CHILDHOOD

MENTAL
DISORDERS
 Types of childhood mental disorder

 Mental Retardation
 Learning disorder
 Motor skill disorder
 Communication disorder
 Disruptive behavior disorder
 Feeding and eating disorder
 Elimination disorder
 Contd.

 Tic disorder
 Pervasive developmental disorder
 Attention- deficit hyperactive disorder
(ADHD)
 Schizophrenia
 BPAD
 Anxiety disorder
 Pervasive developmental disorder

 Delay and deviance in the development of

social skills, language and communication
and behaviour repertoire.
 Idiosyncratic interests
 Resist change
 Inappropriate response to social
environment
 Classification

 Autistic disorder
 Rett’s disorder
 Asperger’s disorder
 Pervasive developmental disorder NOS
 Autistic Disorder
 Also known as early infantile autism, childhood
autism or Kanner’s autism

 Characterised by marked abnormal development

in social interaction & communication, and
restricted repertoire of activities & interests

 First noticed by Henry Maudsley in 1867

 Leo Kanner coined the term “infantile autism” in

1943
Prevalence:
 5 per 10,000 children (0.05%)
 4-5 times more common in boys than in girls
 High socioecnomic status

Etiology:
 Not known
 Emotionally unresponsive “refrigerator”
mother
1. Psychodynamic & family factors:
 Less affectionate family members
 Parental rage and rejection

2. Biological factors:
 Associated with conditions with neurological
lesions
 h/o perinatal complications
 Evidence of minor congenital physical anomalies
 About 75% associated with mental retardation
 4-32% have associated seizure
 Abnormal CT and MRI findings and EEG records
3. Genetic factors:
 2-4% of siblings of autistic children also affected
 High concordance rate in monozygotic twins

4. Immunological factors:
 Incompatibility between mother and fetus

5. Perinatal factors:
 High incidence of various perinatal complications

6. Neuroanatomical factors:
 MRI showing ↑ total brain volume
7. Biochemical factors:
 ↑plasma serotonin
 ↑CSF HVA
 ↑5HIAA:HVA ratio leading to symtom
improvement
Diagnosis:

ICD-10: Childhood Autism

 Abnormal and/or impaired development
evident before the age of 3yrs

 Characteristic abnormal functioning in all

three area of social interaction,
communication, and restricted, repetitive
behaviour
Clinical Features:
Physical Characters:
 Often attractive at 1st glance
 Do not show lateralization
 Abnormal dermatoglyphics (finger prints)

Behavioural Characteristics:
1. Qualitative impairment in social interaction- lack
of attachment towards parents, poor eye contact,
extreme anxiety when routine is disrupted,
inability to make friends, lack of empathy
2. Disturbance of communication and language-
difficulty in using language to communicate, non
verbal communication may also be impaired,
pronoun reversal

3. Stereotyped behaviour- spontaneous exploratory

play absent, activities of play often repetitive and
monotonous, stereotypies, mannerisms and
grimacing often present when alone

4. Instability of mood and affect

5. Impaired response to sensory stimuli

6. Associated behavioural symptoms- hyperkinesis,
aggression, temper tantrums, self injurious
behaviour, short attention span, insomnia,
feeding and eating problems, enuresis

7. Associated physical illness- URTI, GI problems,

febrile seizures

8. Intellectual functioning- 75% have MR, excellent

rote memory and calculating abilities, hyperlexia
Differential Diagnosis:
 Schizophrenia with childhood onset
 MR with behavioural problem
 Congenital deafness and severe hearing disorder
 Mixed receptive- expressive language disorder

Course and Prognosis:

 Generally a lifelong disorder with guarded
prognosis
 Best prognosis in those with IQ >70, use
communicative language by age 5-7yrs
 Better in supportive home
Treatment:
Goal:
 ↑Socially acceptable behaviour
 ↓odd behavioural symptoms
 ↑verbal and nonverbal communication

