By:

Dyah Miryati - Putri Wulan Akbar

Denada Bagus - Fariza Risky - Yoga
Waranugraha
Suprvisor:
dr. Wisnu Wahjuni S. Sp.KJ
 During the past two decades, the importance of
psychological variables in understanding health and
illness has become well established.
Lifestyle and behavioral factors comprise seven of
the leading health-risk factors in the USA.
Child and adolescent psychiatry has emerged as an
academic discipline that covers a wide range of
related topics from the development of the cortex to
the public health implications of childhood disorders.

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 Child and adolescent psychiatry is branch of
medicine concerned with the study and treatment of
mental, emotional, and behavioral disorders of
childhood and adolescent.
The goals within child and adolescent psychiatry are
to diminish risk factors and enhance protective
factors to prevent the emergence of psychiatric
disorders in this population.

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 There is 3 personality theory of
psychology:
Freud Phsycoanalysis (Sigmond Freud)
Cognitif Organization (Jean Piaget)
Theory from Eric Erickson

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 Topographic model of tought
Theory about councious area,sub councious area, pra
councious area
Structural theory of tought
Theory about id, ego, and super ego
Theory about stadium of psychosexual
development
Oral, anal, odipal, phallic, latency, and genital stage
 Age (years old) Stadium

0-1.5 (to 2) Sensorimotoric stadium

2-7 Pra operational stadium

7-11 Concrit operation stadium

11-end of adolescent Formal operation stadium

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 Eriksons Psychosocial Stages

Stadium 1 belief shows with easy to be given food, sleep tight, and intestinal relaxation
Trust versus depend on consistency dan similarity of experiences that be given by nursemaid
Mistrust (0-1 y.o) weaning made bed memory
If the children got strong principle believe, it will develop self confidence
Stadium 2 learning to walk, learning eat to by themselves speaking
Autonomy versus need outer control, same nursemaid before autonomic development
Doubt and Shame shy feeling happen when child get too much punishment and negative statement
(1-3 y.o) doubt feeling to her/himself happen when their parent make them too shy
Children learn that they have choices to keep or to let go their stool

Stadium 3 inisative appear connected with task to activity both motoric and intelectual
Initiative versus guilty feeling appear when he/she gaze of purpose(especially agresive purpose
Guilt (3-5 y.o) willing to copy adult style, taking part of oedipals competition that make
resolution of social role identification
competition with brother/sister often happen

Stadium 4 children are busy to build, create and finishing

Industry versus got systemic instruction and principal technology
Inferiority (6-11 y.o) beware of inadequat feeling and inferiority if child feel hopeless to tools, skills,
and his/her status among his/her friends
sociality depends on age

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Stadium 5 fighting to develop ego identity (same feeling and continuity inside)
Identity versus Role preocupation in style, heroic, and ideology
confusion(11-end of developing of community identity
adolescent) beware of role ambiguity, doubt about sexual identity

Stadium 6 tasks are to love and to work

Intimacy versus intimation characterized with sacrification, quality of sexual orgasm, strong
Isolation (21-41 y.o) relationship
isolation characterized with divorce and see that the other people are
dangerous

Stadium 7 generativity are growing up children, teach new generations, creative

Generativity versus out of stagnation with having child, give teaching, and love
Stagnation(40-65 fearness to him/herself, isolation, and no intimation are signs of stagnation
y.o)
Stadium 8 integrity is satisfaction that live had been productive and precise
Integrity versus hopeless feeling is loosing of hope that causing dislike to another people and
Despair (>65 y.o) dissappointed
people on hopeless condition feel afraid about death
integrity characterized by accepting him/herself on their life

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 Physical Developmental
Cognitive Development
Emotional Development
Social Development
Psychosexual Development
Moral Development

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 Human physical development is directed at
helping infants and children perceive and
negotiate with their external world.
During infancy and early childhood there is
enormous physical growth including changes in
overall body growth, size, shape, body
composition, and maturation in the central
nervous system (CNS) that allows children to
acquire several paramount skills.

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 Cognitive development in children includes all
the processes that lead to maturation of their
mental activity.
Two theoriesthose of Jean Piaget and Leon
Vygotskypresent opposing views of cognitive
maturation.
 Emotional development can be seen as the
literal acquisition of emotions. Children must
develop the ability to recognize and use their
emotions appropriately.
Children must learn to use their emotional
repertoire to handle the inherent anxiety and
stresses that are universal to the human
condition.
 Psychosexual development involves the process
of infants and children learning to view
themselves and others in terms of gender.
Three stages describe psychosexual maturation
in children: the development of gender identity,
the formation of a concept of behavior related to
their own gender identity (gender roles), and the
formation of children's attractions to a particular
gender in others (gender relationships).
 Moral maturation refers to children's acquisition
of internal standards that guide their observable
actions or behavior.
A process that involves five stages of
conceptualization:
The morality of restraint
Morality of mastery
Morality of virtuous striving, idealization, and
individual responsibility
 Identifying the reasons for referral
Assesing the nature and extent of the childs psychological and
behavioral difficulties
Determining family, school, social, and developmental factors that
may be infleucing the childs emotional well being
Very young children do better showing their feelings and
preoccupations in a play situation.
obtain a full description of the current concerns and a history of the
child's previous psychiatric and medical problems.
Clinical interviews offer the most flexibility in understanding the
evolution of problems and in establishing the role of environmental
factors and life events,

