CHILD HOOD MENTAL DISORDERS

-NANCY.P.DOMINGO

LECTURER
 Disorders Usually 1 st Diagnosed
in Infancy, Childhood, &
Adolescence

Core Concept Of Diagnostic

Group:
Categorized by time of onset
Predominantly disorders of abnormal
development and maturation.
Emphasis of disorders is on the inability
of the individual to attain certain
normal developmental milestones and
the associated functions, capabilities, &
behaviors.
10 DIAGNOSTIC SUBGROUPS
(DSM-IV-TR)
 Mental Retardation
 Learning Disorders
 Motor Skills Disorders
 Communication Disorders
 Pervasive Developmental Disorders
 Attention Deficit and Disruptive Behavior Disorders
 Feding & Eating Disordes of Infancy & EarlyChildhod
 Tic Disorders
 Elimination Disorders
 Other Disorders of Infancy, Childhod, orAdolescence
 Mental Retardation
Characteristics:
IQ is significantly below average (<
70)
Accompanied by deficits in adaptive
functioning, e.g. communication,
self-care, home living,
social/interpersonal skills, use of
community resources, self-direction,
academic skills, work, leisure,
health, safety.
Onset and coding

Onset before age 18 years

Coding: coded on axis II

Code based on degree of severity, reflecting
level of intellectual impairment:
◦ Mild Mental Retardation – IQ from 50-55
to 70
◦ Moderate Mental Retardation – IQ from
35-40 to 50-55
◦ Severe Mental Retardation – IQ from
20- 25 to 35-40
◦ Profound Mental Retardation – IQ
below 20-25
 Mental Retardation

Prevalence: 1-3% of population; 90% are mild MR

Course: chronic

Prognosis: variable, depending on IQ & level
of impairment

Gender differences: more prevalent for males (1.6
to 1); no gender differences for severe &
profound MR

Causes: genetic; chromosomal (Down syndrome,
Fragile X syndrome, Lesch-Nyhan syndrome);
environmental (deprivation, abuse, neglect); prenatal
(exposure to disease, alcohol, drugs, chemicals,
poor maternal nutrition); perinatal (difficulties during
labor & delivery); postnatal (malnutrition,
infections, & head injuries)

Treatment: behavioral skills training; communication
training; supported living and employment;
mainstreaming
Causes and Treatment
Causes: genetic; chromosomal
(Down syndrome, Fragile X
syndrome, Lesch- Nyhan syndrome);
environmental (deprivation, abuse,
neglect); prenatal (exposure to
disease, alcohol, drugs, chemicals,
poor maternal nutrition); perinatal
(difficulties during labor & delivery);
postnatal (malnutrition, infections,
& head injuries)
Treatment: behavioral skills training;
communication training; supported
living and employment;
mainstreaming
LEARNING DISORDER
Characteristics:
 Inadequate development of specific
academic skills, such as reading,
writing, and math.
 Specific academic skills are
substantially below expected for age,
intelligence, and education
Significantly interferes with aspects of life
requiring those skills.
Subtypes:
 Reading Disorder
 Mathematics Disorder
 Disorder of Written Expression
 Learning Disorder Not Otherwise
Specified
Prevalence:
◦ general population: 5-10%
◦ reading disorders: 5-15%
◦ math disorders: 6%
Racial: more common in black children
Negative outcomes: negative school
experiences; school drop-out; lower employment
rates; lower educational & career goals
Causes: genetics; structural & functional
differences in the brain
Treatment: educational interventions
(processing skills; cognitive skills; behavioral
skills)
TIC DISORDE
R
 Tic Disorder: Tourette’s Disorder

 Symptoms: characterized by multiple motor tics

and one or more vocal tics (involuntary, sudden,
rapid, nonrhythmic, stereotyped motor
movements or vocalizations), which occur many
times a day, nearly every day, or intermittently
for more than a year.
 Common motor tics: eye-blinking, eye-rolling,
spitting, flipping/twirling hair, rolling head around,
bending/jumping, skin picking, shrugging/jerking
shoulders, thrusting pelvic movements, tapping
fingers/feet
 Common vocal tics: throat clearing, tongue-
clicking, whistling, grunting, humming, hoots,
howls, burps/belches, animal noises, repetition of
one’s own words, repetition of others’ words
 Contd .


Causes: genetic (32% have relatives with TD);
abnormal metabolism of 5HT & D; brain processing
problem (basal ganglia)

Prevalence: decreases with age; 5-30 per 10,000
in childhood; 1-2 per 10,000 in adulthood

Gender: 2-5x as common for males

Onset: as early as 2 yrs; average age of onset is 6-
7 yrs; typically develops by age 14

Course: severity, frequency, and disruptiveness of
sx diminish during adolescence & adulthood

Treatment: antipsychotics; antihypertensive
medications; SSRI’s; self-monitoring; relaxation
training; habit reversal
ADHD
Attention Deficit/Hyperactivity Disorder
Includes two major syndromes:
1) Inattention
2) Hyperactivity-Impulsivity
Syndromes may occur independently or
together, but usually some components
of each are present.
Symptoms begin before age 7
Symptoms cause some impairment in 2
or more settings.
Inattention: 6+ of the following for 6+ months

Often fails to give close attention to details

Often makes careless mistakes in school,
work, etc.

