Childhood Psychiatric Disorders usually first diagnosed in Infancy and Early Childhood

1. CHILDHOOD DISORDERS

2. Disorders usually First
Diagnosed in Infancy,
Childhood or Adolescence

3. Types
•Mental Retardation
•Learning Disorders
•Motor Skills Disorders
•Pervasive Developmental Disorders
•Attention Deficit Hyperactive Disorders
•Feeding and Eating disorders of infancy or early
childhood
•Tic disorders
•Elimination Disorders
•Other Disorders

4. Mental Retardation
Sub average general intellectual
functioning that is accompanied by
significant limitations in adaptive
functioning in at least two of the
following skills areas,
Communication, self care, home living,
social-interpersonal skills, etc

5. Definition
Definition:
Mental Retardation refers to
significantly sub-average general
intellectual functioning, resulting in
or associated with, concurrent
impairments in adaptive behavior
and manifested during the
developmental period.

6. Levels of MR
1. Mild Mental Retardation
2. Moderate Mental Retardation
3. Severe Mental Retardation
4. Profound Mental Retardation

7. Mild level
They can called as Educable Mentally
Retarded (EMR)
IQ range – 55 to 80
Capable of learning basic academic
skills of reading, writing and
arithmatic.
Most children can learn vocational
skills.

8. Moderate level
They called as Trainable Mentally Retarded
(TMR)
IQ range – 35- to 60
They were usually not admitted in public
schools. They can go to special schools.
They need supervisory help.
Special teaching and training on basic skills
needed for day to day life.

9. Severe and profound level
Severe level IQ – 20 to 35
Profound level IQ – below 20
These children usually referred below
the TMR level as custodial
Usually they remained at home or
under some residential facilities

10. MR

11. Learning Disorders
Reading Disorder: (Dyslexia)
Mathematical Disorder: (Dyscalculia)
Writing Disorder: (Dysgraphia)

12. Motor Skills Disorders
• Developmental Coordination disorder
• Impairment in the development of motor
coordination
• Not due to general medical condition
(Cerebral Palsy, Muscular Dystrophy)
• Marked delays in achieving motor
milestones (Walking, crawling, sitting),
dropping things, clumsiness, poor
performance in sports.

13. Communication disorders

14. Expressive Language Disorder
The difficulties with expressive
language interfere with academic or
occupational achievement or with
social communication

15. Phonological Disorder
Failure to use developmentally
expected speech soundsthat are
appropriate for the individuals age
and dialect
Errors in sound production,
substitutions of one sound for
another (Use T for K), omissions of
sounds

16. Stuttering
• Disturbance in the normal fluency and time
patterning of speech that is inappropriate for the
individual’s age.
• Frequent repetitions/ prolongations of sounds or
syllables
• Interjections
• Broken words (pauses within a word)
• Audible/silent blocking
• Circumlocutions(word substitutions to avoid
problematic words)
• Words produced with an excess of physical tension
• Monosyllabic whole word repetitions (I-I-I-I- see

17. Pervasive Developmental
Disorders
• Impairment in several areas of
development
• Reciprocal social interaction skills
• Communication skills
• Presence of stereotyped
behavior/interests/activities
• The qualitative impairments that defines
these conditions are distintly deviant
relative to the individual’s
developmental level or mental age

18. Types of PDD
1. Autistic Disorder
2. Rett’s Disorder
3. Childhood Disintegrative
4. Asperger’s Disorder

19. Autistic Disorder
• Onset prior to age 3 years
• More frequent in males/boys
• Average or above average intelligence with
uneven cognitive skills

20. Symptoms
• Qualitative impairment in social
interaction
• Qualitative impairments in
communication
• Restricted repetitive and stereotyped
pattern of behaviours, interests and
activities

21. Causes
• Genetic
• Prenatal environment
• Perinatal environment
• Postnatal environment

22. Mirror writing

23. Rett’s Syndrome
• Rett syndrome is a rare genetic
neurological and developmental disorder
that affects the way the brain develops,
causing a progressive inability to use
muscles for eye and body movements and
speech. It occurs almost exclusively in
girls.
• Discovered in the first two years of life
• Is a genetic disorder. Mutation in a
particular gene on the X chromosome.

