1. IzBen C. Williams, MD, MPH Lecturer
BEHAVIORAL SCIENCE
IzBen C. Williams, MD, MPH
Lecturer

2. PSYCHIATRIC DISORDERS
Lecture # 11
PSYCHIATRIC DISORDERS
OF CHILDREN

3. Psychiatric Disorders in Children
Child and adolescent psychiatry is the study and treatment of the
mental,
developmental, and
behavioral problems of childhood
An understanding of standard childhood psychological development is essential to the understanding of childhood psychopathology

4. Psychiatric Disorders in Children
Childhood Psychopathology (an overview)
Most disorders are more common in boys
Psychopathology is usually the result of chronic, maladaptive interactions between child and environment, often combined with some genetic, physiologic, or temperamental propensity (bio-psycho-social influences) towards developing a mental illness
Misbehavior may be the result of the parents’ conscious or unconscious prompting

5. Psychiatric Disorders in Children
Feeding and eating disorders of infancy and childhood
Pica: persistent eating of non-food products
Rumination disorder: purposeful expulsion and re-chewing of previously ingested food
Failure to thrive: feeding disorder of infancy or early childhood

6. Psychiatric Disorders in Children
Pervasive developmental disorders of childhood (1)
Autistic spectrum disorders (autism disorder and Asperger disorder)
Rett disorder,
Childhood disintegrative disorder

7. Psychiatric Disorders in Children
Pervasive developmental disorders of childhood (2)
These disorders are characterized by failure to acquire, or the early loss of, social skills and difficulties with language resulting in lifelong problems in social and occupational functioning
They are not reversible

8. Psychiatric Disorders in Children
Autistic Disorder
Autistic disorder is an illness in which the child is:
Is relatively unresponsive to human beings
Demonstrates bizarre responses to his environment
Has unusual language development

9. Psychiatric Disorders in Children
Autistic Disorder
Characteristics include:
Severe problems with communication (despite normal hearing)
Significant problems with social relationships
Repetitive behavior (eg spinning, self-injury)
Subnormal intelligence in many (26% to 75%)
Unusual abilities in some children (savant skills)

10. Psychiatric Disorders in Children
Autistic Disorder
Autism is also a symptom of several disorders (eg schizophrenia)
As a symptom, autism refers to a preoccupation with the internal world of the individual to the exclusion of external reality
Autistic children treat other individuals indifferently, almost as though they were inanimate objects
Social development is invariably abnormal

11. Psychiatric Disorders in Children
Autistic Disorder characteristics:
Usually begins before age 3 yrs
Occurs in about 17 per 10,000 children
Five times more common in boys
Autism is also a symptom of several disorders (eg schizophrenia)
As a symptom autism refers to a preoccupation with the internal world of the individual to the exclusion of external reality

12. Psychiatric Disorders in Children
Asperger Disorder
Asperger disorder is a mild form of autism involving
Significant problems forming social relationships
Repetitive behavior and intense interest in obscure subjects
In contrast to autistic disorder, in Asperger’s there’s normal cognitive development and little or no developmental language delay but conversational language skills are impaired

13. Psychiatric Disorders in Children
Rett disorder
Clinical characteristics:
Diminished social, verbal, and cognitive development after up to four years of normal functioning
Occurrence only in girls (Rett disorder is X-linked and affected males die before birth)
Stereotyped hand wringing movements, ataxia
Mental retardation, breathing problems

14. Psychiatric Disorders in Children
Elimination Disorders
Enuresis: child continues to urinate at inappropriate times and places, past the time after which he should have ceased
May be primary or secondary
Etiology: Organic disorders, Psychological factors
Treatment:
Usually self limiting
Medication Tricyclic antidepressant imipramine
Treat any underlying stress

15. Psychiatric Disorders in Children
Elimination Disorders
Encopresis: Fecal incontinence past the period when bowel control should have been established.
Most encopresis is unconscious and involuntary; only occasionally does it occur deliberately.
May be primary of secondary

16. Psychiatric Disorders in Children
Elimination Disorders
Etiology of Encopresis:
Organic disorders
Psychological Factors
Unresolved anger at parent
Regressive wishes
Psychotic symptoms
When autonomy and control battles focus on toilet training……
Treatment: Appropriate to cause

