1. Child and Adolescent
Psychiatry

2. Standard Autistic Disorder
 DSMIV-TR (A, B, or C)
 A. Six or more items from 1,2, or 3.
 1. Qualitative impairment in social interaction
 Multiple non-verbal behaviors and gestures
 Failure to develop peer relationships
 Lack of sharing social enjoyment
 Lack of social reciprocity


3.  2. Qualitative impairment in communication
 Delay in spoken language
 Marked impairment in sustaining conversations
Repetitive use of language or idiosyncratic language
Lack of make believe play
 3. Stereotyped behavior
 Abnormal preoccupation with a pattern of interest
 Inflexible routines or rituals
 Repetitive motor mannerisms
 Persistent pre-occupation with parts of objects

4.  B. Delays in at least one of the following
 Social interaction
 Social communication
 Symbolic or imaginative play
 C. Not accounted for by Rett’s or another
disintegrative disorder

5. Asperger’ Syndrome
 Usually first observed after age 2
 Oddity of social interaction
 No language impairment
 Mild mental retardation to normal IQ
 Seizure disorder common
 Social interactions can be mastered

6. Rett’s Disorder
 Observed only in females
 Cause unknown
 Normal prenatal and peri-natal development
 Loss of previously acquired hand skills, social
engagement, gait and language between 5 and 30
months
 Onset before age 4
 Severe mental retardation
 Seizure disorder
 Poor prognosis

7. Childhood Disintegrative Disorder
 More common in males
 Normal development for 2 years
 Loss of previously acquired language, social, bowel
and bladder, play and motor skills before age 10
 Outcome very poor

8. Differential diagnosis
 Schizophrenia with childhood onset
 Mental retardation with behavioral symptoms
 Mixed receptive-expressive language
 Acquired aphasia

9. Schizophrenia with Childhood Onset
 Pre-pubertal onset extremely rare
 Neuro-developmental abnormalities
 No onset before the age of 5
 Normal intelligence
 Command hallucinations
 Bizarre delusions
 Loose associations
 Thought blocking

10. Mental Retardation with Behavioral Symptoms
 Chromosomal problems
 Metabolic disorders
 Over 1000 genetic or metabolic causes

11. Mixed Receptive-expressive Language
 Impaired skills in language comprehension and
understanding
 May also have auditory impairment; i.e. sound
discrimination, memory of sound sequences
 Difficulty processing visual symbols
 Developmental lags
 Long term social problems

12. Mixed Receptive-expressive Language
 Selective deficit in language skills
 Poor ability to express self
 Immature articulation

13. Acquired Aphasia
 Difficulty remembering words
 Secondary to brain trauma, tumors, or seizure
disorder
 Preceded by normal language development
 May start to talk again
 Prognosis unsure

14. Attention Deficit Hyperactivity Disorder
 Inattention
 Hyperactivity
 Impulsivity
 Low tolerance for frustration
 Temper outbursts

15. Oppositional Defiant Disorder
 Evident before age 8
 Stubborn
 Argumentative
 Limit testers
 Refusal to accept blame
 Deviant behavior with authority figures
 No serious violations of rights of others
 Symptoms most evident at home
 Severe power struggles

16. Conduct Disorder
 Evident by age 10
 Behavior outside of societal norms
 Aggression towards people and animals
 Destruction of property
 Deceitfulness and/or theft
 Serious violations of rules
 Violation of rights of others
 More common in males

17. Conduct Disorder cont’d
 Poor peer relationships
 Lack of feelings of guilt or remorse
 Low self-esteem
 School discipline problems
 Boys: Fighting, stealing, vandalizing
 Girls: Truancy, substance abuse, run aways,
prostitution

18. Tourette’s Disorder
 Genetic transmission
 70% of female offspring inheriting the gene develop
the illness
 99% of males inheriting the gene develop the illness
 Permanent progressive illness
 Possible periods of remission

19. Tourette’s Disorder, cont’d
 Onset age 2-10
 Motor tics
 Eye blinking
 Tongue protrusion
 Touching
 Squatting
 Skipping
 Verbal tics
 Barking
 Grunts
 Clicks
 Yelps

20. Tourette’s Disorder, cont’d
 Obsessions and compulsions
 Hyperactivity
 Distractibility
 Impulsivity
 Low self-esteem

21. Adjustment Disorder
 Emotional response to an identifiable stressor
 Inception within 3 months of stressor
 Decreased school performance
 Temporary changes in social relationships
 Ceases after 6 months
 Subtypes
 Anxiety
 Mixed anxiety and depression
 Conduct disturbance
 Mixed conduct and emotion disturbance

22. Childhood Eating Disorders
 Pica
 Rumination Disorder
 Feeding and Eating Disorder

23. Pica
 Persistence in eating non-nutritive substances
 Paint –plaster-dirt- animal feces
 No aversion to eating food
 Frequently associated with mental retardation

24. Rumination Disorder
 Repeated regurgitation and re-chewing food
 Lack of nausea, retching, or GI problems
 May occur with developmental delays

25. Feeding and Eating Disorder
 Infant or child does not eat adequate amounts of
food
 No medical disorder or mental retardation
 Food is available
 Failure to gain weight
 Experiences developmental delays