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 Infants may be referred for a variety of reasons : high levels of irritability,
difficulty being consoled, eating disturbances, poor weight gain, sleep
disturbances, withdrawn behavior, lack of engagement in play, and
developmental delay.
clinician assesses areas of functioning that include motor development,
activity level, verbal communication, ability to engage in play, problem-
solving skills, adaptation to daily routines, relationships, and social
responsiveness.
The child's developmental level of functioning is determined by combining
observations made during the interview with standardized developmental
measures. Observations of play reveal a child's developmental level and
reflect the child's emotional state and preoccupations.

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 School-age children can usually tolerate a 45-minute session.
The room should be sufficiently spacious for the child to move
around, but not so large as to reduce intimate contact
between the examiner and the child.
Children in lower grades may be more interested in the toys in
the room.
Questions that are partially open-ended with some multiple
choices may elicit the most complete answers from school-
age children
Simple, closed (yes or no) questions may not elicit sufficient
information

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 An interview with parents and the patient may
take place first or may occur later in the
evaluation.
The clinician's job is to maintain a
nonthreatening atmosphere in which each
member of the family can speak freely without
feeling that the clinician is taking sides with any
particular member.
 The interview with the patient's parents or
caretakers is necessary to get a chronological
picture of the child's growth and development.
The parents' view of the family dynamics, their
marital history, and their own emotional
adjustment are also elicited. The family's
psychiatric history and the upbringing of the
parents are pertinent.
 Physical appearance
Parents child interaction
Separation and reunion
Orientation to time, place, and person
Speech and language
Mood
Affect
Thought process and content
Social relatedness
Motor behavior
Cognition
Memory
Judgment and insight
 Initial goal of any psychotherapeutic strategy to
establish a working relationship with the child or
adolescent
In general, successful individual psychotherapeutic
interventions with children also require establishing
a therapeutic rapport with parents
 Can be highly effective modalities to provide peer
feedback and support to children.
Play group therapy
Therapist allow children to produce fantasies
verbally & in play.
Children use the toys act out aggressive impulses
& to relieve their home difficulties with group
members and the therapist.
Selected children include those with phobias,
effeminate boys, shy and withdrawn children, and
children with disruptive behavior disorders.
 Children verbalize in a problem-oriented
manner, with the awareness that problems
brought them together and that the group aims
to change them.
 Residential treatment are appropriate settings
for children and adolescents with mental
disorders that require a highly structured and
supervised setting for a substantial time.
Partial hospitalization used more frequently
with the advent of managed care as an
alternative to hospitalization to provide short-
term crisis stabilization.
 Day treatment programs sometimes used
interchangeably with the term partial
hospitalization, are designed to serve the needs
of children and adolescents with severe
disorders who require interventions focused on
improved level of function.
Hospitalization in dangerous behavior
(contemplating suicide, or experiencing an
exacerbation of a psychotic disorder or another
serious mental disorder).
 Psychopharmacologic agents.
Electroconvulsive therapy (ECT) is rarely
initiated in childhood and adolescence.
Mental retardation is defined as significantly
subeverage general intellectual functioning
resulting in, or associated with, concurrent
impairment in adaptive behavior and
manifested during the developmental period,
before the age of 18.

(DSM-IV-TR)

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 Epidemiology:
1 until 3% of population
Highest incidence is in school-age children (10 to 14
years olds)
1,5 times >> men
Etiology:
Genetic
Developmental factors
Acquired syndromes
Sociocultural factors.

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 IQ range 50 to 70
85% of persons with mental retardation
It is not identified until after first or second grade
Specific causes for the mental retardation are
often unidentified
Many adults with mild mental retardation can live
independently with appropriate support and raise
their own families.

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 IQ range 35 to 50
10% of persons with mental retardation
Most children can communicate adequately during early
childhood
They are challenged academically and often are not able
to achieve academically above a second to third grade
level.
During adolescence, socialization difficulties often set
these persons apart

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 IQ range 20 to 35
4 % of individuals with mental retardation
The cause for the mental retardation is more
likely to be identified
In adulthood may adapt well to supervised living
situations, such as group homes, and may be
able to perform work-related tasks under
supervision

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- IQ range below 20
- 1 to 2% of persons with mental retardation
- Most individuals have identifiable causes for
their condition
- Children with profound mental retardation may
be taught some self-care skills and learn to
communicate their needs given the appropriate
training.

