DISORDERS USUALLY FIRST DIAGNOSED IN INFANCY,CHILDHOOD, OR ADOLESCENCE

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

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

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

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

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

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

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

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

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

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

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

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

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

Disruptive Behavior Disorders (also NOS) 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 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

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)

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

Broad based impairment or loss of functions expected at that age 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

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

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, -Modeling and operant conditioning one child not learned to greet another human until age 14; learned by behavior-modification - earning points for Hello, Mrs. and Jones; scoring by a golf counter  social reinforcement followed  use of clicks and numbers on the golf counter intrigued individual most common medication is haloperidol, an antipsychotic medication but many autistic children do not respond positively to this drug, and it has potentially serious side effects

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

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

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

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

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

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