Chapter 29 Behavioral and Psychiatric Disorders in Children with Disabilities Overview Developmental disabilities and prevalence of psychiatric disorders Types and symptoms of psychiatric disorders among people with developmental disabilities Interventions for children with dual diagnosis of a developmental disability and a psychiatric disorder Chapter 29 slides in Children with Disabilities, Seventh Edition, Online Companion Materials. Copyright © 2013 Paul H. Brookes Publishing Co., Inc. All rights reserved.

Introduction Children with developmental disabilities may face psychiatric illnesses specific to their disorder The presence of developmental disability can alter symptomatic presentation of psychiatric disorders, making accurate diagnosis more difficult When “dual diagnosis” is not recognized, children can fail in educational and social settings, be unmanageable at home, and show aggression and self-injury If condition is identified early, long-term adverse effects are minimized https://www.youtube.com/watch?v=L41k2p-YRCs Chapter 29 slides in Children with Disabilities, Seventh Edition, Online Companion Materials. Copyright © 2013 Paul H. Brookes Publishing Co., Inc. All rights reserved.

Prevalence Intellectual disabilities—Four- to five-fold higher rate of psychiatric disorders Neurodevelopmental disorders—behavioral/psychiatric disorders: ADHD, MDD, anxiety disorders, mood disorders, self-injurious behavior (SIB) Down syndrome—increased rates of behavior disorders (ADHD, aggression, autism) Prader-Willi syndrome—OCD symptoms, bipolar disorder, mood disorders, social phobias, major depression Prenatal exposure to alcohol—high rates of conduct disorder Chapter 29 slides in Children with Disabilities, Seventh Edition, Online Companion Materials. Copyright © 2013 Paul H. Brookes Publishing Co., Inc. All rights reserved.

Prevalence (continued) Fetal alcohol syndrome—elevated suicide and depression rates, bipolar disorder https://www.youtube.com/watch?v=X9ap3Iimimk Williams syndrome—high rates of psychiatric disorders, particularly ADHD, specific phobias, and generalized anxiety disorder https://www.youtube.com/watch?v=M6n4z0XjPh4 Chapter 29 slides in Children with Disabilities, Seventh Edition, Online Companion Materials. Copyright © 2013 Paul H. Brookes Publishing Co., Inc. All rights reserved.

Causes Biochemical abnormality Conditions affecting developing brain (fetal alcohol exposure, congenital infections) Complex interaction among factors: Biological (including genetic) Environmental Medical Psychosocial Chapter 29 slides in Children with Disabilities, Seventh Edition, Online Companion Materials. Copyright © 2013 Paul H. Brookes Publishing Co., Inc. All rights reserved.

Psychiatric Disorders of Childhood and Adolescence Oppositional defiant disorder (ODD) and conduct disorders (CD) ODD—pattern of negative, hostile, and defiant behaviors; angry moods, vindictiveness (preadolescents) CD—pattern of callous and unemotional behavior in which child violates people’s rights, ignores norms, or breaks rules for at least 12 months (adolescents) Often associated with ADHD; behavioral therapy preferred Impulse control disorders Intermittent explosive disorder—pattern of discrete episodes of failure to resist aggressive impulses, with resultant assaults or destruction of property Hair-pulling disorder—pattern of urge to pull hair for relief, noticeable hair loss, anywhere on the body (not associated with skin or physical condition causing hair loss) Chapter 29 slides in Children with Disabilities, Seventh Edition, Online Companion Materials. Copyright © 2013 Paul H. Brookes Publishing Co., Inc. All rights reserved.

Psychiatric Disorders of Childhood and Adolescence (continued) Anxiety disorders Generalized anxiety disorder—excessive anxiety and worry about family, health, finances, school, or work Panic disorder—panic attacks that recur; usually begin during puberty Social anxiety disorder—intense fear of acting in a way or showing anxiety symptoms that will be negatively evaluated OCD—recurrent thoughts, images, or impulses that are intrusive, inappropriate, and anxiety-causing; repetitive behaviors or mental acts done to neutralize an obsession or as part of following rigid rules Chapter 29 slides in Children with Disabilities, Seventh Edition, Online Companion Materials. Copyright © 2013 Paul H. Brookes Publishing Co., Inc. All rights reserved.

Psychiatric Disorders of Childhood and Adolescence (continued) Post traumatic stress disorder (PTSD)—re-experiencing trauma, avoidance and numbing, and increased arousal Skin picking disorder—skin picking resulting in skin lesions, clinically significant distress/impairment Mood disorders—major depression (at least 2 weeks with 5 of 9 symptoms); bipolar disorder (swings between depression and mania/hypomania) Psychotic disorders—alterations in thinking or perceptions not connected with reality; schizophrenia Eating disorders—rumination, binge eating, and pica Adjustment disorders—development of emotional or behavioral symptoms in response to identifiable stressor Maladaptive behavior disorders—self-stimulating behavior and SIB Chapter 29 slides in Children with Disabilities, Seventh Edition, Online Companion Materials. Copyright © 2013 Paul H. Brookes Publishing Co., Inc. All rights reserved.

Vulnerability Children with developmental disabilities at higher risk for psychiatric disorders for a variety of reasons: Higher rates for certain psychiatric disorders in specific syndromes Impairment in acquisition of age-dependent coping skills Multiple hospital stays for treatment of associated medical problems Physical differences readily seen by peers Family history of psychiatric disorders Changes in school, classmates, living situations, and family Chapter 29 slides in Children with Disabilities, Seventh Edition, Online Companion Materials. Copyright © 2013 Paul H. Brookes Publishing Co., Inc. All rights reserved.

Evaluation Referral to experienced health professional Detailed history of symptoms and behavior Interview and/or observation of child Input from school and other care providers Evaluation of family functioning Referral to psychological testing or behavior assessment, if appropriate Chapter 29 slides in Children with Disabilities, Seventh Edition, Online Companion Materials. Copyright © 2013 Paul H. Brookes Publishing Co., Inc. All rights reserved.

Treatment Educational interventions—supports to help child succeed in classroom, including Positive-behavior interventions and supports Individualized behavior intervention plan Self-contained classrooms or extra aides in general class Therapy with school counselor or behavioral psychologist Rehabilitation therapy—speech-language therapy or physical or occupational therapy to address language or physical disabilities Psychotherapy—psychological or behavioral therapy (individual, group, family) to relieve symptoms and help child cope with disability Chapter 29 slides in Children with Disabilities, Seventh Edition, Online Companion Materials. Copyright © 2013 Paul H. Brookes Publishing Co., Inc. All rights reserved.

Treatment (continued) Pharmacotherapy Antidepressants—depression, anxiety disorders Antihypertensives—explosive and aggressive behavior, ADHD, tic disorder, Tourette syndrome Antipsychotic medications—aggression and SIB in children with intellectual disability or autism spectrum disorders Benzodiazepines—anxiety in the short-term Mood stabilizers—bipolar disorder and aggression Stimulants and atomoxetine—ADHD Chapter 29 slides in Children with Disabilities, Seventh Edition, Online Companion Materials. Copyright © 2013 Paul H. Brookes Publishing Co., Inc. All rights reserved.