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 • Abnormal motor
milestones movements
• Capacity to • Hyperactivity,
communicate with other inattention, or poor
people impulse
• Language impairment • Abnormal behaviors
• Capacity for human (e.g., fire setting,
relationships cruelty to animals)
• Quality of social • Enuresis or encopresis
interaction
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 • Attention-Deficit
& Disruptive Behavior
• Learning Disorders Disorders
• Motor Skills • Feeding & Eating
Disorders Disorders of Infancy &
• Communication Childhood
Disorders • Tic Disorders
• Elimination Disorders
• Pervasive
• Other Disorders –
Developmental
contains 5 diverse
Disorders disorders
 Predominant Symptoms
or Deficits
• Intellectual & cognitive  All MR & All LD
impairment

 Motor Skills, Tic, & Stereotypic

• Motor function impairment Movement Disorders

 ADD & Disruptive Behavior,

• Disruptive or self-injurious Feeding & Eating, Elimination,
Separation Anxiety, Reactive
behavior Attachment Disorders

 Pervasive Developmental,
• Information exchange 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)
• Conduct Disorder • Oppositional Defiant
– Violation of basic Disorder
rights of others or – Persistent patterns of
– Major age-appropriate negativistic, hostile, &
societal norms abused defiant behaviors

• Manifested through • Behaviors include

– Temper loss, arguments
– Aggression to people
with adults, defies to obey
& animals rules, deliberate annoying,
– Destruction of property blames others, easily
– Deceitfulness or theft annoyed by other, often
angry & resentful, spiteful
– Seriousness violations or vindictive
of rules
 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 • Stuttering
Disorder • Communication
• Mixed Receptive- Disorder NOS
Expressive Language
Disorder
• Phonological Disorder
 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