developmental disorders- early childhood

developmental disorders

1. Childhood disorders

2. DisordersUsually1
st
Diagnosed in
Infancy,Childhood,&Adolescence
CoreConceptOf 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
(DSM-IV-TR)
1)MentalRetardation
2)LearningDisorders
3)MotorSkillsDisorders
4)CommunicationDisorders
5)PervasiveDevelopmentalDisorders
6)AttentionDeficitandDisruptiveBehaviorDisorders
7)Feeding&EatingDisordersofInfancy&EarlyChildhood
8)TicDisorders
9)EliminationDisorders
10)OtherDisordersofInfancy,Childhood,orAdolescence

5. 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.

6. 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 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: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 DISORDER

11. Characteristics:
Inadequate development ofspecific
academicskills,suchasreading,writing,
andmath.
Specificacademicskillsaresubstantially
belowexpectedforage,intelligence,and
education
Significantlyinterfereswithaspectsoflife
requiringthoseskills.
Subtypes:
ReadingDisorder
MathematicsDisorder
DisorderofWrittenExpression
LearningDisorderNotOtherwiseSpecified

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 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

15. 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. ADHD

17. 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.

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

26. CONDUCT DISORDER

27. 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

28. 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

29. 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

30. 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

31. 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)

33. Oppositional Defiant Disorder
Pattern of negativistic, hostile, and defiant behavior
for at least 6 months.
At least 4 of the following are present:
◦Oftenlosestemper
◦Oftenargueswithadults
◦Oftenactivelydefiesorrefusestocomplywith
adults’requestsorrules
◦Oftendeliberatelyannoysothers
◦Oftenblamesothersforownmistakesor
misbehavior
◦Isoftentouchyoreasilyannoyedbyothers
◦Isoftenangryorresentful
◦Isoftenspitefulorvindictive

34. 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

38. 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

39. 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

41. 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.

42. 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)

45. Asperger’s Disorder
Qualitative impairment in social
interaction and relationship
development
Restricted, repetitive, and
stereotyped patterns of behavior,
interests, and activities
But lackany clinically significant
delay in language or cognitive
development

46. 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

47. 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)

48. 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
Psychotherapyto address accompanying
psychiatric disorders, such as depression
and anxiety
Medications:antidepressants,
antipsychotics