Childhood Disorders

1
Childhood Disorders

• Conduct Disorder
• Oppositional Defiant Disorder
• Attention Deficit/Hyperactivity Disorder
• Separation Anxiety Disorder

2
Conduct Disorder312.8

• Patient violates rules or the rights of others
• Precursor to Antisocial Personality Disorder

3

• Controversy regarding does this constitute a
  mental disorder or is better seen as a legal,
  moral, or social-systems problem.
• Why?

4

• Lack of personal responsibility
• Should not be excused as a mental disorder
• Maybe client has grown up in environment where
  violence is endemic.
• Is judgment based on a pattern of behavior thats
  seen as a dysfunction within the individual as
  opposed to a moral failing or societal problem
• Class discussion

5

• Diagnosed more commonly in boys
• Does it make sense to give an additional
  diagnosis of Conduct Disorder to one who engages
  is antisocial behavior only while intoxicated or
  as a means of obtaining drugs?

6
Diagnostic Criteria

• Criteria A
• Is reserved only for those individuals who have
  an established pattern of antisocial behavior.
• Behaviors must occur over a 12 month period,
  repetitive and persistent.

7

• Criteria B
• Only about 1/3 of those with Conduct Disorder go
  on to manifest Antisocial Personality Disorder
• Conduct and Personality Disorder are on a
  developmental continuum,therefore,
• APD cannot be given to one under 18

8

• Characteristic
• The best predictor of poor long term outcome is
  the onset of Conduct Disorder symptoms before the
  ind. Reaches 10 years of age

9
Oppositional Defiant Disorder313.81

• Multiple examples of negative behavior which last
  for at least six months
• Might be considered a mild variant of Conduct
  Disorder
• Ind. Who have Conduct Disorder have a history of
  previous Oppositional Defiant Disorder
• However not enough to warrant a single diagnosis.

10
Diagnostic Criteria

• Criteria A and B
• Each of the behaviors can and often occur from
  time to time in perfectly well adapted children.
• Behavior must be persistent and occur much more
  frequently than is typical for an individuals
  developmental level
• Often brought in by parents after a period of
  parent child problems (arguments)

11
Attention Deficit/Hyperactivity Disorder

• Has been the subject of considerable debate and
  controversy
• There has not been a wide consensus concerning
  the boundary between this disorder and
  age-appropriate distractibility or overactivity.

12

• Also a difference of opinion whether the
  definition of this category should focus on
  inattention or hyperactivity.
• DSM-II introduced hyperkinetic Reaction of
  Childhood
• DSM-III shifted the emphasis toward the symptoms
  of inattention by replacing he DSM-II definition
  with Attention-Deficit Disorder with or without
  hyperactivity

13

• DSM-III R Attention Deficit Disorder Without
  Hyperactivity was downgraded into a residual
  category

14

• Particular behaviors that typify inattention,
  hyperactivity, and impulsivity are influenced by
  the patients age, and developmental level.
• Disorder occurs more often in males

15

• Inattention must persist for at least six months
  and be maladaptive
• Clinical judgment may be difficult because
  individuals often become secondarily oppositional
  in response to feeling frustrated with poor
  performance

16

• Many young children may appear to be excessively
  active, to harried parents
• Usually first diagnosed in childhood, however may
  persist into adulthood

17
Separation Anxiety Disorder309.21

• Patient becomes anxious upon separation from
  parent or home
• Rarely appropriate to make this diagnosis in
  adults

18
Diagnostic Criteria

• Critertia A, B, D
• Normal part of mammalian life
• Prominent during developmental phases
• Should be diagnosed only when concerns about
  separation are severe, persistent, impairing, and
  in excess of what would be considered normal for
  developmental period.

19

• Criteria C and E
• Onset is often in preschool years
• Represents an inability to negotiate the
  developmental requirements for separation that
  occur at this time
• Occurrence in middle childhood often represents a
  regression that occurs after a stressful event
• Occurrence in adolescence is unusual and suggests
  the presence of another disorder (panic, phobia,
  mood disorder)

20
Eating Disorders

• Anorexia Nervosa
• Bulimia Nervosa

21
Anorexia Nervosa307.1

• Both are characterized by an over emphasis on
  body image
• Anorexia requires an abnormally low body weight
  and in women, amenorrhea
• Many ind also binge eat and purge to a level that
  would meet the criteria for Bulimia
• Each has a separate category because of treatment
  implications

22
Anorexia - loss of appetite

• Hallmark is refusal to maintain normal body
  weight.
• Name is a misnomer - although ind. deny
  themselves food, they generally maintain their
  appetite and often become preoccupied with food

23
Diagnostic Criteria

• Criteria B and C
• Marked distortion in way ind. experience their
  body size and shape
• Cognition that drives this is the belief that one
  is fat or might easily become fat unless
  extraordinary measures are taken to prevent it.

24

• Criteria A
• The refusal to maintain body weight is based on
  fears and distortions indicated in B and C
• Distinguishing Anorexia from normal thinness, the
  DSM relies on clinical judgment

25

• Criteria D
• Amenorrhea indicates physiological dysfunction
  and is due to abnormally low levels of estrogen
• No corresponding criterion for males

26

• Subtypes
• Weight loss is achieved
• 1. Those who control their weight by rigid
  adherence to diet or exercise tend to have
  compulsive personalities characterized by
  inflexibility , strict adherence to rules, and
  moral scrupulosity.
• 2. Those who binge/purge are more likely to have
  impulsive behavior and engage in substance abuse

27
Bulimia Nervosa307.51

• Bulimics have normal body weight and display a
  pattern of sequential binge eating and
  inappropriate compensatory behaviors to avoid
  gaining weight.

28

• Criteria A
• Episodic bursts must be distinguished from a
  pattern of generalized overeating (grazing) and
  from isolated episodes of overeating that are
  context specific.
• Usually include sweet, high calorie treats, but
  not always

29

• Criteria B
• Binge eating by itself is not sufficient to make
  diagnosis
• Must be accompanied b inappropriate compensatory
  mechanisms intended to counteract the effects of
  the binge.
• Purging, fasting, excessive exercise
• Purging is not necessarily a required feature of
  this disorder

30

• Criteria C
• Minimum frequency of twice per week
• (only a guideline)
• Criteria D
• Are overly focused on their body shape or size,
  which is often manifested by intense fear of
  gaining weight, desire to lose weight, and
  dissatisfaction with their bodies

31

• Criteria E
• Diagnosis should not be given when the binge
  eating and purging behaviors occur only during
  episodes of Anorexia Nervosa