (ADHD)

Case studyLisa's son Jack had always been a handful. Even as a preschooler, he would tear through the house like a tornado, shouting, roughhousing, and climbing the furniture. No toy or activity ever held his interest for more than a few minutes and he would often dart off without warning, seemingly unaware of the dangers of a busy street or a crowded mall.It was exhausting to parent Jack, but Lisa hadn't been too concerned back then. Boys will be boys, she figured. But at age 8, he was no easier to handle. It was a struggle to get Jack to settle down long enough to complete even the simplest tasks, from chores to homework. When his teacher's comments about his inattention and disruptive behavior in class became too frequent to ignore.

ADHD• ADHD is a common behavioral

disorder that affects about 10% of school-age children.

• Boys are about three times more likely than girls to be diagnosed with it, though it's not yet understood why.

ADHD• Of course, all kids (especially

younger ones) act this way at times, particularly when they're anxious or excited.

• But the difference with ADHD is that symptoms are present over a longer period of time and happen in different settings. 

What is ADHD?• ADHD is a neuro developmental disorder

affecting both children and adults. • It is described as a “persistent” or on-going

pattern of inattention and/or hyperactivity-impulsivity that gets in the way of daily life or typical development. Individuals with ADHD may also have difficulties with maintaining attention, executive function (or the brain’s ability to begin an activity, organize itself and manage tasks) and working memory.

ADHD-Subtypes• ADHD broken down into three

subtypes, each with its own pattern of behaviors,

1. an inattentive type2. a hyperactive-impulsive type3. a combined type

an inattentive type• trouble paying attention to details or a tendency

to make careless errors in schoolwork or other activities

• difficulty staying focused on tasks or play activities

• apparent listening problems• difficulty following instructions• problems with organization• avoidance or dislike of tasks that require mental

effort• tendency to lose things like toys, notebooks, or

homework• distractibility• forgetfulness in daily activities

a hyperactive-impulsive type• fidgeting or squirming• difficulty remaining seated• excessive running or climbing• difficulty playing quietly• always seeming to be "on the go"• excessive talking• blurting out answers before hearing the full

question• difficulty waiting for a turn or in line• problems with interrupting or intruding

a combined type• a combination of the other two

type, is the most common

Treating ADHD• ADHD can't be cured, but it can be

successfully managed.• ADHD is best treated with a

combination of medicine and behavior therapy.

• It's important for parents to actively participate in their child's treatment plan, parent education is also an important part of ADHD management.

Feeding and Eating Disorders of Infancy or Early Childhood

Feeding and Eating Disorders of Infancy or Early Childhood

• If a child loses a lot of weight suddenly or is small for their age and doesn't seem to growing normally, it may be a sign that a feeding or eating disorder is present.

• When malnutrition is not caused by a medical problem, it is referred to as a feeding disorder of infancy or early childhood.

Types • Pica  • Rumination Disorder• Feeding Disorder Of Early Childhood

Pica• Pica is a disorder that occurs when children

persistently eat one or more non-food substances over the course of at least one month.

• Pica may result in serious medical problems, such as intestinal blockage, poisoning, parasitic infection, and sometimes death.

• Younger children with Pica frequently eat paint, plaster, string, hair, or cloth.

• older children with Pica tend to eat animal droppings, sand, insects, leaves, or pebbles. 

• Adolescents affected by the disorder often consume clay or soil substances.

Rumination Disorder • Children with Rumination Disorder repeatedly

regurgitate and spit out or re-chew their food following eating. 

• This disorder usually develops in infants or young children. It must last for at least one month before the diagnosis can be made. Children with Rumination Disorder do not show nausea, retching, or disgust associated with their rumination behavior, and do not have associated gastrointestinal problems that can account for the behavior. 

Feeding Disorder Of Early Childhood

• A Feeding Disorder of Early Childhood is diagnosed when a child does not eat adequately and maintain proper nutrition. This disorder, sometimes referred to as "Failure to Thrive" leads to weight loss or to difficulties maintaining normal weight. 

Tic disorders• The body moves repeatedly, quickly, suddenly and

uncontrollably• Any parts of the body- face, shoulders, hands or legs• Involuntary, sudden, recurrent, stereotyped motor

movements or vocalizations that are rapid and not rhythmic.

• It is irresistable• Begin in childhood• Ex for Motor Tics: eye blinking, nose twitching, tooth

clicking, sticking out the tongue, hand clapping• Ex for Vocal Tics: grunting, sniffing, barking, throat

clearing

Diagnostic Criteria• The presence of one or mote tics either motor or vocal –

but not both• The tics occur many times a day, either daily or

intermittently, during a period of more than a year and without any tic free period of 3 or more consecutive months.

