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adolescence
psychiatry
Dasinen Thiagarajan
Content
Anxiety and Depressive Disorders
Neurodevelopmental Disorders
Specific Learning Disorders
Conduct Disorders
Older children may be able to say what is the problem but young children might not be
able to express their feelings.
The anxiety symptoms or disorders are seen in their behaviour, emotion and
temperament changes.
They might show these symptoms:
Internal
Pressure of wanting to do well in school
Fit in with peers
Separation anxiety
Experience excessive fear and intensely distress of being
separated from attached ones.
Intense fear of safety of their loved ones
Overly clinging
Refuse to go to school
Complaint of physical symptoms
Refuse to go to school
Extremely worried of sleeping away from home
Panic, crying, screaming or tantrums at times of separation
Trouble sleeping or nightmares related to separation
Selective Mutism
Persistently not able to speak able to speak in situations where
they are expected to speak e.g. classroom or school but has no
language difficulties, knowledge or intelligence deficit to speak
in other situation.
May have mediator.
DSM-5 at least 1 months and cause problem to academic and
social functions.
Cannot speak due to intense anxiety, but does not look
anxious.
Assoc. with social anxiety disorder, separation anxiety
disorder, panic disorder, agoraphobia.
Tense
Worries anxious
Restless
Poor concentration
Stomach aches
Panic Disorder
Anxiety symptoms are more severe than GAD
Child/Adolescence would experience:
Acute sudden intense attack of anxiety symptoms.
i.e shortness of breath, choking or smothering sensations,
pounding heartbeat, chest pain, nausea, light-headedness,
trembling, shaking and sweating
It come episodically
In between episode they will be symptom free
Classical symptom include
Feel like fainting
Fear of losing ones mind
Phobia
Simple
Fear of specific situation or subject
Social
Intense fear of meeting or talking to their peers and adult
fearing of being scrutinised and negatively evaluated i.e weak,
stupid, anxious
Avoidance of social situation
At school, they may have
Difficulties in answering questions in class
Imitating conversations
Talking/ interact with friends/teacher
Agoraphobia
Fear of going out, out fear that he could not escape or
get help if they get panic attack
Patient would avoid being away from home, using public
transport, being in an open, enclosed or crowded places
Depressive Disorder
Predominant symptoms are mood disturbances which
are low
Persistent for at least 2 weeks.
Mood disturbances are associated with disturbances in
thought, behaviour and perception.
Prevalence is 3% for pre-puberty and 10% adolescence.
Young children may feel depressed or sad feelings, as
such the depressive symptoms or disorders in children
are often manifested through their behaviour, emotion
and temperamental changes.
FTT
Depression in adolescence
Irritable
Feeling low
Hopeless/worthless/ suicidal thought, expresses his/her future is
black
Isolating themselves
Becoming quiet around friends, family and teachers
Lack of energy
Involve in fights
Poor concentration
Lack of energy
Neurodevelopmental disorder
Intellectual disability( Intellectual developmental
disorder)
Autism spectrum disorder
ADHD: Attention Deficit Hyperactivity Disorder (formerly
known MBD: minimal brain dysfunction)
Specific Learning Disorder(SLD)
Conduct Disorder
Intellectual Disability
Was previously referred as mental retardation in DSM IV.
It is characterized by deficits in intellectual (cognitive function)
adaptive functioning which occurs at a early stage of developmental
stages.
Cognitive assessments are based on both clinical and standardized
test
WISC (Wechsler Intelligent test)
Stanford Binet Test for Children
Mild ID
Not detected early but during school life but when the
child enters school.
Will have normal motor and language group but as
going gets though they tend to get left behind.
Individual with mild ID would be able to be independent
and have a semiskilled job.
Moderate ID
Recognised during first year of life
Often presented with speech delay.
Parents notice delay in learning to speak and interact
with others.
As an adult they may be able to perform unskilled job
with training and supervision
Usually lives with family.