24. Symptoms
• A slowing of head growth is one of the
first events in Rett syndrome
• Problems with muscles and coordination
• The child loses any purposeful use of her
hands
• stops talking and develops extreme social
anxiety and withdrawal or disinterest in
other people.

25. Rett’s Syndrome

26. Childhood Disintegrative
• Childhood disintegrative disorder is also
known as Heller's syndrome. It's a very rare
condition in which children develop normally
until at least two years of age, but then
demonstrate a severe loss of social,
communication and other skills.
• Childhood disintegrative disorder is part of a
larger category called autism spectrum
disorder.
• Develop normally through age 3 or 4

27. Childhood Disintegrative
A child who is affected loses:
• Communication skills
• Nonverbal behaviors
• Skills they had already learned

28. Symptoms
• Delay or lack of spoken language
• Impairment in nonverbal behaviors
• Inability to start or maintain a conversation
• Lack of play
• Loss of bowel and bladder control
• Loss of language or communication skills
• Loss of motor skills
• Loss of social skills
• Problems forming relationships with other
children and family members

29. Asperger’s Disorder
• Children with Asperger's syndrome typically
function better than do those with autism
• Children with Asperger's syndrome generally
have normal intelligence and near-
normal language development
• They may develop problems communicating as
they get older.
• Asperger's syndrome was named for the Austrian
doctor, Hans Asperger, who first described the
disorder in 1944.

30. Symptoms
• Problems with social skills
• Eccentric or repetitive behaviors
• Unusual preoccupations or rituals – Ex: getting dressed in a
specific order
• Communication difficulties
• Limited range of interests
• Coordination problems
• Skilled or talented

31. Asperger’s Syndrome

32. Attention Deficit Hyperactive
Disorder (ADHD)

33. Case study
Lisa's son Jack had always been a handful. Even as a
preschooler, he would tear through the house like a tornado,
shouting, roughhousing, and climbing the furniture. No toy or
activity ever held his interest for more than a few minutes and
he would often dart off without warning, seemingly unaware
of the dangers of a busy street or a crowded mall.
It was exhausting to parent Jack, but Lisa hadn't been too
concerned back then. Boys will be boys, she figured. But at
age 8, he was no easier to handle. It was a struggle to get Jack
to settle down long enough to complete even the simplest
tasks, from chores to homework. When his teacher's
comments about his inattention and disruptive behavior in
class became too frequent to ignore.

34. ADHD
• ADHD is a common behavioral
disorder that affects about 10% of
school-age children.
• Boys are about three times more
likely than girls to be diagnosed with
it, though it's not yet understood
why.

35. ADHD
• Of course, all kids (especially
younger ones) act this way at times,
particularly when they're anxious or
excited.
• But the difference with ADHD is that
symptoms are present over a longer
period of time and happen in
different settings.

36. What is ADHD?
• ADHD is a neuro developmental disorder
affecting both children and adults.
• It is described as a “persistent” or on-going
pattern of inattention and/or hyperactivity-
impulsivity that gets in the way of daily life or
typical development. Individuals with ADHD
may also have difficulties with maintaining
attention, executive function (or the brain’s
ability to begin an activity, organize itself and
manage tasks) and working memory.

37. ADHD-Subtypes
• ADHD broken down into three
subtypes, each with its own pattern
of behaviors,
1. an inattentive type
2. a hyperactive-impulsive type
3. a combined type

38. an inattentive type
• trouble paying attention to details or a tendency to
make careless errors in schoolwork or other activities
• difficulty staying focused on tasks or play activities
• apparent listening problems
• difficulty following instructions
• problems with organization
• avoidance or dislike of tasks that require mental
effort
• tendency to lose things like toys, notebooks, or
homework
• distractibility
• forgetfulness in daily activities

39. a hyperactive-impulsive type
• fidgeting or squirming
• difficulty remaining seated
• excessive running or climbing
• difficulty playing quietly
• always seeming to be "on the go"
• excessive talking
• blurting out answers before hearing the full
question
• difficulty waiting for a turn or in line
• problems with interrupting or intruding

40. a combined type
• a combination of the other two type,
is the most common

41. Treating ADHD
• ADHD can't be cured, but it can be
successfully managed.
• ADHD is best treated with a combination
of medicine and behavior therapy.
• It's important for parents to actively
participate in their child's treatment plan,
parent education is also an important part
of ADHD management.

