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Disorders Usually 1 st Diagnosed in Infancy, Childhood, & Adolescence. Core Concept of Diagnostic Group: Categorized by time of onset Predominantly disorders of abnormal development and maturation.

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Disorders usually 1 st diagnosed in infancy childhood adolescence
Disorders Usually 1st Diagnosed in Infancy, Childhood, & Adolescence

Core Concept of Diagnostic Group:

  • Categorized by time of onset

  • Predominantly disorders of abnormal development and maturation.

  • Emphasis of disorders is on the inability of the individual to attain certain normal developmental milestones and the associated functions, capabilities, & behaviors.


10 diagnostic subgroups dsm iv tr
10 Diagnostic Subgroups (DSM-IV-TR)

  • Mental Retardation

  • Learning Disorders

  • Motor Skills Disorders

  • Communication Disorders

  • Pervasive Developmental Disorders

  • Attention Deficit and Disruptive Behavior Disorders

  • Feeding & Eating Disorders of Infancy & Early Childhood

  • Tic Disorders

  • Elimination Disorders

  • Other Disorders of Infancy, Childhood, or Adolescence


Mental retardation
Mental Retardation

Characteristics:

  • IQ is significantly below average (< 70)

  • Accompanied by deficits in adaptive functioning, e.g. communication, self-care, home living, social/interpersonal skills, use of community resources, self-direction, academic skills, work, leisure, health, safety

  • Onset before age 18 years

  • Coding: coded on axis II

  • Code based on degree of severity, reflecting level of intellectual impairment:

    • Mild Mental Retardation – IQ from 50-55 to 70

    • Moderate Mental Retardation – IQ from 35-40 to 50-55

    • Severe Mental Retardation – IQ from 20-25 to 35-40

    • Profound Mental Retardation – IQ below 20-25


Mental retardation1
Mental Retardation

  • Prevalence: 1-3% of population; 90% are mild MR

  • Course: chronic

  • Prognosis: variable, depending on IQ & level of impairment

  • Gender differences: more prevalent for males (1.6 to 1); no gender differences for severe & profound MR

  • Causes: genetic; chromosomal (Down syndrome, Fragile X syndrome, Lesch-Nyhan syndrome); environmental (deprivation, abuse, neglect); prenatal (exposure to disease, alcohol, drugs, chemicals, poor maternal nutrition); perinatal (difficulties during labor & delivery); postnatal (malnutrition, infections, & head injuries)

  • Treatment: behavioral skills training; communication training; supported living and employment; mainstreaming


Learning disorders
Learning Disorders

Characteristics:

  • Inadequate development of specific academic skills, such as reading, writing, and math.

  • Specific academic skills are substantially below expected for age, intelligence, and education

  • Significantly interferes with aspects of life requiring those skills.

    Subtypes:

  • Reading Disorder

  • Mathematics Disorder

  • Disorder of Written Expression

  • Learning Disorder Not Otherwise Specified


Learning disorders1
Learning Disorders

  • Prevalence:

    • general population: 5-10%

    • reading disorders: 5-15%

    • math disorders: 6%

  • Racial: more common in black children

  • Negative outcomes: negative school experiences; school drop-out; lower employment rates; lower educational & career goals

  • Causes: genetics; structural & functional differences in the brain

  • Treatment: educational interventions (processing skills; cognitive skills; behavioral skills)


Tic disorder tourette s disorder
Tic Disorder: Tourette’s Disorder

  • Symptoms: characterized by multiple motor tics and one or more vocal tics (involuntary, sudden, rapid, nonrhythmic, stereotyped motor movements or vocalizations), which occur many times a day, nearly every day, or intermittently for more than a year.

  • Common motor tics: eye-blinking, eye-rolling, spitting, flipping/twirling hair, rolling head around, bending/jumping, skin picking, shrugging/jerking shoulders, thrusting pelvic movements, tapping fingers/feet

  • Common vocal tics: throat clearing, tongue-clicking, whistling, grunting, humming, hoots, howls, burps/belches, animal noises, repetition of one’s own words, repetition of others’ words


Tourette s disorder
Tourette’s Disorder

  • Causes: genetic (32% have relatives with TD); abnormal metabolism of 5HT & D; brain processing problem (basal ganglia)

  • Prevalence: decreases with age; 5-30 per 10,000 in childhood; 1-2 per 10,000 in adulthood

  • Gender: 2-5x as common for males

  • Onset: as early as 2 yrs; average age of onset is 6-7 yrs; typically develops by age 14

  • Course: severity, frequency, and disruptiveness of sx diminish during adolescence & adulthood

  • Treatment: antipsychotics; antihypertensive medications; SSRI’s; self-monitoring; relaxation training; habit reversal


Attention deficit hyperactivity disorder
Attention Deficit/Hyperactivity Disorder

  • Includes two major syndromes:

    1) Inattention

    2) Hyperactivity-Impulsivity

  • Syndromes may occur independently or together, but usually some components of each are present.

  • Symptoms begin before age 7

  • Symptoms cause some impairment in 2 or more settings.


