15. DISODERS OF CHILDHOOD AND ADOLESCENCE.pptx

CHILDHOOD DISORDERS

1. DISODERS OF CHILDHOOD AND ADOLESCENCE

2. ATTENTION DEFICIT/HYPERACTIVITY DISORDER (ADHD) ADHD is characterized by persistent inattention, hyperactivity, and impulsivity inconsistent with the patient’s developmental stage. There are three subcategories of ADHD: -predominantly inattentive type -predominantly hyperactive/impulsive type -combined type.

3. DIAGNOSIS AND DSM-5 CRITERIA Two symptom domains: inattentiveness and hyperactivity/impulsivity At least six inattentive symptoms Fails to give close attention to details or makes careless mistakes. Has difficulty sustaining attention. Does not appear to listen. Struggles to follow through on instructions. Has difficulty with organization. Avoids or dislikes tasks requiring a lot of thinking. Loses things. Is easily distracted. Is forgetful in daily activities.

4. and/or At least six hyperactivity/impulsivity symptoms Fidgets with hands or feet or squirms in chair. Has difficulty remaining seated. Runs about or climbs excessively in childhood; extreme restlessness in adults. Difficulty engaging in activities quietly Acts as if driven by a motor; may be an internal sensation in adults Talks excessively. Blurts out answers before questions have been completed. Difficulty waiting or taking turns. Interrupts or intrudes upon others

5. Symptoms >6 months and present in two or more settings (e.g., home, school, work) Symptoms interfere with or reduce 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

6. ETIOLOGY Genetic factors: There is greater concordance in monozygotic than in dizygotic twins Siblings of hyperactive children have about twice the risk of having the disorder as does the general population Biological parents of children with the disorder have a higher incidence of ADHD than do adoptive parents. Environmental factors: Environment lead Food additives, coloring and sugar have been suggested as possible causes of hyperactive behavior but there is no definite evidence Biochemical theory: A deficit of dopamine and norepinephrine has been attributed in the overactivity seen in ADHD

7. Pre, peri and postnatal factors Prenatal toxic exposure, prenatal mechanical insult to the fetal nervous system Prematurity, fetal distress, precipitated or prolonged labour perinatal asphyxia, and low APGAR scores Postnatal infections, CNS abnormalities resulting from trauma etc Psychological factors Prolonged emotional deprivation Stressful psychic events Disruption of family equilibrium

8. TREATMENT Multimodal treatment plan: medications are the most effective treatment for decreasing core symptoms, but should be used in conjunction with educational and behavioral interventions. Pharmacological treatments: First-line: Stimulants—methylphenidate compounds, dextroamphetamine, and mixed amphetamine salts Second-line choice: atomoxetine, a norepinephrine reuptake inhibitor Alpha-2 agonists (e.g., clonidine, guanfacine) can be used instead of or as adjunctive therapy to stimulants

9. Nonpharmacological treatments: Behavior modification techniques social skills training Cognitive behavioral therapy Educational interventions (i.e., classroom modifications) Parent psychoeducation

10. AUTISM SPECTRUM DISORDER (ASD) ASD is characterized by impairments in social communication/interaction and restrictive, repetitive behaviors/interests.

11. DIAGNOSIS AND DSM-5 CRITERIA Problems with social interaction and communication: -impaired social/emotional reciprocity (e.g., inability to hold conversations) -deficits in nonverbal communication skills (e.g., decreased eye contact) -interpersonal/relational challenges (e.g., lack of interest in peers) Restricted, repetitive patterns of behavior, interests, and activities: -intense, peculiar interests (e.g., preoccupation with unusual objects) --inflexible adherence to rituals (e.g., rigid thought patterns) stereotyped, repetitive motor mannerisms (e.g., hand flapping) -hyper/hyporeactivity to sensory input (e.g., hypersensitive to particular textures)

12. Abnormalities in 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 developmental level. Causes significant social or occupational impairment

13. ETIOLOGY Etiology of ASD is multifactorial: Prenatal neurological insults (e.g., infections, drugs),advanced paternal age, low birth weight 15% of ASD cases are associated with a known genetic mutation Fragile X syndrome = most common known single gene cause of ASD Other genetic causes of ASD: Down’s syndrome, Rett syndrome, tuberous sclerosis, High comorbidity with ID [intellectual disability] Association with epilepsy

14. TREATMENT There is no cure for autism, but various treatments are used to help manage symptoms and improve basic social, communicative, and cognitive skills: Early intervention Remedial education Behavioral therapy Psychoeducation Low dose atypical antipsychotic medications (e.g., risperidone, aripiprazole) may help reduce disruptive behavior, aggression, and irritability

15. INTELLECTUAL DISABILITY Intellectual disability (ID, intellectual developmental disorder) replaces the term mental retardation (MR). ID is characterized by severely impaired cognitive and adaptive/social functioning. Severity level is currently based on adaptive functioning, indicating degree of support required. A single IQ score does not adequately capture the level of severity of ID and is no longer used solely to determine ID severity

16. Genetic Down syndrome: trisomy 21 (1/700 live births) Fragile X syndrome: Involves mutation of X chromosome, second most common cause of intellectual disability, m > F Others: phenylketonuria, familial mental retardation, Prader-Willi syndrome, Williams syndrome, Angelman syndrome, tuberous sclerosis Prenatal Infection and toxins (TORCH): Toxoplasmosis, Other (syphilis, aids, alcohol/illicit drugs),Rubella, Cytomegalovirus (CMV) and Herpes simplex Perinatal anoxia, prematurity, birth trauma, meningitis, hyperbilirubinemia Postnatal hypothyroidism, malnutrition, toxin exposure, trauma, psychosocial causes

17. DIAGNOSIS AND DSM-5 CRITERIA Deficits in intellectual functioning, such as reasoning, problem solving, planning, abstract thinking, judgment, and learning Deficits in adaptive functioning, such as communication, social participation, and independent living Deficits affect multiple domains: conceptual, practical, and social 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

18. Classification Intelligence quotient (IQ) is the ratio between mental age and chronological age Mid (educatable)- 50-70 Moderate (trainable)- 35-50 Severe ( depedent retarded)- 20-35 Profound (life support)- < 20

19. TREATMENT Systematic, individualized education tailored to child’s specific needs Behavioral techniques may be used to improve learning skills

20. COMMUNICATION DISORDERS Encompass impaired speech, language or social communication that are below those expected for chronological age, begin in the early developmental period, and lead to academic or adaptive issues -Language disorder —difficulty acquiring and using language due to expressive and/or receptive impairment (e.g., reduced vocabulary, limited sentence structure, impairments in discourse). There is increased risk in families of affected individuals - Speech sound disorder (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 first-degree relatives of affected individuals

21. -Social (Pragmatic) communication disorder—challenges with the social use of verbal and nonverbal communication. If restricted/repetitive behaviors, activities, or interests also present → diagnose autism spectrum disorder (ASD). There is increased risk with family history of communication disorders, ASD, or specific learning disorder.

22. TREATMENT Speech and language therapy Family counseling Tailor education to meet the individual’s needs