CHAPTER 21: BEHAVIORAL AND PSYCHIATRIC

DISORDERS IN CHILDREN WITH DISABILITIES

Pages 297-311

Presented By Sonya Felmly

OBJECTIVES

After this presentation you will be able to….

1. Describe different psychiatric and behavioral disorders

2. Match treatment with the correct disorder

WHY?

Dual Diagnosis is a term applied to the co-existence of the symptoms of both intellectual or developmental disabilities and mental health problems

Causes: Stress- in social situations

These negative social conditions include social rejection, stigmatization, and the lack of acceptance in general.

Lack of communication skills Heredity Limited coping skills unknown

STATISTICS

Wright, Rutter, Graham, and Yule found emotional disturbances in 7%-10% of children who do not have any disabilities.

They also found 30%-42% of children with intellectual disabilities had psychiatric disorders

Gillberg found 57% of children and adolescents with mild intellectual disabilities and 64% with severe intellectual disabilities met the criteria for psychiatric disorders.

OPPOSITIONAL DEFIANT DISORDER

Children must exhibit negative, hostile, and defiant behaviors for at least six months.

Children must have at least four of the eight symptoms.

1. Often loses temper

2. Often argues with adult

3. Often breaks rules or fails to comply with adult requests

4. Deliberately annoys people

5. Blames others for one’s mistakes

6. Is touchy or easily annoyed

7. Is angry and resentful

8. Is spiteful and vindictive

Most diagnosis are usually given to preadolescent children.

CONDUCT DISORDER

To be diagnosis with conduct disorder the child must exhibit behaviors in which peoples rights are violated, norms are ignored, and rules are broken for at least 12 months.

Four main problem areas include1. Aggression towards people and animals2. Destruction of property3. Deceitfulness or theft4. Serious violation of rules

TREATMENT FOR ODD AND CD

Same behavior management techniques that are used for children with ADHD.

Medication Behavioral Therapy

Includes setting consistent limits, behavioral expectations, and consequences for violating the limits

Expectations must be the same at home and school

Positive Reward System Prize box at the end of the week Tokens to buy time at the computer or in front of

the TV

IMPULSE CONTROL DISORDERS

Explosive Disorder Diagnosis after the child demonstrates several

episodes of failing to resist aggression Example: A child wants to go outside instead of eating

their dinner. The child's parent tells them they can go outside after dinner. The child throws their food across the room, throws their chair, and hits their baby brother.

Treatment Beta blockers such as propranolol, and certain

antiepileptic/mood stabilizers.

IMPULSE CONTROL DISORDERS

Trichotillomania Child pulls out their hair and sometimes eats it There is a sense of relief when the child pulls out

their hair. Eating hair can be very dangerous and might

require surgery to get it out of the body

Treatment Medicine Cognitive- Behavior Therapy

GENERALIZED ANXIETY DISORDER

Children have at least six months of anxiety and worry about situations.

Situations include school, play, sports, friends, and family

Other symptoms can include.. Being keyed up, being easily fatigued, having

problems concentration, and experiencing irritability, muscle tension, and disturbed sleep.

Treatment Cognitive-Behavioral Therapy

To reduce worry Medication

PANIC DISORDER

Panic Attacks usually do not begin until puberty

Panic Attacks include at least four of these symptoms

1. Rapid or racing heartbeat2. Sweating, trembling, or shaking3. Feeling short of breath or as it smothering4. Feeling as if choking5. Chest pain or discomfort6. Nausea or abdominal distress7. Feeling dizzy, lightheaded, or faint8. Feeling of unreality or detachment9. Fear of losing control or going crazy10. Fear of dying11. Numbness and tingling12. Hot flashes or chills

PANIC DISORDER

Treatment- High-potency benzodiazepines such as alprazolam (Xanax) and clonazepam (Klonopin) Cognitive- behavioral therapy

Develop a list of things that triggers panic attacks Patients work through the list (facing the different issues)

SOCIAL PHOBIA

A fear of doing something embarrassing in front of others including strangers.

In order to be diagnosed with social phobia the child has appropriate relationships with family and friends but is afraid of other peers and adults.

The child might cry, have a tantrum, freeze or shrink from situations with unfamiliar people.

Symptoms must last for more than 6 months. Treatment-

Cognitive-behavioral therapy Reduce anxiety in social settings

Speech classes/acting classes

OBSESSIVE-COMPULSIVE DISORDER

A child with OCD has obsessions, compulsions, or both.

Obsessions are reoccurring thoughts, images, or impulses that cause anxiety.

Compulsions are repetitive behaviors or mental acts that are done to neutralize and obsession. Hand washing, counting, arranging,

tapping, touching, and hoarding To be diagnosed with OCD the obsessions

and compulsions must occupy more than one hour per day and interfere with everyday functioning.

OBSESSIVE-COMPULSIVE DISORDER

Treatment Cognitive-behavioral Therapy Exposure and Response Prevention

Example- A child with a fear of germs would be asked to touch a doorknob and then they are not permitted to wash their hands.

Medications Zoloft, Prozac, Luvox

POSTTRAUMATIC STRESS DISORDER

Anxiety disorder that happens after a traumatic event in which a person witnesses a death, serious injury, or threat.

Children with a developmental disability might occur after physical abuse or after the injury that caused the disability.

