1. DISORDERS USUALLY FIRST DIAGNOSED IN INFANCY,CHILDHOOD, OR ADOLESCENCE

2. 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

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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

15. 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

16. 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)

17. 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

18. 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

19. 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

20. 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

21. 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

22. 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

23. 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

24. 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

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

26. 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