2. CHILDHOOD DISORDERS Dr. Rebwar Ghareeb Hama Psychiatrist
University of Sulaimani
School of Medicine

3. Classification Learning Disorders Motor Skills Disorders
Communication Disorders
Pervasive Developmental Disorders
Attention –Deficit Disorders
Disruptive Behavior Disorders
Feeding & Eating Disorders
Tic Disorders
Elimination Disorders
Other Disorders: like separation anxiety disorder, elective mutism ,etc…
Mood Disorders
Substance Abuse

4. Confidentiality directly related to age of child/adolescent
Must be familiar with normal development and remember what is normal for one age may be a problem for another
Example: Tantrum Behavior
2 year old ~ normal and expected behavior
12 year old ~ not expected within normal development
Confidentiality directly related to age of child/adolescent
Young child ~ all information shared with caretaker
Adolescent ~ try to establish privacy agreement between caretaker and adolescent with understanding of what must be shared (significant danger to self and/or others, abuse)

5. Motor Skills Disorders
This is also called developmental coordination disorders
Its essential characteristic is a marked impairment in the development of motor coordination
It is characterized by imprecise or clumsy gross motor skill

6. Communication Disorders
This category includes disorders of speech & language
They include:
1. Expressive language disorder:
the child skills in vocabulary ,the use of correct tenses ,the production of complex sentences & the recall of words are below the expected level for his or her age & intelligence
2 . Mixed receptive –expressive language disorder:
child is impaired in both understanding and expressing language
3 . Phonological disorder:
it is manifested by inappropriate or poor sound production
4 . Stuttering or Stammering:
disturbance in the fluency and time patterning of speech that is inappropriate for the patient’s age

7. Pervasive developmental disorders
These disorders are severe ,pervasive impairment in developmental areas ,such as social interaction & communication ,or stereotyped behavior ,interests and activities
The impairments are deviant in comparison to a person’s mental or developmental level
These disorders include:
Autistic disorder
Rett’s disorder
Childhood disintegrative disorder
Asperger’s disorder

9. Autistic disorder
Sometimes called “childhood autism, early infantile autism, Kanner’s autism”
Prevalence is %
In most cases it starts before the age of 36 months( 3 years)
It is more frequent in boys
The etiology of autistic disorder is not clear but there is more reliance on biological causes

10. Clinical features
Impairment in social interaction: lacking social smile, fail to show the usual relatedness to their parents and other people, abnormal eye contact, …
Disturbance of communication &language
Stereotyped behavior :the activities &play are rigid ,repetitive & monotonous. Ritualistic and compulsive phenomena are common
Unstability of mood
Abnormal response to sensory stimuli( either exaggerated or decreased)
Other behavioral symptoms hyperkinesis or hypokinesis ,aggressive behavior ,temper tantrums, self injurious behavior

11. Prognosis is generally unfavorable
The patient needs a complicated care which include:
Educational therapy
Behavioral therapy
Pharmacotherapy: no specific therapy is available. It can be only symptomatic like anti-obsessive, antipsychotic and antiepileptic

12. In the absence of specific treatment, management has 6 main aspects:
Management of abnormal behavior
Education and social services
Speech and language therapy ,occupational therapy, dietary advice…
Treat medical conditions (e.g. epilepsy ,GIT problems)
Help for families
Pharmacotherapy :symptom management (e.g. antipsychotic for stereotypes ),SSRI for compulsive and self harming behaviors and depression, and anxiety

13. Aspergers Syndrome( AS)
A syndrome first described by Hans Asperger’s in ,and sometimes called autistic psychopath ,is characterized by:-
The child develops normally until about the third year when they begin to lack warmth in relationships, and speak in monotonous stilted ways
Severe persistent impairment in social interactions ,repetitive behavior patterns, and restricted interests
IQ and language are normal or in some cases, superior
Motor mannerisms such as hand and finger twisting, or whole body movements

14. They are often clumsy and eccentric
They are more interested in others than autistic children
The disorder is more common in boys than girls
A family history of autism may be present
The cause of AS is unknown
It differ from autism in that there is no general delay or retardation of cognitive development or language
They are solitary, and embark on and spend much time in narrow interests

16. Attention Deficit / Hyperactivity Disorder (ADHD)
This disorder is common ,appears more often in boys than in girls and causes disruption in school and at home
It is characterized by:
Features of hyperactivity: age-inappropriate hyperactivity which is mostly purposeless & intolerable causing a lot of disturbance
Poor attention span
Impulsivity
These symptoms should be present for at least 6 months before the diagnosis is made
The symptoms should be present in more than one setting ( home, school, work)
And should be severe enough to cause significant impairment

