1. PSYCHIATRIC DISORDERS IN CHILDHOOD AND ADOLESCENCE Robert L. Hendren, D.O. Professor of Psychiatry and Pediatrics UMDNJ-RWJMS

2. Developmental Model of Psychopathology 2 4-5 6-7 12 14 21 0 Autism Schizoid Reactive Attachment Separation Anxiety ODD Conduct Disorder Tourettes PDD Mental Retardation Anxiety ODD ADHD Separation Anxiety Overanxious Conduct Disorder Eating Disorder Schizophrenia Depression Eating Disorder Identity Disorder 6 MOS

3. Retardation Mental Retardation Mild (50-55 to 70) Moderate (35-40 to 50-55) Severe (20-25 to 35-40) Profound (<20-25)

4. Etiology Etiology l Unknown 30-40% l Genetic 5% l Prenatal 30% l Perinatal medical conditions and complications -15% l Environmental influences 15 -20%

5. Learning, Motor Skills, Communication Disorders l Reading disorder 7-9% l Mathematics disorder l Disorder of Written Expression 2-8% l Developmental Coordination Disorder 6% l Expressive Language Disorder 3-10% l Mixed Receptive - Expressive Language Disorder 3-10% l Phonological Disorder 5-10% l Stuttering

6. Autistic Disorder Reciprocal interaction Communication Stereotypes Brain changes

7. Pervasive Developmental Disorders l Asperger’s Disorder l Rett’s Disorder l Childhood Disintegrative Disorder l PDD NOS

8. Elimination Disorders l Encopresis l Enuresis

9. Concept of Impulse Control Disorder l Common etiology l Diagnostic overlap l Co-morbidity

10. Attention Deficit Hyperactivity Disorder l Over vs. under diagnosis controversy l Subtypes include inattentive, impulsive/hyperactive and combined l Similar life cycle except hyperactivity and co-morbidity

11. ADHD Prevalence 3 - 5% school-aged children Boys more than girls, but may be under-diagnosed in girls

12. ADHD Biologic Etiology l Genetic risk l Prenatal stress and toxins l Frontal lobe, basal ganglia and RAS implicated l Norepinepherine - inattention l Serotonin - impulsivity

13. ADHD Psychosocial Etiology l Poor social relatedness l Peer/Authority rejection l Goodness of fit

14. ADHD Assessment l Context and development l Life cycle issues l Family issues l Rule out medical causes

15. Rating Scales - ADHD l Connors l AcTERS l Continuous Performance l Wender Utah Rating Scale for retrospective diagnosis

16. Alternative Diagnoses Schizophrenia l PTSD l Bipolar Disorder

17. ADHD Co-morbidity l Depression l Tics and Tourettes l Conduct Disorder l Substance Use Disorder l Learning Disability

18. ADHD Outcome l Normal 15% l Continued Problems 50% l Significant pathology 25% l Substance abuse

19. Conduct Disorder l Repetitive persistent pattern of violation l Childhood vs. adolescent onset l 9% males; 2% females l Co-morbidity

20. CD - Biologic Etiology l Temperament l Genetics l Serotonin Developmental instability

21. CD - Psychosocial Etiology Cognitive factors Family factors Peer group SES Culture

22. “You left your goddam car in the driveway again!”

23. Oppositional Defiant Disorder l Recurrent pattern greater than 6 months l Evident by age 8 l Non-aggressive grow out

24. Substance Use Disorder l Prevalence l Co-morbidity l Type I/Type II