Upload
vibin-varghese
View
189
Download
2
Embed Size (px)
Citation preview
05/01/23 JStar 1
CHILDHOOD DISORDERS
05/01/23 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
05/01/23 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
05/01/23 JStar 4
Mental Retardation
05/01/23 JStar 5
Mental RetardationMild
• 50-55 to 70-85 IQ 85% of MR
population Academic level- 6th
grade Holds job, makes
change
05/01/23 JStar 6
Mental RetardationModerate
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
05/01/23 JStar 7
Mental RetardationProfound
20-25 and below IQ 1% of MR population Academic level-
BELOW 1st Dependent on others
05/01/23 JStar 8
–Most common INHERITED cause of mental retardation-Fragile X
–Most common GENETIC cause of mental retardation-Down syndrome
05/01/23 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
05/01/23 JStar 10
05/01/23 JStar 11
Pervasive Developmental Disorders
Autism Asperger R ett PD D N O S C hi ld ho od D isin teg ra tiv e D iso rd e r
PD D
05/01/23 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.
05/01/23 JStar 13
AUSTISTIC DISORDERDiagnostic 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.
05/01/23 JStar 14
AUTISTIC DISORDERDiagnostic 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
05/01/23 JStar 15
AUTISTIC DISORDERDiagnostic 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
05/01/23 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
05/01/23 JStar 17
Interventions in AutismPresently: 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
05/01/23 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)
05/01/23 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
05/01/23 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
05/01/23 JStar 21
PDD NOSWhen 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.
05/01/23 JStar 22
Pervasive Developmental Disorders
05/01/23 JStar 23
Learning DisordersDefinition
Skills in a specific academic area are greatly below those expected for age or IQ and academic level
Must cause academic or adaptive defect
05/01/23 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
05/01/23 JStar 25
Learning DisordersCourse/Prognosis
Diagnosed in grade school, but not outgrown
Complications include: low self-esteem school dropout low frustration tolerance
Academic achievement associated with language skills
05/01/23 JStar 26
Learning DisordersDiagnosis
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
05/01/23 JStar 27
Disruptive Disorders in Children
05/01/23 JStar 28
Oppositional Defiant DisorderA 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
05/01/23 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
05/01/23 JStar 30
Oppositional Defiant Disorder
http://www.hsc.wvu.edu/aap/aap-car/videos.htm
05/01/23 JStar 31
Conduct Disorder(CD)
Aggression toward people or animals
Deceitfulness or Theft
Destruction of property
Serious violation of rules
05/01/23 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
05/01/23 JStar 33
Conduct Disorder
“You left your D__M care in the driveway again!”
05/01/23 JStar 34
Conduct Disorder
http://www.hsc.wvu.edu/aap/aap-car/videos.htm
05/01/23 JStar 35
05/01/23 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)
05/01/23 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
05/01/23 JStar 38
Movement Disorders
http://www.wemove.org/ts_ssv1.0.html
05/01/23 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
05/01/23 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/Impulsivity Fidget Leaves seat often Runs or climbs
excessively Always “on the go” Talks excessively Blurts out answers Can’t wait turn,
interrupts others
05/01/23 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)
05/01/23 JStar 42
Attention Deficit Hyperactivity DisorderMedical 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
05/01/23 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
05/01/23 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
05/01/23 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
05/01/23 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
05/01/23 JStar 47
EncopresisEncopresis
High association between encopresis and enuresis
Medical therapy, behavioral modification and counseling results in the greatest success in the treatment of encopresis
05/01/23 JStar 48
Our Time is up!