Disorders of Children and

Adolescents
 Pervasive Developmental
Disorders
• Characterized by pervasive and usually
severe impairment of reciprocal social
interaction skills, communication deviance,
and restricted stereotypical behavioral
patterns
• Also called autism spectrum disorders
– Autistic disorder (classic autism)
– Rett’s disorder
– Childhood disintegrative behavior
– Asperger’s disorder
• Approximately 75% of children with these
disorders have mental retardation
 AUTISTIC DISORDER
• A pervasive developmental disorder
characterized by inappropriate
responses to the environment and
pronounced impairments in language,
communication, and social interaction
• It begins during childhood and lasts
throughout life.
• Occurs in 10-12 of every 10,000
children and is up to 5 times more
common in boys than girls.
 AUTISTIC DISORDER
• Causes:
– No known single cause for autism exists,
but some studies suggest it may stem from
abnormalities in brain structure or function.
Brain scans show differences in brain shape
and structure in autistic children
– Autism does have a genetic link; many
children with autism have a relative with
autism or autistic traits
– Controversy continues about whether MMR
vaccinations contribute to the development
of late-onset autism.
 AUTISTIC DISORDER
• Signs and symptoms
– It’s commonly discovered when parents
notice their child doesn’t appear to hear.
– Sometimes the child appears to develop
normally until about age 2, and then
regresses rapidly
– Young children with autism usually have
impaired language development and
difficulty expressing their needs. They
may laugh or cry for no apparent reason
 AUTISTIC DISORDER
• Indifference toward others
• Delayed and impaired verbal and
nonverbal communication
• Abnormal speech patterns, such as
echolalia
• Lack of intonation and expression in
speech
• Repetitive rocking motions
• Hand flapping
• Insistence on sameness
 AUTISTIC DISORDER
• Dislike of changes in daily activities and
routines
• Self-injurious behaviors, such as
headbanging, hitting or biting
• Unusual fascination with inanimate objects,
such as fans and air conditioners
• Dislike of touching or cuddling
• Frequent outburst and tantrums
• Little or no eye contact with others
• Increased or decreased sensitivity to pain
• No fear of danger
 Diagnostic criteria
• At least 6 characteristics from the following 3
categories must be present, including at least 2
from the social interaction category and one
each from the communication and pattern
categories
• Social interaction
– Marked impairment in the use of multiple non-
verbal behaviors, such as eye-to-eye gaze, facial
expression, body postures and gestures to regulate
social interaction
– Failure to develop peer relationships appropriate to
developmental level
– No spontaneous sharing of enjoyment, interests, or
achievements with others
– Lack of social or emotional reciprocity
– Gross impairment in the ability to make peer
friendships
 Diagnostic criteria
• Communication
– Delay in, or total lack of, spoken language
development (not accompanied by an attempt
to compensate through alternative modes of
communication, such as gestures or mime)
– In an individual with adequate speech, marked
impairment in initiating or sustaining a
conversation with others
– Stereotyped and repetitive use of language or
idiosyncratic language
– Lack of varied, spontaneous make believe play
or social imitative play appropriate to
developmental level
 Diagnostic criteria
• Patterns: The person demonstrates
restricted, repetitive, and stereotyped
patterns of behavior, interests, and
activities as manifested by at least one
of the ff. criteria:
– Encompassing preoccupation with one or
more stereotyped and restricted patterns
of interest that’s abnormal either in
intensity or focus
– Apparently inflexible adherence to specific
nonfunctional routines or rituals
– Persistent preoccupation with parts of
objects
 Diagnostic criteria
• Additional criteria: The person
exhibits delays or abnormal
functioning in at least one of the
following areas before age 3:
– Social interaction
– Language as used in social
communication
– Symbolic or imaginative play
 Treatment
• A combination of early intervention,
special education, family support, and
in some cases medication may help
some autistic children lead more
normal lives
• Early intervention and special education
programs may increase the child’s
capacity to learn, communicate, and
relate to others. This approach also
may reduce the severity and frequency
of disruptive behaviors
 Nursing interventions
• Choose your words carefully when speaking to a
verbal autistic child. The child is likely to interpret
words concretely and may interpret a harmless
request as a threat.
• Offer emotional support and information to the
parents. Suggest they meet with parents of other
autistic children for advice on coping with tantrums,
toilet training, and other problems
• To promote communication, advise the parents to
have close, face-to-face contact with the child.
• Teach the parents to maintain regular, predictable
daily routine, with consistent times for waking up,
dressing, eating, attending school, and going to bed.
• Suggest that the parents use a picture board showing
the activities that will occur during the day to help the
child make transitions more easily
 Nursing interventions
• Advise the parents to avoid situations
known to trigger outbursts.
• Teach the parents how to recognize the
behaviors that precede temper tantrums,
such as increased hand flapping. Instruct
them to intervene before a tantrum occurs.
• Instruct the parents on ways to make home
safer-for example, by installing locks and
gates so that the child can’t wander
unsupervised.
• Inform the parents that punishment may
worsen self-injurious behavior
 Rett’s Disorder
• A pervasive developmental disorder
characterized by the development of
multiple deficits after a period of normal
functioning
• It occurs exclusively in girls.
• It is rare, and persists throughout life.
• It develops between birth and 5 months of
age. The child loses motor skills and begins
showing stereotyped movements instead.
