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2 Important Facts Category of convenience –– no intent of clear distinction between “adult’/“childhood” disorders Primarily diagnosed in regard to age –not phenomenology Usually identified by others Children regarded as more malleable than adults –thus more amenable to treatment Differential Diagnosis –diagnosis which nearly fits symptoms but must be ruled out Necessary information = Knowledge of normal life-span development

3 Making a Diagnosis: 7 Steps Observation of diagnostic clues –Focus on behavior, cognitive ability, verbal responses, etc. Screen the problem –Consider symptoms/behaviors indicating or excluding a specific diagnosis Follow-up of preliminary impressions –Testing or ruling out “your” diagnostic assumptions Confirmatory history –Gather pertinent information Complete data base –Specific info relevant to diagnosis under consideration Diagnosis –All information, including DD Prognosis –Consider individual’s response to & motivation for treatment

4 Clinical Info Necessary for Diagnosis of Disorders First Evidenced in Children & Adolescents Times of developmental milestones Capacity to communicate with other people Language impairment Capacity for human relationships Quality of social interaction Abnormal motor movements Hyperactivity, inattention, or poor impulse Abnormal behaviors (e.g., fire setting, cruelty to animals) Enuresis or encopresis

5 Understanding Normal Life-span Development Allows identification of appropriate behaviors at appropriate stages Childhood problems not to be viewed as downward extension of adult issues Possible to diagnose children with some “adult” disorders as major depression or PTSD if adult criteria met

6 Subcategories of Diagnoses Mental Retardation Learning Disorders Motor Skills Disorders Communication Disorders Pervasive Developmental Disorders Attention-Deficit & Disruptive Behavior Disorders Feeding & Eating Disorders of Infancy & Childhood Tic Disorders Elimination Disorders Other Disorders – contains 5 diverse disorders

7 Predominant Symptoms or Deficits Intellectual & cognitive impairment Motor function impairment Disruptive or self-injurious behavior Information exchange  All MR & All LD  Motor Skills, Tic, & Stereotypic Movement Disorders  ADD & Disruptive Behavior, Feeding & Eating, Elimination, Separation Anxiety, Reactive Attachment Disorders  Pervasive Developmental, Communication Disorders, & Selective Mutism

8 MENTAL RETARDATION (Axis II) Significantly subaverage intellectual functioning Based on test scores & adaptive behavior Check present adaptive functioning in various areas –communication, self-care, academics, social etc Cultural/ethnic considerations Onset before 18 years of age Criteria met for MR, diagnosis given regardless of presence of another disorder Differentiate Mild MR from borderline intellectual functioning –careful consideration of all available information

9 Some MR Interventions Head Start Programs –may help prevent Mild MR Applied behavior analysis (operant conditioning) –adaptive skills, communication, self-help, social & vocational Cognitive behavior therapy –self-instructional training as in “Little Bear” pictures Computer-assisted instruction –maintain attention, material individualized, repetitions helpful without boredom or loss of patience

10 Learning Disorders (Academic Skills Disorders) Academic functioning –below expected for chronological age, measured IQ, & age-appropriate education Reading Disorder Mathematics Disorder Disorder of Written Expression Learning Disorder NOS –criteria for any specific LD not met

11 A Motor Skills Disorder Developmental Coordination Disorder Not due to general medical condition Substantial impairments in motor coordination –Significantly interfering with academic achievement or daily activities –Marked delays in normal milestones as sitting, crawling, walking –Or clumsiness, poor performance in sports or poor handwriting

12 Tic Disorders – Motor Function Disorders Tourette’s Disorder –Multiple motor tics & 1 or more vocal tics –Occur many times a day, nearly every day or intermittently for more than 1 year Chronic Motor or Vocal Tic Disorder Transient Tic Disorder Tic Disorder NOS Another Motor Function Disorder in the “Other” category –Stereotypic Movement Disorder

13 Disruptive & Self-Injurious Behavior Disorders Behaviors socially unacceptable or potentially harmful Include: –Hyperactive, impulsive, inattentive, oppositional, defiant, impulsive, & disruptive behavior –Also abnormalities of eating & elimination