Severe ID
Identified during infancy
Would have marked delay in development.
Usually unable to read and write but able to perform
simple daily life activity under supervision
Profound ID
Recognised during infancy
Skills of one years old during seven years old.
Often related with multiple physical abnormalities
indicating neurological damage.
As adults they require intense family and social support
throughout their life.
Autistic disorder
Aspergers disorder
Pervasive developmental disorder
NOS Childhood disintegrative disorder
Rhett's disorder
Sharing of interest
Sharing/reciprocating of affect
Sharing/reciprocating emotion/enjoyment
showing./sharing mid
Not response to call
Not aware/engaged/interact with surrounding
Eye contact
Posture
Facial expressions
Tone of voice and gestures
Ability to read others body gestures
Diagnostic Criteria
A.
Persistent deficits in social communication and social interaction across
multiple contexts, as manifested by the following, currently or by history
(examples are illustrative, not exhaustive, see text):
Deficits in social-emotional reciprocity, ranging, for example, from abnormal social
approach and failure of normal back-and-forth conversation; to reduced sharing of
interests, emotions, or affect; to failure to initiate or respond to social interactions.
Deficits in nonverbal communicative behaviours used for social interaction, ranging, for
example, from poorly integrated verbal and nonverbal communication; to abnormalities
in eye contact and body language or deficits in understanding and use of gestures; to a
total lack of facial expressions and nonverbal communication.
Deficits in developing, maintaining, and understanding relationships, ranging, for
example, from difficulties adjusting behaviour to suit various social contexts; to
difficulties in sharing imaginative play or in making friends; to absence of interest in
peers.
B.
Restricted, repetitive patterns of behaviour, interests, or activities, as manifested by at
least two of the following, currently or by history (examples are illustrative, not exhaustive;
see text):
Stereotyped or repetitive motor movements, use of objects, or speech (e.g., simple motor stereotypies,
lining up toys or flipping objects, echolalia, idiosyncratic phrases).
Insistence on sameness, inflexible adherence to routines, or ritualized patterns or verbal nonverbal
behaviour (e.g., extreme distress at small changes, difficulties with transitions, rigid thinking patterns,
greeting rituals, need to take same route or eat food every day).
Highly restricted, fixated interests that are abnormal in intensity or focus (e.g., strong attachment to or
preoccupation with unusual objects, excessively circumscribed or perseverative interest).
Hyper- or hypo reactivity to sensory input or unusual interests in sensory aspects of the environment
(e.g., apparent indifference to pain/temperature, adverse response to specific sounds or textures,
excessive smelling or touching of objects, visual fascination with lights or movement).
C.
Symptoms must be present in the early developmental period (but may not
become fully manifest until social demands exceed limited capacities, or may be
masked by learned strategies in later life).
D.
Symptoms cause clinically significant impairment in social, occupational, or
other important areas of current functioning.
E.
These disturbances are not better explained by intellectual disability
(intellectual developmental disorder) or global developmental delay. Intellectual
disability and autism spectrum disorder frequently co-occur; to make comorbid
diagnoses of autism spectrum disorder and intellectual disability, social
communication should be below that expected for general developmental level.
Note: Individuals with a well-established DSM-IV diagnosis of autistic disorder,
Aspergers disorder, or pervasive developmental disorder not otherwise specified
should be given the diagnosis of autism spectrum disorder. Individuals who have
marked deficits in social communication, but whose symptoms do not otherwise
meet criteria for autism spectrum disorder, should be evaluated for social
(pragmatic) communication disorder.
Specify if:
With or without accompanying intellectual
impairment
With or without accompanying language
impairment
Associated with a known medical or genetic
condition or environmental factor
Associated with another neurodevelopmental,
mental, or behavioural disorder
With catatonia (refer to the criteria for
catatonia associated with another mental
Behaviours
A child with autism may
Communication skills
Child may have problem in
Cause is unknown
Symptoms continue for whole life and majority unable to be
independent but IQ may be normal
Sometimes may have seizures and low muscle tone.
