childhood disorders(report)

CHILDHOOD

DISORDERS

Mental Retardation Overview

Children with Mental Retardation have

deficits in cognitive skills that range from

mild to severe. A number of genetic factors

and biological traumas in the early years of

life can contribute to Mental Retardation.

Social factors, such as poverty or lack of

good education, can also contribute to

Mental Retardation.

Mental Retardation

Developmental disorder is characterized by

significantly sub average intellectual

functioning, as well as deficits (relative to

other children) in life skill areas, such as

communication, self-care, work &

interpersonal relationships with onset before

age 18 years.

Criteria for diagnosing

Mental Retardation

The diagnosis of mental retardation requires

that a child show both poor intellectual

functional & significant defects in

everyday skills.

A. Significant sub average intellectual functioning indicated by an IQ of approximately 70 or below.

B. Significant deficits in at least the following areas:

1. Communication

2. Self-care

3. Home living

4. Social or interpersonal skills

5. Use of community resources

6. Self direction

7. Academic skills

8. Work

9. Leisure

10. Health

11. Personal safety

Degrees of Severity of Mental

Retardation

Mild Mental Retardation

It is roughly equivalent to what used to be

referred to as the educational category of

“educable.” This group constitutes the

largest segment of about 85% of those with

disorder. Their scores on IQ tests tend to be

between about 50-70.

Moderate Mental Retardation

Moderate Mental Retardation is roughly

equivalent to what used to be referred to as

the educational category of “trainable.”

This group constitutes about 10% of the

entire population with Mental Retardation.

Their scores on IQ test tend to be between

about 35-50.

Severe Mental Retardation

This group constitutes 3%-4% of individuals

with Mental Retardation. Their IQ scores

tend to run between 20-35.

Profound Mental Retardation

It constitutes 3%-4% of individuals with

Mental Retardation. Their IQ scores tend to

be under 20.

Predisposing Factors

Heredity(Approximately 5%): thesefactors include inborn errors ofmetabolism inherited mostly throughautosomal recessive mechanisms, othersingle-gene abnormalities with Mendelianinheritance and variable expression , andchromosomal berrations.

Early alterations of embryonicdevelopment (approximately 30%):These factors include chromosomalchanges or prenatal exposure due totoxins.

Pregnancy and prenatal Problems

(approximately 10%) these factors include

fetal malnutrition, prematurity, hypoxia,

viral and other infections, and trauma.

General medical conditions acquired in

infancy or childhood (approximately

5%): it includes infections and poisoning.

Environmental influences and other

mental disorders

GENDER

Mental Retardation is more common in males,

with a male-to-female ratio of

approximately 1.5:1

ONSET

Before age 18

COURSE

Mental Retardation is not necessarily alifelong disorder. Individuals who had Mildmental Retardation earlier in their livesmanifested by failure in academic learningtasks may, with appropriate training andopportunities, develop good adaptive skillsin other domains and may no longer havethe level of impairment required for adiagnosis of Mental retardation.

PREVALENCE

The prevalence of Mental Retardation has

been estimated at approximately 1%.

However, different studies have reported

different rates depending on definitions

used, methods of ascertainment &

population studied.

TREATMENT

Comprehensive treatment programs for

mental retardation involve biological,

behavioral, and sociocultural interventions.

Behavioral Strategies

Caregivers are taught skills for enhancing thechild's positive behaviors and reducingnegative behaviors.

Desired behaviors are modeled in incrementalsteps; rewards are given to the child as he orshe masters the skill.

Self-injurious behavior is extinguished.

Drug Therapies

Neurololeptic medications reduce aggressive

& antisocial behavior.

Atypical antipsychotics reduce aggresion &

self injury.

Antidepressant medications reduce depression,

improve sleep & reduce self-injury.

Social Programs

Early intervention programs, includingcomprehensive services addressing physical,development, & educational needs & the training ofparents.

Mainstreaming of children into regular classroom.

Group homes that provide comprehensive services toadults.

Institutionalization of children or adults with severephysical handicaps or behavior problems.

Learning Disorder

Reading Disorders (Dyslexia)

Deficits in ability to read

SIGNS & SYMPTOMS

Difficulty with reading and reading

comprehension.

GENDER

From 60% to 80% of individuals diagnosedwith Reading disorder are males. Referralprocedures may often be biased towardidentifying males, because they morefrequently display disruptive behavior inassociation with learning disorders. Thedisorder has been found to occur at more equalrates in males and females when carefuldiagnostic ascertainment and stringent criteriaare used rather than traditional school-basedreferral and diagnostic procedures.

PREVALENCE

The prevalence of Reading Disorder is difficult toestablish because many studies focus on theprevalence of Learning Disorder without carefulseparation into specific disorders of Reading,Mathematics, or Written Expression. Readingdisorder, alone or in combination with mathematicsdisorder or disorder of written expression, accountsfor approximately four of every five cases of LearningDisorder. The prevalence of reading Disorder inUnited States is estimated at 4% of school-agechildren. Lower incidence and prevalence figures forreading disorder may be found in other countries inwhich strict criteria are used.