42. Feeding and Eating Disorders
of Infancy or Early Childhood

43. Feeding and Eating Disorders of
Infancy or Early Childhood
• If a child loses a lot of weight
suddenly or is small for their age and
doesn't seem to growing normally, it
may be a sign that a feeding or eating
disorder is present.
• When malnutrition is not caused by a
medical problem, it is referred to as a
feeding disorder of infancy or early
childhood.

44. Types
• Pica
• Rumination Disorder
• Feeding Disorder Of Early Childhood

45. Pica
• Pica is a disorder that occurs when children
persistently eat one or more non-food substances
over the course of at least one month.
• Pica may result in serious medical problems, such as
intestinal blockage, poisoning, parasitic infection, and
sometimes death.
• Younger children with Pica frequently eat paint,
plaster, string, hair, or cloth.
• older children with Pica tend to eat animal droppings,
sand, insects, leaves, or pebbles.
• Adolescents affected by the disorder often consume
clay or soil substances.

46. Rumination Disorder
• Children with Rumination Disorder repeatedly regurgitate
and spit out or re-chew their food following eating.
• This disorder usually develops in infants or young children.
It must last for at least one month before the diagnosis can
be made. Children with Rumination Disorder do not show
nausea, retching, or disgust associated with their
rumination behavior, and do not have associated
gastrointestinal problems that can account for the
behavior.

47. Feeding Disorder Of Early
Childhood
• A Feeding Disorder of Early
Childhood is diagnosed when a child
does not eat adequately and
maintain proper nutrition. This
disorder, sometimes referred to as
"Failure to Thrive" leads to weight
loss or to difficulties maintaining
normal weight.

48. Tic disorders
• The body moves repeatedly, quickly, suddenly and
uncontrollably
• Any parts of the body- face, shoulders, hands or legs
• Involuntary, sudden, recurrent, stereotyped motor
movements or vocalizations that are rapid and not
rhythmic.
• It is irresistable
• Begin in childhood
• Ex for Motor Tics: eye blinking, nose twitching, tooth
clicking, sticking out the tongue, hand clapping
• Ex for Vocal Tics: grunting, sniffing, barking, throat clearing

49. Diagnostic Criteria
• The presence of one or mote tics either motor or vocal –
but not both
• The tics occur many times a day, either daily or
intermittently, during a period of more than a year and
without any tic free period of 3 or more consecutive
months.
• The tics cause marked distress or significant impairment in
one or more important areas of functioning, such as social
or occupational
• The symptoms began before age 18
• The tics are not due to the direct effects of some chemical
substances or some general medical condition
• The person has never met the criteria for Tourette’s
Disorder

50. Tourette’s Syndrome
• Is one type of tic disorder
• Begins as early as age 2
• Cause significant social and
functional difficulties for children
• More in boys than girls

51. Diagnostic Criteria
• Both multiple motor and one or more vocal tics have been
identified at sometime during the disorder, although it is
not necessary for them to occur in the same period.
• The tics occur many times a day and nearly everyday or
they occur intermittently, for a period of more than a year
and without any tic free period of 3 or more consecutive
months.
• The tics cause marked distress or significant impairment in
one or more important areas of functioning, such as social
or occupational
• The symptoms began before age 18
• The tics are not due to the direct effects of some chemical
substances or some general medical condition.

52. Elimination Disorders
• 2 types
– Non-organic Enuresis
– Non-organic Encopresis

53. Non-organic Enuresis
• Enuresis is repetitive voiding of urine,
either during the day or night, at
inappropriate places.
• Enuresis is diagnosed only after 5 years of
age
• Enuresis can be either of:
– Primary type, where bladder control has never
been achieved or
– Secondary type, where enuresis emerges after a
period of bladder control.

