CHILDHOOD PSYCHIATRIC DISORDERS

CATEGORIES:

I. DEVELOPMENTAL DISORDERS II. DISRUPTIVE BEHAVIOR DISORDERS

1. Mental Retardation 1. Attention deficit hyperactivity disorder
Mild 2. Conduct disorder
Moderate 3. Oppositional defiant disorder
Severe
Profound III. TIC DISORDERS
2. Learning Disorders 1. Transient tic disorder
Reading disorder 2. Chronic tic disorder
Mathematics disorder 3. Tourettes disorder
Disorder of written expression
3. Motor Skill Disorder / Developmental IV. ELIMINATION DISORDERS
Coordination Disorder 1. Encopresis
4. Communication Disorders 2. Enuresis
Expressive language disorder
Mixed receptive and expressive language V. FEEDING AND EATING DISORDERS
disorder 1. Pica
Phonologic disorder 2. Rumination disorder
Stuttering 3. Feeding disorder
5. Pervasive Developmental Disorders
Autistic disorder VI. INTERNALIZING DISORDERS
Retts disorder 1. Anxiety Disorders
Childhood disintegrative disorder Separation Anxiety Disorder
Aspergers disorder Obsessive-Compulsive Disorder
2. Mood Disorders
Major Depressive Disorder
Bipolar Disorder

DEVELOPMENTAL DISORDERS

I. MENTAL RETARDATION
below average intellectual functioning accompanied
by significant limitations in areas of adaptive functioning
Etiology:
Genetic (Down syndrome/Trisomy 21, Klinefelter)
Errors of metabolism (PKU/Phenylketonuria, Tay Sachs)
Acquired (Nutritional deficiency, lead poisoning)
Prenatal, Perinatal, Post-natal (Hydrocephalous, Measles, Alcoholism)

II. LEARNING DISORDERS

childs achievement in reading, mathematics, or written expression is below that expected for age,
formal education, and intelligence.
Children: Low self-esteem and poor social skills
Adults: Problems with employment or social adjustment
Etiology:
Hereditary
Behavioral, cognitive, social, environmental factors
Problems during pregnancy
Types:

1. Reading disorder / Dyslexia

decreased reading accuracy, speed or comprehension
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 2. Mathematics disorder / Dyscalculia
math ability that falls significantly below what is expected for their age,
intelligence, and education

3. Disorder of written expression / Dysgraphia

grammatical and punctuation errors, poor paragraph organization, multiple
spelling errors, and poor handwriting

Management:
Early identification of the learning disorder
Effective intervention
Special education classes

III. MOTOR SKILLS DISORDER / DEVELOPMENTAL COORDINATION DISORDER

Impaired coordination severe enough to interfere with academic achievement or activities of daily living
Diagnosis not made if the problem with motor coordination is part of a general medical condition
Often coexists with a communication disorder.
Common manifestation: clumsiness and tendency
to fall down
Management:
Adaptive physical education programs
emphasize inclusion of movement games
Sensory integration programs
target improvement in areas where the child has
difficulties
tactile defensiveness

IV. COMMUNICATION DISORDERS

Communication deficit is severe enough to hinder development, academic
achievement, or ADLs including socialization.
Etiology:
Developmental
Neurologic injury
Hereditary
Types:
1. Expressive language disorder
- impaired ability to communicate through verbal and sign language
- difficulty learning new words and speaking in complete and
correct sentences
- his or her speech is limited.
2. Mixed receptive expressive language disorder
- problems of expressive language disorder along with difficulty
understanding (receiving) and determining the meaning of words
and sentences
3. Phonologic disorder
- problems with articulation (forming sounds that are part of speech)
4. Stuttering
- disturbance of the normal fluency and time patterning of speech
- more frequent in boys than in girls
Management:
Speech and language therapists
Parent Education

V. PERVASIVE DEVELOPMENTAL DISORDERS

also called autism spectrum disorder
Characterized by pervasive and usually severe impairment of reciprocal social interaction skills,
communication deviance, and restricted stereotypical behavioral patterns
75% of children with pervasive developmental disorders have mental retardation
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 Types:
1. Autistic disorder
most common; more prevalent in boys than in girls
identified no later than 3 years of age.
Etiology:
Hereditary
Metabolic deficiency
Chemical exposure during pregnancy
Decreased interaction
Management:
Goal: To reduce behavioral symptoms and to promote learning and development particularly the
acquisition of language skills.
Short-term inpatient treatment (head-banging or tantrums are out of control)
Special education and language therapy
Pharmacologic treatment:
a. Antipsychotics: Haloperidol (Haldol) or Risperidone (Risperdal) for temper tantrums,
aggressiveness, self-injury, hyperactivity, and stereotyped behaviors
b. Other medications: Naltrexone (ReVia), Clomipramine (Anafranil),Clonidine (Catapres),
and stimulants - to diminish self injury and hyperactive and obsessive behaviors