Treatment
Specific treatment is unknown.
Usually require special school
There are special techniques for teaching autistic
children and special psychotherapeutic approach is
needed,
Antipsychotics and antidepressants may be need for
child showing symptoms.
Cognitive
Emotional
Motor
Sensory
Autonomic functions.
ADHD
Most common neurobehavioral disorder in childhood.
Occurs mostly in first 5 years of life.
Common among developed countries, urban, lower
middle socioeconomic class and non-professionals.
More common in boys than girls 8:1
Symptoms decline with increasing age
Aetiology : genetic predisposition, maternal deprivation,
maternal alcohol abuse, environmental toxins or
intrauterine or postnatal brain damage.
Inattentive
Poor persistent towards goals and tasks
Make careless blunders or mistakes
Poor inhibitions towards distract ability
Difficulty in re-engaging with previous task.
Has difficulties in organizing task
Doesn't listen when spoken to
Doesnt follow instruction
Frequently losses or misplaces belonging
Forgetful in daily activity
Hyperactive-impulsive
Fidgety
Leave seat/place when remaining seat/place are expected
Blurts answer in class before hearing the whole question
Interfere and intrudes others
Unable to engage play or activity quietly
Trouble keeping still
Always on the go as if driven by motor
Talk excessively
Cant wait for his or her turn in line or in game
People with ADHD show a persistent pattern of inattention and/or hyperactivity-impulsivity that
interferes with functioning or development:
1.Inattention:
Six or more symptoms of inattention for children up to age 16, or five or more for adolescents 17
and older and adults; symptoms of inattention have been present for at least 6 months, and they
are inappropriate for developmental level:
a) Often fails to give close attention to details or makes careless mistakes in schoolwork, at
work, or with other activities.
b) Often has trouble holding attention on tasks or play activities.
c) Often does not seem to listen when spoken to directly.
d) Often does not follow through on instructions and fails to finish schoolwork, chores, or duties
in the workplace (e.g., loses focus, side-tracked).
e) Often has trouble organizing tasks and activities.
f) Often avoids, dislikes, or is reluctant to do tasks that require mental effort over a long period
of time (such as schoolwork or homework).
g) Often loses things necessary for tasks and activities (e.g. school materials, pencils, books,
tools, wallets, keys, paperwork, eyeglasses, mobile telephones).
h) Is often easily distracted
i) Is often forgetful in daily activities.
Treatment
Parents and teachers much be advised on how to cope
with hyperactive children
Nootropic drugs and mild doses of anti-psychotics are
sometimes prescribed
Stimulant drugs as methylphenidate sometime have the
paradoxical effect, according to theory, the stimulants
act by reducing the excessive, poorly synchronized
variability in the various dimensions of arousal and
reactivity seen in ADHD
Stimulants are drugs of first choice
Treatment
A reading specialist, mathematics tutor or other trained
professional to guide on study skills.
Individualised education program
Therapy
If there is severe depression or anxiety SSRI would help.
Conduct Disorder
Is now classified under Disruptive, impulse control and conduct
disorders category in DSM-5.
A group behavioural problem thats usually begins during
childhood.
Children have chronic pattern of poorly controlled behaviour that
violates the rights of others and out of the major social norm.
Often patient brought in after conflict with authority and legal
actions.
DSM 5 requires 3 sx for at least 12 months and ! Sx for at least 1
month.
Must be before 18 years old.
Environmental causes
Child abuse
Poverty broken home or marital disharmony
Parents with antisocial personality
Substance abuse
Treatment
Family therapy is useful to enhance emotional support
and understanding
In certain cases such as pathological family, abused or
neglected children, foster homes or special residence is
recommended .
In severe cases court intervention is sometimes
required for placement.