DISORDERS USUALLY FIRST DIAGNOSED IN INFANCY,CHILDHOOD, OR ADOLESCENCE.

DISORDERS USUALLY FIRST DIAGNOSED IN

INFANCY,CHILDHOOD, OR ADOLESCENCE

Important Facts• Category of convenience

– – no intent of clear distinction between “adult’/“childhood” disorders

• Primarily diagnosed in regard to age – not phenomenology

• Usually identified by others• Children regarded as more malleable

than adults – thus more amenable to treatment

• Differential Diagnosis – diagnosis which nearly fits symptoms but

must be ruled out

• Necessary information = Knowledge of normal life-span development

Making a Diagnosis: 7 Steps• Observation of diagnostic clues

– Focus on behavior, cognitive ability, verbal responses, etc.

• Screen the problem– Consider symptoms/behaviors indicating or excluding a

specific diagnosis

• Follow-up of preliminary impressions– Testing or ruling out “your” diagnostic assumptions

• Confirmatory history– Gather pertinent information

• Complete data base – Specific info relevant to diagnosis under consideration

• Diagnosis– All information, including DD

• Prognosis– Consider individual’s response to & motivation for

treatment

Clinical Info Necessary for Diagnosis of Disorders First Evidenced in Children &

Adolescents• Times of developmental

milestones• Capacity to

communicate with other people

• Language impairment• Capacity for human

relationships• Quality of social

interaction

• Abnormal motor movements

• Hyperactivity, inattention, or poor impulse

• Abnormal behaviors (e.g., fire setting, cruelty to animals)

• Enuresis or encopresis

Understanding Normal Life-span Development

Allows identification of appropriate behaviors at appropriate stages

Childhood problems not to be viewed as downward

extension of adult issues

Possible to diagnose children with some “adult” disorders as major depression or PTSD if adult criteria met

Subcategories of Diagnoses

• Mental Retardation• Learning Disorders• Motor Skills

Disorders• Communication

Disorders• Pervasive

Developmental Disorders

• Attention-Deficit& Disruptive Behavior Disorders

• Feeding & Eating Disorders of Infancy & Childhood

• Tic Disorders• Elimination Disorders• Other Disorders –

contains 5 diverse disorders

Predominant Symptoms or Deficits

• Intellectual & cognitive impairment

• Motor function impairment

• Disruptive or self-injurious behavior

• Information exchange

All MR & All LD

Motor Skills, Tic, & Stereotypic Movement Disorders

ADD & Disruptive Behavior, Feeding & Eating, Elimination, Separation Anxiety, Reactive Attachment Disorders

Pervasive Developmental, Communication Disorders, & Selective Mutism

MENTAL RETARDATION (Axis II)

• Significantly subaverage intellectual functioning• Based on test scores & adaptive behavior• Check present adaptive functioning in various

areas – communication, self-care, academics, social etc

• Cultural/ethnic considerations• Onset before 18 years of age• Criteria met for MR, diagnosis given regardless of

presence of another disorder• Differentiate Mild MR from borderline intellectual

functioning – careful consideration of all available information

Some MR Interventions

• Head Start Programs – may help prevent Mild MR

• Applied behavior analysis (operant conditioning)– adaptive skills, communication, self-help,

social & vocational• Cognitive behavior therapy

– self-instructional training as in “Little Bear” pictures

• Computer-assisted instruction – maintain attention, material

individualized, repetitions helpful without boredom or loss of patience

Learning Disorders (Academic Skills Disorders)

• Academic functioning– below expected for chronological age,

measured IQ, & age-appropriate education

• Reading Disorder • Mathematics Disorder• Disorder of Written Expression• Learning Disorder NOS

– criteria for any specific LD not met

A Motor Skills Disorder

• Developmental Coordination Disorder• Not due to general medical condition• Substantial impairments in motor coordination

– Significantly interfering with academic achievement or daily activities

– Marked delays in normal milestones as sitting, crawling, walking

– Or clumsiness, poor performance in sports or poor handwriting

Tic Disorders – Motor Function Disorders

• Tourette’s Disorder– Multiple motor tics & 1 or more vocal tics– Occur many times a day, nearly every day or

intermittently for more than 1 year

• Chronic Motor or Vocal Tic Disorder• Transient Tic Disorder• Tic Disorder NOSAnother Motor Function Disorder in the “Other”

category– Stereotypic Movement Disorder

Disruptive & Self-Injurious Behavior Disorders

• Behaviors socially unacceptable or potentially harmful

• Include:– Hyperactive, impulsive, inattentive,

oppositional, defiant, impulsive, & disruptive behavior

– Also abnormalities of eating & elimination

Attention-Deficit Disorders

• Criteria with code based on type– Attention-Deficit/Hyperactivity Disorder,

Combined Type– Attention-Deficit/Hyperactivity Disorder,

Predominately Inattentive Type– Attention-Deficit/Hyperactivity Disorder,

Predominately Hyperactive-impulsive Type– Attention-Deficit/Hyperactivity Disorder NOS

