Selected Disorders Related to Children and Adolescents

 Mental Retardation (will probably change to Intellectual Disability)  Pervasive Mental Disorders (will probably change to Autism Spectrum Disorders)  Conduct and Oppositional Defiant Disorder  Elimination Disorders  ADHD

The majority of Mental Health Professionals agree:  that diagnosing in children is a difficult and delicate task  that any professional other than a specialist trained in the area should not diagnosis  that the younger the child the more difficult the task  many children are taking medications and over 80% of the WORLD’S supply of Ritalin (for ADHD) is given in the United States  Exercise, diet, and sleep

IQ 71-84, Code on Axis II.

If present, always diagnose it.  Must have significantly sub-average intelligence and deficits in adaptive functioning.  Adaptive functioning means how individuals cope with life demands and meet expectations of activities of daily living.  Definition is compatible with AAMR definition except for sub-typing.

Onset prior to age 18 — if after it is Dementia. Must have IQ of 70 or below on an individual IQ test (5 point error margin). This disorder is slightly more common in males.

 MILD: IQ approximately (50-55) 55 to 70, considered educable, able to perform at 6th grade level, can use minimal assistance may need some supervision and guidance, live in community or in supervised settings  MODERATE: IQ approximately (35-40) 35 to 55 (50-55), considered trainable, able to perform at 2nd grade level, with moderate supervision can attend to their own personal care, can perform unskilled or semi-skilled work, can live in the community  SEVERE: IQ approximately (20-25) 20 to 35, (35-40) generally institutionalized, have little or no communicative speech, possible group home  PROFOUND: IQ below 20, generally total care

Case Example

 Involve multiple functions and behaviors that are not considered normal at any age.  Qualitative impairment in: reciprocal interaction, verbal and nonverbal skills, imaginative activity, and intellectual skills.

 Severe form, onset in infancy or childhood, self-stimulating, and self-injuring behaviors often present, (i.e., rocking, spinning, head banging)  2/3 of Autistic are mentally retarded/moderate range  Facilitative communication is used  NO PROOF THAT CONDITION IS RELATED TO PARENTING STYLES  Age of onset requirement in DSM-IV is age 3

 Rett’s Disorder  Childhood Disintegrative Disorder  Asperger's Disorder

 Only in females  Deceleration of head growth, start out normal and 5 to 24 months problems develop  Loss of previously acquired hand skills, loss of social engagement, appearance of stereotyped movements, impaired language functioning Generally associated with severe or profound mental retardation  DSM-IV-TR highlights now that many of these cases are related to a specific genetic mutation

 Normal development for two years then a drastic decline  Followed by a loss of previously acquired skills and development of autistic like symptoms

 Autistic-like symptoms without language impairment  Severely impaired social interaction  DSM-IV-TR Since this is a new category major revisions have been made to this section

 Asperger’s  Autism

DSM-5  Will suggest new categories for the learning disorders and create a category called Autism Spectrum Disorders, will incorporate aspects of all the current disorders.  ASD will be categorized as mild, moderate, and severe  Groups in opposition have already been formed.

Learning Disabilities: These disorders have significant difficulties in acquisition of listening, speaking, reading, writing, reasoning, and math. Significant delay in skill level (2 standard deviations below the mean) Generally noted between ages of 8 and 13 More common in boys than girls Kids don't always catch up—continues into adulthood Involve specific functions—not multiple like pervasive—the behavior is characteristic of an earlier state of development Social Work Treatment: Generally behavioral in nature

 Symptoms now in grouped in four categories: 1. Aggression to people and animals 2. Destruction of property 3. Deceitfulness or theft 4. Serious violations of rules

Two items were added to increase applicability to females: 1. Staying out at night 2. Intimidating others

New subtypes based on age of onset  Childhood onset and adolescent onset  Onset before age 10 has a poor prognosis  When 18 used to be diagnosed anti-social but now can remain into early 20s because not all conduct disorders become anti- socials

 Based on research deleted from the criteria "uses obscene language."  Also increased clarification on clearly establishing the deviation from what could be considered normal.  DSM-IV-TR clarifies that many children with Oppositional Disorder do not develop conduct disorder.

