Childhood Disorders

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Childhood Disorders

• 7.24.2006

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Childhood Disorders

• Disorders that are commonly first diagnosed in
  childhood or that can only be diagnosed in
  childhood
• Variation in presentation of illnesses between
  children and adults
• Behavior that would be seen as abnormal in an
  adult may occur in a normal child
• Not studied at all until the 20th Century

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Mental Retardation

• Significantly subaverage intellectual
  functioning an IQ of approximately 70 or below
• Concurrent deficits or impairments in present
  adaptive functioning in at least two of the
  following areas communication, self-care, home
  living, social/interpersonal skills, use of
  community resources, self-direction, functional
  academic skills, work, leisure, health, and
  safety
• Age of onset is before age 18

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Mental Retardation - Severity

• Mild IQ level of 50-55 to 70
• Moderate IQ level of 35-40 to 50-55
• Severe IQ level 20-25 to 35-40
• Profound IQ level below 20-25

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IQ

• Mean score 100, Standard Deviation 15

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95
99
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Mental Retardation - Severity

• Mild (50-55 to 70)
• 85 of people with Mental Retardation
• Educable, can acquire skills up to a 6th grade
  level
• Can achieve social and vocational skills adequate
  to live independently
• Can usually live successfully in the community,
  may need some supervision
• Moderate (35-40 to 50-55)
• 10 of people with Mental Retardation
• Trainable, can acquire skills up to a 2nd grade
  level
• Can profit from vocational training, typically
  work in unskilled/semiskilled occupations
• Can live and work in the community with
  supervision

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Mental Retardation - Severity

• Severe (20-25 to 35-40)
• 3-4 of those with Mental Retardation
• May learn to talk and can be trained in
  elementary self-care
• Profit to a limited extent from pre-academic
  skills (e.g. alphabet)
• Typically live in closely supervised settings
• Profound (below 20-25)
• 1-2 of those with Mental Retardation
• Optimal development in a highly structured
  environment, constant supervision, and individual
  caregivers
• May be able to do simple tasks under close
  supervision

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Learning Disorders

• Given a persons chronological age, measured
  intelligence, and age-appropriate education
• Reading Disorder
• Reading achievement significantly below that
  expected
• Mathematics Disorder
• Mathematics ability significantly below that
  expected
• Disorder of Written Expression
• Writing skills significantly below that expected

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Pervasive Developmental Disorders

• Autistic Disorder
• Retts Disorder
• Childhood Disintegrative Disorder
• Asbergers Disorder

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Austism

• A total of six (or more) items from 1, 2, and 3,
  with at least two from group 1, and at least one
  each from groups 2 and 3
• Group 1 Qualitative impairment in social
  interaction
• Marked impairment in the use of multiple
  nonverbal behaviors
• Failure to develop peer relationships appropriate
  to developmental level
• Lack of spontaneous seeking to share enjoyment,
  interests, or achievements with other people
• Lack or social or emotional reciprocity

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Autism

• Group 2 Qualitative impairments in
  communication
• Delay in, or total lack of, the development of
  spoken language
• In individuals with adequate speech, marked
  impairment in the ability to initiate or sustain
  a conversation with others
• Stereotyped and repetitive use of language
• Lack of varied, spontaneous make-believe play or
  social imitative play appropriate to
  developmental level
• Group 3 Restricted repetitive and stereotyped
  patterns of behavior, interests, and activities
• Encompassing preoccupation with one or more
  stereotyped and restricted patterns of interest
  that is abnormal either in intensity or focus
• Apparently inflexible adherence to specific,
  nonfunctional routines
• Stereotyped and repetitive motor mannerisms
• Persistent preoccupation with parts of objects

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Autism

• Delays or abnormal functioning in at least one of
  the following areas, with onset prior to age 3
  years
• Social interaction
• Language as used in social communication
• Symbolic or imaginative play
• The disturbance is not better accounted for by
  Retts Disorder or Childhood Disintegrative
  Disorder
• Essentially, the presence of markedly abnormal
  or impaired development in social interaction and
  communication and a markedly restricted
  repertoire of activity and interests

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Autism

• Prevalence 2-20/10,000 individuals (consistent
  across ethnicity and SES)
• Gender 4-5 times more common in boys
• Course 1/3 adults with Autism lead independent
  lives
• Associated w/ ¾ have IQs below 70
• Splinter Skills Some people with Autism do very
  well on one or more isolated tasks (Autistic
  savants)
• As a child Failure to cuddle,
  indifference/aversion to affection or
  physical contact, lack of eye contact,
  responsiveness, or socially directed smiles,
  failure to respond to parents voices

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Autism

• Appear to be unaware that other people think,
  feel, and have beliefs
• Sometimes even unable to identify someone elses
  age, gender, emotion
• Can be difficult to diagnose
• Other medical conditions can produce similar
  behaviors
• Autistic symptom profile has been found in kids
  with and without neurological impairments
• Shares several characteristics with other
  disorders that involve social/communication
  impairment
• Symptoms can vary widely