Children with intellectual disorders are more prone to PTSD because they have limited coping skills.

To be diagnosed with PTSD the child must demonstrate symptoms for at least one month and symptoms must interfere with daily life functioning.

POSTTRAUMATIC STRESS DISORDER

Symptoms-Reexperiencing the trauma

-Dreams, flashbacksAvoidance and numbing

-avoids thoughts, feelings, people, places -unable to recall important aspects of the event -decreased interest or participation in activities Increased arousal -difficulty sleeping -angry outburst -difficulty concentrating

Treatment psychotherapy and play therapy -patients must talk through thoughts and

events that remind them of the trauma

MAJOR DEPRESSION

Children with major depression exhibit a 2 week period with at least five of the following symptoms

1. Depressed mood by subjective report or as observed by others

2. Decreased interest or pleasure in most activities

3. Significant change in weight or appetite

4. Insomnia or hypersomnia

5. Psychomotor agitation or retardation

6. Fatigue or loss of energy

7. Feelings of worthlessness or guilt

8. Decreased concentration or indecisiveness

9. Recurrent thoughts of death and dying

Treatment Medicine Psychotherapy

BIPOLAR DISORDER Consists of changes between depression and mania

or both together A manic episode consists of a period of abnormally

and persistently elevated, expansive, or irritable mood lasting at least 1 week.

Mood disturbance must have at least three of the following if happy and four if irritable. 1. Inflated self-esteem 2. Decreased need for sleep3. More talkative 4. Flight of ideas 5. Distractibility6. Increased goal directed activity or psychomotor agitation7. excessive involvement in pleasurable activities that

have high potential for painful consequences

BIPOLAR DISORDER

Treatment Mood stabilizers Antipsychotic medications

Risperdal, Abilify, Zyprexia, Seroquel, Geodon Children with bipolar must have consistent

bedtimes and routines so the lack of sleep does not participate to manic or a mixed episode.

PSYCHOTIC DISORDERS Schizophrenia

Two or more of the following symptoms for at least a one month period

1. Delusions (someone is following you)2. Hallucinations (hearing voices when no one is talking)3. Disorganized speech and grossly disorganized or catatonic

behavior

Treatment -antipsychotic medication

**Youtube the 20/20 on children with schizophrenia

EATING DISORDERS

Rumination Repeatedly regurgitate without nausea or

gastrointestinal illness for at least 1 month Self-stimulatory behavior for children with

intellectual disabilities

Binge Eating Large amounts of food during a short period of

time Do not use purging Risk for choking, and death Obesity

MALADAPTIVE BEHAVIOR DISORDERS

Self-Stimulating Behavior Biting their hands, banging their heads, picking

at their skin, poking their eyes, and hitting themselves with their fist.

May do this once or twice a day or several hundred times an hour

Tissue destruction, infection, internal injury, loss of vision , and even death

Occur in fewer than 5% of people with disabilities

TREATMENT

Educational Interventions -self-contained classroom -one on one support -therapy sessions with the school counselor and

a behavioral psychologist Rehabilitation Therapy

- language impairments contribute to behavior problems

- teaching functional communication skills - speech-language therapy and other

communication systems (PECS) -Physical and Occupational Therapy

-motor function

TREATMENT

Psychotherapy - Table 21.2 on page 306 - The table shows the different types

psychotherapy and uses in different disorders -Goals of therapy are to relieve symptoms and

help the child to understand the nature of his or her disability. -Including feelings to recognize their strengths.

- social skills - peer pressure, rejection, stigmatization, and

exploitation Behavior Therapy (most widely researched

psychotherapeutic intervention for children and adolescents with disabilities.

TREATMENT

Pharmacotherapy -use of medicine - table 21.3 on page 308 gives all of the different

medicines and which psychiatric disorder it treats

Antidepressants Treat major depression and anxiety disorders

(OCD, generalized anxiety disorder, separation anxiety)

Antihypertensive - beta blockers - explosive and aggressive behavior, tourette

syndrome, ADHD

TREATMENT

Benzodiazepines -reduces anxiety - children with developmental disabilities may

become agitated rather than clam and sleepy -can not be used over a longer period of time

Mood Stabilizers -Treat bipolar disorder and aggressive behaviors

Stimulants and Atomxetine - Treats ADHD and ASD - side effects include loss of appetite, insomnia, tics,

headache, and gastrointestinal side effects - controls hyperactive/impulsive symptoms

PHYSICAL EDUCATION

Modify Rules of the game so students are very successful

Modify Equipment Soft Can not eat

Consistency Routines are the same Kids know what to expect!

SUMMARY

Children with developmental disabilities are more likely to develop psychiatric and behavioral disorders.

Psychiatric and behavioral disorders can interfere with the child’s daily living if it goes untreated.

Behavioral disorders include oppositional defiant, conduct , intermittent explosive, and trichotillomania.

Anxiety disorders include panic disorder, social phobia, obsessive-compulsive disorder, and posttraumatic stress disorder

SUMMARY

Mood disorders included major depression and bipolar disorder.

Other disorders that were discussed was schizophrenia, eating disorders, adjustment disorders, and maladaptive behavior disorders.

There are several different ways to help treat all of these disorders. Some ways can include rehabilitation therapy, psychotherapy, and pharmacotherapy.

Don’t forget to look at page 308 in your book to see the table of medications used to treat psychiatric disorders!