Download disorders usually first diagnosed in infancy, childhood, or adolescence

DISORDERS USUALLY
FIRST DIAGNOSED IN
INFANCY,CHILDHOOD, OR
ADOLESCENCE
Important Facts
• Category of convenience
– – no intent of clear distinction between
“adult’/“childhood” disorders
• Primarily diagnosed in regard to age
– not phenomenology
• Usually identified by others
• Children regarded as more malleable
than adults
– thus more amenable to treatment
• Differential Diagnosis
– diagnosis which nearly fits symptoms but
must be ruled out
• Necessary information = Knowledge
of normal life-span development
Making a Diagnosis: 7 Steps
• Observation of diagnostic clues
– Focus on behavior, cognitive ability, verbal responses,
etc.
• Screen the problem
– Consider symptoms/behaviors indicating or excluding a
specific diagnosis
• Follow-up of preliminary impressions
– Testing or ruling out “your” diagnostic assumptions
• Confirmatory history
– Gather pertinent information
• Complete data base
– Specific info relevant to diagnosis under consideration
• Diagnosis
– All information, including DD
• Prognosis
– Consider individual’s response to & motivation for
Clinical Info Necessary for Diagnosis of
Disorders First Evidenced in Children &
Adolescents
• Times of developmental
milestones
• Capacity to
communicate with other
people
• Language impairment
• Capacity for human
relationships
• Quality of social
interaction
• Abnormal motor
movements
• Hyperactivity,
inattention, or poor
impulse
• Abnormal behaviors
(e.g., fire setting,
cruelty to animals)
• Enuresis or encopresis
Understanding Normal Life-span
Development
 Allows identification of
appropriate behaviors
 at appropriate stages
 Childhood problems
 not to be viewed as downward
extension of adult issues
 Possible to diagnose children
with some “adult” disorders as
major depression or PTSD if
adult criteria met
Subcategories of Diagnoses
• Mental Retardation
• Learning Disorders
• Motor Skills
Disorders
• Communication
Disorders
• Pervasive
Developmental
Disorders
• Attention-Deficit
& Disruptive Behavior
Disorders
• Feeding & Eating
Disorders of Infancy &
Childhood
• Tic Disorders
• Elimination Disorders
• Other Disorders –
contains 5 diverse
disorders
Predominant Symptoms
or Deficits
• Intellectual & cognitive
impairment
 All MR & All LD
• Motor function impairment
 Motor Skills, Tic, & Stereotypic
Movement Disorders
• Disruptive or self-injurious
behavior
 ADD & Disruptive Behavior,
Feeding & Eating, Elimination,
Separation Anxiety, Reactive
Attachment Disorders
• Information exchange
 Pervasive Developmental,
Communication Disorders, &
Selective Mutism
MENTAL RETARDATION
(Axis II)
• Significantly subaverage intellectual functioning
• Based on test scores & adaptive behavior
• Check present adaptive functioning in various
areas
– communication, self-care, academics, social etc
• Cultural/ethnic considerations
• Onset before 18 years of age
• Criteria met for MR, diagnosis given regardless of
presence of another disorder
• Differentiate Mild MR from borderline intellectual
functioning
– careful consideration of all available information
Some MR Interventions
• Head Start Programs
– may help prevent Mild MR
• Applied behavior analysis (operant
conditioning)
– adaptive skills, communication, self-help,
social & vocational
• Cognitive behavior therapy
– self-instructional training as in “Little
Bear” pictures
• Computer-assisted instruction
– maintain attention, material
individualized, repetitions helpful without
boredom or loss of patience
Learning Disorders
(Academic Skills Disorders)
• Academic functioning
– below expected for chronological age,
measured IQ, & age-appropriate
education
•
•
•
•
Reading Disorder
Mathematics Disorder
Disorder of Written Expression
Learning Disorder NOS
– criteria for any specific LD not met
A Motor Skills Disorder
• Developmental Coordination Disorder
• Not due to general medical condition
• Substantial impairments in motor coordination
– Significantly interfering with academic
achievement or daily activities
– Marked delays in normal milestones as sitting,
crawling, walking
– Or clumsiness, poor performance in sports or poor
handwriting
Tic Disorders –
Motor Function Disorders
• Tourette’s Disorder
– Multiple motor tics & 1 or more vocal tics
– Occur many times a day, nearly every day or
intermittently for more than 1 year
• Chronic Motor or Vocal Tic Disorder
• Transient Tic Disorder
• Tic Disorder NOS
 Another Motor Function Disorder in the “Other”
category
– Stereotypic Movement Disorder
Disruptive & Self-Injurious
Behavior Disorders
• Behaviors socially unacceptable or
potentially harmful
• Include:
– Hyperactive, impulsive, inattentive,
oppositional, defiant, impulsive, & disruptive
behavior
– Also abnormalities of eating & elimination
