Mental and Developmental Disorder in Child

Types of neurodevelopmental disorder

ID, ASD, ADHD, LD

DSM ID

Must meet all 3:

A. Deficit in intellectual function confirmed by IQ test and clinical test

B. Deficit in adaptive function (conceptual, social or practical domain)

C. Onset during developmental period

How does global developmental delay differ from unspecified

Global for <5 y/o and failure to meet milestone and cannot do IQ test

Unspecified >5 y/o with inability to assess IQ

Causes of ID

Congenital (Down, PWS, Angelman), neural tube defect, rubella, HIV, FAS

Perinatal hypoxia or hyperbilirubinemia

Post natal toxin exposure or malnutrition

Unknown 30-50%

ID evaluations

IQ and adaptive function test, hearing test, CT/MRI if needed, genetic test (US)

ID/GDD comorbidity

ADHD, anxiety and mood disorder, epilepsy, disordered sleep

ID treatment

0-6 → medical rehab to stimulate

7-15 → educational rehab, IEP

15-18 → vocational rehab

DSM SLD

A. Difficulties learning in word reading, meaning of words, spelling, written expression, number sense, mathematical reasoning for 6 mo despite help

B. Skills below chronological age

SLD evaluation

Hx and psychological testing only

DSM ASD

Social Communication deficit must have: Lack of social-emotional reciprocity, lack understanding of nonverbal, cannot adjust behavior for social context

Restricted/repetitive behavior 2/4: Repetitive motor movements, use of object or speech; insistence on sameness and routine; highly restricted fixed interest; hyper/hyporeactivity to sensory

ASD comorbidities

Epilepsy, anxiety/depression, ID, ADHD (maybe)

ASD treatment

Applied behavioral analysis, speech therapy, educational support, CBT; medication for domain B symptoms or comorbid

DSM ADHD

Onset before 12; chronic display at 2+ setting (home, school); 6+/9 symptoms in children or 5+/9 in >17 y/o; clinically significant impairment; not from neglect, ID etc → symptom of both inattention and hyperactivity

Hyperactive symptoms

• R = run or restless

• U = unable to wait for their turn

• N = not able to play quietly

• S = slow no on the go

• F = fidget with hand or feet

• A = answers are blurted out

• S = staying seated is difficult

• T = talks excessively

• T = tend to interrupt

Inattentive symptom

• C = careless mistake

• A = attention difficulty

• L = listening problem

• L = loses things

• F = fails to finish what they start

• O = organizational skill lacking

• R = reluctant to do task that require effort

• F = forgetful in R = routine activity

• E =easily D = distracted

ADHD comorbidity

30-40% associated with disruptive behavior like ODD or CD; 33% come with LD

ADHD evaluation

PE and MSE, NEBA in US

ADHD medication

Ritalin (short, intermediate or long acting)

ADHD medication side effect

Insomnia, anorexia and weight loss, nausea/vomiting, headache

DSM Tourette’s disorder

A. Both motor and 1+ vocal tic present

B. Tic may wax and wane in frequency but persist for >1 yr

C. Onset is before 18

D. not caused by substance or other medical condition

DSM Persistent motor or vocal tic disorder

A. Single or many motor or vocal tic but is not both at the same time

B. Persist for >1 yr

C. Onset before 18

D. Not caused by substance or disease

E. Has never met Tourrette’s disorder criteria

DSM provisional tic disorder

A. Single or multiple motor/vocal tic

B. Present <1yr

C. Onset before 18 y

D. not caused by substance or disease

E. Has never met Tourette’s or persistent motor/vocal tic disorder

What is Gesell drawing

Give a set of shapes and polygon → ask child to copy → accuracy of each shape determines the age of the child

What age does each polygon equal to

Number 1 = 2 y/o, #2 = 3 y/o, #3 = 4 y/o, #4 = 4.5 y/o, #5-11 = age correspond with number

What is draw-a-person test

Ask child to draw a person → 1 point per body part drawn → can estimate the mental age

What is sentence completion test

Give incomplete sentences like I always feel _____ → ask child to fill in the blank → uncovers how they think about the world/themself

What is strange situation experiment

Mother and child play in a room → Doctor enters the room → mother leaves → child should start crying → Mother returns → baby stops crying

Avoidant insecure attachment sign from strange situation experiment

Child is unconcerned whether mother is in or out of the room and is comfortable with stranger

Resistant insecure attachment sign from strange situation experiment

Intense distress when mother leaves, uncomfortable with stranger and rejects mother when she returns

What is enuresis

Bed wetting → caused by UTI, DM, DI, neurogenic bladder, medication, sleep disorder

What is encopresis

Repeated passage of feces → caused by constipation, medical condition, anal fissure, rectal stenosis, hemorrhoid, hypercalcemia

Age for enuresis and encopresis

Enuresis >=5

Encopresis >=4

Treatment for enuresis

Education, behavioral treatment, medication (imipramine, DDAVAP)

Treatment for encopresis

Education, toilet training, medication (stool softener or laxative)

DSM Oppositional defiant disorder

A. Angry/irritable mood, argumentative/defiant or vindictiveness

Angry = loses temper, touchy or easily annoyed, angry and resentful

Argumentative = argues with other, actively defies request, annoys others blames others

Vindictiveness = spiteful or vindictive

DSM conduct disorder

A. Behavior that violate others basic right (aggression, destruction of property, theft, violation of rules)

Conduct disorder subtype

Childhood onset (<10) → worse prognosis, more common in boys

Adolescent → short lived, less severe, boys > girls, more prevalent

Common in ADHD

How does school refusal differ from truancy

Refusal → emotional distress about school, stay at home (parents know), no antisocial behavior

Truancy → no fear about going to school, parent don’t know, does not stay at home

DSM Separation Anxiety disorder

A. Excessive fear or anxiety of separation with >=3 of the following

• Recurrent distress when anticipating/experiencing separation

• Excessive worry about losing attachment figures

• Persistent worry about experiencing untoward event

• Refusal to go out because of fear

• Fear about being alone

• Refusal to sleep away from home or major attachment figure

• Nightmare about separation

• Complaint of physical symptom when separation is anticipated

B. Lasting >=4 wk

C. Causes distress

What is selective mutism

Failure to speak in social situations, at least 1 mo, not caused by lack of knowledge, interferes with social life, not caused by communication disorder

DSM reactive attachment disorder

A. Pattern of being withdrawn or inhibited toward caregiver

• Rarely or minimally seeks or respond to comfort when distressed

B. Characterized by >=2 of the following

• Minimal social/emotional response to other

• Limited positive affect

• Episode of irritability, sadness or fearfulness

C. Pattern of extreme of insufficient care experienced

DSM Disinhibited social engagement disorder

A. Pattern of approaching and interacting with unfamiliar adults

B. Not limited to impulsivity

C. Pattern of extreme insufficient care