Childhood disorders

childhood disorder or developmental disorder

1. Presentation on Presentation on
childhood disorders childhood disorders
Presented by : Parul Prasher
mental health nursing dept

2. Disorders Usually 1Disorders Usually 1
stst
Diagnosed Diagnosed
in Infancy, Childhood, & in Infancy, Childhood, &
AdolescenceAdolescence
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.

3. 10 DIAGNOSTIC SUBGROUPS 10 DIAGNOSTIC SUBGROUPS
(DSM-IV-TR)(DSM-IV-TR)
1)Mental Retardation
2)Learning Disorders
3)Motor Skills Disorders
4)Communication Disorders
5)Pervasive Developmental Disorders
6)Attention Deficit and Disruptive Behavior Disorders
7)Feeding & Eating Disorders of Infancy & Early Childhood
8)Tic Disorders
9)Elimination Disorders
10)Other Disorders of Infancy, Childhood, or Adolescence

5. Mental RetardationMental 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.

6. Onset and coding 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

7. Mental RetardationMental 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

8. Causes and Treatment 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

9. LEARNING DISORDERLEARNING DISORDER

11. 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

12. 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)

13. TIC DISORDER

14. Tic Disorder: Tourette’s Tic Disorder: Tourette’s
DisorderDisorder
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

15. Contd .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

16. ADHDADHD

17. Attention Deficit/Hyperactivity DisorderAttention 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.

18. 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

19. Attention Deficit/Hyperactivity DisorderAttention 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

20. Attention Deficit/Hyperactivity DisorderAttention 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

21. ADHD: Associated FeaturesADHD: 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

22. ADHD: Diagnostic ConsiderationsADHD: 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.

23. ADHD: Contributing FactorsADHD: 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

24. Attention Deficit/Hyperactivity DisorderAttention Deficit/Hyperactivity Disorder
Treatments:
Medication – stimulants, Strattera (SNRI),
Wellbutrin
Psychoeducation & bibliotherapy
Skills-based training – time management,
organizational skills, study skills, problem-
solving, social skills

26. CONDUCT DISORDERCONDUCT DISORDER

27. Conduct DisorderConduct 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

28. Conduct DisorderConduct 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

29. Conduct DisorderConduct 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

30. Conduct DisorderConduct 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

31. Conduct DisorderConduct 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)

33. Oppositional Defiant DisorderOppositional 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

34. Oppositional Defiant DisorderOppositional 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

38. Separation Anxiety DisorderSeparation 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

39. Pervasive Developmental Pervasive Developmental
DisordersDisorders
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

41. Autistic DisorderAutistic 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.

42. AutismAutism
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)

45. Asperger’s DisorderAsperger’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

46. Asperger’s SyndromeAsperger’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

47. Asperger’s SyndromeAsperger’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)

48. Asperger’s Syndrome: TreatmentsAsperger’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

50. Nurses Role In Management Of Nurses Role In Management Of
Childhood Disorder Childhood Disorder

51. 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.

52. Contd.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