Attention-Deficit Disorders
• Criteria with code based on type
– Attention-Deficit/Hyperactivity Disorder,
Combined Type
– Attention-Deficit/Hyperactivity Disorder,
Predominately Inattentive Type
– Attention-Deficit/Hyperactivity Disorder,
Predominately Hyperactive-impulsive Type
– Attention-Deficit/Hyperactivity Disorder NOS
Disruptive Behavior Disorders
(also NOS)
• Oppositional Defiant
• Conduct Disorder
Disorder
– Violation of basic
rights of others or
– Major age-appropriate
societal norms abused
• Manifested through
– Aggression to people
& animals
– Destruction of property
– Deceitfulness or theft
– Seriousness violations
of rules
– Persistent patterns of
negativistic, hostile, &
defiant behaviors
• Behaviors include
– Temper loss, arguments
with adults, defies to obey
rules, deliberate annoying,
blames others, easily
annoyed by other, often
angry & resentful, spiteful
or vindictive
Feeding and Eating Disorders
Diagnosable at Point Where Health Endangered
• Disturbances of eating
– eating nonnutritive substances
– repeated regurgitation of food
– failure or refusal to eat
• Pica – repeatedly eating
nonnutritive substances
• Rumination Disorder –
regurgitate & rechew
• Feeding Disorder – failure to
gain wt. Or loss of significant
wt. over period of 1 mo. Due to
not eating adequately (onset
before 6)
Elimination Disorders
• Encopresis – passing feces
into inappropriate places
– Must be at least 4 yrs. old
• Enuresis – repeated
urination into beds or
clothes
– Criterion regulated
occurrence
– Or clinically significant
distress/impairment is
produced
– Must be at least 5 yrs. old
Pervasive Developmental Disorders
Autism, Rett’s, Childhood Disintegrative Disorder,
Asperger’s, & Pervasive Developmental NOS
Common elements:
• Broad based impairment or loss of
functions expected at that age
• Three components covered:
– social interactions
– communication
– patterns of behavior, interests, activities
• Patterns which may surface include:
– restricted, repetitive, stereotypic
Autism
• Named "early infantile autism" from observations
of an extreme autistic aloneness that, whenever
possible, disregards, ignores, shuts out anything
that comes to the child from the outside
• Prior to age three
• Abnormal functioning in at least one area:
– social interaction
– language by social communication
– symbolic/imaginative play
Autism Treatment
• Most successful technique is in intense
behaviorally oriented programs.
• -Goals to work with are: social skills, breaking
down tasks, eliminating maladaptive behaviors;
medication.
• -Try to relieve symptoms and improve
communication, social skills, and adaptive
behavior
• -Modeling and operant conditioning
• Drug treatment
– most common medication is haloperidol,
Rett's Disorder (females only)
• Normal functioning at birth & through first
5 months of life
– between ages 5 months - 48 months decelerated (decreased) head growth occurs
– loss of previously acquired hand movement.
– loss of social skills
– difficult gait/movement
• Usually medical intervention
Childhood Disintegrative
Disorder
• Rare
• Development normal first 2 years of life
(distinguishing feature from autism)
• A loss of ability (in autism abilities never
developed)
• Often symptoms first noticed by parents
Asperger’s Disorder
• Lack of interest in social action
• Severe & sustained impairment in social
interactions
• Different from autism because no significant delay
in language & communication
• Some idiosyncratic features similar to autism;
repetitive patterns of behavior, interests and
activities
Pervasive Developmental Disorder
Not Otherwise Specified (NOS)
• Severe & pervasive impairments in
– Reciprocal social interactions
– Communications skills
• Or stereotypical behavior, interests, or
activities
• Criteria for Pervasive Development
Disorder not met
Communication Disorders
check if acquired or developmental
• Expressive Language
Disorder
• Mixed ReceptiveExpressive Language
Disorder
• Phonological Disorder
• Stuttering
• Communication
Disorder NOS
Other Subcategory –
5 Diverse Disorders
• Stereotypic Movement Disorder -- repetitive, seemingly
driven nonfunctional motor behavior
• Separation Anxiety Disorder -- Inappropriate or excessive
anxiety about separation from home or person of attachment
– Onset before 18 years of age
• Reactive Attachment Disorder of Infancy or Early
Childhood --Excessively inhibited, hypervigilant, ambivalent &
contradictory responses to most social interactions
– Or diffuse indiscriminate attachments to other people
– Associated with pathogenic care
• Selective Mutism – consistent failure to speak in speific social
situations yet speaking in others
• Disorder of Infancy, Childhood, or Adolescence NOS –
residual category where criteria for no specific disorder is met