• The tics cause marked distress or significant impairment in one or more important areas of functioning, such as social or occupational

• The symptoms began before age 18 • The tics are not due to the direct effects of some

chemical substances or some general medical condition• The person has never met the criteria for Tourette’s

Disorder

Tourette’s Syndrome• Is one type of tic disorder• Begins as early as age 2• Cause significant social and

functional difficulties for children• More in boys than girls

Diagnostic Criteria• Both multiple motor and one or more vocal tics have

been identified at sometime during the disorder, although it is not necessary for them to occur in the same period.

• The tics occur many times a day and nearly everyday or they occur intermittently, for a period of more than a year and without any tic free period of 3 or more consecutive months.

• The tics cause marked distress or significant impairment in one or more important areas of functioning, such as social or occupational

• The symptoms began before age 18 • The tics are not due to the direct effects of some

chemical substances or some general medical condition.

Elimination Disorders• 2 types– Non-organic Enuresis– Non-organic Encopresis

Non-organic Enuresis• Enuresis is repetitive voiding of urine,

either during the day or night, at inappropriate places.

• Enuresis is diagnosed only after 5 years of age

• Enuresis can be either of:– Primary type, where bladder control has

never been achieved or– Secondary type, where enuresis emerges

after a period of bladder control.

Non-organic Encopresis• Encopresis is repetitive passage of faeces at

inappropriate time and/or place, after bowel control is physiologically possible. It is not due to the presence of any organic cause, which is called as faecal incontinence.

• Encopresis can be either of:– Primary type, where toilet training has never

been achieved or– Secondary type, where encopresis emerges

after a period of faecal continence.

Other Disorders• Oppositional Defiant Disorder• Conduct Disorder• Separation Anxiety Disorder• Childhood Schizophrenia• PTSD in Childhood• OCD in Childhood• Depression in Childhood• Elective (Selective) Mutism• Habit Disorder

Oppositional Defiant Disorder• Child/adolescent behave in

negativistic, defiant, disobedient and hostile ways towards authority figures

• If this behavior is severe enough to interfere with the child’s functioning and relationship with others then the child may be ODD

Diagnostic Criteria• A pattern that includes negativistic, defiant, disobedient and hostile

behavior that lasts at least 6 months and includes the frequent occurrence of at least 4 of the following behaviors during that period (more frequently

• lose temper• Argues with adults• Actively defies or refuses to comply with adults’ rules or requests• Deliberately annoys others• Blames others for own mistakes or misbehaviors• Is easily annoyed by others, touchy• Is angry and resentful• Is spiteful or vindictive

• These behavior cause clinically significant impairment in social, academic or work related functioning

• These behavior do not occur exclusively as part of a psychotic disorder or mood disorder

• Criteria are not met for conduct disorder or if 18 years or older for antisocial personality disorder.

Conduct Disorder• Is often more serious in their consequences

than ODD because of the violation of important societal norms and disregard of the rights of others

• Persistent behavior – include aggressive actions that cause or threaten harm to people or animals

• Non aggressive conduct that causes property damage, major deceitfulness or theft and

• Serious rule violations.

Diagnostic Criteria• Three or more of these behavioural criteria must have been present in

the last 12 months and at least one in the past 6 months• Aggression – toward people – bullying, intimidation, use of weapons,

physical cruelty, forced sexual activity, mugging, purse snatching and aggression toward animal.

• Destruction of property including fire setting, and other deliberate property destruction

• Deceitfulness or theft including breaking into a building or a car, conning others to obtain goods, stealing items of value

• Serious rule violation including staying out at night without parents’ permission before age 13, running away from home, school truancy before 13

• These behavior do not occur exclusively as part of a psychotic disorder or mood disorder

• Criteria are not met for conduct disorder or if 18 years or older for antisocial personality disorder.

Separation Anxiety Disorder• Separation anxiety is normal in very young

children (those between 8 and 14 months old). Kids often go through a phase when they are "clingy" and afraid of unfamiliar people and places. When this fear occurs in a child over age 6 years, is excessive, and lasts longer than four weeks, the child may have separation anxiety disorder.

• Separation anxiety disorder is a condition in which a child becomes fearful and nervous when away from home or separated from a loved one -- usually a parent or other caregiver -- to whom the child is attached. 