COURSE

Although symptoms of reading difficulty (e.g inabilityto distinguish among common letters or to associatecommon phonemes with letter symbols) may occuras early as kindergarten or the beginning of firstgrade because formal reading instruction usually doesnot begin until this point in most school settings.Particularly when Reading Disorder is associatedwith high IQ, the child may function at or near gradelevel in the early grades, and the Reading Disordermay not be fully apparent until the fourth grade orlater. With early identification and intervention, theprognosis is good in a significant percentage of cases.Reading Disorder may persist into adult life.

Mathematics Disorder(Dyscaculia)

Deficits in mathematics skills

The essential feature of mathematics Disorder

is mathematically ability (as measured by

individually administered standardized tests of

mathematical calculation or reasoning) that

falls substantially below that expected for the

individual’s chronological age, measured

intelligence, and age appropriate education.

SIGNS & SYMPTOMS

Difficulty with computation, remembering

math facts, concepts of time and money.

PREVALENCE

The prevalence of Reading Disorder is difficultto establish because many studies focus on theprevalence of Learning Disorder withoutcareful separation into specific disorders ofReading, Mathematics, or Written Expression.The prevalence of mathematical Disorderalone has been estimated at approximately onein every five cases of Learning Disorder. It isestimated that 1% of school-age children havemathematics disorder.

COURSE

Although symptoms of difficulty in Mathematics(e.g. confusion in number concepts or inability tocount accurately) may appear as early askindergarten or first grade, mathematics Disorderis seldom diagnosed before the end of first gradebecause sufficient formal mathematics instructionhas usually not occurred until this point in mostschool setting. It usually becomes apparent duringsecond or third grade. Particularly whenmathematics disorder is associated with High IQ,the child may be able to function at or near gradelevel in the early grades, and Mathematic disordermay not be apparent until the fifth grade or later.

Disorder of Written

Expression(Dysgraphia)

Deficits in the ability to write

SIGNS & SYMPTOMS

Difficulty with handwriting, spelling,

composition, grammar, punctuation.

PREVALENCE

The prevalence of Reading Disorder is

difficult to establish because many studies

focus on the prevalence of Learning

Disorder without careful separation into

specific disorders of Reading, Mathematics,

or Written Expression. Disorder of Written

Expression is rare when not associated with

other Learning disorder.

COURSE

Although difficulty in writing (e.g. particularlypoor handwriting or copying ability or inabilityto remember letter sequences in common words)may appear as early as the first grade, disorderof written expression is seldom diagnosedbefore the end of first grade because sufficientformal writing instruction has usually notoccurred until this point in school in most schoolsetting. The disorder is usually apparent bysecond grade. Disorder of Written Expressionmay occasionally be seen in older children oradults, and little is known about its long-termprognosis.

Motor Skills Disorder

Developmental Coordination

Disorder

It is marked impairment in the development

of motor coordination.

Deficits in the ability to walk, run, hold on

to the subject

PREVALENCE

Prevalence of Developmental Coordination

Disorder has been estimated to be as high as

6% for children in the age range of 5-11

years.

COURSE

Recognition of developmental coordination

Disorder usually occurs when the child first

attempt such tasks as running, holding a

knife or fork, buttoning clothes, or playing

ball games. The course is variable. In some

cases, lack of coordination continues

through adolescence and adulthood.

Communication Disorders

Expressive Language Disorders

Deficits in the ability to express oneself

through language

GENDER

It is more common in males than in females.

PREVALENCE

Estimates suggest that 3%-5% of children

may be affected by the development type of

Expressive language Disorder. The acquired

type is less common.

COURSE

The developmental type of expressive languagedisorder is usually recognized by age 3 years,although milder forms of the disorder may notbecome apparent until early adolescence, whenlanguage ordinarily becomes more complex. Theacquired type of expressive language disorder dueto brain lesions, head trauma, or stroke may occurat any age, and the onset is sudden. The outcomeof the developmental type of expressive languagedisorder is variable. Approximately one half of thechildren with this disorder appear to outgrow it,whereas one-half appear to have more long lastingdifficulties.

Most children ultimately acquire more orless normal language abilities by lateadolescence although subtle deficits maypersist. In the acquired type of expressivelanguage disorder, the course and prognosisare related to the severity and location of thebrain pathology, as well as to the age of thechild and the extent of languagedevelopment at the time the disorder isacquired. Clinical improvement in languageabilities is sometimes rapid and complete,whereas in other instances there may beincomplete recovery or progressive deficit.

Mixed receptive-Expressive

Language Disorder

Deficits in the ability both to express oneself

through language and to understand the

language of others.

PREVALENCE

It is estimated that the developmental type of

Mixed receptive-Expressive Language

Disorder may occur in up to 3% of school

age children but is probably less common

that Expressive Language disorder.