1. Behavioural Therapy
2. Language remediation and facilitated
communication
3. Parental counselling
4. Psychopharmacology- valuable adjunctive
treatment to ↓ behavioural symptoms
 Antipsychotics, SSRI, Lithium
 Rett’s Disorder
 Described by Andreas Rett in1965
 Occurs in girls only
 Development of several specific deficit following a
period of normal functioning during 1st 5 months
after birth
 At 6 months to 2yrs- develop progressive
encephalopathy
1)↓ head growth between 5 & 48 months
2) loss of previously acquired purposeful hand skill &
subsequent stereotypical hand movement
3) loss of social engagement early in the course
4) appearance of poorly coordinated gait or trunk
movement
5) expressive & receptive language deficits with
psychomotor retardation

Treatment:
 Symptomatic
 Anticonvulsant
 Behavior therapy
 Physiotherapy for muscular dysfunction
 Attention Deficit Hyperactivity
Disorder
 Consists of a persistent pattern of inattention
and/or hyperactive and impulsive behaviour that is
more severe than expected in children of that age
and level of development

Epidemiology:
 Vary from 2-20%
 Boys:Girls- 2-9:1
Etiology:
1. Genetic factors-
 High concordance rate among monozygotic than
dizygotic twins
 High risk of siblings being affected

2. Developmental factors-
 Born during September
 Infection in the 1st trimester
 Fetal and perinatal subtle CNS damage
 Soft neurological signs
3. Neurochemical factors-
 ↓Noradrenaline
 ↓adrenaline, dopamine

4. Neurophysiological factors-
 Delay in sequence of brain development
 Abnormal EEG and PET scan

5. Psychosocial factors-
 Prolonged emotional deprivation
 Stressful psychic events, disruption of family
equilibrium
Diagnosis:
 Presence of impaired attention and overactivity
 Evident in more than one situation
 Should be of early onset (before 6yrs age) and
long duration

Clinical Features:
 Impared attention- prematurely breaking off from
task, leaving activities unfinished, change activities
frequently, doesnot seem to listen, avoids or
dislikes tasks requiring sustained mental effort,
forgetful and loses things frequently, easily
distracted
 Overactivity- restlessness, running and jumping
around, excessive talkativeness, noisiness,
fidgeting and wriggling

 Impulsivity- blurts out answer before question is

completed, difficulty awaiting turn, interrupts or
intrudes on others

Differential Diagnosis:
 Temperamental characteristic
 Mania
 Anxiety
 Conduct disorder
Course and Prognosis:
 Course is variable
 Overactivity is usually the 1st symptom to remit and
distractibility is the last
 Remission usually occurs between 12-20 yrs
 In 15-20% symptoms persist into adulthood

 Persistance of symptoms may be predicted by-

 Family hx of ADHD
 Negative life events
 Comorbidity
Treatment:
1. Pharmacotherapy-
 Stimulants- methyphenydate,
dextroamphetamine
 Antidepressants- bupropion, venlafaxine
 Atomoxetine
 Clonidine, guanfacine

2. Psychological intervention-
 Behaviour therapy
 Parental counselling and training
 Enuresis
 A disorder characterised by involuntary voiding of
urine by day and/or by night, which is abnormal in
relation to individuals mental age

 Prevalence decreases with increasing age

 Mental disorders present in about 20% of enuretic

children
Etiology:
1. Physiological factors- major role in most cases
 Difficulty in bladder control influenced by
neuromuscular and cognitive development

2. Genetic factors-
 75% have affected 1st degree relative
 Risk increases 7 times if father is enuretic
 High cconcordance rate among monozygotic
twins than dizygotic twins

3. Biological factors-
 Anatomically normal but functionally small bladder
 ↓ADH
4. Psychosocial factors-
 Birth of sibling
 Hospitalisation between 2-4yrs
 Start of school
 Break up in family

Diagnosis:
 Atleast 5yrs age
 Involuntary voiding of urine by day and/or by
night
 not a consequence of a lack of bladder control
due to any neurological disorder, epileptic
attacks, or any structural abnormality of the
urinary tract
Differential Diagnosis:
 Genitourinary pathology- spina bifida
occulta, obstructive uropathy, cystitis
 Diabetes mellitus, diabetes insipidus,
seizure, drug intoxication

Course and Prognosis:

 Usually self limited
 Late onset usually associated with comorbid
psychiatric conditions
Treatment:
 Rule out organic condition
 Review appropriate toilet training
 Star chart
 Restricting fluid before bed and night lifting
to toilet train the child
 Behavioural therapy
 Pharmacotherapy
 Imipramine
 desmopressin