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بِسْمِ اللّهِ الرَّحْمـَنِ الرَّحِيمِ الْحَمْدُ للّهِ رَبِّ Ø§Ù„Ù’Ø PowerPoint Presentation
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بِسْمِ اللّهِ الرَّحْمـَنِ الرَّحِيمِ الْحَمْدُ للّهِ رَبِّ الْØ

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بِسْمِ اللّهِ الرَّحْمـَنِ الرَّحِيمِ الْحَمْدُ للّهِ رَبِّ Ø§Ù„Ù’Ø - PowerPoint PPT Presentation


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بِسْمِ اللّهِ الرَّحْمـَنِ الرَّحِيمِ الْحَمْدُ للّهِ رَبِّ الْعَالَمِينَ الرَّحْمـنِ الرَّحِيمِ مَـالِكِ يَوْمِ الدِّينِ إِيَّاكَ نَعْبُدُ وإِيَّاكَ نَسْتَعِينُ اهدِنَــــا الصِّرَاطَ المُستَقِيمَ صِرَاطَ الَّذِينَ أَنعَمتَ عَلَيهِمْ غَيرِ المَغضُوبِ عَلَيهِمْ وَلاَ الضَّالِّينَ.

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slide1

بِسْمِ اللّهِ الرَّحْمـَنِ الرَّحِيمِ

الْحَمْدُ للّهِ رَبِّ الْعَالَمِينَ

الرَّحْمـنِ الرَّحِيمِ

مَـالِكِ يَوْمِ الدِّينِ

إِيَّاكَ نَعْبُدُ وإِيَّاكَ نَسْتَعِينُ

اهدِنَــــا الصِّرَاطَ المُستَقِيمَ

صِرَاطَ الَّذِينَ أَنعَمتَ عَلَيهِمْ غَيرِ المَغضُوبِ عَلَيهِمْ وَلاَ الضَّالِّينَ

child psychiatry the basics

Child Psychiatry The Basics

Dr. M.NasarSayeed Khan

13-B, Aibak Block, garden town

03328440242

nasarsayeed@yahoo.com

is infant toddler mental health really a problem
Is Infant &Toddler Mental Health Really a Problem?
  • Yes!
  • Young children do experience problems in social emotional competency and even psychopathology
  • We are better able to understand and measure these problems
why we resist this
Why we resist this…
  • We are too worried about cognitive skills (“ready to learn”)
  • Stigma associated with mental health issues
  • Myth of childhood
  • Our own discomfort with the idea
prevalence
Prevalence
  • Best estimates of serious behavior concerns in children 2 to 3 years fall between 10 to 15%
  • Parent and pediatrician report behavior problems in 10% of 1 to 2 year olds
but won t these problems go away
But won’t these problems go away?
  • No!
  • 37% of 18 mos with extreme behavior/emotional problems continue to have problems at 30 mos
  • Over ½ of 2-3 with psychiatric d/o still have symptoms 2 years out
long term effects
Long Term Effects
  • Exposure to poor caregiving, abuse, or domestic violence can lead to developmental and mental health problems in young children
  • Babies, toddlers, and preschoolers can demonstrate depression, PTSD, and disruptive behaviors
the science of early childhood development
The Science of Early Childhood Development
  • Babies brains are growing at a phenomenal rate
  • The infant brain is “experience expectant”
  • Both positive and negative experiences have significant and long lasting effects
the science of early childhood development1
The Science of Early Childhood Development
  • Experience, especially social experiences, change the way the brain is shaped and functions
  • Babies who experience or witness violence have behavioral and physiological changes
mh challenges in young children
MH Challenges in Young Children
  • Are real
  • Involve a substantial number of babies
  • Can be assessed and treated
areas to consider when assessing young children
Areas to Consider When Assessing Young Children
  • Developmental Levels of Infant or Child
  • Quality of Important Relationships
  • Parent Status (Capacity for Relationship)
  • Family Situations
infant child development
Infant & Child Development
  • A good working knowledge of typical development is needed when you assess young children
  • You can’t tell what is atypical if you don’t know what is typical
infant child development1
Infant & Child Development
  • Expected order of milestones is knownSkills are traditionally divided into 5 areasThere is much overlap between the areasUneven development across areas is concerning
infant child development2
Infant & Child Development

Ways to learn about development

  • Have a great memory from college
  • Get a child development text
  • Watch some babies
  • Review some developmental checklists online
infant child development3
Infant & Child Development
  • Cognitive
  • Receptive, Expressive, and Pragmatic Communication
  • Fine & Gross Motor
  • Social-emotional and behavior
  • Adaptive Skills (Self Help)
cognitive skills
Cognitive Skills
  • Thinking
  • Problem Solving
  • Memory
  • Attention
  • Imitation
communication
Communication
  • Use of gestures and facial expressions
  • Understanding speech
  • Expressive language
  • Social or pragmatic aspects of communication
fine gross motor skills
Fine & Gross Motor Skills
  • Use of hands and arms to manipulate objects
  • Balance
  • Strength and tone
  • Walking, running, jumping
social emotional and behavior
Eye contact