COURSE

The developmental type Mixed receptive-Expressive LanguageDisorder is usually detectable before age 4 years. Severalforms of the disorder may be apparent by age 2 years.Milder forms may not be recognized until the child reacheselementary school, where deficits in comprehension becomemore apparent. The acquired type of Mixed receptive-Expressive Language Disorder due to brain lesions, headtrauma, or stroke may occur at any age. The acquired typedue to Landau-Kleffner Syndrome (acquired epilepticaphasia) usually occurs between ages 3 and 9 years. Manychildren with Mixed receptive-Expressive LanguageDisorder eventually acquire normal language abilities, butthe prognosis is worse than for those with expressiveLanguage disorder.

Phonological disorder (formerly

Developmental Articulation

Disorder)

Use of speech sounds inappropriate for

age or dialect

GENDER

Phonological Disorder is more common in

males.

PREVALENCE

Approximately 2%-3% of 6 & 7 years olds

present with moderate to severe

Phonological Disorder, although the

prevalence of milder forms of this disorder

is higher. The prevalence falls to 0.5% by

age 17 years.

COURSE

In severe Phonological disorder, the child’s speech

may be relatively unintelligible even to family

members. Less severe forms of the disorder may

not be recognize until the child enters a

preschool or school environment and has

difficulty being understood by those outside the

immediate family. The course of the disorder is

variable depending on associated causes and

severity. In mild presentation with unknown

causes, spontaneous recovery often occurs.

Stuttering

Severe problems in word fluency

The essential feature of stuttering is a

disturbance in the normal fluency and time

patterning of speech that is inappropriate for

the individual’s age. This disturbance is

characterized by frequent repetitions or

prolongations of sounds or syllables.

PREVALENCE

The prevalence of stuttering in prepubertal

children is 1% and drops to 0.8% in

adolescence. The male-to-female ratio is

approximately 3:1.

COURSE

Retrospective studies of individuals withstuttering report onset typically between ages 2and 7 years (with peak onset at around age 5years). Onset occurs before 10 years in 98% ofcases. The onset is usually insidious, coveringmany months during which episodic, unnoticedspeech dysfluencies become a chronic problem.Typically, the disturbance starts gradually, withrepetition of initial consonants, words that areusually the first words of a phrase, or longwords. Some research suggests that up to 80%of individuals with stuttering recover, with upto 60% recovering spontaneously. Recovertypically occurs before age 16 years.

CAUSES

The causes of the disorders of cognitive,

motor, and communication skills are not

well understood. Genetic factors are

implicated in several of the disorders,

especially stuttering and reading disorder.

These disorders may also be linked to lead

poisoning, birth defects, sensory

dysfunction, or impoverished environments.

TREATMENT

The treatment to these disorders usually involvestherapies designed to build and correct missingskills, such as “Speech Therapy” for thecommunication disorders, “Reading Therapy” forDyslexia, and “Physical Therapy” for motor skillsdisorder. The use of computerized exercises hasproven useful in helping children withcommunication and learning disorders learn to readand communicate normally. Studies suggest that theatypical antipsychotic medication risperidone canreduce stuttering.

Pervasive Developmental

Disorders

Pervasive Developmental Disorders are

characterized by severe and pervasive

impairment in several areas of

development: reciprocal social interaction

skills, communication skills, or the

presence of stereotypes behavior, interest

and activities.

Autism

Deficits in social interaction; in

communication, including significant

language deficits; and in activities and

interest.

SIGNS & SYMPTOMS

The symptoms of autism include a range of

deficits in social interactions,

communication, and activities and

interests. To be diagnosed with autism,

children must show these deficits before

the age of 3.

Deficits in Social Interaction

Little use of nonverbal behaviors that indicatea social “connection,” such as eye-to-eyegazes, facial reaction to others, body posturesthat indicate interest in others, or gestures.

Failure to develop peer relationships as otherchildren do

Little expression of pleasure when other arehappy

Little reciprocity in social interactions

Deficits in Communication

Delay in, or total absence of, spoken language

In children who do speak, significant trouble in

initiating and maintaining conversations

Unusual language, including repetition of

certain phrases and pronoun reversal

Lack of make believe play or imitation of

others at a level appropriate for the child’s age.

Deficits in Activities and Interest

Preoccupation with certain activities or

toys or compulsive adherence to routines

and rituals

Stereotypes and repetitive movements, such

as hand flapping and head banging

Preoccupation with parts of objects and

unusual uses of objects.

GENDER

The rates of the disorder are four to five

times higher in males than in females.

Females with the disorder are more likely,

however, to exhibit more severe Autism.

PREVALENCE

Epidemiological studies suggest rates of

autistic disorder of 2-5 cases per 10,000.

COURSE

Manifestations of the disorder in infancy aremore subtle and difficult to define thanthose seen after age 2 years. In a minority ofcases, the child may be reported to havedeveloped normally for the first year (oreven 2 years) of life. Autistic Disorderfollows a continuous course. In school-agechildren and adolescents, developmentalgains in some areas are common.