2. Retts disorder
characterized by the development of multiple deficits after a period of normal functioning
rare, occurs exclusively in girls and persists throughout life
develops between birth - 5 months of age
microcephaly, small hands and small feet
child loses motor skills and begins showing stereotyped movements
loses interest in the social environment, and severe impairment of expressive and receptive
language becomes evident as she grows older
Etiology: Sporadic mutations in the gene
Management: similar to autism

3. Childhood disintegrative disorder

characterized by marked regression in multiple are
as of functioning after at least 2 years of apparently
normal growth and development
rare; occurs slightly more often in boys than in girls
typical age of onset is 3 to 4 years
have the same social and communication deficits
and behavioral patterns seen with autistic disorder

4. Aspergers disorder
characterized by the same impairments of social interaction and restricted, stereotyped behaviors
seen in autistic disorder but there are no language or cognitive delays
rare; occurs more often in boys than in girls; effects are generally life-long

DISRUPTIVE BEHAVIOR DISORDERS

I. ATTENTION DEFICIT HYPERACTIVITY DISORDER (ADHD); formerly Hyperkinesis
characterized by inattentiveness, hyperactivity, and impulsiveness
common; especially in boys
Onset: not later than 7 years old
Etiology:
Unknown
Environmental toxins
Heredity
Damage to brain structure and functions
Prenatal exposure to alcohol, tobacco, and lead
Severe malnutrition in early childhood
Decreased metabolism in the frontal lobes (attention, impulse
control, organization, and sustained goal-directed activity)
Types:
1. Primary Inattentive (ADHDI)
previously known as ADD-H or Attention Deficit Disorder without Hyperactivity
2. Primarily Hyperactive/Impulsive (ADHD-HI)
previously known as ADHD
3. Combined Type (ADHD-C)

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 previously known as ADD+H or Attention Deficit Disorder with Hyperactivity
DSM-IV-TR Criteria
A. Inattention:
At least six of the following symptoms of inattention have persisted for at least 6 months and are
maladaptive:
o Inattentive to details or makes careless mistakes in schoolwork, work, or other activities.
o Difficulty sustaining attention in tasks or play.
o Does not seem to listen to what is being said.
o Poor follow-through on instructions and fails to finish schoolwork and chores.
o Difficulties with organizing tasks.
o Avoids or strongly dislikes sustained mental effort.
o Often loses things necessary for tasks or activities.
o Is often easily distracted by extraneous stimuli.
o Is often forgetful in daily activities.
B. Hyperactivity-Impulsivity:
At least six symptoms of hyperactivity-impulsivity that are
maladaptive and have persisted for at least 6 months:
1. Hyperactivity
o Fidgety
o Inappropriately leaves seat
o Inappropriate running or climbing
o Difficulty in playing or engaging in leisure activities quietly
o Often on the go
o Talks excessively
2. Impulsivity
o Blurts out answers to questions
o Often has difficulty waiting in lines or awaiting turn
o Often interrupts or intrudes on others
Management:
Goal: managing symptoms, reducing hyperactivity and impulsivity,
and increasing the childs attention
Combination of pharmacotherapy with behavioral, psychosocial,
and educational interventions
Pyschopharmacology:
a. Methylphenidate (Ritalin) - reduces hyperactivity, impulsivity, and mood lability and helps the
child to pay attention more appropriately
b. Amphetamine (Adderal)
c. Dextroamphetamine (Dexedrine)
d. Pemoline (Cylert) liver damage
Side effects: insomnia, loss of appetite, and weight loss or failure to gain weight
Sustained-release form: Methylphenidate, Amphetamine and Dextroamphetamine
d. Antidepressant: Atomoxetine (Strattera) second choice for treatment
Side effects: (children) decreased appetite, nausea, vomiting, tiredness, and upset stomach.
(adults) insomnia, dry mouth, urinary retention, decreased appetite, nausea,
vomiting, dizziness, and sexual side effects; liver damage
Behavioral strategies
Environmental strategies
Educating parents and helping them with parenting strategies
Effective approaches: consistent rewards and consequences for behavior, offering consistent praise,
using time-out, and giving verbal reprimands
Therapeutic play

II. CONDUCT DISORDER

characterized by persistent antisocial behavior in children and adolescents that significantly impairs their
ability to function in social, academic, or occupational areas
occurs three times more often in boys than in girls
30% to 50% of these children are diagnosed with antisocial personality disorder as adults
Symptoms: aggression to people and animals, destruction of property, deceitfulness and theft, and
serious violation of rules
Onset: Two subtypes of conduct disorder based on age of onset.
a. Childhood-onset type - before 10 years of age
b. Adolescent-onset type - after 10 years of age
Etiology
Genetic vulnerability
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 Environmental adversity
Poor coping
Poor family functioning
Marital discord
Poor parenting
Family history of substance abuse and psychiatric problems
Child abuse
Classification:
1. Mild The person has some conduct problems that cause relatively minor harm to others.
Example: lying, truancy, and staying out late without permission
2. Moderate The number of conduct problems increases as does the amount of harm to others.
Example: vandalism and theft
3. Severe The person has many conduct problems with considerable harm to others.
Example: forced sex, cruelty to animals, use of a weapon, burglary, and robbery

