1. Disorders of children and Adolescents Dr. Hassan Sarsak, PhD, OT

2. Children with psychiatric disorders Children are not far from getting psychiatric disorders; according to DSM-IV several psychiatric disorders started in infancy, childhood, or adolescence. It is classified as: – Limitation of intellectual function – Learning disorders – Motor skills disorders – Communication disorders – Pervasive developmental disorders – Attention-deficit & disruptive behavior disorders – Feeding and eating disorders of infancy and early childhood – Tic disorders – Elimination disorders – Other disorders of infancy, childhood or adolescence

3. Limitation of intellectual function  Mental retardation: Axis II, classified as mild, moderate, severe, profound, or unspecified. Affect 1% of the population, 80% of them have mild mental retardation (IQ 50-70); male to female 3:2 Begins before the age of 18 Criteria for diagnosis: IQ < 70 and impaired ability to adapt to the demands of normal life May have difficulty in communicating, caring for self, living at home, relating to others, using community resources, academic functioning, working, using free time and in maintaining health and safety. Behavioral: aggression, dependency, impulsivity, self- injury & poor frustration tolerance

4. Limitation of intellectual function Borderline intellectual functioning (borderline MR): Axis V code IQ 71-84 Does not have problems in coping with life associated with mental retardation

5. Learning Disorders This diagnosis indicates substantially more difficulty than normal in learning specific academic skills. Coded in axis I, Must be diagnosed based on standardized individual test. Reading disorder: developed far more slowly than those of peers. Mathematics disorder: skills are markedly less than expected for person’s age Disorders of written expressions: writing skills are slow to develop

6. Learning Disorders Academic problems: a V code ( not a diagnosis but the presenting problem) used when scholastic problems are the focus of treatment. Learning disorders not otherwise specified: this can be used for other categories, such as spelling that do not fit the criteria above.

7. Motor Skills Disorders Developmental Coordination Disorder: – Coded in Axis I. – The person is slow to develop motor coordination as shown by dropping things, general clumsiness, poor handwriting, poor sports ability or delays in achieving developmental milestones, such as setting crawling, or walking, and is not necessarily mentally retarded. – The incoordination is not due to general medical condition and substantially impedes daily living and academic achievement.

8. Communication Disorders These disorders are measured by standardized tests that are given individually and they substantially interfere with social and educational life. Coded Axis I, It includes: 1.Expressive language disorder: patient may have small vocabularies or trouble producing grammatically correct sentence 2.Mixed receptive-expressive language disorder: patient has the problem listed above but with problems understanding words or sentences 3.Phonological disorders: speech develops slowly for the person’s age or dialect لهجة 4.Stuttering: frequent disruption in the normal fluency of speech

9. Pervasive developmental disorders (PDD) Definition: children fail to develop normally in a number of areas including the ability to interact socially, to communicate verbally and none verbally, and to use their imagination. These are coded on Axis I. These conditions may continue to affect adults but they will rarely be focus of evaluation of an adult

10. Pervasive developmental disorders (ASDs) Autistic disorder: the child has impaired social interactions and communications and develops stereotyped behaviors and interests before age 3. Asperger’s Disorder: similar to autistic disorder, except children with this disorder do not have delayed or impaired language. Pervasive Developmental Disorders Not Otherwise Specified: used for conditions such as atypical autism.

11. Pervasive developmental disorders (cont’d) Childhood Disintegrative disorder: following two years of normal development the child losses acquired skills (language, communication, social, bladder control, play, motor…). Rett’s disorder: after six months of apparently normal development, the child has abnormal development as shown by slow head growth, delayed language, poorly coordinated gait, loss of purposeful hand movements with development of stereotyped movements such as handwringing or hand washing, and of social engagement

12. Attention deficit and Disruptive Behavior Disorders This category involves: – Attention deficit /Hyperactivity disorder (ADHD): it is a common condition in which children are hyperactive, impulsive or inattentive or all three. Symptoms typically begin before the child goes to school, but it is usually diagnosed around age nine. Developmental milestones may occur early. They usually have trouble sitting quietly and cannot focus in school. They tend to be impulsive and say things that may hurt others’ feelings, so they may be unpopular. They may be unhappy that they may also fit criteria of dysthymic disorder

13. Attention deficit and Disruptive Behavior Disorders – Attention-deficit/hyper activity disorders not otherwise specific: used for symptoms of hyperactivity, impulsivity or inattention that do not meet the criteria for ADHD.