Social smile

Relationships/attachment

Regulation

Sleep

Feeding

Aggression

Compliance

Social-emotional and behavior
self help adaptive
Self-Help/Adaptive
  • Eating
  • Dressing
  • Participation in grooming
  • Toileting
ways development can be atypical
Ways development can be atypical
  • Global delays in development
  • Inconsistent development
  • Atypical, unusual behaviors—red flags
red flags in 6 month olds
Red Flags in 6 Month Olds:
  • Inability to Read Signals
  • Persistent Sleep Problems
  • Lack of Predictability
  • Failure to Imitate Sounds and Gestures
  • No Affect, Range of Feelings
  • Lack of Stranger Anxiety (8 months)
red flags 12 18 month olds
No Words

Persistent Sleep Problems

Withdrawn

Excessive Rocking

Prolonged Fears

No Separation Distress

Immobile, Low Activity

No Social Engagement

Predominant Anger and Outbursts

Red Flags 12-18 Month Olds:
red flags in 18 months to 3 year olds
Eating Problems

Non Speaking

Extreme Shyness

Lack Autonomy

Failure in Gender Identification

No Enjoyment in Play

Poor Problem Solving

Total Lack of Self Control

Chaotic Behavior

Red Flags in 18 Months to 3 Year olds
screening referral
Screening & Referral
  • Screening methods tell you if the child needs further assessment in a given developmental area
  • Many screening tools use caregiver report
  • Do not use social-emotional screener for CPS population
do s and don ts
Do’s and Don’ts
  • Infants and Toddlers must be evaluated within the context of relationships with their primary caregivers
  • Assessment should always include collaboration with parents and caregivers
  • Multiple assessments over time are recommended
  • Information from Multiple sources is recommended
do s and don ts1
Do’s and Don’ts
  • Standardized Instruments May be used
  • but not be the sole basis of the Evaluation
  • Young Children Should Never be Challenged
  • by Separation from Primary Caregivers
  • Evaluation should utilize the DSM V
etiology
Etiology
  • Brain damage
  • Lead intoxication
  • Family
  • Divorce
  • Death
problems with preschoolers
Problems with preschoolers
  • Bed wetting
  • Over activity
  • Difficulty in settling at night
  • Fears
  • Disobedience
  • Attention Seeking
  • Temper tantrums
poor prognosis if persists beyond 3 and require intervention
Poor prognosis if persists beyond 3 and require intervention
  • over-activity
  • conduct disorder
  • speech difficulty
  • effeminacy
  • autism
slide35
Pica
  • Is the eating of items considered as inedible

Common causes include:

  • brain damage
  • autism
  • mental retardation
  • emotional distress
  • usually diminishes as the child grows
hyperkinetic and attention deficit disorders classification
Hyperkinetic and Attention Deficit disordersClassification
  • F90 Hyperkinetic disorders
  • F90.0 Disturbance of activity and attention
  • F90.1 Hyperkinetic conduct disorder
  • F90.8 Other hyperkinetic disorders
  • F90.9 Hyperkinetic disorder, unspecified
conduct and oppositional disorders classification
Conduct and Oppositional disordersClassification
  • Conduct disorder confined to the family
  • Unsocial zed conduct disorder
  • Socialized conduct disorder
  • Oppositional defiant disorder
  • Other conduct disorders
  • Conduct disorder, unspecified
f84 pervasive developmental disorders
F84 Pervasive Developmental Disorders
  • F84.0 Childhood Autism (Kanner, 1943)
  • Epidemiology
  • prevalence of 2 per 10,000
  • M:F=3:1
  • Clinical features
  • Kanner described four main features of autism:
  • autistic aloneness
  • delayed or abnormal speech
  • an obsessive desire for sameness
  • onset in the first two years of life
f93 emotional disorders with specific onset in childhood
F93 Emotional Disorders with specific onset in childhood
  • Maternal overprotection (Levy, 1943)
    • excessive contact
    • prolongation of infantile care
    • prevention of independence
    • fathers were generally submissive
    • overprotected children had three times as many operations
  • Separation Anxiety Disorder
    • onset is before the age of six
    • diagnosis is not made when there is a generalized disturbance of personality development
school refusal
School refusal
  • Clinical features:
    • there are often somatic symptoms - complaints occur on school days but not at other times
    • the final refusal may occur after several events:
    • following a period of increasing difficulty
    • after an enforced absence such as respiratory infection
    • after an event at school such as change of class
    • following a problem in the family such as illness of another family member
  • Treatment
    • an early return to school is important (The Kennedy Approach)
    • discussion with teachers is needed
    • depressive disorder should be treated
    • it has been reported that antidepressants are effective for school refusal, even when there is no depression
  • Prognosis
elective mutism
Elective Mutism
  • The child refuses to speak in certain circumstances, although he does so normally in others
  • usually, speech is normal in the home but lacking in school
  • often associated with other negative behaviours such as refusing to sit down or play when invited to do so
  • Epidemiology
  • usually begins between 3 and 5 years, after normal speech has been acquired
  • prevalence of approx. 1 in 1000
  • Treatment
  • no evidence that treatment is effective
  • Prognosis
  • can persist for months or years
  • a five- to ten-year follow-up showed that only 50% had improved
stammering
Stammering

Disturbance of the rhythm and fluency of speech

  • Epidemiology
  • M:F = 4:1
  • affects about 1% of children
  • Treatment
  • speech therapy
  • Prognosis
  • most children improved whether treated or not