SYMPTOMS OF CONDUCT DISORDER

Aggression to people and animals
Bullies, threatens, or intimidates others
Physical fights
Use of weapons
Forced sexual activity
Cruelty to people or animals
Destruction of property
Fire setting
Vandalism
Deliberate property destruction
Deceitfulness and theft
Lying
Shoplifting
Breaking into house, building, or car
Cons other to avoid responsibility
Serious violation of rules
Stays out overnight without parental
consent
Runs away from home overnight
Truancy from school
Management:
INTERVENTIONS FOR CONDUCT DISORDER
Parental education
Decreasing violence and increasing compliance with
Social skills training
treatment
Children: Family therapy
o Protect others from clients aggression and
Adolescents: Individual therapy
manipulation.
Medication: symptomatic o Set limits for unacceptable behavior.
o Provide consistency with clients treatment plan.
III. OPPOSITIONAL DEFIANT DISORDER
o Use behavioral contracts.
o Institute time-out.
o Provide a routine schedule of daily activities.
Improving coping skills and self-esteem
o Show acceptance of the person, not necessarily the
behavior.
o Encourage the client to keep a diary.
o Teach and practice problem-solving
. skills.
Promoting social interaction
o Teach age-appropriate social skills.
o Role-model and practice social skills.
o Provide positive feedback for acceptable behavior.
Providing client and family education
Enduring pattern of uncooperative, defiant, and hostile behavior toward authority figures without major
antisocial violations.
most expected in 2 to 3 years of age and in early adolescence
diagnosed only when behaviors are more frequent and intense and cause
dysfunction in social, academic, or work situations.
occurs equally among male and female adolescents

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 25% develop conduct disorder; 10% diagnosed with antisocial personality
disorder as adults
Etiology:
Hereditary
Temperament
Adverse social conditions
Management: Similar to conduct disorder

TIC DISORDERS
Tic - sudden, rapid, recurrent, nonrhythmic, stereotyped motor movement or vocalization
- can be suppressed but not indefinitely
Simple motor tics blinking, jerking the neck, shrugging the shoulders, grimacing, and coughing
Simple vocal tics clearing the throat, grunting, sniffing, snorting, and barking
Complex motor tics facial gestures, jumping, or touching or smelling an object
Complex vocal tics coprolalia, palilalia, echolalia
Types:

1. Transient tic disorder

- single or multiple vocal and/or motor tics for at least 2 weeks but less than 1 year
2. Chronic tic disorder
- either single or multiple vocal or motor tics for more than 1 year
3. Tourettes disorder
- both vocal and motor tics for more than 1 year
Etiology:
Unknown
Hereditary
Dopamine
Management:
Rest
Manage stress
Atypical antipsychotics - Risperidone (Risperdal) or Olanzapine (Zyprexa)

ELIMINATION DISORDERS
I. ENCOPRESIS
repeated passage of feces into inappropriate places by a child who is at least 4 years of age
Types:
1. Involuntary encopresis - occurs for psychological, not medical, reasons
2. Intentional encopresis - oppositional defiant disorder or conduct disorder
II. ENURESIS
repeated voiding of urine during the day or at night into clothing or
bed by a child at least 5 years of age
Nocturnal / Diurnal
Types:
1. Involuntary enuresis - occurs for psychological, not medical reasons
2. Intentional enuresis - oppositional defiant disorder / conduct disorder

Etiology:
Hereditary
Dysfunctional relationship between the child and parents (mother)
Stress
Anxiety/Regression
Mental Retardation
Management:
Enuresis Antidepressant: Imipramine (Tofranil) - urinary retention
Behavioral approaches (pad with a warning bell)
Positive reinforcement
Psychological treatment

FEEDING AND EATINGDISORDERS OF INFANCY AND EARLY CHILDHOOD

I. PICA
persistent ingestion of nonnutritive substances
common in children with mental retardation; occasional in pregnant women
lasts for several months and then remits
Etiology:
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 Unknown
Cultural influences
Low socioeconomic status
Deficiency diseases
Psychological disorders

Examples:
Amylophagia Coprophagia
Hyalophagia Trichophagia
Pagophagia Vapirism
Geophagia Urophagia
Xylophagia Lesch-Nyhan Syndrome
Management:
Parent Education
Healthy eating behavior
Treatment of the underlying disease/condition

II. RUMINATION DISORDER

repeated regurgitation and rechewing of food
brings partially digested food up into the mouth and rechews and reswallows the food
uncommon; occurs more often in boys than in girls
results in malnutrition, weight loss, and even death in about 25% of affected infants.
Etiology:
Unknown
Lack of nurturing or physical contact
Management:
Parent Education
Behavior Modification

III. FEEDING DISORDER

characterized by persistent failure to eat adequately which results in significant weight loss
or failure to gain weight
common in boys and in girls and occurs most often during the first year of life
Etiology:
Inappropriate parent-child interaction (hunger cues / forcing food)
Lack of nurturing
Parental aggression, anger or apathy
Management:
Parent Education
Improve feeding skills and nutrient intake
Behavior Modification
Multidisciplinary team (physician, dietitian, psychologist, speech pathologist, occupational therapist)