PSYCHIATRIC DISORDERS IN CHILDHOOD AND ADOLESCENCE Robert L. Hendren, D.O. Professor of Psychiatry and Pediatrics UMDNJ-RWJMS

Developmental Model of Psychopathology Autism Schizoid Reactive Attachment Separation Anxiety ODD Conduct Disorder Tourettes PDD Mental Retardation Anxiety ODD ADHD Separation Anxiety Overanxious Conduct Disorder Eating Disorder Schizophrenia Depression Eating Disorder Identity Disorder 6 MOS

Retardation Mental Retardation Mild (50-55 to 70) Moderate (35-40 to 50-55) Severe (20-25 to 35-40) Profound (<20-25)

Etiology Etiology l Unknown 30-40% l Genetic 5% l Prenatal 30% l Perinatal medical conditions and complications -15% l Environmental influences %

Learning, Motor Skills, Communication Disorders l Reading disorder 7-9% l Mathematics disorder l Disorder of Written Expression 2-8% l Developmental Coordination Disorder 6% l Expressive Language Disorder 3-10% l Mixed Receptive - Expressive Language Disorder 3-10% l Phonological Disorder 5-10% l Stuttering

Autistic Disorder Reciprocal interaction Communication Stereotypes Brain changes

Pervasive Developmental Disorders l Asperger’s Disorder l Rett’s Disorder l Childhood Disintegrative Disorder l PDD NOS

Elimination Disorders l Encopresis l Enuresis

Concept of Impulse Control Disorder l Common etiology l Diagnostic overlap l Co-morbidity

Attention Deficit Hyperactivity Disorder l Over vs. under diagnosis controversy l Subtypes include inattentive, impulsive/hyperactive and combined l Similar life cycle except hyperactivity and co-morbidity

ADHD Prevalence 3 - 5% school-aged children Boys more than girls, but may be under-diagnosed in girls

ADHD Biologic Etiology l Genetic risk l Prenatal stress and toxins l Frontal lobe, basal ganglia and RAS implicated l Norepinepherine - inattention l Serotonin - impulsivity

ADHD Psychosocial Etiology l Poor social relatedness l Peer/Authority rejection l Goodness of fit

ADHD Assessment l Context and development l Life cycle issues l Family issues l Rule out medical causes

Rating Scales - ADHD l Connors l AcTERS l Continuous Performance l Wender Utah Rating Scale for retrospective diagnosis

Alternative Diagnoses Schizophrenia l PTSD l Bipolar Disorder

ADHD Co-morbidity l Depression l Tics and Tourettes l Conduct Disorder l Substance Use Disorder l Learning Disability

ADHD Outcome l Normal 15% l Continued Problems 50% l Significant pathology 25% l Substance abuse

Conduct Disorder l Repetitive persistent pattern of violation l Childhood vs. adolescent onset l 9% males; 2% females l Co-morbidity

CD - Biologic Etiology l Temperament l Genetics l Serotonin Developmental instability

CD - Psychosocial Etiology Cognitive factors Family factors Peer group SES Culture

“You left your goddam car in the driveway again!”

Oppositional Defiant Disorder l Recurrent pattern greater than 6 months l Evident by age 8 l Non-aggressive grow out

Substance Use Disorder l Prevalence l Co-morbidity l Type I/Type II