54. Non-organic Encopresis
• Encopresis is repetitive passage of faeces at
inappropriate time and/or place, after bowel
control is physiologically possible. It is not due to
the presence of any organic cause, which is called
as faecal incontinence.
• Encopresis can be either of:
– Primary type, where toilet training has never been
achieved or
– Secondary type, where encopresis emerges after a
period of faecal continence.

55. Other Disorders
• Oppositional Defiant Disorder
• Conduct Disorder
• Separation Anxiety Disorder
• Childhood Schizophrenia
• PTSD in Childhood
• OCD in Childhood
• Depression in Childhood
• Elective (Selective) Mutism
• Habit Disorder

56. Oppositional Defiant Disorder
• Child/adolescent behave in
negativistic, defiant, disobedient and
hostile ways towards authority
figures
• If this behavior is severe enough to
interfere with the child’s
functioning and relationship with
others then the child may be ODD

57. Diagnostic Criteria
• A pattern that includes negativistic, defiant, disobedient and hostile
behavior that lasts at least 6 months and includes the frequent occurrence
of at least 4 of the following behaviors during that period (more
frequently
• lose temper
• Argues with adults
• Actively defies or refuses to comply with adults’ rules or requests
• Deliberately annoys others
• Blames others for own mistakes or misbehaviors
• Is easily annoyed by others, touchy
• Is angry and resentful
• Is spiteful or vindictive
• These behavior cause clinically significant impairment in social, academic
or work related functioning
• These behavior do not occur exclusively as part of a psychotic disorder or
mood disorder
• Criteria are not met for conduct disorder or if 18 years or older for
antisocial personality disorder.

58. Conduct Disorder
• Is often more serious in their consequences than
ODD because of the violation of important
societal norms and disregard of the rights of
others
• Persistent behavior – include aggressive actions
that cause or threaten harm to people or animals
• Non aggressive conduct that causes property
damage, major deceitfulness or theft and
• Serious rule violations.

59. Diagnostic Criteria
• Three or more of these behavioural criteria must have been present in the
last 12 months and at least one in the past 6 months
• Aggression – toward people – bullying, intimidation, use of weapons,
physical cruelty, forced sexual activity, mugging, purse snatching and
aggression toward animal.
• Destruction of property including fire setting, and other deliberate
property destruction
• Deceitfulness or theft including breaking into a building or a car, conning
others to obtain goods, stealing items of value
• Serious rule violation including staying out at night without parents’
permission before age 13, running away from home, school truancy
before 13
• These behavior do not occur exclusively as part of a psychotic disorder or
mood disorder
• Criteria are not met for conduct disorder or if 18 years or older for
antisocial personality disorder.

60. Separation Anxiety Disorder
• Separation anxiety is normal in very young
children (those between 8 and 14 months old).
Kids often go through a phase when they are
"clingy" and afraid of unfamiliar people and
places. When this fear occurs in a child over age
6 years, is excessive, and lasts longer than four
weeks, the child may have separation anxiety
disorder.
• Separation anxiety disorder is a condition in
which a child becomes fearful and nervous when
away from home or separated from a loved one -
- usually a parent or other caregiver -- to whom
the child is attached.

61. Separation Anxiety Disorder
• Following are some of the most common symptoms of separation anxiety
disorder:
• An unrealistic and lasting worry that something bad will happen to the
parent or caregiver if the child leaves
• An unrealistic and lasting worry that something bad will happen to the
child if he or she leaves the caregiver
• Refusal to go to school in order to stay with the caregiver
• Refusal to go to sleep without the caregiver being nearby or to
sleep away from home
• Fear of being alone
• Nightmares about being separated
• Bed wetting
• Complaints of physical symptoms, such as headaches and stomachaches,
on school days
• Repeated temper tantrums or pleading

62. Childhood Schizophrenia
• Childhood schizophrenia is a severe brain disorder in which
children interpret reality abnormally.
• Signs and symptoms may vary, but they reflect an impaired ability
to function.
• It occurs early in life and has a profound impact on a child's
behavior and development. And it requires lifelong treatment.
• The earliest indications of childhood schizophrenia may include
developmental problems, such as:
– Language delays
– Late or unusual crawling
– Late walking
– Other abnormal motor behaviors — for example, rocking or arm flapping

