Presentation on theme: "Disorders Usually 1st Diagnosed in Infancy, Childhood, & Adolescence"— Presentation transcript:
1Disorders Usually 1st Diagnosed in Infancy, Childhood, & Adolescence Core Concept of Diagnostic Group:Categorized by time of onsetPredominantly 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.
210 Diagnostic Subgroups (DSM-IV-TR) Mental RetardationLearning DisordersMotor Skills DisordersCommunication DisordersPervasive Developmental DisordersAttention Deficit and Disruptive Behavior DisordersFeeding & Eating Disorders of Infancy & Early ChildhoodTic DisordersElimination DisordersOther Disorders of Infancy, Childhood, or Adolescence
3Mental 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, safetyOnset before age 18 yearsCoding: coded on axis IICode based on degree of severity, reflecting level of intellectual impairment:Mild Mental Retardation – IQ from to 70Moderate Mental Retardation – IQ from to 50-55Severe Mental Retardation – IQ from to 35-40Profound Mental Retardation – IQ below 20-25
4Mental Retardation Prevalence: 1-3% of population; 90% are mild MR Course: chronicPrognosis: variable, depending on IQ & level of impairmentGender differences: more prevalent for males (1.6 to 1); no gender differences for severe & profound MRCauses: 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
5Learning 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 educationSignificantly interferes with aspects of life requiring those skills.Subtypes:Reading DisorderMathematics DisorderDisorder of Written ExpressionLearning Disorder Not Otherwise Specified
6Learning Disorders Prevalence: Racial: more common in black children general population: 5-10%reading disorders: 5-15%math disorders: 6%Racial: more common in black childrenNegative outcomes: negative school experiences; school drop-out; lower employment rates; lower educational & career goalsCauses: genetics; structural & functional differences in the brainTreatment: educational interventions (processing skills; cognitive skills; behavioral skills)
7Tic 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/feetCommon 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
8Tourette’s DisorderCauses: 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 adulthoodGender: 2-5x as common for malesOnset: as early as 2 yrs; average age of onset is 6-7 yrs; typically develops by age 14Course: severity, frequency, and disruptiveness of sx diminish during adolescence & adulthoodTreatment: antipsychotics; antihypertensive medications; SSRI’s; self-monitoring; relaxation training; habit reversal
9Attention Deficit/Hyperactivity Disorder Includes two major syndromes:1) Inattention2) Hyperactivity-ImpulsivitySyndromes may occur independently or together, but usually some components of each are present.Symptoms begin before age 7Symptoms cause some impairment in 2 or more settings.
10Attention Deficit/Hyperactivity Disorder Inattention: 6+ of the following for 6+ monthsOften fails to give close attention to detailsOften makes careless mistakes in school, work, etc.Often has difficulty sustaining attentionOften doesn’t seem to listen when spoken to directlyOften doesn’t follow instructionsOften fails to finish schoolwork, chores, or work dutiesHas difficulty organizing tasks & activitiesAvoids or dislikes tasks requiring sustained mental effortOften loses thingsIs easily distracted by extraneous stimuliIs forgetful in daily activities
11Attention Deficit/Hyperactivity Disorder Hyperactivity-Impulsivity 6+ of following for 6+ monthsHyperactivity:Fidgets with hands or feet; squirms in seatDifficulty staying in seatExcessive running, climbing, or restlessnessDifficulty playing or engaging in leisure activities quietlyOften “on the go;” acts as if “driven by a motor”Often talks excessivelyImpulsivity:Often blurts out statementsImpatient; difficulty awaiting turnOften interrupts or intrudes on others
12Attention Deficit/Hyperactivity Disorder Subtypes:AD/HD, Predominantly Inattentive TypeAD/HD, Predominantly Hyperactive-Impulsive TypeAD/HD, Combined TypeAD/HD, Not Otherwise SpecifiedOnset: 3-4 years oldAge: 68% have ongoing sx in adulthood; inattentive subtype is more common in adolescents and adultsGender: ratios of males to females range from 2:1 to 9:1; Combined and Hyperactive Subtypes are much more common in males than femalesPrevalence: up to 3-7% of school-age children
14ADHD: 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.