Separation Anxiety Disorder• Following are some of the most common symptoms of separation

anxiety disorder:• An unrealistic and lasting worry that something bad will happen to the

parent or caregiver if the child leaves• An unrealistic and lasting worry that something bad will happen to the

child if he or she leaves the caregiver• Refusal to go to school in order to stay with the caregiver• Refusal to go to sleep without the caregiver being nearby or to

sleep away from home• Fear of being alone• Nightmares about being separated• Bed wetting• Complaints of physical symptoms, such as headaches and

stomachaches, on school days• Repeated temper tantrums or pleading

Childhood Schizophrenia• Childhood schizophrenia is a severe brain disorder in which

children interpret reality abnormally.• Signs and symptoms may vary, but they reflect an impaired

ability to function.• It occurs early in life and has a profound impact on a child's

behavior and development. And it requires lifelong treatment.• The earliest indications of childhood schizophrenia may

include developmental problems, such as:– Language delays– Late or unusual crawling– Late walking– Other abnormal motor behaviors — for example, rocking or arm

flapping

PTSD in Childhood• Children and teens could have PTSD if they have lived through

an event that could have caused them or someone else to be killed or badly hurt. Such events include sexual or physical abuse or other violent crimes. Disasters such as floods, school shootings, car crashes, or fires might also cause PTSD. Other events that can cause PTSD are war, a friend's suicide, or seeing violence in the area they live.

• Posttraumatic stress disorder, or PTSD, is diagnosed after a person experiences symptoms for at least one month following a traumatic event. The disorder is characterized by three main types of symptoms:– Re-experiencing the trauma through intrusive distressing recollections of

the event, flashbacks, and nightmares.– Avoidance of places, people, and activities that are reminders of the

trauma, and emotional numbness.– Increased arousal such as difficulty sleeping and concentrating, feeling

jumpy, and being easily irritated and angered.

PTSD in Childhood• Diagnosis criteria that apply specifically to

children younger than age six include the following:  

Exposure to actual or threatened death, serious injury, or sexual violation:– direct experience – witnessing the events as they occurred to others,

especially primary caregivers (Note: Does not include events witnessed only in electronic media, television, movies, or pictures.)

– learning that the traumatic events occurred to a parent or care giving figure

OCD in Childhood• Symptoms of childhood-onset OCD vary widely from child to child.

Some common obsessions experienced by children and adolescents with OCD include:– exaggerated fears of contamination from contact with certain

people, or everyday items such as clothing, shoes, or schoolbooks

– excessive doubts that he/she has not locked the door, shut the window, turned off the lights, or turned off the stove or other household appliance

– marked over-concern with the appearance of homework assignments

– excessive worry about symettrical arrangement of everyday objects such as shoelaces, school books, clothes, or food

– fears of accidentally harming a parent, sibling or friend– superstitious fears that something bad will happen if a

seemingly unconnected behavior is done (or not done)

OCD in Childhood• Some common compulsions experienced by

children and adolescents with OCD include:– Compulsive washing, bathing, or showering– Ritualized behaviors in which the child needs to touch body

parts or perform bodily movements in a specific order or symmetrical fashion

– Specific, repeated bedtime rituals that interfere with normal sleep

– Compulsive repeating of certain words or prayers to ensure that bad things don’t occur

– Compulsive reassurance-seeking from parents or teachers about not having caused harm

– Avoidance of situations in which they think “something bad” might occur

Depression in Childhood• If the Child’s sadness becomes

persistent, or if disruptive behavior that interferes with normal social activities, interests, schoolwork, or family life develops, it may indicate that he or she has a depressive illness. 

Depression in Childhood• The signs and symptoms of childhood depression include:• Changes in appetite -- either increased appetite or decreased• Changes in sleep -- sleeplessness or excessive sleep• Continuous feelings of sadness or hopelessness• Difficulty concentrating• Fatigue and low energy• Feelings of worthlessness or guilt• Impaired thinking or concentration• Increased sensitivity to rejection• Irritability or anger• Physical complaints (such as stomachaches or headaches that do not respond to

treatment• Reduced ability to function during events and activities at home or with friends,

in school or during extracurricular activities, or when involved with hobbies or other interests

• Social withdrawal• Thoughts of death or suicide• Vocal outbursts or crying

Elective (Selective) Mutism• Characterized by a marked, emotionally

determined selectivity in speaking, such that the child demonstrates a language competence in some situations but fails to speak in other (definable) situations. The disorder is usually associated with marked personality features involving social anxiety, withdrawal, sensitivity, or resistance.

Habit Disorder• Habit disorder is the term used to describe

several related disorders linked by the presence of repetitive and relatively stable behaviors that seem to occur beyond the awareness of the person performing the behavior. As with other disorders, these behaviors cause impairment and result in negative physical and/or social consequences.

• Habit disorders includes thumb sucking, nail biting, hair pulling 

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