PSYCHIATRIC

CHILDHOOD
DISORDERS
BY GROUP
Musobya Draman
Muwanguzi Franklin
Lutaaya Ibrahim
Arefin
Yahya
Ashyaa
 Categories of psychiatric childhood disorder

• Intellectual Disability
• Global development delay
• Specific learning disorder
• Communication disorder
• Attention Deficit/Hyperactivity Disorder(ADHD)
• Autism Spectrum Disorder(ASD)
• Disruptive and Conduct Disorders
• Elimination Disorderd
• Tic Disorders
 Intellectual Disability (ID)

Intellectual developmental disorder is x-tised by

severely impaired cognitive & adaptive/ social
functioning
The severity is based on adaptive functioning
which indicates the degree of support required
A single IQ score does not adequately capture this
is no longer used to determine ID severity
 Diagnosis and DSM-5 criteria

• Deficits in intellectual functioning such as

reasoning, problem solving, planning, abstract
thinking judgement and learning

• Deficits in adaptive functioning such as

communication, social participation and
independent living
• Deficits affect multiple domain; Conceptual,
practical and social
 Con’t DSM-5 criteria

• Onset during the developmental period

• Intellectual deficits confirmed by clinical
assessment and standardized intelligence
testing(scores at least 2 standard deviations
below the population mean)

• Adaptive functioning deficits require ongoing

support for activities of daily life
• Severity levels; mild, moderate severe, profound
 Epidemiology

• Overall ID affects 1% of the population

• Severe ID affects 6/1000 live birthv
 Etiology of ID

• However it should be noted that 50% of the ID

has no identiable causes and the causes of the
other 50% can be genetical, prenatal, perinatal
and postnatal condition.
 Global developmental delay

This is failure to meet the expected developmental

milestones in several areas of the intellectual
functioning

• The diagnosis is reserved for patients < 5 years

old when severity level cannot be reliably
assessed via standardized testing
Such patients will need to be re-evaluated to clarify
the diagnosis at a later time
 Specific learning disorder

• This condition is x-tised by delayed cognitive

development in a particular academic domain.
Challenges with reading, writing and arithmetic
often co-occur

Specific learning learning disorder frequently

occurs with ADHD which can worsen the prognosis
 Diagnosis and DSM-5 criteria

• Significantly impaired academic skills which are

below expected for the chronological age and
interfere with schooling, occupation or activities
of the daily
• Begin during school-age but may become more
impairing as demands increase
• Affected area are ; Reading (eg dyslexia) writing,
or arthmetic (e.g dyscalculia)
• Not better accounted for by intellectual,
disability,visual/auditory deficits, language
barriers or subpar education
 Epidemiology

• The prevalence in school age children is about

5-15% and the males are more affected than the
females

Etiology
• Enviromental factors; Increase the risk of
prematurity, low birth weight, prenatal nicotine
use
• Genetic factors; Increase the risk in first degree
relatives of affected individual.
 Comorbidity

• Commonly co-occurs with other

neurodevelopmental disorders such as ADHD,
communitication disorders, developmental
coordination disorder & autistic spectrum
disorder

• Also comorbid with other mental disorders,

including anxiety, depressive, and bipolar
disorders
 Treatment

• Systemic, individualized education tailored to

child’s specific needs
• Behavioral techniques may be used to improve
learning skills
 Communication disorders

• It encompasses impaired speech, language, or

social communication that are below those
expected for chronological age.
Begin in the early developmental period and leads
to academic and adaptive issues.

Language disorder- Difficulty acquiring and using

language due to expressive &/ or receptive
impairment eg reduced vocabulary, limited
sentence structure, impairment in discourse &
there is a genetic suspitibility
 con’t

• Speech sound this order (phonological

disorder)-difficulty producing articulate,
intelligible speech

• Childhood-onset fluency disorder (stuttering)-

Dysfluency and speech motor production issues
there is increased risk of stuttering in the first
degree relatives of the affected individual
 Con’t

• Social (pragmatic) communication disorder -

Challenges with the social use of verbal and
nonverbal communication.
If restricted/repetive behaviors, activitivities or
interest also present then dx ASD

• There is increased risk with family history of

communication disorders, ASD, or specific
learning disorder.
 Treatment

• Speech and languange therapy

• Family counseling
• Tailor education to meet the individual’s
need.
Attention Deficit/Hyperactivity Disorder (ADHD)

This is x-tised by persistent inattention,

hyperactivity, and impulsivity inconsistent with the
pt’s developmental age.