Rett’s Disorder

Pervasive developmental disorder in which

children develop normally at first and later

show permanent loss of basic skill in social

interactions, language, and/or movement.

SIGNS & SYMPTOMS

Normal development for at least fivemonths/onset between 5-48 months.

Deceleration of head growth

Loss of previously acquired movements anddevelopment of stereotyped hand movements

Loss of social engagement

Appearance of poorly coordinated movements

Marked delay and impairment in language

PREVALENCE

Data are limited to mostly

case series, and it

appears that Rett’s

Disorder is much less

common than autistic

disorder. This disorder

has been reported only

in females.

COURSE

Rett’s disorder has its onset prior to age 4 years,usually in the first or second year of life. Theduration of the disorder is lifelong, and the lossof skills is generally persistent and progressive.In most instances, recovery is quite limited,although some very modest development gainsmay be made and interest in social interactionmay be observed as individuals enter laterchildhood or adolescence. The communicativeand behavioral difficulties usually remainrelatively constant throughout life.

Childhood Disintegrative

Disorder

Marked regression in multiple areas of

functioning following a period of at least

2 years of apparently normal

development.

SIGNS & SYMPTOMS

Normal development for at least two years

Loss of previously acquired skills in two ormore areas: language, social skills, bowel orbladder control, play, or motor skills

Qualitative impairment in social interactionand communication

Restricted, stereotyped interest andactivities.

PREVALENCE

Initial studies suggested an equal ratio, the

most recent data suggest that the condition

is more common among males.

COURSE

The onset is prior to age 10 years.

Asperger’s Disorder

Deficits in social interactions and in

activities and interest, but not in language

or basic cognitive skills.

SIGNS & SYMPTOMS

Qualitative impairment in social interaction

Repetitive, stereotyped interest and

activities

No significant delay in language

No delay in cognitive development

PREVALENCE

Information on the prevalence of Asperger’s

Disorder is limited, but it appears to be

more common in males.

COURSEMotor delays or motor clumsiness may be noted

in the preschool period. Difficulties in social

interaction may become more apparent in the

context of school. It is during this time that

particularly idiosyncratic or circumscribed

interests may appear or be recognized as such.

As adults, individuals with the condition may

have problems with empathy and modulation

of social interaction. This disorder apparently

follows a continuous course and in vast

majority of cases, the duration is lifelong.

Behavior Disorders Overview

The behavior disorders include attention-deficit/hyperactivity disorder, conductdisorder, and oppositional defiant disorder.Children with attention-deficit/hyperactivitydisorder have trouble maintaining attentionand controlling impulsive behavior and arehyperactive. Children with conduct oroppositional defiant disorder engage infrequent antisocial or defiant behavior.

Attention-deficit/Hyperactivity

Disorder

Syndrome marked by deficits in controlling

attention, inhibiting impulses, and

organizing behavior to accomplish long-

term goals.

SIGNS & SYMPTOMS

The Signs & Symptoms of ADHD fall into

three clusters: Inattention, Hyperactivity

and Impulsivity.

Inattention

Does not pay attention to details and makes careless mistakes.

Has difficulty sustaining attention.

Does not seem to be listening when others are talking.

Does not follow through instructions or finish tasks.

Has difficulty organizing behaviors

Avoids activities that require sustained effort and attention.

Loses thing frequently.

Is easily distracted

Is forgetful

Hyperactivity

Fidgets with hands or feet and squirms in

seat.

Is restless, leaving his or her seat or running

around when it is inappropriate.

Has difficulty engaging in quiet activities.

Often talks excessively

Impulsivity

Blurts out responses while others are talking

Has difficulty waiting his or her turn.

Often interrupts or intrudes on others.

Subtypes


Disorder, Combined Type

This subtype should be used if six (or more)

symptoms of inattention and six(or more)

symptoms of hyperactivity-impulsivity have

persisted for at least 6 months. Most

children and adolescents with the disorder

have the Combined Type. It is not known

whether the same is true of adult with the

disorder.


Disorder, Predominantly

Inattentive Type

This subtype should be used if six(or more)

symptoms of inattention (but fewer than

six symptoms of hyperactivity-

impulsivity) have persisted for at least 6

months.


Disorder, Predominantly

Hyperactive Type

This subtype should be used if six( or more)

symptoms of hyperactivity-impulsivity

(but fewer than six symptoms of

inattention) have persisted for at least 6

months. Inattention may often still be

significant clinical feature in such cases.

Biological factors

Children with ADHD often have histories ofprenatal and birth implications, includingmaternal ingestion of large amounts of nicotineand barbiturates during pregnancy, low birthweight, premature delivery, and difficult delivery,leading to oxygen deprivation. Some investigatorssuspect that moderate to severe drinking bymothers during pregnancy can lead to the kinds ofproblems inhibiting behaviors seen in childrenwith ADHD.