17. Psychiatric Disorders in Children
Thumb sucking
More common in girls than boys
Is normal at traditional periods in child’s life (eg at bedtime, at times of separation from the parent)
If it persists after age 3yrs it can cause changes in dentition
Exploration of child’s relationship with parent is usually indicated.
In older child behavior modification may be useful (eg: where child is insecure or withdrawn)

18. Psychiatric Disorders in Children
Masturbation
Childhood masturbation involves general manipulation and fondling. Parents may complain
It is a universal behavior and not restricted to children (as is well known).
An open attitude by physician is important
Any notion that masturbation may cause growth retardation, mental retardation, or any other adverse physical consequences should be dispelled

19. Psychiatric Disorders in Children
Masturbation
Masturbation occurs in all children.
It can develop before age 1 year. During the oedipal period (3-6yys) there may be heightened genital focus.
Continuous masturbation may be a sign of severe under-stimulation (psychological), environmental deprivation, excessive sexual stimulation, or sexual abuse.

20. Psychiatric Disorders in Children
Tourette Disorder:
Clinical data. Tourette disorder consists of recurrent, involuntary, purposeless, motor movements accompanied by verbal tics. There may be coprolalia, involuntary swearing, barking and grunting).
Psychological stress exacerbates the symptoms, but the cause, although unknown, is probably organic
ADHD & OCD occur with increased frequency in these patients

21. Psychiatric Disorders in Children
Tourette Disorder
Epidemiology:
More common in boys,
Onset before age 21
Occurs in all socioeconomic classes
Treatment:
Psychotherapy
Education
Medical treatment

22. Psychiatric Disorders in Children
Attention Deficit Hyperactivity Disorder
Key symptoms of ADHD include:
A short attention span
Difficulty concentrating
Impulsivity
Distractibility
Excitability and
Hyperactivity

23. Psychiatric Disorders in Children
Attention Deficit Hyperactivity Disorder
Three types recognized:
ADHD predominantly inattentive
ADHD predominantly hyperactive –impulsive
ADHD combined
Seen more often in boys

24. Psychiatric Disorders in Children
Attention Deficit Hyperactivity Disorder
Etiology:
Medication eg: sedative hypnotics (paradoxical)
Depression. Sad feelings …..hyperactivity
Anxiety
Constitutional hyperactivity (from birth)
Intolerant parent, teacher or supervisor
Severe CNS disease
Specific learning disabilities….etc.

25. Psychiatric Disorders in Children
Attention Deficit Hyperactivity Disorder
Treatment:
Medication: stimulants, clonidine, antidepressants
Diet eg decrease sugar intake
Behavior modification programs
Environmental engineering

26. PROBLEMS OF ADOLESCENTS.
PROBLEMS OF ADOLESCENTS

27. Psychiatric Disorders in Children
Problems of adolescents
Identity Disturbances
Adult sexual development
Separation
Treatment

28. Psychiatric Disorders in Children
Problems of adolescents
Identity Disturbances
Adolescents struggle to achieve a stable identity. Certain problems result when this aspect of development breaks down.
Identity diffusion
Peer-related disorders
Problems with successfully resolving this developmental task my contribute to the development of identity disorder, narcissistic and borderline personality disorders

29. Psychiatric Disorders in Children
Problems of adolescents
Adult sexual development
Homosexual behaviors: found commonly in early adolescence. However, when they persist through early adulthood it usually represents true homosexual preference
Paraphilias: experiences of intense sexual arousal to atypical objects, situations, or individuals.
Pregnancy
Sexually transmitted diseases

30. Psychiatric Disorders in Children
Problems of adolescents
Separation: Adolescents negotiate their emancipation from family and redefine the parent-child and sibling roles and boundaries
Difficulty with emancipation
Schizophrenia
Anorexia
Depression
Mobilization of aggression (emancipation ritual)
Incestuosity (can develop to prevent emancipation)

31. Psychiatric Disorders in Children
Problems of adolescents
Treatment: Special problems in psychotherapy with adolescents
Labile allegiances good/bad from day to day
Labile moods hormonal and psyc turbulence
Communication difficulties (many adolescents communicate by means of their behavior)
Overprotective parents

32. Vignettes –Personality Disorders

33. Vignettes Psychiatric Disorders of children
Autism Spectrum Disorder
Tourette Disorder
ADHD

34. Vignettes Psychiatric Disorders of children
ADHD