There are three subcategories of ADHD

• Predominantly inattentive type
• Predominantly hyperactive/impulsive type
• The combined type
 Diagnosis and DSM-5 criteria

• Two symptom domains; inattentiveness and

hyperactivity/impulsivity
• At least six inattentive symptoms
a) Fails to give close attension to details or makes
careless mistakes
b) Has difficulty sustaining attention
c) Does not appear to listen
d) Struggle to follow through instruction
e) Has difficulty with organisation
f) Avoids or dislikes tasks that requires a lot of
thinking
 DSM-5 con,t

h) Loses things
I) Is easily distracted
k) Is forgetful in daily activity
and/or
• At least six hyperactivity/impulsivity symptom
a) Fidgets with hands or feet or squirms in chair
b) Has difficulty remaing seated
c) Runs about or climbs excessively in childhood
d) Difficulty engaging in activity quietly
 DSM-5 Con’t

e) Acts as if driven by a motor; may be an

internal sensation in adults.
f) Talks excessively
g) Blurts out answers before questions have
been completed
h) Difficulty waiting or taking turns
i) Interrupts or intrudes upon others
• Symptom > 6 months and present in two or
more setting eg home work school
 DSM-5

• Symptoms interfer with or reduce the quality of

social/academic/occupational functioning
• Onset prior to age 12 but can be diagnosed
retrospectively in adulthood
• Symptoms not due to another mental disorder

Epidemiology
Prevalence 5% of children and 2.5% of adults
and male to female ratio is 2:1
Female present more often with inattentive
symptom
 Etiology

The etiology of ADHD is multifactorial and may

include
• Genetic factors; The rate increases in the first
degree relative of the affected individuals
• Enviromental factors; Low birth weight,
smoking during pregnancy, childhood
abuse/neglect, neurotoxin/alcohol
 ADHD con’t

Prognosis
• Stable through adolescence
• Many continue to have symptoms as adults
( inattentive > hyperactive)
• High incidence of comorbid oppositional
defiant disorder, conduct disorder (CD) and
specific learning disorder
 Treatment of ADHD

Multimodal treatment is used however the most

the most effective for decreasing the core
symptoms is the pharmacological txt but should be
used in conjuction with education & behavioral and
interventions
Pharmacological mgt
• First line stimulants -methylphenidate compounds,
dextroamphetamine and mixed amphitamine
• Second line -Atomoxetine, a norepinephrine
reuptake inhibitor
 Treatment con’t

• Alpha-2 agonist eg clonidine, guanfacine can be

used instead of the or as adjunctive therapy to
stimulants

Non-pharmacological mgt
• Behavior modification technique and social skill
training
• Education intervention ie classroom
modifications
• Parent psychoeducation
 Autism spectrum Disorder ( ASD)

ASD is x-tised by impairment in social

communication/interaction and restrictive,
repetitive behavior/interests

• The disorder encompasses the spectrum of

symptoms formerly diagnosed as autism,
Asperger’s disorder, childhood disintegrative
disorder and pervasive developmental disorder.
 Diagnosis and DSM-5 criteria

• Problem with social interaction & communication

a) Impaired social/emotional reciprocity eg inability to
hold conversations
b) Decifit in nonverbal communication skills eg
decreased eye contact
c) Interpersonal/relational challenges eg lack of
interest in peers
 DSM-5 Con’t

• Restricted, repetitive patterns of behavior,

interests and activities
a) Intense, peculiar interest eg preoccupation
with unusual objects
b) Inflexible adherence to rituals eg rigid
thought pattern
c) Stereotyped, repetitive motor mannerisms
eg hand flapping
d) Hyper/hyporeactivity to sensory input eg
hypersensitive to particular texture
 DSM-5 Con’t

• Abnormalities in the functioning begin in the

early developmental period

• Not better accounted for by ID or global

developmental delay. When ID and ASD co-
occur, social communication is below
expectation based on the developmental level

• Causes significant social or occupational

impairment
 Epidemiology

• ASD has been of rescent increase and it affects

1% of the population
• The ratio of male to female is 4:1 and the
symptoms are typically recognised between 12
& 24 months olds but varies but varies based on
severity
 Etiology of ASD

Etiology is multifactorial;
• Prenatal neurological insults eg (infections,
drugs) advanced paternal age & low birth birth
weight
• 15% of ASD are associated with a known
genetic mutation
• Fragile X syndrome= most common known
single gene cause of ASD
• Other genetic causes of ASD are Down’s
syndrome, Rett syndrome, tuberous sclerosis
 Etiology con’t