As preschoolers, some of these children wereexposed to high concentrations of lead, when theyingested lead base paint.

The popular notion that hyperactivity in

children is caused by dietary factors, such

as the large consumption of large amounts

of sugar, has not been supported in

controlled studies.

A few studies do suggest, however, that a

subject of children with ADHD have

severe allergies to food additives and that

removing these additives from these

children’s diets can reduce hyperactivity.

GENDER

The disorder is much more frequent in males

than in females, with male-to-female ratios

ranging from 4:1 to 9:1, depending on the

setting (general population or clinics).

PREVALENCE

The prevalence of ADHD is estimated at 3%-

5% in school-age children. Data on

prevalence in adolescence and adulthood

are limited.

TREATMENT

Stimulant Drugs like methylphenidate

(trade name Ritalin) and

Dextroamphetamine.

Behavior Therapy focused on reinforcing

attentive, goal-directed behaviors and

extinguishing impulsive, hyperactive

behaviors.

Oppositional Defiant Disorder

Syndrome of chronic misbehaviorin childhood marked bybelligerence, irritability, anddefiance, though not to the extentfound in a diagnosis of conductdisorder.

It is a recurrent pattern ofnegativistic, defiant, disobedient,and hostile behavior towardauthority figures that persist for atleast 6 months.

SIGNS & SYMPTOMS

The Signs & Symptoms of Oppositional

Defiant Disorder are not as severe as the

signs & symptoms of Conduct Disorder but

have their onset at an earlier age, and

oppositional defiant disorder often develops

into conduct disorder.

Often loses temper

Often argues with adults

Often refuses to comply with request or rules

Deliberately tries to annoy other

Blames others for his or her mistakes or misbehaviors

Is touchy or easily annoyed

Is angry and resentful

Is spiteful or vindictive

ONSET

The onset of the Signs & Symptoms of OppositionalDefiant Disorder often occurs very early in life,during the toddler and preschool years; however,many children with Oppositional Defiant Disorderseem to outgrow their behaviors by late childhood orearly adolescence. Subsets of children withOppositional Defiant Disorder, particularly thosewho trend to be aggressive, go on to develop conductdisorder in childhood and adolescence. Indeed, itseems that almost all children who develop conductdisorder during elementary school had symptoms ofoppositional defiant disorder in the earlier years oftheir lives.

GENDER

The disorder is more prevalent in males than

in females before puberty, but the rates are

probably equal after puberty. Symptoms are

generally similar in each gender except that

males may have more confrontational

behavior and more persistent behaviors.

PREVALENCE

Rates of Oppositional defiant disorder from

2% to 6% have been reported, depending on

the nature of the population sample and

methods of ascertainment.

COURSE

Oppositional Defiant Disorder usually becomesevident before age 8 years and usually notlater than early adolescence. The oppositionalsymptoms often emerge in the home settingbut over time may appear in other settings aswell. Onset is typically gradual, usuallyoccurring over the course of months or years.In a significant proportion of cases,Oppositional Defiant Disorder is adevelopmental antecedent to ConductDisorder.

Conduct Disorder

Syndrome marked by chronic disregard for

the rights of others, including specific

behaviors, such as stealing, lying, and

engaging in acts of violence.

SIGNS & SYMPTOMS

The Signs & Symptoms of Conduct Disorder

include behaviors that violate the basic

rights of other and the norms for appropriate

social behavior.

Bullies, threatens, or intimidates others

Initiates physical fights

Uses weapons in fights

Engages in theft and burglary

In physically abusive to people and animals

Forces others into sexual activity

Lies and breaks promises often

Violates parents’ rules about staying out at night

Runs away from home

Set fires deliberately

Vandalizes and destroys others’ property deliberately

Often skips school

SUBTYPES

Childhood-Onset Type (at least one

conduct problem before age 10)This subtype is defined by the onset of at least

one criterion characteristic of conduct disorderprior to age 10 years. Individuals withChildhood-Onset type are usually male,frequently display physical aggression towardothers, have disturbed peer relationships, mayhave had ODD during early childhood, andusually have symptoms that meet full criteriafor conduct disorder prior to puberty. Theseindividuals are more likely to have persistentConduct Disorder and to develop adultAntisocial Personality disorder than are thosewith Adolescent-Onset Type.

Adolescent-Onset Type (conduct problem

first occurs after age 10)

This subtype is defined by the absence of any criteriacharacteristic of Conduct Disorder prior to age 10years. Compared with those with the Childhood-Onset type, these individuals are less likely todisplay aggressive behaviors and tend to have morenormative peer relationships. These individuals areless likely to have persistent Conduct disorder or todevelop adult antisocial personality disorder. Theratio of males-to-females with conduct disorder islower for the adolescent type than for theChildhood-Onset type.