Often has difficulty sustaining attention

Often doesn’t seem to listen when spoken
to directly

Often doesn’t follow instructions

Often fails to finish schoolwork, chores, or
work duties

Has difficulty organizing tasks & activities

Avoids or dislikes tasks requiring sustained
mental effort

Often loses things

Is easily distracted by extraneous stimuli

Is forgetful in daily activities
Attention Deficit/Hyperactivity Disorder
Hyperactivity-Impulsivity 6+ of following for 6+ months
Hyperactivity:

Fidgets with hands or feet; squirms in seat

Difficulty staying in seat

Excessive running, climbing, or restlessness

Difficulty playing or engaging in leisure activities quietly

Often “on the go;” acts as if “driven by a motor”

Often talks excessively
Impulsivity:

Often blurts out statements

Impatient; difficulty awaiting turn

Often interrupts or intrudes on others
Attention Deficit/Hyperactivity Disorder

Subtypes:
◦ AD/HD, Predominantly Inattentive Type
◦ AD/HD, Predominantly Hyperactive-Impulsive Type
◦ AD/HD, Combined Type
◦ AD/HD, Not Otherwise Specified

Onset: 3-4 years old

Age: 68% have ongoing sx in adulthood;
inattentive subtype is more common in
adolescents and adults

Gender: ratios of males to females range from 2:1 to
9:1; Combined and Hyperactive Subtypes are much
more common in males than females

Prevalence: up to 3-7% of school-age children
 ADHD: Associated Features

Academic deficits

School-related problems

Peer rejection

Low frustration tolerance

Tantrums

Poor self-esteem

Mood swings

Bossiness

Stubbornness

Accidents

Driving difficulties – speeding, accidents
 ADHD: Diagnostic Considerations

Difficulty of distinguishing normal activity from
hyperactivity and normal distractibility from
attention deficit distractibility.

Need to evaluate behavior in terms of what’s normal
for others of same gender, age, developmental level,
cultural background.

Behaviors must occur in multiple settings.

Behaviors must cause clinically significant impairment.

Symptoms must have been present and
caused impairment by age 7.

Combined and Hyperactive Subtypes are less likely to
be missed.
 ADHD: Contributing Factors
Genetics: increased incidence of ADHD
& psychopathology in families &
relatives
Prenatal factors: inadequate oxygen;
drug exposure; maternal smoking
Neurotransmitters: inadequate availability
of dopamine; NE, 5HT, GABA also
implicated
Brain abnormalities: frontal cortex,
basal ganglia, & cerebellar vermis are
smaller
Exposure to toxins: allergens, food additives
Parenting: negative attempts to control
their behavior; intrusive, over-bearing
parenting
Attention Deficit/Hyperactivity Disorder
Treatments:
Medication – stimulants, Strattera
(SNRI), Wellbutrin
Psychoeducation & bibliotherapy
Skills-based training – time management,
organizational skills, study skills,
problem- solving, social skills
CONDUCT DISORDER
 Conduct Disorder

Repetitive, persistent pattern of behavior
in which the basic rights of others or
major societal norms or rules are
violated.

3 or more of the following are present in
the past 12 months, and at least one of
the following is present in the past 6
months.
1) Aggression to people and animals
2) Destruction of property
3) Deceitfulness or theft
4) Serious violations of rules
 Conduct Disorder
1) Aggression to People and
Animals:
◦ Bullying, threats, intimidation
◦ Physical fights
◦ Use of weapons
◦ Physical cruelty to people
◦ Physical cruelty to animals
◦ Mugging, purse snatching,
extortion, armed robbery
◦ Forced sexual activity
 Conduct Disorder
2) Destruction of Property:
◦ Deliberate fire-setting
◦ Deliberate destruction of others’ property
3) Deceitfulness or Theft
◦ Breaking & entering
◦ Lying; conning
◦ Stealing; shoplifting; forgery
4) Serious Violations of Rules
◦ Breaking curfew prior to age 13
◦ School truancy prior to age 13
◦ Running away from home
 Conduct Disorder
Subtypes:
 Conduct Disorder, Childhood Onset – onset of at
least 1 criterion prior to age 10
 Conduct Disorder, Adolescent Onset – absence of
any criteria prior to 10
 Conduct Disorder, Unspecified Onset – age of
onset is unknown
Specifiers:
 Mild – few, if any, conduct problems in excess of
those required to make dx; cause only minor harm
to others
 Moderate – number of conduct problems and
effect on others are in the intermediate range
 Severe – many conduct problems in excess of
those required to make dx; cause considerable harm
to others
 Conduct Disorder
 Etiology: genetics; decreased arousal; low levels
of 5HT; neurological deficits
 Prevalence: 2-9% of nonclinical population; up to
1/3- 1/2 of child mental health referrals; 87-91%
of incarcerated juveniles
 Gender Differences: mostly males
 Onset: as early as preschool
 Prognosis: poor; 2/3rds of cases develop
into Antisocial Personality Disorder
 Treatment: parent management training;
community- based interventions (group homes,
wilderness programs; therapeutic boarding schools);
CBT (social skills, problem solving, cognitive
restructuring)
 Oppositional Defiant Disorder
 Pattern of negativistic, hostile, and defiant behavior for
at least 6 months.
 At least 4 of the following are present:
◦ Often loses temper
◦ Often argues with adults
◦ Often actively defies or refuses to comply with
adults’ requests or rules
◦ Often deliberately annoys others
◦ Often blames others for own mistakes or
misbehavior
◦ Is often touchy or easily annoyed by others
◦ Is often angry or resentful
◦ Is often spiteful or vindictive
 Oppositional Defiant Disorder
 Prevalence: 1-6%
 Gender differences: more prevalent for males
prior to puberty; ratio evens out after puberty
 Prognosis: relatively persistent – some of the
behaviors persist into adulthood, others are
outgrown; higher divorce rate, employment
difficulties, and drug/alcohol abuse for those with
ODD
 Causes: marital conflict; family discord;
inconsistent parenting; overly lenient or rigid
parent; coercive or aversive parent-child
interactions; genetics
 Treatment: parent training; family therapy; behavioral
therapy (anger management, social skills
training, problem solving, frustration tolerance);
cognitive interventions to reduce negativity
 Separation Anxiety Disorder
At least 4 weeks of inappropriate or excessive
anxiety about separation from home or major attachment
figures, as evidenced by at least 3 of the following:
◦ excessive anxiety regarding separation
◦ excessive fears of losing major attachment figures
◦ nightmares involving the theme of separation
◦ refusal to go to school
◦ refusal to be alone or without major
attachment figures
◦ refusal to sleep away from home or
attachment figures
◦ repeated physical complaints when separation
occurs or is anticipated
Onset prior to age 18
 Pervasive Developmental
Disorders
Characterized by:

A broad-based impairment or a loss
of functions expected for child’s
age.

Includes 3 components:
1) Impairment in social
interactions/relationships
2) Impairment in communication/language
3) Restricted, repetitive, and stereotyped
patterns of behavior, interests, and
activities
 Autistic Disorder

Abnormal functioning in at least one of
the following areas, with onset prior to
3:
1) Social interaction
2) Language and communication
3) Symbolic, imaginative play

Qualitative impairment in social
interaction and relationship development

Qualitative impairment in
communication, language, and
conversation skills

Restricted, repetitive, stereotyped patterns
of behavior, interests, activities.
 Autism

Mental retardation: 75-80%; 50% are profoundly or
severely MR; 25% are moderately MR; 25% borderline
to average IQ

Gender differences: higher IQ – more prevalent
among males; IQ < 35 – more prevalent among
females

Prevalence: 1 in 500 births

Onset: first apparent in infancy & toddlerhood

Course: chronic; life-long impairment; 50% never
acquire speech

Causes: abnormalities in brain structure and function
(5HT synthesis, cerebellum); genetics

Treatments: intensive behavioral Tx focusing on
improving communication, social and daily living skills
and reducing problem behaviors; early intervention
programs; applied behavior analysis; parent training;
mainstreaming for education; community
interventions (supportive living arrangements & work
settings)
 Asperger’s Disorder
Qualitative impairment in
social interaction and
relationship development
Restricted, repetitive, and
stereotyped patterns of
behavior, interests, and
activities
But lack any clinically
significant delay in language
or cognitive development
 Asperger’s Syndrome
What you see:

Anxious, excessive desire for sameness

Preoccupation with stereotyped, repetitive activities

Obsess about objects

Limited interests

Can’t relate to others

Can’t read emotions

Can’t understand social cues

Social isolation, socially inept

Average IQ scores

Motor clumsiness

Poor coordination
 Asperger’s Syndrome
Gender: up to 4x as common for males
Prevalence: up to 5x as common
as Autism
Onset: later onset than Autism
Course: chronic, life-long
Etiology: genetics; brain abnormalities
(limbic system, 5HT & D systems,
right hemisphere)
 Asperger’s Syndrome: Treatments
Behavioral treatments/skills building:
interventions targeting problem
behaviors, problem solving, social skills,
communication skills, empathy-building,
daily living skills
School-based interventions: mainstreaming;
tutoring; special aides; multiple modalities for
presenting information
Psychotherapy to address
accompanying psychiatric disorders, such
as depression and anxiety
Medications: antidepressants, antipsychotics
Nurses Role In Management
Of Childhood Disorder

Ensuring the child’s safety and that of others
Stop unsafe behavior.

Provide close supervision

Give clear directions about acceptable and
unacceptable behavior.
 Improved role performance

Give positive feedback for meeting
expectations.

Manage the environment (e.g., provide a quiet
place free of distractions for task completion).

Simplifying instructions/directions

Get child’s full attention.
Contd.
 Break complex tasks into small steps .
 Allow breaks.
 Structured daily routine
 Establish a daily schedule.
 Minimize changes.
 Client/family education and support
 Listen to parent’s feelings and
frustrations.
 Improving role performance
 Simplifying instructions
 Promoting a structured daily routine
 Providing client and family education and
support