Disruptive Behavior Disorders (also NOS)

• Conduct Disorder– Violation of basic

rights of others or– Major age-appropriate

societal norms abused

• Manifested through– Aggression to people

& animals– Destruction of property– Deceitfulness or theft– Seriousness violations

of rules

• Oppositional Defiant Disorder– Persistent patterns of

negativistic, hostile, & defiant behaviors

• Behaviors include– Temper loss, arguments

with adults, defies to obey rules, deliberate annoying, blames others, easily annoyed by other, often angry & resentful, spiteful or vindictive

Feeding and Eating DisordersDiagnosable at Point Where Health Endangered

• Disturbances of eating – eating nonnutritive substances

– repeated regurgitation of food– failure or refusal to eat

• Pica – repeatedly eating nonnutritive substances

• Rumination Disorder – regurgitate & rechew

• Feeding Disorder – failure to gain wt. Or loss of significant wt. over period of 1 mo. Due to not eating adequately (onset before 6)

Elimination Disorders

• Encopresis – passing feces into inappropriate places– Must be at least 4 yrs. old

• Enuresis – repeated urination into beds or clothes– Criterion regulated

occurrence

– Or clinically significant distress/impairment is produced

– Must be at least 5 yrs. old

Pervasive Developmental DisordersAutism, Rett’s, Childhood Disintegrative Disorder,

Asperger’s, & Pervasive Developmental NOS

Common elements:• Broad based impairment or loss of

functions expected at that age• Three components covered: 

– social interactions– communication– patterns of behavior, interests, activities

• Patterns which may surface include:– restricted, repetitive, stereotypic

Autism

• Named "early infantile autism" from observations of an extreme autistic aloneness that, whenever possible, disregards, ignores, shuts out anything that comes to the child from the outside

• Prior to age three• Abnormal functioning in at least one area:

– social interaction– language by social communication– symbolic/imaginative play

Autism Treatment

• Most successful technique is in intense behaviorally oriented programs.  

• -Goals to work with are: social skills, breaking down tasks, eliminating maladaptive behaviors; medication. 

• -Try to relieve symptoms and improve communication, social skills, and adaptive behavior

• -Modeling and operant conditioning• Drug treatment

– most common medication is haloperidol,

Rett's Disorder (females only)

• Normal functioning at birth & through first 5 months of life– between ages 5 months - 48 months -

decelerated (decreased) head growth occurs– loss of previously acquired hand movement.– loss of social skills– difficult gait/movement

• Usually medical intervention

Childhood Disintegrative Disorder

• Rare

• Development normal first 2 years of life (distinguishing feature from autism)

• A loss of ability (in autism abilities never developed) 

• Often symptoms first noticed by parents

Asperger’s Disorder

• Lack of interest in social action• Severe & sustained impairment in social

interactions• Different from autism because no significant delay

in language & communication• Some idiosyncratic features similar to autism;

repetitive patterns of behavior, interests and activities

Pervasive Developmental Disorder Not Otherwise Specified (NOS)

• Severe & pervasive impairments in– Reciprocal social interactions– Communications skills

• Or stereotypical behavior, interests, or activities

• Criteria for Pervasive Development Disorder not met

Communication Disorderscheck if acquired or developmental

• Expressive Language Disorder

• Mixed Receptive-Expressive Language Disorder

• Phonological Disorder

• Stuttering• Communication

Disorder NOS

Other Subcategory – 5 Diverse Disorders

• Stereotypic Movement Disorder -- repetitive, seemingly driven nonfunctional motor behavior

• Separation Anxiety Disorder -- Inappropriate or excessive anxiety about separation from home or person of attachment– Onset before 18 years of age

• Reactive Attachment Disorder of Infancy or Early Childhood --Excessively inhibited, hypervigilant, ambivalent & contradictory responses to most social interactions– Or diffuse indiscriminate attachments to other people– Associated with pathogenic care

• Selective Mutism – consistent failure to speak in speific social situations yet speaking in others

• Disorder of Infancy, Childhood, or Adolescence NOS – residual category where criteria for no specific disorder is met