PREVALENCE

The prevalence of Conduct Disorder appears tohave increased over the last decades and maybe higher in urban than in rural settings. Ratesvary widely depending on the nature of thepopulation sampled and methods ofascertainment: for males under age 18 years,rates range from 6% to 16%; for females, ratesrange from 2% to 9%. Conduct Disorder is oneof the most frequently diagnosed conditions inoutpatient and inpatient mental health facilitiesfor children.

COURSEThe onset of conduct Disorder may occur as early as age 5-6 years but

usually in late childhood or early adolescence. Onset is rare after age

16 years. The course of conduct disorder is variable. In a majority of

individuals, the disorder remits by adulthood. However, a substantial

proportion continue to show behaviors in adulthood that meet criteria

for Antisocial Personality Disorder. Many individuals with conduct

Disorder, particularly those with adolescent-onset type and those

with few or milder symptoms achieve adequate social and

occupational adjustment as adults. Early onset predicts a worse

prognosis and an increased in adult life for Antisocial Personality

Disorder and Substance-Related Disorders. Individuals with conduct

disorder are at risk for later Mood or Anxiety Disorders, somatoform

Disorders, and Substance-Related Disorders.

TREATMENT

Antidepressants, neuroleptics, stimulants,

and lithium

Cognitive-Behavioral Therapy focused on

changing hostile cognitions, teaching

children to take others’ perspectives, and

teaching problem-solving skills.

Cognitive Contributors to

Conduct Disorder

Children with Conduct Disorder tend to processinformation about social interactions in ways thatpromote aggressive reactions to these interactions. Theyenter social interactions with assumptions that otherchildren will be aggressive toward them, and they usethese assumptions, rather than cues from specificsituations, to interpret the actions of their peers. Forexample, when another child accidentally bumps intohim or her, a child with a conduct disorder will assumethat the bumping was intentional and meant to provokea fight. In addition, conduct-disordered children tend tobelieve that any negative actions that peer tacky againstthem, such as taking their favorite pencils, areintentional rather than accidental.

Biological Contributors to

Conduct & Oppositional Defiant

Disorder

Antisocial behavior clearly runs in families.

Children with conduct disorder are much

more likely than children without this

disorder to have parents with antisocial

personalities. Their fathers are also highly

likely to have histories of criminal arrest

& alcohol abuse, & their mothers tend to

have histories of depression.

Social Contributors to Conduct &

Oppositional Defiant DisorderConduct disorder & oppositional defiant disorder are

found more frequently in children in lowersocioeconomic classes and in urban areas than inchildren in higher socioeconomic classes & ruralareas. This may be because a tendency towardsantisocial behavior runs in families, & families withmembers who engage in antisocial behavior mayexperience "downward social drift": The adults inthus families cannot maintain good jobs (because oftheir educational attainment); thus, the families tendto decline in socioeconomic status. Alternately, thistendency may be due to differences betweensocioeconomic groups in some of the environmentalcauses of antisocial behavior, such as poverty & poorparenting.

Feeding and Eating Disorder of

Infancy or Early Childhood

Feeding and Eating Disorder of Infancy or

Early Childhood are characterized by

persistent feeding and eating disturbances.

PicaPersistent eating of nonnutritive

substances for a period of at least 1month. The typical substanceingested tends to vary with age.Infants and younger children mayeat animal droppings, sands,insects, leaves or pebbles.Adolescents and adults mayconsume clay or soil. Thisbehavior must be developmentallyinappropriate and not part of aculturally sanctioned practice. Theeating of nonnutritive substances isan associated feature of othermental disorders (e.g. PervasiveDevelopmental disorder

CULTURE AND AGE

Is some culture, the eating of dirt or other

seemingly nonnutritive substances is

believed to be of value. Pica is more

commonly seen in young children and

occasionally in pregnant females.

PREVALENCE

Epidemiological data on Pica are limited. The

condition is not often diagnosed but may

not be uncommon in preschool children.

Among individuals with mental

Retardation, the prevalence of the disorder

of the disorder appears to increase with the

severity of the retardation.

COURSE

Pica may have its onset in infancy. In most

instances, the disorder probably lasts for

several months and then remits. It may

occasionally continue into adolescence or,

less frequently, into adulthood. In

individuals with mental retardation, the

behavior may diminish during adulthood.

Rumination Disorder

A repeated regurgitation and rechewing of

food that develops in infant or child after

a period of normal functioning and lasts

for at least 1 month.

PREVALENCE

Rumination Disorder appears to be

uncommon. It may occur more often in

males than in females.

COURSE

The onset of Rumination Disorder may occurin the context of developmental delays. Theage at onset is between ages 2 and 12months, except in individuals with MentalRetardation in whom the disorder mayoccur at somewhat later development stage.In infants, the disorder frequently remitsspontaneously. In some severe cases,however, the course is continuous.

Feeding Disorder of Infancy or

Early Childhood

The persistent failure to eat adequately, as

reflected in significant failure to gain

weight or significant weight loss over at

least 1 month.

PREVALENCE

Of all pediatric hospital admission, 1%-5%

are for failure to gain adequate weight, and

up to one-half of these may reflect feeding

disturbances without any apparent

predisposing general medical condition.