Attention deficit hyperactivity disorder1
Attention Deficit/Hyperactivity Disorder

Inattention: 6+ of the following for 6+ months

  • Often fails to give close attention to details

  • Often makes careless mistakes in school, work, etc.

  • Often has difficulty sustaining attention

  • Often doesn’t seem to listen when spoken to directly

  • Often doesn’t follow instructions

  • Often fails to finish schoolwork, chores, or work duties

  • Has difficulty organizing tasks & activities

  • Avoids or dislikes tasks requiring sustained mental effort

  • Often loses things

  • Is easily distracted by extraneous stimuli

  • Is forgetful in daily activities


Attention deficit hyperactivity disorder2
Attention Deficit/Hyperactivity Disorder

Hyperactivity-Impulsivity 6+ of following for 6+ months

Hyperactivity:

  • Fidgets with hands or feet; squirms in seat

  • Difficulty staying in seat

  • Excessive running, climbing, or restlessness

  • Difficulty playing or engaging in leisure activities quietly

  • Often “on the go;” acts as if “driven by a motor”

  • Often talks excessively

    Impulsivity:

  • Often blurts out statements

  • Impatient; difficulty awaiting turn

  • Often interrupts or intrudes on others


Attention deficit hyperactivity disorder3
Attention Deficit/Hyperactivity Disorder

  • Subtypes:

    • AD/HD, Predominantly Inattentive Type

    • AD/HD, Predominantly Hyperactive-Impulsive Type

    • AD/HD, Combined Type

    • AD/HD, Not Otherwise Specified

  • Onset:3-4 years old

  • Age: 68% have ongoing sx in adulthood; inattentive subtype is more common in adolescents and adults

  • Gender: ratios of males to females range from 2:1 to 9:1; Combined and Hyperactive Subtypes are much more common in males than females

  • Prevalence: up to 3-7% of school-age children


Adhd associated features
ADHD: Associated Features

  • Academic deficits

  • School-related problems

  • Peer rejection

  • Low frustration tolerance

  • Tantrums

  • Poor self-esteem

  • Mood swings

  • Bossiness

  • Stubbornness

  • Accidents

  • Driving difficulties – speeding, accidents


Adhd diagnostic considerations
ADHD: Diagnostic Considerations

  • Difficulty of distinguishing normal activity from hyperactivity and normal distractibility from attention deficit distractibility.

  • Need to evaluate behavior in terms of what’s normal for others of same gender, age, developmental level, cultural background.

  • Behaviors must occur in multiple settings.

  • Behaviors must cause clinically significant impairment.

  • Symptoms must have been present and caused impairment by age 7.

  • Combined and Hyperactive Subtypes are less likely to be missed.


Adhd contributing factors
ADHD: Contributing Factors

  • Genetics: increased incidence of ADHD & psychopathology in families & relatives

  • Prenatal factors: inadequate oxygen; drug exposure; maternal smoking

  • Neurotransmitters: inadequate availability of dopamine; NE, 5HT, GABA also implicated

  • Brain abnormalities: frontal cortex, basal ganglia, & cerebellar vermis are smaller

  • Exposure to toxins: allergens, food additives

  • Parenting: negative attempts to control their behavior; intrusive, over-bearing parenting


Attention deficit hyperactivity disorder4
Attention Deficit/Hyperactivity Disorder

Treatments:

  • Medication – stimulants, Strattera (SNRI), Wellbutrin

  • Psychoeducation & bibliotherapy

  • Skills-based training – time management, organizational skills, study skills, problem-solving, social skills


Conduct disorder
Conduct Disorder

  • Repetitive, persistent pattern of behavior in which the basic rights of others or major societal norms or rules are violated.

  • 3 or more of the following are present in the past 12 months, and at least one of the following is present in the past 6 months.

    • Aggression to people and animals

    • Destruction of property

    • Deceitfulness or theft

    • Serious violations of rules


Conduct disorder1
Conduct Disorder

  • Aggression to People and Animals:

    • Bullying, threats, intimidation

    • Physical fights

    • Use of weapons

    • Physical cruelty to people

    • Physical cruelty to animals

    • Mugging, purse snatching, extortion, armed robbery

    • Forced sexual activity


Conduct disorder2
Conduct Disorder

2) Destruction of Property:

  • Deliberate fire-setting

  • Deliberate destruction of others’ property

    3) Deceitfulness or Theft

  • Breaking & entering

  • Lying; conning

  • Stealing; shoplifting; forgery

    4) Serious Violations of Rules

  • Breaking curfew prior to age 13

  • School truancy prior to age 13

  • Running away from home


Conduct disorder3
Conduct Disorder

Subtypes:

  • Conduct Disorder, Childhood Onset – onset of at least 1 criterion prior to age 10

  • Conduct Disorder, Adolescent Onset – absence of any criteria prior to 10

  • Conduct Disorder, Unspecified Onset – age of onset is unknown

    Specifiers:

  • Mild – few, if any, conduct problems in excess of those required to make dx; cause only minor harm to others

  • Moderate – number of conduct problems and effect on others are in the intermediate range

  • Severe – many conduct problems in excess of those required to make dx; cause considerable harm to others


Conduct disorder4
Conduct Disorder

  • Etiology: genetics; decreased arousal; low levels of 5HT; neurological deficits

  • Prevalence: 2-9% of nonclinical population; up to 1/3-1/2 of child mental health referrals; 87-91% of incarcerated juveniles

  • Gender Differences: mostly males

  • Onset: as early as preschool

  • Prognosis: poor; 2/3rds of cases develop into Antisocial Personality Disorder

  • Treatment: parent management training; community-based interventions (group homes, wilderness programs; therapeutic boarding schools); CBT (social skills, problem solving, cognitive restructuring)


Oppositional defiant disorder
Oppositional Defiant Disorder

  • Pattern of negativistic, hostile, and defiant behavior for at lease 6 months.