63. PTSD in Childhood
• Children and teens could have PTSD if they have lived through an
event that could have caused them or someone else to be killed
or badly hurt. Such events include sexual or physical abuse or
other violent crimes. Disasters such as floods, school shootings,
car crashes, or fires might also cause PTSD. Other events that can
cause PTSD are war, a friend's suicide, or seeing violence in the
area they live.
• Posttraumatic stress disorder, or PTSD, is diagnosed after a
person experiences symptoms for at least one month following a
traumatic event. The disorder is characterized by three main types
of symptoms:
– Re-experiencing the trauma through intrusive distressing recollections of the event,
flashbacks, and nightmares.
– Avoidance of places, people, and activities that are reminders of the trauma, and
emotional numbness.
– Increased arousal such as difficulty sleeping and concentrating, feeling jumpy, and
being easily irritated and angered.

64. PTSD in Childhood
• Diagnosis criteria that apply specifically to
children younger than age six include the
following:
Exposure to actual or threatened death, serious
injury, or sexual violation:
– direct experience
– witnessing the events as they occurred to others, especially primary
caregivers (Note: Does not include events witnessed only in
electronic media, television, movies, or pictures.)
– learning that the traumatic events occurred to a parent or care
giving figure

65. OCD in Childhood
• Symptoms of childhood-onset OCD vary widely from child to child.
Some common obsessions experienced by children and adolescents
with OCD include:
– exaggerated fears of contamination from contact with certain people, or
everyday items such as clothing, shoes, or schoolbooks
– excessive doubts that he/she has not locked the door, shut the window,
turned off the lights, or turned off the stove or other household
appliance
– marked over-concern with the appearance of homework assignments
– excessive worry about symettrical arrangement of everyday objects
such as shoelaces, school books, clothes, or food
– fears of accidentally harming a parent, sibling or friend
– superstitious fears that something bad will happen if a seemingly
unconnected behavior is done (or not done)

66. OCD in Childhood
• Some common compulsions experienced by
children and adolescents with OCD include:
– Compulsive washing, bathing, or showering
– Ritualized behaviors in which the child needs to touch body parts or
perform bodily movements in a specific order or symmetrical
fashion
– Specific, repeated bedtime rituals that interfere with normal sleep
– Compulsive repeating of certain words or prayers to ensure that
bad things don’t occur
– Compulsive reassurance-seeking from parents or teachers about
not having caused harm
– Avoidance of situations in which they think “something bad” might
occur

67. Depression in Childhood
• If the Child’s sadness becomes
persistent, or if disruptive behavior
that interferes with normal social
activities, interests, schoolwork, or
family life develops, it may indicate
that he or she has a depressive
illness.

68. Depression in Childhood
• The signs and symptoms of childhood depression include:
• Changes in appetite -- either increased appetite or decreased
• Changes in sleep -- sleeplessness or excessive sleep
• Continuous feelings of sadness or hopelessness
• Difficulty concentrating
• Fatigue and low energy
• Feelings of worthlessness or guilt
• Impaired thinking or concentration
• Increased sensitivity to rejection
• Irritability or anger
• Physical complaints (such as stomachaches or headaches that do not respond to
treatment
• Reduced ability to function during events and activities at home or with friends, in
school or during extracurricular activities, or when involved with hobbies or other
interests
• Social withdrawal
• Thoughts of death or suicide
• Vocal outbursts or crying

69. Elective (Selective) Mutism
• Characterized by a marked, emotionally
determined selectivity in speaking, such that the
child demonstrates a language competence in
some situations but fails to speak in other
(definable) situations. The disorder is usually
associated with marked personality features
involving social anxiety, withdrawal, sensitivity, or
resistance.

70. Habit Disorder
• Habit disorder is the term used to describe
several related disorders linked by the presence
of repetitive and relatively stable behaviors that
seem to occur beyond the awareness of the
person performing the behavior. As with other
disorders, these behaviors cause impairment and
result in negative physical and/or social
consequences.
• Habit disorders includes thumb sucking, nail
biting, hair pulling