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- Persons who are strongly suspected of having
mental retardation, but who cannot be tested by
standard intelligence tests or are too impaired or
uncooperative to be tested
- Intellectual level is presumed to be above 70.

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 Class IQ

Profound mental retardation Below 20

Severe mental retardation 2034

Moderate mental retardation 3549

Mild mental retardation 5069

Borderline mental retardation 7079

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 The treatment of individuals with mental
retardation is based on an assessment of social,
educational, psychiatric, and environmental
need.

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 Autism is a brain development disorder
characterized by impaired social interaction
and communication, and by restricted and
repetitive behavior. These signs all begin
before a child is three years old.
 Genetic Factor
Biologocal Factor
Perinatal Factor
Psychosocial and Family Factor

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 Diagnosis is based on behavior.
Autism is defined in the DSM-IV-TR as exhibiting
at least six symptoms total, including:
Two symptoms of qualitative impairment in social interaction.
One symptom of qualitative impairment in communication.
One symptom of restricted and repetitive behavior.
Delays or abnormal functioning in at least one of the following
area with onset prior to age 3 years.
The disturbance is not better accounted for by Retts disorder or
childhood disintegrative disorder.

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 The goals of treament for children with autistic disorder
are to target behaviors that will improve their abilities to
integrate into schools, develop meaningful peer
relationships, and increase the likehood of maintaining
independent living as adults
no specific medications with proved efficacy in the
treatment of the core symptoms of autistic disorder are
available
increase socially acceptable and prosocial behavior
decrease old behavioral symptoms
improve verbal and nonverbal communication.
 Autistic disorder is generally a life long disorder
with a guarded prognosis.
Most demonstrated positive changes in
communication and social domains over time.
The prognosis is improved if the environment or
home is supportive and capable of meeting the
extensive needs of such a child.
 The principal characteristics of ADHD are
inattention, hyperactivity, and impulsivity.
Is the most common psychiatric disorder among
school-age children and the best understood.
Often associated with other psychopathology
Characterized by a pattern of diminished
sustained attention and higher levels of
impulsivity in a child or adolescent than
expected of that age and developmental level.
 Genetic factor
Acquired Etiological Influences
A variety of acquired influences have received
support as etiologic factors for some children and
adolescents with ADHD, including pregnancy and
delivery complications, low birth weight, traumatic
brain injury, and prenatal substance exposure
 Inattention
Hyperactive/impulsive
Combined all manifestations

The symptoms persisted for at least 6 months to a

degree that is maladaptive & inconsistent with
developmental level.
 Pharmacotherapy
Methylphenidate
Dextroamphetamine
Psychosocial therapy
Behavior therapy
behavioral parent training and classroom
behavioral modification
 Learning disordes refer to a group of disorders
that affect a broad range of academic and
functional skills including the ability to speak,
listen, read, write, spell, reason and organize
information.
Learning disorders in a child or adolescent are
characterized by academic underachievement in
reading, written expression, or mathematics in
comparison with the overall intellectual ability of
the child.

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 Reading Disability
Reading disability is the most common learning disability
Dyslexia - synonym for reading disability Common indicators of reading
disability include difficulty with phonemic awareness -- the ability to
break up words into their component sounds, and difficulty with
matching letter combinations to specific sounds.
Writing Disability
Impaired written language ability may include impairments in
handwriting, spelling, organization of ideas, and composition.
Dysgraphia - used as an overarching term for all disorders of written
expression.
Math Disability
Sometimes called dyscalculia, a math disability can cause such
difficulties as learning math concepts (such as quantity, place value, and
time), difficulty memorizing math facts, difficulty organizing numbers,
and understanding how problems are organized on the page.
 Difficulty understanding and following instructions
Trouble remembering what someone just told them
Failing to master reading, spelling, writing, and/or math skills
and therefore fails schoolwork
Difficulty telling the difference between "right" and "left,"
problems identifying words or a tendency to reverse letters,
numbers or words (e.g., confusing "b" with "d," 18 with 81, or
"on" with "no.")
Lacking motor coordination when walking, playing sports,
holding a pencil or trying to tie a shoelace
Frequently loses or misplaces homework, schoolbooks or
other items
Unable to understand the concept of time, confused by the
difference between "yesterday," "today," and "tomorrow

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 Accept child and focus on strengths to raise self
esteem
Identify learning deficits early
Minimize long term consequences
Treatment of associated problems
Infant child stimulation
Parent Education

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