14 Attention-Deficit Disorders Criteria with code based on type –Attention-Deficit/Hyperactivity Disorder, Combined Type –Attention-Deficit/Hyperactivity Disorder, Predominately Inattentive Type –Attention-Deficit/Hyperactivity Disorder, Predominately Hyperactive-impulsive Type –Attention-Deficit/Hyperactivity Disorder NOS

15 Disruptive Behavior Disorders (also NOS) Conduct Disorder –Violation of basic rights of others or –Major age-appropriate societal norms abused Manifested through –Aggression to people & animals –Destruction of property –Deceitfulness or theft –Seriousness violations of rules Oppositional Defiant Disorder –Persistent patterns of negativistic, hostile, & defiant behaviors Behaviors include –Temper loss, arguments with adults, defies to obey rules, deliberate annoying, blames others, easily annoyed by other, often angry & resentful, spiteful or vindictive

16 Feeding and Eating Disorders Diagnosable at Point Where Health Endangered Disturbances of eating –eating nonnutritive substances –repeated regurgitation of food –failure or refusal to eat Pica – repeatedly eating nonnutritive substances Rumination Disorder – regurgitate & rechew Feeding Disorder – failure to gain wt. Or loss of significant wt. over period of 1 mo. Due to not eating adequately (onset before 6)

17 Elimination Disorders Encopresis – passing feces into inappropriate places –Must be at least 4 yrs. old Enuresis – repeated urination into beds or clothes –Criterion regulated occurrence –Or clinically significant distress/impairment is produced –Must be at least 5 yrs. old

18 Pervasive Developmental Disorders Autism, Rett’s, Childhood Disintegrative Disorder, Asperger’s, & Pervasive Developmental NOS Common elements: Broad based impairment or loss of functions expected at that age Three components covered: –social interactions –communication –patterns of behavior, interests, activities Patterns which may surface include: –restricted, repetitive, stereotypic

19 Autism Named "early infantile autism" from observations of an extreme autistic aloneness that, whenever possible, disregards, ignores, shuts out anything that comes to the child from the outside Prior to age three Abnormal functioning in at least one area: –social interaction –language by social communication –symbolic/imaginative play

20 Autism Treatment Most successful technique is in intense behaviorally oriented programs. -Goals to work with are: social skills, breaking down tasks, eliminating maladaptive behaviors; medication. -Try to relieve symptoms and improve communication, social skills, and adaptive behavior -Modeling and operant conditioning Drug treatment –most common medication is haloperidol,

21 Rett's Disorder (females only) Normal functioning at birth & through first 5 months of life –between ages 5 months - 48 months - decelerated (decreased) head growth occurs –loss of previously acquired hand movement. –loss of social skills –difficult gait/movement Usually medical intervention

22 Childhood Disintegrative Disorder Rare Development normal first 2 years of life (distinguishing feature from autism) A loss of ability (in autism abilities never developed) Often symptoms first noticed by parents

23 Asperger’s Disorder Lack of interest in social action Severe & sustained impairment in social interactions Different from autism because no significant delay in language & communication Some idiosyncratic features similar to autism; repetitive patterns of behavior, interests and activities

24 Pervasive Developmental Disorder Not Otherwise Specified (NOS) Severe & pervasive impairments in –Reciprocal social interactions –Communications skills Or stereotypical behavior, interests, or activities Criteria for Pervasive Development Disorder not met

25 Communication Disorders check if acquired or developmental Expressive Language Disorder Mixed Receptive- Expressive Language Disorder Phonological Disorder Stuttering Communication Disorder NOS

26 Other Subcategory – 5 Diverse Disorders Stereotypic Movement Disorder -- repetitive, seemingly driven nonfunctional motor behavior Separation Anxiety Disorder -- Inappropriate or excessive anxiety about separation from home or person of attachment –Onset before 18 years of age Reactive Attachment Disorder of Infancy or Early Childhood --Excessively inhibited, hypervigilant, ambivalent & contradictory responses to most social interactions –Or diffuse indiscriminate attachments to other people –Associated with pathogenic care Selective Mutism – consistent failure to speak in speific social situations yet speaking in others Disorder of Infancy, Childhood, or Adolescence NOS – residual category where criteria for no specific disorder is met


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