She loses interest in the social environment,
and severe impairment of expressive and
receptive language becomes evident as she
grow older.
 Asperger’s Disorder
• Same impairments of social
interaction and restricted
stereotyped behaviors seen in
autistic disorder, but there are no
language or cognitive delays.
• Occurs more often in boys than in
girls, and the effects are generally
lifelong.
 Childhood Disintegrative
Disorder
• Characterized by marked regression in
multiple areas of functioning after at
least 2 years of apparently normal
growth and development
• Typical age at onset is between 3 an 4
years
• Children with CDD have the same social
and communication deficits and
behavioral patterns seen with autistic
disorder
Attention Deficit and
Disruptive Disorders
 Attention Deficit Hyperactive
Disorder
• Characterized by inattentiveness,
overactivity, and impulsiveness.
• Affects roughly 3%-5% of school-age
children
• Affects at least twice as many boys
as girls. The child’s behavior may
cause problems at school, in the
home, and in the community and
may influence his emotional
development and social skills.
 Diagnostic criteria
• The person must have at least 6 symptoms
from the inattention group or at least 6 from
the hyperactivity-impulsivity group.
Symptoms must have persisted for at least
6 months to a degree that’s maladaptive
and inconsistent with the person’s
developmental level
• Symptoms of inattention
– Often fails to pay close attention to details or
makes careless mistakes in school, work, or
other activities
– Often has trouble sustaining attention in tasks
or play activities
 Diagnostic criteria
– Often seems not to listen when spoken to
directly
– Often fails to follow through on instructions or
to finish schoolwork, chores or workplace
duties ( not because of oppositional behavior
or failure to understand instructions)
– Often has trouble organizing tasks and
activities
– Often avoids, dislikes, or is reluctant to engage
in tasks that require sustained mental effort
(such as schoolwork or homework)
– Often loses things necessary for tasks or
activities
– Often becomes distracted by extraneous
stimuli
– Often demonstrates forgetfulness in daily
 Diagnostic criteria
• Symptoms of hyperactivity
– Often fidgets with his hands or feet or
squirms in his seat
– Often leaves his seat in the classroom or in
other situations in which remaining seated
is expected
– Often runs about or climbs excessively in
inappropriate situations
– Often has trouble playing or engaging in
leisure activities quietly
– Often is described as “on the go” or “driven
by a motor”
– Often talks excessively
 Diagnostic criteria
• Symptoms of impulsivity
– Often blurts out answers before questions have
been completed
– Often has difficulty awaiting his turn
– Often interrupts or intrudes on others in
conversation or games
• Additional features
– Some symptoms causing impairment appear before
age 7
– Impairment form the symptoms is present in two or
more settings (at school and at home)
– Clinically significant impairment in social, academic
or occupational functioning is clearly evident
 Treatment
• Focuses on coordinating the child’s
psychological and physiologic needs.
• Psychotherapy can reduce ADHD
symptoms and teach the child ways
to modify behavior.
• Pharmacologic agents
– Dextroamphhetamine (Dexedrine)
– Methylphenidate (Ritalin)
– Pemoline (Cylert)
 Treatment
• The child also may benefit from an
individualized educational plan, with
special services that support his
strengths and minimize problems
stemming from his vulnerabilities
 Conduct Disorder
• Characterized by persistent
antisocial behavior in children and
adolescents that significantly impairs
their ability to function in social,
academic, or occupational areas
• Symptoms are clustered in 4 areas
– Aggression to people and animals
– Destruction of property
– Deceitfulness and theft
– Serious violation of rules
 Conduct Disorder
• People with conduct disorder have
little empathy for others; have low
self-esteem; poor frustration
tolerance; temper outbursts
• Occurs 3x more often in boys than in
girls
• As many as 30% to 50% of these
children are diagnosed with
antisocial personality disorder
 Diagnostic criteria
• At least 3 of the criteria from any of the
categories below must have been present in
the past year, and at least one criterion
must have been present within the past 6
months
• Aggression to people and animals
– Often initiates physical fights
– Has used a weapon that can cause serious
physical harm to others
– Has been physically cruel to people/animals
– Has stolen while confronting a victim (as in
mugging, purse snatching, extortion)
– Has forced someone into sexual activity
 Diagnostic criteria
• Destruction of property
– Deliberately set fire with the intention of
causing serious damage
– Deliberately destroyed other’s property (other
than by setting a fire)
• Deceitfulness or theft
– Has broken into someone else’s house, car, or
building
– Often lies to obtain goods or favors or to avoid
obligations
– Has stolen items of nontrivial value without
confronting a victim
 Diagnostic criteria
• Serious violations of rules
– Often stays out at night despite parental
prohibitions, starting before age 13
– Has run away from home overnight at least
twice while living the parent’s or surrogate
parent’s home.
– Often skips school, beginning before age 13
• Additional criteria
– The behavior disturbance must cause clinically
significant impairment in social, academic, or
occupational functioning
– The person is age 18 or older and doesn’t meet
the criteria for antisocial personality disorder
• Studies show that roughly 30% to
50% of clinical populations with
conduct disorder also has ADHD.
 Treatment
• Treatment focuses on coordinating
the child’s psychological, physiologic,
and educational needs.
• Psychotherapy can help him learn
problem-solving skills, decrease
disruptive symptoms, and modify
behavior