14.5 Elimination + 14.6 Neurodevelopmental Disorders

Definition: Children with elimination disorders have repeated instances of urinating or passing feces in inappropriate places. They are typically above the age expected to control these bodily functions, and symptoms are not due to physical illness.

Definition: Enuresis refers to involuntary urination, which can be intentional or not. It usually occurs at night (bedwetting) but can also happen during the day.
Diagnosis: Children must be at least 5 years old for diagnosis.
Prevalence:
- 33% of 5-year-olds experience bedwetting.
- 16% meet criteria for enuresis.
- 5% of 10-year-olds and <2% of 15-year-olds have enuresis.
Gender: Boys are affected more often than girls (2:1 ratio).
Risk Factors: Close relatives often have a history of the condition.
Possible Causes: Stressful events (like hospitalizations or school entry) may trigger symptoms.
Treatment: Many cases resolve on their own, but cognitive behavioral therapy can accelerate improvement.
- Alarm Treatment: Ringing a bell when a child begins to wet their bed to condition them to wake up.
- Dry Bed Training: Teaching children to control their bladder and rewarding them for it.
- Example: Sarah Silverman discusses her experiences with enuresis in her memoir.

Definition: Encopresis involves defecating in inappropriate locations, less common than enuresis, and usually not occurring at night.
Prevalence: Affects about 1.5% to 4% of children; more common in boys.
Causes: Often linked to constipation, stress, or issues with toilet training. 80% of cases involve constipation.
Treatment: Includes behavioral therapies to manage constipation, biofeedback, nutrition changes (high fiber diets), and family therapy.

Oppositional Defiant Disorder (ODD): Characterized by arguments with adults, violating rules, and feelings of anger and frustration.
Conduct Disorder: More severe, involving aggression, destruction of property, and violation of others' rights. Treatment can involve parent management training, multi-systemic therapy, and social skills interventions.

Definition: Disorders impacting brain functions seen at birth or early childhood, affecting behavior, memory, attention, and learning capacities.
Prevalence: Many children with ADHD and autism spectrum disorder show continued symptoms into adulthood.

Definition: Characterized by inattention, hyperactivity, and impulsiveness beyond typical developmental norms.
Symptoms: Difficulty sitting still, completing tasks, and following instructions, often resulting in social issues and poor academic performance.
Prevalence: Affects 7% to 10% of children; 3 to 8 times more likely to drop out of school.
Treatment: Combination of behavioral therapies and medications (stimulants like methylphenidate and amphetamines). Parent management training and school interventions are also utilized.

Definition: Marked by difficulties in social communication, unresponsiveness, and rigid behaviors. Symptoms typically manifest before age three.
Recent Trends: Increasing prevalence; currently estimated to affect 1 in 60 children.
Causation: Theories include cognitive deficits (lack of theory of mind) and biological factors (brain abnormalities).
Treatment Approaches: Focus on cognitive behavioral therapy, communication training, and effective parent training.

Definition: Characterized by low general intellectual functioning (IQ < 70) and significant limitations in adaptive behavior developed before age 18.
Prevalence: At least 1 in 100 meet criteria; about 60% have mild intellectual disabilities.
Diagnosis: Requires assessments of IQ and adaptive functioning in various settings.
Types: Four levels based on IQ scores (mild, moderate, severe, profound). Mild ID is often linked to environmental factors, while severe forms are mostly biological.
- Biological Causes: Chromosomal abnormalities (e.g., Down syndrome), metabolic disorders (e.g., PKU), prenatal and birth complications, childhood injuries.
Intervention Programs: Aim for normalization in residence and education, with programs focusing on skills for daily living, social interaction, and occupational training.