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Nelson Series
Atypical social interaction Restricted range of interests Onset before 3 years of age
Alan As an infant, Alan was playful and affectionate. At 6 months old, he could sit up and crawl. He began to walk and say words at 10 months and could count by 13 months. One day, in his 18th month, his mother found him sitting alone in the kitchen, repeatedly spinning the wheels of her vacuum cleaner with such persistence and concentration, he didn't respond when she called. From that day on, she recalls, "It was as if someone had pulled a shade over him." He stopped talking and relating to others. He often tore around the house like a demon. He became fixated on electric lights, running around the house turning them on and off. When made to stop, he threw a tantrum, kicking and biting anyone within reach.
Asperger Disorder
Children with Asperger disorder have a qualitative impairment in the development of reciprocal social interaction, often showing repetitive behaviors and restricted, obsessional, idiosyncratic interests. They have deficits in nonverbal and pragmatic aspects of communication (facial expressions, gestures). They do not have the severe language impairments that characterize autism.
Asperger Disorder
Though somewhat socially aware, these children appear to others to be peculiar or eccentric. They are awkward and clumsy and have unusual postures and gait. To meet the diagnostic criteria for Asperger syndrome, a child must manifest impairments in social interactions and show restrictive, repetitive patterns of behavior, interests, or achievements with other people These disturbances must cause significant impairments in social or occupational functioning.
Asperger Disorder
Unlike children with autism, those diagnosed with Asperger syndrome have a history of normal language milestones, with single words used by age 2 yr and communicative phrases used by age 3 yr. There are often similar traits in family members. Prevalence is estimated to be approximately 11/10,000 children.
Asperger Disorder
Group social skill training is the hallmark of intervention, although children with Asperger disorder appear to be at high risk for other psychiatric disorders, particularly oppositional-defiant disorder and mood disorders. Cognitive-behavioral therapy has been useful in patients with associated anxiety, whereas risperidone may improve negative symptoms similar to those seen in schizophrenia.
Rett Disorder
a neurodevelopmental disorder resulting from a genetic mutation of the MECP2 gene an X-linked dominant disorder affecting predominantly girls and few boys has a prevalence of 1/10,000 development is initially normal, but then rapidly regresses in the latter of the 1st year of life.
Rett Disorder
Children initially have normal prenatal and perinatal development, with normal head circumference and normal psychomotor development until 5 mo of age After this period of normal development, all of the following are observed:
deceleration of head growth at 548 mo, with development of microcephaly; l oss of previously acquired purposeful hand skills at 530 mo, with subsequent development of stereotyped hand movements (handwringing); loss of social engagement; poorly coordinated gait or trunk movements; severely impaired receptive and expressive language development, with severe psychomotor retardation.
Childhood Schizophrenia
Psychotic reactions in older children tend to more closely resemble the psychoses of adulthood, and the same diagnostic criteria apply
Childhood Schizophrenia
Clinical Manifestations
prominent symptoms include thought disorder, disorganized speech, delusions, and hallucinations delusions, and hallucinations, in addition to later onset, higher intelligence scores, and fewer perinatal complications, differentiate schizophrenia from autism may have paranoid delusions, aggressive behavior, hebephrenic silliness, social withdrawal, and alternating moods not apparently related to environmental stimuli.
Childhood Schizophrenia
Clinical Manifestations
The typical age of onset is late adolescence to early adulthood. Early-onset schizophrenia (before puberty or in early adolescence) is rare. Schizophrenic children show significant premorbid maladjustments, including social withdrawal, disruptive behaviors, developmental delays, and speech and language problems.
Childhood Schizophrenia
Clinical Manifestations
Auditory hallucinations are seen in 80% of schizophrenic children. Delusions and formal thought disorders usually do not present until midadolescence. Children with early-onset schizophrenia show preliminary evidence of progressive ventricular enlargement, a decrease in total cerebral volume, and a decline in intellectual functioning. (Poor prognosis)
Childhood Schizophrenia
Clinical Manifestations
Affective blunting and disturbed interpersonal relationships predict psychotic adult psychopathology In schizophrenic children, initial presenting symptoms cluster around violent aggression and school problems. Psychotic symptoms are 1st recognized at 211 yr, followed 2 yr later by a diagnosis of schizophrenia.
Childhood Schizophrenia
Clinical Manifestations
Before diagnosis, children with schizophrenia often have a prodromal period characterized by deficits in attention, impaired language and verbal memory, poor gross motor skills, and impaired coordination. Most children receive a psychiatric diagnosis before the development of psychosis, with the most common diagnoses being pervasive developmental disorder, attention-deficit/hyperactivity disorder, and depression.
Childhood Schizophrenia
Clinical Manifestations
In the premorbid period before the diagnosis of schizophrenia, affected children showed higher rates of social withdrawal and greater global impairment, and had fewer friends. Individuals with various psychotic processes are often misdiagnosed as having schizophrenia.
Childhood Schizophrenia
Treatment
Multimodal therapeutic approach Parent training is necessary Individual therapy designed to build a positive alliance Neuroleptic therapy hallucinations and psychotic delusions, these medications appear to have lower risks of extrapyramidal symptoms and tardive dyskinesia Clozapine appears to be the most effective antipsychotic medication for refractory cases, but the risk of agranulocytosis and seizures limits its use
Acute phobic hallucinations are benign and common and occur in previously healthy preschool children