Child and Adolescent Psychiatry

Standard Autistic Disorder

DSMIV-TR (A, B, or C)

A. Six or more items from 1,2, or 3.

1. Qualitative impairment in social interaction

Multiple non-verbal behaviors and gestures

Failure to develop peer relationships

Lack of sharing social enjoyment

Lack of social reciprocity

2. Qualitative impairment in communication

Delay in spoken language

Marked impairment in sustaining conversations

Repetitive use of language or idiosyncratic language

Lack of make believe play

3. Stereotyped behavior

Abnormal preoccupation with a pattern of interest

Inflexible routines or rituals

Repetitive motor mannerisms

Persistent pre-occupation with parts of objects

B. Delays in at least one of the following

Social interaction

Social communication

Symbolic or imaginative play

C. Not accounted for by Rett’s or another disintegrative disorder

Asperger’ Syndrome

Usually first observed after age 2

Oddity of social interaction

No language impairment

Mild mental retardation to normal IQ

Seizure disorder common

Social interactions can be mastered

Rett’s Disorder

Observed only in females

Cause unknown

Normal prenatal and peri-natal development

Loss of previously acquired hand skills, social engagement, gait and language between 5 and 30 months

Onset before age 4

Severe mental retardation

Seizure disorder

Poor prognosis

Childhood Disintegrative Disorder

More common in males

Normal development for 2 years

Loss of previously acquired language, social, bowel and bladder, play and motor skills before age 10

Outcome very poor

Differential diagnosis

Schizophrenia with childhood onset

Mental retardation with behavioral symptoms

Mixed receptive-expressive language

Acquired aphasia

Schizophrenia with Childhood Onset

Pre-pubertal onset extremely rare

Neuro-developmental abnormalities

No onset before the age of 5

Normal intelligence

Command hallucinations

Bizarre delusions

Loose associations

Thought blocking

Mental Retardation with Behavioral Symptoms

Chromosomal problems

Metabolic disorders

Over 1000 genetic or metabolic causes

Mixed Receptive-expressive Language

Impaired skills in language comprehension and understanding

May also have auditory impairment; i.e. sound discrimination, memory of sound sequences

Difficulty processing visual symbols

Developmental lags

Long term social problems

Mixed Receptive-expressive Language

Selective deficit in language skills

Poor ability to express self

Immature articulation

Acquired Aphasia

Difficulty remembering words

Secondary to brain trauma, tumors, or seizure disorder

Preceded by normal language development

May start to talk again

Prognosis unsure

Attention Deficit Hyperactivity Disorder

Inattention

Hyperactivity

Impulsivity

Low tolerance for frustration

Temper outbursts

Oppositional Defiant Disorder

Evident before age 8

Stubborn

Argumentative

Limit testers

Refusal to accept blame

Deviant behavior with authority figures

No serious violations of rights of others

Symptoms most evident at home

Severe power struggles

Conduct Disorder

Evident by age 10

Behavior outside of societal norms

Aggression towards people and animals

Destruction of property

Deceitfulness and/or theft

Serious violations of rules

Violation of rights of others

More common in males

Conduct Disorder cont’d

Poor peer relationships

Lack of feelings of guilt or remorse

Low self-esteem

School discipline problems

Boys: Fighting, stealing, vandalizing

Girls: Truancy, substance abuse, run aways, prostitution

Tourette’s Disorder

Genetic transmission

70% of female offspring inheriting the gene develop the illness

99% of males inheriting the gene develop the illness

Permanent progressive illness

Possible periods of remission

Tourette’s Disorder, cont’d

Onset age 2-10

Motor tics Eye blinking

Tongue protrusion

Touching

Squatting

Skipping

Verbal tics Barking

Grunts

Clicks

Yelps

Tourette’s Disorder, cont’d

Obsessions and compulsions

Hyperactivity

Distractibility

Impulsivity

Low self-esteem

Adjustment Disorder

Emotional response to an identifiable stressor

Inception within 3 months of stressor

Decreased school performance

Temporary changes in social relationships

Ceases after 6 months

Subtypes Anxiety

Mixed anxiety and depression

Conduct disturbance

Mixed conduct and emotion disturbance

Childhood Eating Disorders

Pica

Rumination Disorder

Feeding and Eating Disorder

Pica

Persistence in eating non-nutritive substances

Paint –plaster-dirt- animal feces

No aversion to eating food

Frequently associated with mental retardation

Rumination Disorder

Repeated regurgitation and re-chewing food

Lack of nausea, retching, or GI problems

May occur with developmental delays

Feeding and Eating Disorder

Infant or child does not eat adequate amounts of food

No medical disorder or mental retardation

Food is available

Failure to gain weight

Experiences developmental delays