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Autism - Treatment

• Difficult due to social/communication impairments
• Effective programs do the following
• Focus on social/communication skills
• Structured teaching environment
• Predictable routine
• Use of choices
• Family involvement
• Carefully planned transitions
• Most promising
• Intensive behavior modifications have been
  successful at
• Eliminating echoing, self-mutilation,
  self-stimulation
• Increasing verbalizations, playing with others,
  attending to others

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Retts Disorder

• All of the following
• Apparently normal prenatal and perinatal
  development
• Apparently normal psychomotor development through
  the first 5 months after birth
• Normal head circumference at birth
• Onset of all of the following after the period of
  normal development
• Deceleration of head growth between ages 5 and 48
  months
• Loss of previously acquired purposeful hand
  skills between ages 5 and 30 months with the
  subsequent development of hand movements
• Loss of social engagement early in the course
• Appearance of poorly coordinated gait or trunk
  movements
• Severely impaired expressive and receptive
  language development with severe psychomotor
  retardation

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Retts Disorder

• Prevalence Unknown at this point
• Gender Only present in females
• Age of Onset Prior to 4 years, most often in
  year 1 or 2
• Course Lifelong, persistent and progressive
• Associated w/ Severe or profound mental
  retardation
• Cause Thought to be due to a genetic mutation

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Childhood Disintegrative Disorder

• Apparently normal development for at least the
  first 2 years after birth as manifested by the
  presence of age-appropriate verbal and nonverbal
  communication, social relationships, play, and
  adaptive behavior
• Clinically significant loss of previously
  acquired between ages 2 and 10 in at least two of
  the following areas
• Expressive or receptive language
• Social skills or adaptive behavior
• Bowel or bladder control
• Play
• Motor skills

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Childhood Disintegrative Disorder

• Abnormalities of functioning in at least two of
  the following areas
• Qualitative impairment in social interaction
  (e.g. impairment in nonverbal behaviors, failure
  to develop peer relationships, lack of varied
  make-believe play, etc.)
• Qualitative impairments in communication (e.g.
  delay or lack of spoken language, inability to
  initiate or sustain conversation, etc.)
• Restricted, repetitive, and stereotyped patterns
  of behavior, interests, and activities
• The disturbance is not better accounted for by
  another mental disorder

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Asbergers

• Qualitative impairment in social interaction,
  manifested by at least two of the following
• Marked impairment in the use of multiple
  nonverbal behaviors
• Failure to develop peer relationships appropriate
  to developmental level
• Lack of spontaneous seeking to share enjoyment,
  interests, or achievements with other people
• Lack or social or emotional reciprocity
• Restricted repetitive and stereotyped patterns of
  behavior, interests, and activities, manifested
  by at least one of the following
• Encompassing preoccupation with one or more
  stereotyped and restricted patterns of interest
  that is abnormal either in intensity or focus
• Apparently inflexible adherence to specific,
  nonfunctional routines
• Stereotyped and repetitive motor mannerisms
• Persistent preoccupation with parts of objects

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Asbergers

• The disturbance causes significant distress or
  impairment in functioning
• There is no clinically signficant general delay
  in language (e.g. single word use by age 2,
  communicative phrases by age 3)
• There is no clinically significant delay in
  cognitive development or in the development of
  age-appropriate self-help skills and curiosity
  about the environment
• Criteria are not met for another Pervasive
  Developmental Disorder or Schizophrenia

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Asbergers

• Prevalence Unknown
• Gender 5 times more common in males
• Course Continuous, lifelong
• Communication
• May appear precocious (adult-like vocabulary)
• Unlike Autism, children with Asbergers have an
  eccentric, one-sided approach to social
  interactions rather than indifference
• Unlike Autism, children with Asbergers have
  difficulties with communication only in social
  situations (e.g. failure to understand rules of
  conversation, etc.), but otherwise have no
  trouble understanding or producing speech

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Attention-Deficit/Hyperactivity Disorder

• Either 1 or 2
• Six or more of the following symptoms of
  inattention have persisted for at least 6 months
  to a degree that is maladaptive and inconsistent
  with developmental level
• Often fails to give close attention to details or
  makes careless mistakes in schoolwork, work, or
  other activities
• Often has difficulty sustaining attention in
  tasks or play activities
• Often does not seem to listen when spoken to
  directly
• Often does not follow through on instructions and
  fails to finish schoolwork, chores, or duties in
  the workplace
• Often has difficulty organizing tasks and
  activities
• Often avoids, dislikes, or is reluctant to engage
  in tasks that require sustained mental effort
• Often loses things necessary for tasks or
  activities
• Is often easily distracted by extraneous stimuli
• Is often forgetful in daily activities

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ADHD

• 2. Six (or more) of the following symptoms of
  hyperactivity-impulsivity has persisted for at
  least 6 months to a degree that is maladaptive
  and inconsistent with developmental level
• Often fidgets with hands/feet or squirms in seat
• Often leaves seat in classroom or in other
  situations in which remaining seated is expected
• Often runs about or climbs excessively in
  situations in which it is inappropriate
• Often has difficulty playing or engaging in
  leisure activities quietly
• Is often on the go or often acts as if driven
  by a motor
• Often talks excessively
• Often blurts out answers before questions have
  been completed
• Often has difficulty awaiting turn
• Often interrupts or intrudes on others