 Do not meet the full criteria for conduct or oppositional disorder but have clinically significant impairment

 Severe mood dysregulation  Helps to distinguish children who have recurrent behavioral outbursts (severe and inappropriate)  Helps adolescents from bipolar and severe mood dysregulation, irritability, and behavior outbursts

 Diagnosis explosion of bipolar in children since 1994  Severe irritability and handling behavior outbursts that could be considered/confused with mania  Outbursts need to be severe and developmentally inappropriate

 ADHD—TDDD is more aggressive  Bipolar—TDDD more continuous and not cyclic  Disruptive Behavior Disorder—mood is more labile

ALWAYS GET A PHYSICAL FIRST NOT DUE TO A PHYSICAL or MEDICAL DISORDER Enuresis:  Elimination of urine during day or night  Must be age 5 before it can be diagnosed  Remember that a diagnosis can be made before thresholds are met, if clinical significance can be established Encopresis:  Repeated elimination of feces in inappropriate places  One time a month for 3 months (used to be 6 months)  Must be at least four years of age to diagnose

 Must last at least six months  Predominately inattentive, hyperactivity- impulsivity  Combined symptoms required in two or more situations: home, work, or at school

 Can occur in adulthood but must have onset in childhood (generally before age 7)  Not intellectual deficits just attention and concentration  Etiology: unknown, hereditary link, tends to run in families, more common in males

 Will make it easier to diagnose ADHD in adults  Number of symptoms will be reduced from six to three  In adults will no longer have to have symptoms before the age of 7 will probably change to 12 years old

 Evaluate by a neurologist or physician (medical check)  Exercise, sleep habits, and diet  Medication

 Short-acting  Long-acting  Non-stimulant

It is compelling to think about changing to a new long-acting medication because of the convenience of once-a-day dosing and their long lasting effects, but it is important to remember that they shouldn't be any more effective than a short-acting medicine.

 Ritalin (Methylphenidate HCl)  Methylin Chewable Tablet and Oral Solution  Metadate ER  Methylin ER  Focalin  Dexedrine (Dextroamphetamine sulfate)  Dextrostat  Adderall  Adderall (generic)  Dexedrine Spansules

Stimulant Medications  Ritalin, Metadate (age 6 and older)  Ritalin-SR (Methylphenidate) (age 6 and older)  Concerta (Methylphenidate Extended Release) (age 6 and older)  Adderall (Dextroamphetamine and Amphetamine) (age 3 and older)  Desoxyn (Methamphetamine)  Provigil (Modafanil)  Cylert* (Pemoline) (age 6 and older) *because of potential for serious side effects to the liver, not usually used as a first line for ADHD  Focalin (dexmethlphenidate) (age 6 and older)

 The long-acting stimulants generally have a duration of 8-12 hours and can be used just once a day.  They are especially useful for children who are unable or unwilling to take a dose at school.

 The latest medication to get approval to treat ADHD is Vyvanse, a long-acting stimulant.  This stimulant is similar to Adderall with a main ingredient of lisdexamfetamine dimesylate, a derivative of one of the ingredients in Adderall.  Initially available in 30mg, 50mg, and 70mg capsules, newer 20mg, 40mg, and 60mg capsules.

 This is a methyphenidate or Ritalin patch.  The patch is available in 10mg, 15mg, 20mg, and 30mg dosages.  Patch can be worn for about nine hours at a time on a child's hip.  The medication works for a few more hours once you take the patch off.

 Approved for use in children over the age of six years, although regular Adderall can be used in younger children from 3-5 years of age.  Adderall XR is a sustained release form of Adderall, a popular stimulant which contains dextroamphetamine and amphetamine.  Available as a 10mg, 15mg, 20mg, 25mg, and 30mg capsule.  The capsule can be opened and sprinkled onto applesauce if your child can't swallow a pill.

When medication alone is not enough consider: (A) Is there an accurate diagnosis? (B) Help families deal with the child at home (e.g., parenting styles reinforce negative behaviors). (C) Help teachers deal with child at school (e.g., sit in least distracting section of the class, away from the door). (D) May need academic "catch up" help (e.g., computers are an excellent tool for these children). (E) Allow these children "more time" to complete tasks. (F) Address self-esteem issues in counseling.

Impulsive type: -Often in trouble at school Inattentive Type: -Poor grades in school

 PICA  Anorexia Nervosa: intense fear of gaining weight, usually underweight, disturbance in body image, won’t eat, over- exercise, often have amenorrhea, refusal to maintain minimum normal body weight, resistance to treatment with strong denial, onset during late adolescence (12-18) and can go into 30s, individuals can die from starvation, 1/2 anorectics are bulimics, common co-conditions: substance abuse and depression  Bulimia Nervosa: episodes of binge eating (recurring), self- induced vomiting with laxatives, diuretics or fasting, sense of lack of control during eating binges, chronic concern with body weight and shape, two binges per week for three months