• High comorbidity with ID

• Association with epilepsy

Prognosis and treatment

ASD is a chronic condition with variable prognosis
and the two most important predictors of adult
outcome are
• Level of intectual functioning
• Language impairment
 Prognosis and treatment Con,t

Only minority of the of patients are able to live and

work independently in adulthood

There is no cure for autism and treatment focuses

on improving symptoms and improving basic
social, communicative and cognitive skills like
early intervation, remedial education, behavioral
therapy, psychoeducation & low dose atypical
antipsychotic medication (eg risperidone &
aripiprazole) may help reduce on disruptive
behavior aggression & irritability
 Disruptive and Conductc Disorders

These disorders involves problematic

interactions or inflicting harm on others.

Although disruptive behavior may appear within

the scope of normal development, they become
pathological when the frequency, pervasiveness
and severity impair functioning of the individual or
others
 Oppositional Defiant Disorder (ODD)

A maladaptive pattern of irritability/anger, defiance or

vindictiveness, which causes dysfuction or distress in
the pt or those affect. These interpersonal issues
involve at least one non-sibling

Diagnosis and DSM-5 Criteria

It’s x-tised by at least four symptoms present for
greater than or equal to 6 months ( with at least
one individual who is not a sibling)
 Diagnosis and DSM-5 Criteria Con’t

• Anger/Irritable mood- loses temper;

touchy/easily annoyed; often angry/resentful
• Argumentative/Defiant behavior - breaks
rules, argues with authority figures, deliberately
annoys others, then blames others
• Vindictiveness - spiteful at least 2x in past 6
months
• Disturbance is associated with distress in the
individual or others, or it impacts negatively on
functioning
 Epidemiology

• Prevalence; Approximately 3%
• Onset usually during preschool years and it
more in males than female
• Increase incidence of comorbid substance use
and ADHD
• Although ODD often precedes CD, most do not
develop CD
 Treatment

• Behavior modification, conflict management

training and proving provlem-solving skills
• Parent management traing(PMT) can help with
setting limits and enforcing consistent rules
• Pharmacological mgt is used to treat comorbid
conditions such as ADHD
 Conduct disorder (CD)

CD includes the most serious disruptive beheviors,

which violate the rights of other humans and
animal
These individuals inflict cruelty and harm through
physical and sexual violence and they lack remorse for
commiting crimes or lack empathy for their victims
CD con’t
 Epidemiology

• life prevalence: 9%
• More common in male
• High incidence of comorbid ADHD and ODD
• Associated with antisocial personality disorder

Treatment
• It involves multimodal approach with behavior
modification, family & community involvement
 Treatment Con’t
• PMT can help parents with limit setting and
enforcing consistent rules

• Pharmacological mgt can be used to target

comorbid symptoms and aggression eg SSRI,
guanfacine, propranolol, mood stabilizers &
antipsychotics
 Elimination Disorders

Is x-tised by developmentally inappropriate

elimination of urine or feces
The course may be primary( never established
continence) or secondary (continence achieved for a
period and then lost)
Treatment
 TIC Disorders

Are defined as sudden, rapid, repetitive,

stereotyped movements or vocalizations. Although
it’s involutary pts learn to temporarily express it

Prior to the tic pts may feel a premonitory urge

( somatic sensation) with subsequent tension
release after the tic

Tics are aggreviated by anxiety, fatigue &

excitement
 Con’t

• Tourette’s disorder is the most severe of the tics

disorder & it’s x-tised by one motor tics & at least
one vocal tic lasting for at leasting for 1 yr

• Vocal tics may appear many years after the

motor tics and they may wax and wane in freq.
Most common motor tics involve the face & the
haed such blinking and throat clearing
 Examples of vocal tics;

• Coprolalia- utterance of obscene, taboo words

as an abrupt, sharp bark or grunt
• Echolalia- repeating other’s words
 Treatment

• Psychoeducation
• Behavioral interventions- habit reversal therapy
• Medications - utilize only if tics become impairing
due to fluctuating course of disorder.
– Alpha -2 agonist; guanfacine is the drug of choice ,
clonidine ( more sedating)
– In severe cases consider txt with atypical eg
risperidone or atypical antipsychotics eg pimozides
 Others disorder

• Persistent( chronic) motor or vocal tic disorder

( single or multiple motor or vocal tics[ but not
both] that have never met the criteria for
Tourette’s)

• Provisional tic disorder( Single or multiple motor

&/or vocal tics < 1 yr that have never met criteria
for Tourette’s)
THE END