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ADHD

• Some hyperactive-impulsive or inattentive
  symptoms that caused impairment were present
  before age 7
• Some impairment from the symptoms is present in
  two or more settings
• There must be clear evidence of clinically
  significant impairment in functioning
• Symptoms are not between accounted for by another
  mental disorders

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ADHD

• Prevalence 3-7 of school-aged children
• Gender More common in males
• Girls more likely to have inattentive
  type, Boys more likely to have
  hyperactivity/impulsivity type
• Age of Onset Retrospectively, parents identify
  hyperactivity in children as toddlers
• Course Over half of cases remit in late
  adolescence, early adulthood
• Rest persist into adulthood however,
  hyperactive/impulsive behaviors often
  replaced by inner feelings of restlessness

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Conduct Disorder

• A repetitive and persistent pattern of behavior
  in which the basic rights of others or major
  age-appropriate societal norms or rules are
  violated
• (Three or more of the following criteria in
  the past 12 months and at least one in the past 6
  months)
• Aggression to people and animals
• Often bullies, threatens, or intimidates others
• Often initiates physical fights
• Has used a weapon that can cause serious physical
  harm to others
• Has been physically cruel to people
• Has been physically cruel to animals
• Has stolen while confronting a victim
• Has forced someone into sexual activity

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Conduct Disorder

• Destruction of property
• Has deliberately engaged in fire setting with the
  intention of causing serious damage
• Has deliberately destroyed others property
  (other than arson)
• Deceitfulness or theft
• Has broken into someone elses house, building,
  or car
• Often lies to obtain goods or favors or to avoid
  obligations
• Has stolen items of nontrivial value without
  confronting a victim
• Serious violation of rules
• Often stays out at night despite parental
  prohibitions, beginning before age 13
• Has run away from home overnight at least twice
  while living in parental or parental surrogate
  home
• Is often truant from school, beginning before age
  13

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Conduct Disorder

• B. The disturbance in behavior causes significant
  impairment in functioning
• C. If the individual is 18 years or older,
  criteria are not met for Antisocial Personality
  Disorder

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Conduct Disorder

• Prevalence Rates vary widely (1-over 10)
• Rates higher in urban settings
• Rates higher in clinical samples
• Gender Higher rates in males (esp. child-onset)
• Males fighting, stealing, vandalism, etc.
• Females lying, truancy, running away, etc.
• Age of onset
• Childhood-onset Type Onset of at least one
  criterion characteristic of Conduct Disorder
  prior to age 10 years
• Adolescent-onset Type Absence of any criteria
  characteristic of Conduct Disorder prior to age
  10
• Unspecified onset Age at onset is not known

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Oppositional Defiant Disorder

• A pattern of negativistic, hostile, and defiant
  behavior lasting at least 6 months, manifested by
  4 or more of the following
• Often loses temper
• Often argues with adults
• Often actively defies or refuses to comply with
  adults requests or rules
• Often deliberately annoys people
• Often blames others for his or her mistakes or
  misbehaviors
• Is often touchy or easily annoyed by others
• Is often angry and resentful
• Is often spiteful or vindictive
• Consider a criterion met only if the
  behavior occurs more frequently than is typically
  observed in individuals of comparable age and
  developmental level

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Oppositional Defiant Disorder

• Prevalence 2-16, depending on sample
• Gender More common in males prior to
  puberty, after puberty equal rates
• Age of Onset Typically before 8 years old and
  rarely after adolescence
• Course Onset is usually gradual, expanding
  into more and more life areas w/ time
• Can lead to Conduct Disorder

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Separation Anxiety Disorder

• Developmentally inappropriate and excessive
  anxiety concerning separation from home or from
  those to whom the individual is attached,
  manifested by three or more of the following
• Recurrent excessive distress when separation from
  home or major attachment figures occurs or is
  anticipated
• Persistent and excessive worry about losing, or
  about possible harm befalling, major attachment
  figures
• Persistent and excessive worry that an event will
  lead to separation from a major attachment figure
• Persistent reluctance or refusal to go to school
  or elsewhere because of fear of separation
• Persistently and excessively fearful or reluctant
  to be alone or without major attachment figures
  at home or in other settings
• Persistent reluctance or refusal to go to sleep
  without being near a major attachment figure or
  to sleep away from home
• Repeated nightmares involving the theme of
  separation
• Repeated complaints of physical symptoms when
  separation occurs or is anticipated

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Separation Anxiety Disorder

• The duration of the disturbance is at least 4
  weeks
• The onset is before age 18
• The disturbance causes clinically significant
  distress or impairment in functioning
• Is not better explained by another mental disorder

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Separation Anxiety Disorder

• Prevalence 4 in children and young adolescents
• Gender In community samples, it is more
  common in females
• In clinical samples, rates are equal
• Age of onset Anytime from preschool to
  adolescence
• May develop after a life stress (e.g. death
  of relative or pet, change of schools,
  move to a new neighborhood, etc.
• Course Typically remits with age
• In adulthood, separation anxiety is most
  often about children/spouses