COURSE

Feeding Disorder of Infancy or Early

Childhood commonly has its onset in the

first year of life, but may have an onset in

children ages 2-3 years. The majority of the

children have improved growth after

variable lengths of time.

Diagnostic criteria for Feeding

Disorder of Infancy or Early

Childhood

A. Feeding disturbance as manifested by persistentfailure to eat adequately with significant failureto gain weight or significant loss of weight overat least 1 month.

B. The disturbance is not due to an associatedgastrointestinal or other general medicalcondition.

C. The disturbance is not better accounted byanother mental disorder or by lack of availablefood.

D. The onset is before age 6 years.

Anorexia Nervosa

Bulimia Nervosa

Tic Disorders

A tic is sudden, rapid, recurrent,

nonrhythmic, stereotyped motor

movement or vocalization.

Tourette’s Disorder

Multiple motor tics and one or more vocal

tics.

SPECIFIC CULTURE &

GENDER FEATURES

Tourette’s Disorder has been widely

reported in diverse racial and ethnic

groups. The disorder is approximately

1.5-3 times more common in males than

in females.

PREVALENCE

Tourette’s Disorder occurs in approximately

4-5 individuals per 10,000.

COURSE

The age at onset of Tourette’s Disorder may be asearly as age 2 years, usually during childhood orearly adolescence, and is by definition before age18 years. The median age at onset for motor ticsis 7 years. The duration of the disorder is usuallylifelong, though periods of remission lastingfrom weeks to years may occur. In most cases,the severity, frequency and variability of thesymptoms diminish during adolescence andadulthood. In other cases, the symptomsdisappear entirely, usually by earl adulthood.

DIAGNOSTIC CRITERIA FOR

TOURETTE’S DISORDER

A. Both multiple motor and one or more vocal tics have been present at some time during the illness, although not necessarily concurrent.

B. The tics occur many times a day nearly everyday or intermittently throughout a period of more than 1 year, during this period there was never a tic-free period of more than 3 consecutive months.

C. The disturbance causes marked distress or significant impairment in social, occupational, or other important areas of functioning.


E. The disturbance is not due to the direct physiological effects of a substance or a general medical condition.

Chronic Motor or Vocal Tic

Disorder

It is the presence of either motor tic or

vocal tics, but not both.

Characterized by tics that last longer than

one year.

DIAGNOSTIC CRITERIA FOR CHRONIC

MOTOR OR VOCAL TIC DISORDERA. Single or multiple motor or vocal tics but not both, have been

present at some time during the illness.

B. The tics occur many times a day nearly everyday or intermittently throughout a period of more than 1 year, during this period there was never a tic-free period of more than 3 consecutive months.




F. Criteria have never been met for Tourette’s Disorder.

Transient Tic Disorder

The presence of single or multiple motor

tics and/or vocal tics.

Characterized by tics; lasts longer than 4

weeks, less than 1 year.

DIAGNOSTIC CRITERIA FOR

TRANSIENT TIC DISORDERA. Single or multiple motor and/or vocal tics.

B. The tics occur many times a day nearly every day for at least 4 weeks, but for longer than 12 consecutive months.




F. Criteria have never been met for Tourette’s Disorder or Chronic Motor or Vocal Tic Disorder.

Elimination Disorders

Encopresis

Involving repeated defecation into clothing or

onto the floor.

Sometimes observed in children as a result of

improper toilet training or emotional conflicts.

Diagnosis given to children who are at least 4

years old and who defecate inappropriately at

least once a month for 3 months.

SUBTYPES

With constipation and overflow

Incontinence

There is evidence of constipation on physical

examination or by history. Feces are

characteristically poorly formed and

leakage is continuous, occurring both

during the day and during sleep. Only small

amounts of feces are passed during

toileting, and the incontinence resolves after

treatment of the constipation

Without constipation and overflow

Incontinence

There is no evidence of constipation on

physical examination or by history. Feces

are likely to be of normal form and

consistency, and soiling is intermittent.

Feces may be deposited in a prominent

location. This is usually associated with the

presence of ODD or CD or may be the

consequence of anal marturbation.

SIGNS & SYMPTOMS

Unintended defecation at least one time per

month for three months; child over 4

years of age.

PREVALENCE

It is estimated that approximately 1% of 5

years olds have Encopresis, and the disorder

is more common in males than in females.

COURSE

Encopresis is not diagnosed until a child has

reached a chronological age of at least 4

years. Inadequate, inconsistent toilet

training and psychosocial stress may be

predisposing factors.

TREATMENT

Medications to clear out the colon, laxatives or

mineral oil to soften stools, recommendations

to increase dietary fiber, and encouragement to

the child to sit on the toilet a certain amount of

time each day.

Behavioral contracting to increase appropriate

toilet use and diet change, relaxation method.

Enuresis

Enuresis is persistent, uncontrolled wetting by

children who have attained bladder control.

