CHILDHOOD DISORDERS Dr Nesif J. Al-Hemiary MBChB - FICMS(Psych) ARCPsych.(UK.)

Classification 1. Learning Disorders. 2. Motor Skills Disorders. 3. Communication Disorders. 4. Pervasive Developmental Disorders. 5. Attention –Deficit Disorders. 6. Disruptive Behavior Disorders. 7. Feeding & Eating Disorders. 8. Tic Disorders. 9. Elimination Disorders. 10. Other Disorders: like separation anxiety disorder, elective mutism,etc… 11. Mood Disorders. 12. Substance Abuse.

Specific developmental disorders The term ‘specific developmental disorders' includes a variety of severe and persistent difficulties in spoken language, spelling, reading, arithmetic, and motor function. Skills are substantially below the expected level in terms of chronological age, measured intelligence, and age-appropriate education and cannot be explained by any obvious neurological disorder or any specific adverse psychosocial or family circumstances.

As the deficits are quite substantial, analogies were initially made to neurological concepts and disorders such as word- blindness, alexia, aphasia, and apraxia, thus giving rise to the notion that neurological deficits are the etiological basis of these disorders. Since this could not be demonstrated, the next step was to define the disorders in a more functional way, taking into account not only psychometric testing but also psychosocial risk factors and the quality of schooling and education. They include: learning disorders, motor skills disorders and communication disorders.

Learning Disorders They are diagnosed when achievement on standardized tests in reading, mathematics,or written expression is substantially below that expected for age schooling and level of intelligence. The learning disorders significantly interfere with academic achievement or everyday activities. They are also associated with low self esteem and deficits in social skills. There are three types of learning disorders: 1. Reading disorder: defined as reading achievement that is below the expected level for a child age, education & intelligence, that significantly interferes with academic success or the daily activities that involve reading.

2. Mathematics disorder: characterized by impairment in understanding and solving of mathematical operations. 3. Disorder of written expression: characterized by writing skills that are significantly below the expected level for a child’s age,intellectual capacity and education.

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.

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.

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: 1. Autistic disorder. 2. Rett’s disorder. 3. Childhood disintegrative disorder. 4. Asperger’s disorder.

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.

Clinical features 1. Impairment in social interaction: lacking social smile, fail to show the usual relatedness to their parents and other people, abnormal eye contact, … 2. Disturbance of communication &language. 3. Stereotyped behavior :the activities &play are rigid,repetitive & monotonous. Ritualistic and compulsive phenomena are common. 4. Unstability of mood. 5. Abnormal response to sensory stimuli( either exaggerated or decreased). 6. Other behavioral symptoms hyperkinesis or hypokinesis,aggressive behavior,temper tantrums, self injurious behavior.

Prognosis is generally unfavorable. The patient needs a complicated care which include: 1. Educational therapy. 2. Behavioral therapy. 3. Pharmacotherapy: no specific therapy is available. It can be only symptomatic like anti-obsessive, antipsychotic and antiepileptic.

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: 1. Features of hyperactivity: age-inappropriate hyperactivity which is mostly purposeless & intolerable causing a lot of disturbance. 2. Poor attention span. 3. 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.

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.

Treatment of ADHD 1. Pharmacotherapy: a. CNS stimulants: dextroamphetamine, methylphenidate, and pemoline. b. Antidepressants. 2. Psychotherapy : which include behavioral therapy, education of parents and teachers.

Disruptive behavior disorders There are two types: 1. Oppositional defiant disorder: described as a recurrent pattern of negativistic, defiant, disobedient, and hostile behaviors toward authority figures. 2. 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.

Elimination Disorders 1. 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. 2. 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.

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.

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.

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