  • At least 4 of the following are present:

    • Often loses temper

    • Often argues with adults

    • Often actively defies or refuses to comply with adults’ requests or rules

    • Often deliberately annoys others

    • Often blames others for own mistakes or misbehavior

    • Is often touchy or easily annoyed by others

    • Is often angry or resentful

    • Is often spiteful or vindictive

  • Absence of behavior that violate the rights of others


Oppositional defiant disorder1
Oppositional Defiant Disorder

  • Prevalence: 1-6%

  • Gender differences: more prevalent for males prior to puberty; ratio evens out after puberty

  • Prognosis: relatively persistent – some of the behaviors persist into adulthood, others are outgrown; higher divorce rate, employment difficulties, and drug/alcohol abuse for those with ODD

  • Causes: marital conflict; family discord; inconsistent parenting; overly lenient or rigid parent; coercive or aversive parent-child interactions; genetics

  • Treatment: parent training; family therapy; behavioral therapy (anger management, social skills training, problem solving, frustration tolerance); cognitive interventions to reduce negativity


Separation anxiety disorder
Separation Anxiety Disorder

At least 4 weeks of inappropriate or excessive anxiety about separation from home or major attachment figures, as evidenced by at least 3 of the following:

  • excessive anxiety regarding separation

  • excessive fears of losing major attachment figures

  • nightmares involving the theme of separation

  • refusal to go to school

  • refusal to be alone or without major attachment figures

  • refusal to sleep away from home or attachment figures

  • repeated physical complaints when separation occurs or is anticipated

    Onset prior to age 18


Pervasive developmental disorders
Pervasive Developmental Disorders

Characterized by:

  • A broad-based impairment or a loss of functions expected for child’s age.

  • Includes 3 components:

    • Impairment in social interactions/relationships

    • Impairment in communication/language

    • Restricted, repetitive, and stereotyped patterns of behavior, interests, and activities


Autistic disorder
Autistic Disorder

  • Abnormal functioning in at least one of the following areas, with onset prior to 3:

    • Social interaction

    • Language and communication

    • Symbolic, imaginative play

  • Qualitative impairment in social interaction and relationship development

  • Qualitative impairment in communication, language, and conversation skills

  • Restricted, repetitive, stereotyped patterns of behavior, interests, activities.


  • Autism
    Autism

    • Mental retardation: 75-80%; 50% are profoundly or severely MR; 25% are moderately MR; 25% borderline to average IQ

    • Gender differences: higher IQ – more prevalent among males; IQ < 35 – more prevalent among females

    • Prevalence: 1 in 500 births

    • Onset: first apparent in infancy & toddlerhood

    • Course: chronic; life-long impairment; 50% never acquire speech

    • Causes: abnormalities in brain structure and function (5HT synthesis, cerebellum); genetics

    • Treatments: intensive behavioral Tx focusing on improving communication, social and daily living skills and reducing problem behaviors; early intervention programs; applied behavior analysis; parent training; mainstreaming for education; community interventions (supportive living arrangements & work settings)


    Asperger s disorder
    Asperger’s Disorder

    • Qualitative impairment in social interaction and relationship development

    • Restricted, repetitive, and stereotyped patterns of behavior, interests, and activities

    • But lack any clinically significant delay in language or cognitive development


    Asperger s syndrome
    Asperger’s Syndrome

    What you see:

    • Anxious, excessive desire for sameness

    • Preoccupation with stereotyped, repetitive activities

    • Obsess about objects

    • Limited interests

    • Can’t relate to others

    • Can’t read emotions

    • Can’t understand social cues

    • Social isolation, socially inept

    • Average IQ scores

    • Motor clumsiness

    • Poor coordination


    Asperger s syndrome1
    Asperger’s Syndrome

    • Gender: up to 4x as common for males

    • Prevalence: up to 5x as common as Autism

    • Onset: later onset than Autism

    • Course: chronic, life-long

    • Etiology: genetics; brain abnormalities (limbic system, 5HT & D systems, right hemisphere)


    Asperger s syndrome treatments
    Asperger’s Syndrome: Treatments

    • Behavioral treatments/skills building: interventions targeting problem behaviors, problem solving, social skills, communication skills, empathy-building, daily living skills

    • School-based interventions: mainstreaming; tutoring; special aides; multiple modalities for presenting information

    • Psychotherapy to address accompanying psychiatric disorders, such as depression and anxiety

    • Medications: antidepressants, antipsychotics


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