1. 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.

2. 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
Chapter 29 slides in Children with Disabilities, Seventh Edition, Online Companion Materials. Copyright © 2013 Paul H. Brookes Publishing Co., Inc. All rights reserved.

3. 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.

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

5. 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.

6. 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.

7. 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.

8. 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.

9. 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.

10. 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.

11. 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.

12. 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.