14. Attention deficit and Disruptive Behavior Disorders – Conduct disorder: the individual violates rules, age appropriate norms or the rights of others, evidenced by aggression against people or animals, property destruction, lying or theft, or seriously violating rules. The symptoms cause impairment in job, school, or social life. Childhood onset type is coded if at least one problem occurs before age 10. Adolescent onset is coded if there are no problems before age 10. severity, such as mild, moderate, or severe, is also coded. This is a common precursor to anti social personality disorder

15. Attention deficit and Disruptive Behavior Disorders – Oppositional Defiant Disorder: the individual may have multiple examples of negativistic behavior, such as losing temper, arguing with adults, defying rules, doing things to deliberately annoy others, blaming others for own mistakes, being angry and resentful or being spiteful (mean) or vindictive (hurtful), persist for at least six months. The symptoms cause much distress or impairment in work, school, or social life.

16. Attention deficit and Disruptive Behavior Disorders – Child or Adolescent antisocial Behavior: this is a V-code (not a diagnosis but a presenting problem) where antisocial behavior occurs but cannot be ascribed to a mental disorder. – Disruptive Behavior Disorder Not Otherwise Specified: this is used for disturbances of conduct or oppositional behaviors that do not meet the criteria for Conduct or Oppositional Defiant Disorder.

17. Feeding and Eating Disorders of Infancy or Early Childhood Pica: the child eats material that is not food Ruminating Disorder: there is persistent regurgitation and chewing of food already eaten. Feeding Disorders of infancy or Early Childhood: A child failure to eat enough leads to weight loss or a failure to gain weight

18. Tic Disorders – Tourette’s Disorder: multiple vocal and motor tics (any stereotyped movement or vocalization that is sudden, non-rhythmic, rapid and repeated) occur frequently throughout the day. It usually occur at age of seven or at least by early teens, it lasts throughout life, with periods of remission, and reduction in severity when one is mature. – Chronic Motor or Vocal Tic Disorder: a patient has either motor or vocal tics, but not both.

19. Tic Disorders – Transient Tic Disorder: this occurs for no longer than one year – Tic Disorder Not Otherwise specified: this is for tics that that do not meet the above

20. Elimination Disorders – Encopresis: at the age of four years or later the child repeatedly passes feces into clothes or onto the floor. – Enuresis: at the age of five years or later, there is a repeated voiding of urine into bedding or clothing (it can be voluntary or involuntary)

21. Other Disorders of Infancy, Child or Adolescent – Separation Anxiety Disorder: the child becomes anxious when separated from parent or home. – Reactive Attachment Disorder of Infancy or early Childhood: beginning before age five. The child does not relate appropriately to others. – Selective Mutism: the child elect not to talk. – Stereotypic Movement Disorder: patient repeatedly rock, bang their heads, bite themselves, or pick at their own skin or body orifices

22. Other Disorders of Infancy, Child or Adolescent – Parent Child Relational Problem: A V- code (not a mental disorder, but a presenting problem) used when a parent and child have problems getting along. – Sibling Relational Problem: A V-code used for difficulties between siblings. – Problems Related to Abuse or Neglect: A V-code used to cover difficulties that arise from neglect or from physical or sexual abuse.

23. Disorders of Infancy, Childhood or Adolescence Not Otherwise Specified A catchall category for mental disorders that begin in early life and do not meet the criteria for any other disorder described above