Feeding/Eating, Sleep, and Other Disorders

PICA

• Eating of nonnutritive/nonfood substances

• For at least 1 month or more

• Ct must be at least 2 years or older

• R/O ID, ASD, Schizophrenia, medical condition/pregnancy

Rumination Disorder

• Repeated regurgitation of food, then rechewed, swallowed or spit out

• At least 1 month several times a week to daily

• R/O medical condition

• Typically diagnoses before 1yo

Avoidant/Restrictive Food Intake Disorder (ARFID)

• Avoidance of eating or restriction in types of food

• Significant weight loss / failure to meet milestones

• Nutritional deficiency

• R/O AN/BN or medical condition, depression, trauma

• Infancy – early childhood

Anorexia

• Significant low weight, fear of gaining weight, disturbance in perceived weight/shape

• Early adolescence

Bulimia

Binge-eating, compensatory behaviors to prevent weight gain, self evaluation disproportionately influenced by weight/shape

Adolescence to adulthood

Binge-Eating Disorder (BED)

• Binge eating without the compensatory behaviors of BN

• 1x/week for 3 months

• Associated with marked distress

  • Eating more rapidly than normal

  • Eating till uncomfortably full

  • Eating large amounts when not hungry

  • Eating alone due to embarrassment

  • Negative feelings after eating

• Late adolescence or early adulthood, can present later

Neonatal Sleep

• Birth to 5 weeks

• Short periods alternating with wakefulness

• Indeterminate & not established

Infants Sleep

• 6 weeks - 3 months

• Longer nocturnal periods

• 10 to 19 hrs overall

Early Childhood Sleep

• 1-4 years old

• Decrease in daytime naps

• Minimum 10 hrs

School Aged Sleep

• 5 – 11 yrs

• Excellent with sustained nocturnal sleep

• Maximum of 10 - 11 hrs

Adolescence Sleep

• 12 – 18 yrs

• Sleep affected by multifactorial origins

• 9-10 hrs

Insomnia

• Difficulty initiating sleep, maintaining sleep, or early-morning waking without ability to fall back asleep

• Onset early adulthood but can occur at any age

• 20% of children/preadolescents

  • Higher in children with ASD (40-80%)

• Clinically significant life distress/impairment in daily functions

• R/O substance use, medical conditio

Hypersomnolence Disorder

• Disproportionate amounts of sleep – excessive daytime sleep despite 7 hrs or more of sleep at night

• Late adolescence – early adulthood with gradual onset

• Determined through sleep study

Narcolepsy

• Disproportionate amount of daytime sleepiness

• Lifelong with onset between 15-25

• At least 3x/week over 3mo

Breathing – Related Sleep Disorders

• Sleep Apnea

• Obstructive sleep apnea hypopnea (partial or complete upper airway obstruction)

• Sleep-related hypoventilation

Circadian Rhythm Sleep-Wake Disorders

• Persistent disruption in the endogenous sleep cycle due to issues with physical environment or social/work related schedule demands

• 7% of adolescent population

• Comorbid with other mental health diagnosis

• Insomnia, obesity, substance abuse, anxiety, disrupted executive functioning

6 Types of Circadian Rhythm Sleep-Wake Disorders

• Delayed sleep

• advanced sleep

• irregular sleep-wake

• non 24hr sleep-wake

• shift work

• unspecified

Parasomnias

• Repeated episodes of sleep waking or sleep terror during 1st 3rd of primary sleep lasting approx. 10 min. More common in children/adolescents & considered nonthreatening with little impact on quality & quantity of sleep

• Nonrapid eye movement sleep arousal disorder

• Nightmare disorder

• Rapid eye movement sleep behavior disorder

• Restless Legs Syndrome

Nonrapid eye movement sleep arousal disorder

• Sleepwalking 30% of children

• Sleep Terror – 40% of children

Nightmare disorder

• Frightening experiences during sleep that arouse individual and are recalled upon waking

• Occur during 2nd period of sleep

Rapid eye movement sleep behavior disorder

• Vocalizations / motor movements

• Occur later in sleep period

Restless Legs Syndrome

Onset between 20 – 40, for children it’s often comorbid with ADHD, kidney disease, migraines

Children's Sleep Habits Questionnaire (CSHQ)

• Responses are used to generate 8 subscales that correspond to the following sleep issues:

  • Bedtime resistance

  • Sleep onset delay

  • Sleep duration

  • Sleep anxiety

  • Night wakings

  • Parasomnias

  • Sleep disordered breathing

  • Daytime sleepiness

• Given to parents – intended for the following

  • Typically developing children with sleep problems

  • Infants with sleep problems

  • Children with ASD

  • Children with ADHD

Total Sleep Disturbance Index (CSHQ)

• Range 33-99

• Score of 41+ indicates presence of sleep disorder

Enuresis

repeated passing of urine in places other than the toilet.