17. 3%-7% of children suffer from ADHD
ADHD is diagnosed approximately three times more often in boys than in girls
As many as half of those with ADHD also have other mental disorders
Over half of the children diagnosed with ADHD carry the disorder into adulthood
A large number of adults who were never diagnosed as a child show clear symptoms of ADHD

18. The symptoms of ADHD are present since the early childhood (before the age of 7 years)
The causes of ADHD are unknown ,but the disorder is predictably associated with a variety of other disorders that affect the brain function ,such as learning disorders
The suggested contributory factors to ADHD include prenatal toxic exposure, prematurity, and prenatal mechanical insult to the fetal nervous system
Food additives ,colorings, preservatives, and sugar have been suggested as possible causes
There is evidence for a genetic cause

19. Symptoms of Inattention must have 6 or more
Often fails to give close attention to details or makes careless mistakes in schoolwork, work, or other activities
Often has difficulty sustaining attention in tasks or play activities
Often does not seem to listen when spoken to directly
Often does not follow through on instructions and fails to finish school-work, chores, or duties in the workplace (not oppositional)

20. 5. Often has difficulty organizing tasks and activities 6
5. Often has difficulty organizing tasks and activities 6. Often avoids, dislikes, or is reluctant to engage in tasks that require a sustained mental effort 7. Often loses things necessary for tasks or activities 8. Often easily distracted by extraneous stimuli 9.Often forgetful in daily activities

21. Symptoms of Hyperactivity-Impulsivity Must have 6 or more
Often fidgets with hands or feet or squirms in seat
Often leaves seat in classroom or in other situations in which remaining seated is expected
Often runs about or climbs excessively in situations in which it is inappropriate (adolescents ~ may be subjective feelings of restlessness)
Often has difficulty playing or engaging in leisure activities quietly
Often “on the go” or often acts as if “driven by a motor”
Often talks excessively

22. Impulsivity
Often blurts out answers before questions have been completed
Often has difficulty awaiting turn
Often interrupts or intrudes on others

23. Treatment of ADHD Pharmacotherapy:
a. CNS stimulants: dextroamphetamine, methylphenidate, and pemoline
b. Antidepressants
Psychotherapy :
which include behavioral therapy , education of parents and teachers

24. Disruptive behavior disorders
There are two types:
Oppositional defiant disorder:
described as a recurrent pattern of negativistic, defiant, disobedient, and hostile behaviors toward authority figures
Conduct disorder:
A repetitive & persistent pattern of behavior in which the basic rights of others or major age- appropriate societal norms or rules are violated

26. Elimination Disorders
Enuresis :
The repeated voiding of urine into clothes or bed ,whether, the voiding is involuntary or intentional .The behavior must occur twice weekly for at least 3 months or must cause clinically significant distress or impairment socially or academically. The child’s age must be at least 5 years
Encopresis:
Passing feces into inappropriate places whether the passage is involuntary or intentional. The pattern must be present for at least 3 months ; the child’s age must be at least 4 years

27. Separation Anxiety Disorder
Defined as an excessive anxiety about separation from home or from those to whom the child is attached
This disorder must last for at least 4 weeks
Must begin before age of 18 years
Must cause significant distress or impairment
Separation anxiety requires the presence of at least three symptoms related to excessive worry about separation from the major attachment figures

28. The worries may take the form of refusal to go to school( school phobia, school refusal), fears & distress upon separation ,repeated complaints of such physical symptoms like headaches & stomach aches when separation is anticipated and night mares related to separation issues
The disorder is common and onset may occur during preschool years but is most common in 7-8 years old
Prevalence is 3-4% of all school children
It occurs equally in males and females
Treatment : behavioral therapy

30. Pediatric Psychopharmacology Summary:
Substantial Empirical Evidence Currently Supports
Stimulants for ADHD
SSRI’s for OCD
Well Designed Trials support
Risperidone for aggression and self-injurious behaviors in autism
Fluvoxamine for Childhood Anxiety Disorders
Fluoxetine for Moderate – Severe Major Depression

31. Pediatric Psychotherapy Summary:
Best Evidence for;
CBT (cognitive behavioral therapy) for Depression, Anxiety
CBT/Behavioral Strategies for Conduct Problems
Parent Training for Conduct Problems
MST (multi systemic treatment) for Conduct Problems