Involuntary discharge of urine; bed-wetting.

Diagnosis given to children over 5 year of age

who wet the bed or their clothes at least twice

a week for 3 months.

SUBTYPES

Nocturnal Only- this is the most common

subtype and is defined as passage of urine

only during nighttime sleep. The enuretic

event typically occurs during the first one-

third of the night. Occasionally the voiding

takes place during the rapid eye movement

stage of sleep, and the child may recall a

dream that involved the act of urinating.

Diurnal Only- this subtype is define as the passageof urine during waking hours. Diurnal Enuresis ismore common I females than in males and isuncommon after age 9 years. The enuretic eventmost commonly occurs in the early afternoon onschool days. Diurnal Enuresis is sometimes due to areluctance to use the toilet because of social anxietyor a preoccupation with school or play activity.

Nocturnal and Diurnal- this subtype is defined as acombination of the two subtypes above.

SIGNS & SYMPTOMS

Unintended urination at least two times

per week for three months; child over 5

years of age.

PREVALENCE

The prevalence of Enuresis at age 5 years is

7% for males and 3% for females; at age 10

years the prevalence is 3% for males and

2% for females. At age 18 years, the

prevalence is 1% for males and less among

females.

COURSE

Primary Enuresis begins at age 5 years. The mostcommon type for the onset of secondaryEnuresis is between the ages of 5 and 8 years,but it may occur at any time. After age 5 years,the rate of spontaneous remission is between5% and 10% per year. Most children with thedisorder become continent by adolescence, butin approximately 1% of cases the disordercontinues into adulthood.

TREATMENT

Antidepressant drugs, synthetic antidiuretic

hormone

A behavioral method referred to as the “Bell

and Pad Method” is a reliable, long-term

solution to enuresis.

Separation Anxiety Disorder

Excessive anxiety concerning separation

from the home or from those to whom the

person is attached.

SIGNS & SYMPTOMS Excessive distress when separated from home or

caregivers or when anticipating separation.

Persistent and excessive worry about losing, or harm

coming to, caregivers.

Excessive fear about being alone

Reluctance to go to sleep without caregivers nearby

Repeated nightmares involving themes of separation

Repeated complaints of physical symptoms when

separation from caregivers occur or is anticipated

Persistent reluctance or refusal to go to school or

elsewhere because of fear of separation

PREVALENCE

Prevalence estimates average about 4% in

children and young adolescents.

ONSET

May be as early as preschool age and may

occur at any time before age 18 years, but

onset as late as adolescence is uncommon.

Selective Mutism

(Formerly Elective Mutism)

Is the persistent failure to speak in specific

social situations where speaking is expected,

despite speaking in other situations.

It includes excessive shyness, fear of social

embarrassment, social isolation and

withdrawal, clinging, compulsive traits,

negativism, temper tantrums, or controlling

or oppositional behavior.

GENDER

Selective mutism is slightly more common

in females than in males.

PREVALENCE

Selective Mutism is apparently rare and is

found in less than 1% of individuals seen

in mental health settings.

COURSE

Onset of Selective Mutism is usually before

age 5 years, but the disturbance may not

come to clinical attention until entry to

school. Although the disturbance usually

lasts for only a few months, it may

sometimes persist longer and may even

continue for several years.

Reactive Attachment Disorder of

Infancy or Early Childhood

Markedly disturbed and developmentally

inappropriate social relatedness in most

contexts that begins before age 5 years

and is associated with grossly

pathological care.

SUBTYPE

Inhibited type- the predominantdisturbance in social relatedness is thepersistent failure to initiate and to respondto most social interactions in adevelopmentally appropriate way.

Disinhibited type- this is used if thepredominant disturbance in socialrelatedness is indiscriminate sociability or alack of selectivity in the choice ofattachment figures.

COURSE

The onset of Reactive Attachment Disorder isusually in the first several years of life and, bydefinition, begins before age 5 years. Thecourse appears to vary depending on individualfactors in child and caregivers, the severity andduration of associated psychosocialdeprivation, and the nature of intervention.Considerable improvement or remission mayoccur if an appropriately supportiveenvironment is provided.

Stereotype Movement Disorder

(Formerly Stereotypy/Habit

Disorder)

The essential feature of Stereotype

Movement Disorder is motor behavior

that is repetitive, often seemingly driven,

and nonfunctional.

AGE AND GENDER

Self-injurious behavior occurs in individuals

of all ages. There are indications that head

banging is more prevalent in males (with

about a 3:1 ratio), and self-biting may be

more prevalent in females.

PREVALENCE

The estimates of prevalence of self-injurious

behaviors in individuals with Mental

Retardation vary from 2% and 3% in

children and adolescents living in the

community to approximately 25% in adults

with severe or profound Mental Retardation

living in institutions.

Reported by:

Jomar V. Sayaman

Geraldine Valdenarro

Mary Antonette Gamez

childhood disorders(report)

Education