Encropesis

repeated passing of feces into places other than the toilet

Problems related to family upbringing (Zcode)

Parent-child relational problem

Sibling relational problem

Upbringing away from parents

Child affected by parental relationship distress

Other problems related to primary support group (Zcode)

Disruption of family by separation/divorce

Relationship distress with spouse/intimate partner

High expressed emotional level within family

Uncomplicated bereavement

Child Maltreatment & Neglect Problems

Child physical abuse suspected/confirmed – initial / subsequent encounter

Child sexual abuse suspected/confirmed – initial / subsequent encounter

Child neglect suspected/confirmed – initial / subsequent encounter

Child psychological abuse suspected/confirmed – initial / subsequent encounter

Encounter for mental health services for victim of child abuse by parent (specify)

Encounter for mental health services for victim of child abuse by nonparent (specify)

Personal history of physical abuse in childhood (specify)

Housing & Economic Problems

Homelessness

Inadequate housing

Problem related to living in residential institution

Lack of adequate food/water

Extreme poverty

Low income

Insufficient social insurance/welfare support

Unspecified housing / economic problem

Occupational problems / social environment

Other problem related to employment

Phase of life problem

Acculturation difficulty

Social exclusion / rejection

Target of perceived adverse discrimination / persecution

Unspecified problem related to social environment

Problems related to crime / interactions with legal system

Victim of crime

Conviction in civil / criminal proceeding w/o impresionment

Imprisonment / other incarceration

Problems related to other legal circumstances

Other health service encounters (counseling & medical advice)

Sex counseling

Other counseling/consultation

Problems related to Other psychological, personal, environmental circumstances

Religious / spiritual problem

Problem related to unwanted pregnancy

Problems with multiparity

Discord with social service provider (probation officer, case manger, social services worker)

Victim of terrorism/torture

Exposure to disaster, war, other hostilities

Other problem related to psychosocial circumstances

Unspecified problem related to psychosocial circumstances

Other circumstances of personal history

Other personal history of psychological trauma

Personal history of self-harm

Other personal risk factors

Problems related to lifestyle

Child/adolescent antisocial behavior

Problems related to access to medical & other health care

Unavailability or inaccessibility of health care facilities

Unavailability or inaccessibility of other heling agencies

Nonadherence to medical treatment

Nonadherence to medical treatment

Overweight/obesity

Malingering

Wandering associated with mental disorder

Youth Outcome Questionnaire

• YOQ Completed by parent for clients ages 4-17 years

• YOQ SQ (Self Report): Completed by clients ages 12-18 Years

• Intrapersonal Distress (ID): Range -4 to 68 A high score suggests the client has a great deal of emotional distress (e.g., anxiety, depression, fearfulness, self-harm).

• Somatic (S): Range 0 to 32 A high score suggests the client reports several physical and/or somatic concerns (e.g., headache, stomach problems, bowel problems, dizziness).

• Interpersonal Relations (IR): Range -6 to 34 A high score suggests the client has considerable interpersonal difficulty with family, adults and/or peers (e.g., verbal aggression, defiance, arguing).

• Social Problems (SP): Range -2 to 30 A high score suggests the client engages in many behaviors that violate social norms and/or expectations (e.g., drug/alcohol use, truancy, physical aggression).

• Behavioral Dysfunction (BD): Range -4 to 40 A high score suggests the client has difficulty with attention, concentration, managing impulsive behaviors, organization, task completion and frustration tolerance.

• Critical Items (CI): Range 0 to 36 High score suggests the client has problems requiring immediate clinical attention, (e.g., paranoia, suicidal ideation, hallucinations). In addition, a score of 1 or higher on any single item may warrant immediate clinical attention.

• Total Score: Range -16 to 240 A summation of all subscales that reflects total distress in the client’s life.