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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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