BS 15 PSYCHIATRIC DISORDERS IN CHILDREN

1.PERVASIVE DEVELOPMENT DISORDERS OF CHILDHOOD 1.PERVASIVE DEVELOPMENT DISORDERS OF CHILDHOOD A. OVERVIEW A. OVERVIEW 1. Pervasive development disorders are characterized by the failure to acquire (autistic disorder) or the early loss (Retts disorder) of social skills and language resulting in lifelong problems in social and occupational functioning. 1. Pervasive development disorders are characterized by the failure to acquire (autistic disorder) or the early loss (Retts disorder) of social skills and language resulting in lifelong problems in social and occupational functioning.

2. These disorders are not reversible. treatment involves behavioral therapy to increase social and communicative skills, decrease behavior problems and improve self care skills as well as supportive therapy and counseling to parents. 2. These disorders are not reversible. treatment involves behavioral therapy to increase social and communicative skills, decrease behavior problems and improve self care skills as well as supportive therapy and counseling to parents. 3. the prototype of these disorders is autistic disorder. 3. the prototype of these disorders is autistic disorder.

B. A utistic disorder B. A utistic disorder 1. characteristics of autistic disorders 1. characteristics of autistic disorders Severe problems with communication Severe problems with communication Significant problems forming social relation ships Significant problems forming social relation ships Repetitive behavior –spinning Repetitive behavior –spinning Sub normal intelligence Sub normal intelligence Unusual abilities – exceptional memory, calculation---- they are called savants. Unusual abilities – exceptional memory, calculation---- they are called savants.

2. Occurrence 2. Occurrence Autistic disorder occurs in 5 children per 10,000. Autistic disorder occurs in 5 children per 10,000. Begins before 3 years of age Begins before 3 years of age More common in boys. More common in boys. 3. etiology 3. etiology Cerebral dysfunction Cerebral dysfunction History of perinatal complications History of perinatal complications Genetic component Genetic component

C. other pervasive developmental disorders C. other pervasive developmental disorders Asperger disorder Asperger disorder Problems forming social relationships Problems forming social relationships Repetitive behavior Repetitive behavior Normal cognitive development Normal cognitive development 2. Retts disorder 2. Retts disorder Diminished social, verbal, and cognitive development upto 4 years of normal functioning Diminished social, verbal, and cognitive development upto 4 years of normal functioning Occurs only in girls Occurs only in girls Stereotyped hand wringing movements Stereotyped hand wringing movements Mental retardation Mental retardation

Childhood disintegrative disorder Childhood disintegrative disorder Diminished social, verbal, cognitive and motor development after at least 2 years of normal functioning Diminished social, verbal, cognitive and motor development after at least 2 years of normal functioning Mental retardation Mental retardation

II Attention –deficit hyperactivity disorder (ADHD) and disruptive behavior disorders of childhood II Attention –deficit hyperactivity disorder (ADHD) and disruptive behavior disorders of childhood Overview Overview 1. ADHD and the disruptive behavior disorders are characterized by inappropriate behavior that causes problems in social relationships and school performance 1. ADHD and the disruptive behavior disorders are characterized by inappropriate behavior that causes problems in social relationships and school performance N0 frank mental retardation N0 frank mental retardation Not uncommon. more in boys Not uncommon. more in boys DD mood disorders and anxiety disorders DD mood disorders and anxiety disorders

Etiology Etiology 1.Genetics factors. relatives of these children have increased incidence of these disorders and antisocial personality disorder and substance abuse 1.Genetics factors. relatives of these children have increased incidence of these disorders and antisocial personality disorder and substance abuse Minor brain dysfunction present Minor brain dysfunction present Substance abuse and child abuse seen in parents of these children Substance abuse and child abuse seen in parents of these children

Treatment Treatment Cns stimulants– methyl phenidate, dextroamphetamine sulfate, pemoline Cns stimulants– methyl phenidate, dextroamphetamine sulfate, pemoline Cns stimulants decrease activity level and increase attention span Cns stimulants decrease activity level and increase attention span Cns stimulants decrease appetite they may inhibit growth and failure to gain weight Cns stimulants decrease appetite they may inhibit growth and failure to gain weight Family therapy is most effective for conduct disorder and oppositional defiant disorder. Family therapy is most effective for conduct disorder and oppositional defiant disorder.

Other disorders of childhood Other disorders of childhood Tourettes disorder –involuntary movements and vocalization-tics Tourettes disorder –involuntary movements and vocalization-tics Life long & chronic begins at 7-8 yrs Life long & chronic begins at 7-8 yrs Dysfunctional regulation of dopamine in caudate nucleus Dysfunctional regulation of dopamine in caudate nucleus 3 times more common in males 3 times more common in males Genetic relation ship between tourettes and both ADHD and OCN Genetic relation ship between tourettes and both ADHD and OCN Haloperidol most effective Haloperidol most effective

Separation anxiety disorder Separation anxiety disorder School phobia—overwhelming fear of loss of major attachment figure School phobia—overwhelming fear of loss of major attachment figure Often complains of physical symptoms - to avoid going to school-stomach/head ache Often complains of physical symptoms - to avoid going to school-stomach/head ache Children with this disorder are at greater risk of having anxiety disorder in adulthood Children with this disorder are at greater risk of having anxiety disorder in adulthood

Selective mutism Selective mutism Children- most commonly girls speak in some social situations but not at others Children- most commonly girls speak in some social situations but not at others Has to be distinguished from shyness Has to be distinguished from shyness