15ADHD: Contributing Factors Genetics: increased incidence of ADHD & psychopathology in families & relativesPrenatal factors: inadequate oxygen; drug exposure; maternal smokingNeurotransmitters: inadequate availability of dopamine; NE, 5HT, GABA also implicatedBrain abnormalities: frontal cortex, basal ganglia, & cerebellar vermis are smallerExposure to toxins: allergens, food additivesParenting: negative attempts to control their behavior; intrusive, over-bearing parenting
16Attention Deficit/Hyperactivity Disorder Treatments:Medication – stimulants, Strattera (SNRI), WellbutrinPsychoeducation & bibliotherapySkills-based training – time management, organizational skills, study skills, problem-solving, social skills
17Conduct DisorderRepetitive, 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 animalsDestruction of propertyDeceitfulness or theftSerious violations of rules
18Conduct Disorder Aggression to People and Animals: Bullying, threats, intimidationPhysical fightsUse of weaponsPhysical cruelty to peoplePhysical cruelty to animalsMugging, purse snatching, extortion, armed robberyForced sexual activity
19Conduct Disorder 2) Destruction of Property: Deliberate fire-setting Deliberate destruction of others’ property3) Deceitfulness or TheftBreaking & enteringLying; conningStealing; shoplifting; forgery4) Serious Violations of RulesBreaking curfew prior to age 13School truancy prior to age 13Running away from home
20Conduct Disorder Subtypes: Specifiers: Conduct Disorder, Childhood Onset – onset of at least 1 criterion prior to age 10Conduct Disorder, Adolescent Onset – absence of any criteria prior to 10Conduct Disorder, Unspecified Onset – age of onset is unknownSpecifiers:Mild – few, if any, conduct problems in excess of those required to make dx; cause only minor harm to othersModerate – number of conduct problems and effect on others are in the intermediate rangeSevere – many conduct problems in excess of those required to make dx; cause considerable harm to others
21Conduct DisorderEtiology: genetics; decreased arousal; low levels of 5HT; neurological deficitsPrevalence: 2-9% of nonclinical population; up to 1/3-1/2 of child mental health referrals; 87-91% of incarcerated juvenilesGender Differences: mostly malesOnset: as early as preschoolPrognosis: poor; 2/3rds of cases develop into Antisocial Personality DisorderTreatment: parent management training; community-based interventions (group homes, wilderness programs; therapeutic boarding schools); CBT (social skills, problem solving, cognitive restructuring)
22Oppositional Defiant Disorder Pattern of negativistic, hostile, and defiant behavior for at lease 6 months.At least 4 of the following are present:Often loses temperOften argues with adultsOften actively defies or refuses to comply with adults’ requests or rulesOften deliberately annoys othersOften blames others for own mistakes or misbehaviorIs often touchy or easily annoyed by othersIs often angry or resentfulIs often spiteful or vindictiveAbsence of behavior that violate the rights of others
23Oppositional Defiant Disorder Prevalence: 1-6%Gender differences: more prevalent for males prior to puberty; ratio evens out after pubertyPrognosis: relatively persistent – some of the behaviors persist into adulthood, others are outgrown; higher divorce rate, employment difficulties, and drug/alcohol abuse for those with ODDCauses: marital conflict; family discord; inconsistent parenting; overly lenient or rigid parent; coercive or aversive parent-child interactions; geneticsTreatment: parent training; family therapy; behavioral therapy (anger management, social skills training, problem solving, frustration tolerance); cognitive interventions to reduce negativity
24Separation 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 separationexcessive fears of losing major attachment figuresnightmares involving the theme of separationrefusal to go to schoolrefusal to be alone or without major attachment figuresrefusal to sleep away from home or attachment figuresrepeated physical complaints when separation occurs or is anticipatedOnset prior to age 18
25Pervasive 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/relationshipsImpairment in communication/languageRestricted, repetitive, and stereotyped patterns of behavior, interests, and activities
26Autistic DisorderAbnormal functioning in at least one of the following areas, with onset prior to 3:Social interactionLanguage and communicationSymbolic, imaginative playQualitative impairment in social interaction and relationship developmentQualitative impairment in communication, language, and conversation skillsRestricted, repetitive, stereotyped patterns of behavior, interests, activities.
27AutismMental retardation: 75-80%; 50% are profoundly or severely MR; 25% are moderately MR; 25% borderline to average IQGender differences: higher IQ – more prevalent among males; IQ < 35 – more prevalent among femalesPrevalence: 1 in 500 birthsOnset: first apparent in infancy & toddlerhoodCourse: chronic; life-long impairment; 50% never acquire speechCauses: abnormalities in brain structure and function (5HT synthesis, cerebellum); geneticsTreatments: 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)
28Asperger’s DisorderQualitative impairment in social interaction and relationship developmentRestricted, repetitive, and stereotyped patterns of behavior, interests, and activitiesBut lack any clinically significant delay in language or cognitive development
29Asperger’s Syndrome What you see: Anxious, excessive desire for samenessPreoccupation with stereotyped, repetitive activitiesObsess about objectsLimited interestsCan’t relate to othersCan’t read emotionsCan’t understand social cuesSocial isolation, socially ineptAverage IQ scoresMotor clumsinessPoor coordination
30Asperger’s Syndrome Gender: up to 4x as common for males Prevalence: up to 5x as common as AutismOnset: later onset than AutismCourse: chronic, life-longEtiology: genetics; brain abnormalities (limbic system, 5HT & D systems, right hemisphere)
31Asperger’s Syndrome: Treatments Behavioral treatments/skills building: interventions targeting problem behaviors, problem solving, social skills, communication skills, empathy-building, daily living skillsSchool-based interventions: mainstreaming; tutoring; special aides; multiple modalities for presenting informationPsychotherapy to address accompanying psychiatric disorders, such as depression and anxietyMedications: antidepressants, antipsychotics