2. بِسْمِ اللّهِ الرَّحْمـَنِ الرَّحِيمِ الْحَمْدُ للّهِ رَبِّ الْعَالَمِينَ الرَّحْمـنِ الرَّحِيمِ مَـالِكِ يَوْمِ الدِّينِ إِيَّاكَ نَعْبُدُ وإِيَّاكَ نَسْتَعِينُ اهدِنَــــا الصِّرَاطَ المُستَقِيمَ صِرَاطَ الَّذِينَ أَنعَمتَ عَلَيهِمْ غَيرِ المَغضُوبِ عَلَيهِمْ وَلاَ الضَّالِّينَ

3. Child Psychiatry The Basics Dr. M.Nasar Sayeed Khan 13-B, Aibak Block, garden town 03328440242 nasarsayeed@yahoo.com

6. Is Infant &Toddler Mental Health Really a Problem? Yes! Young children do experience problems in social emotional competency and even psychopathology We are better able to understand and measure these problems

7. Why we resist this… We are too worried about cognitive skills (“ready to learn”) Stigma associated with mental health issues Myth of childhood Our own discomfort with the idea

8. Prevalence Best estimates of serious behavior concerns in children 2 to 3 years fall between 10 to 15% Parent and pediatrician report behavior problems in 10% of 1 to 2 year olds

9. But won’t these problems go away? No! 37% of 18 mos with extreme behavior/emotional problems continue to have problems at 30 mos Over ½ of 2-3 with psychiatric d/o still have symptoms 2 years out

10. Long Term Effects Exposure to poor caregiving, abuse, or domestic violence can lead to developmental and mental health problems in young children Babies, toddlers, and preschoolers can demonstrate depression, PTSD, and disruptive behaviors

11. The Science of Early Childhood Development Babies brains are growing at a phenomenal rate The infant brain is “experience expectant” Both positive and negative experiences have significant and long lasting effects

12. The Science of Early Childhood Development Experience, especially social experiences, change the way the brain is shaped and functions Babies who experience or witness violence have behavioral and physiological changes

13. MH Challenges in Young Children Are real Involve a substantial number of babies Can be assessed and treated

15. Areas to Consider When Assessing Young Children Developmental Levels of Infant or Child Quality of Important Relationships Parent Status (Capacity for Relationship) Family Situations

16. Infant & Child Development A good working knowledge of typical development is needed when you assess young children You can’t tell what is atypical if you don’t know what is typical

17. Infant & Child Development Expected order of milestones is known Skills are traditionally divided into 5 areas There is much overlap between the areas Uneven development across areas is concerning

18. Infant & Child Development Ways to learn about development Have a great memory from college Get a child development text Watch some babies Review some developmental checklists online

19. Infant & Child Development Cognitive Receptive, Expressive, and Pragmatic Communication Fine & Gross Motor Social-emotional and behavior Adaptive Skills (Self Help)

20. Cognitive Skills Thinking Problem Solving Memory Attention Imitation

21. Communication Use of gestures and facial expressions Understanding speech Expressive language Social or pragmatic aspects of communication

22. Fine & Gross Motor Skills Use of hands and arms to manipulate objects Balance Strength and tone Walking, running, jumping

23. Social-emotional and behavior Eye contact Social smile Relationships/ attachment Regulation Sleep Feeding Aggression Compliance

24. Self-Help/Adaptive Eating Dressing Participation in grooming Toileting

25. Ways development can be atypical Global delays in development Inconsistent development Atypical, unusual behaviors—red flags

26. Red Flags in 6 Month Olds: Inability to Read Signals Persistent Sleep Problems Lack of Predictability Failure to Imitate Sounds and Gestures No Affect, Range of Feelings Lack of Stranger Anxiety (8 months)

27. Red Flags 12-18 Month Olds: No Words Persistent Sleep Problems Withdrawn Excessive Rocking Prolonged Fears No Separation Distress Immobile, Low Activity No Social Engagement Predominant Anger and Outbursts

28. Red Flags in 18 Months to 3 Year olds Eating Problems Non Speaking Extreme Shyness Lack Autonomy Failure in Gender Identification No Enjoyment in Play Poor Problem Solving Total Lack of Self Control Chaotic Behavior

29. Screening & Referral Screening methods tell you if the child needs further assessment in a given developmental area Many screening tools use caregiver report Do not use social-emotional screener for CPS population

30. Do’s and Don’ts Infants and Toddlers must be evaluated within the context of relationships with their primary caregivers Assessment should always include collaboration with parents and caregivers Multiple assessments over time are recommended Information from Multiple sources is recommended

31. Do’s and Don’ts Standardized Instruments May be used but not be the sole basis of the Evaluation Young Children Should Never be Challenged by Separation from Primary Caregivers Evaluation should utilize the DSM V

33. Etiology Brain damage Lead intoxication Family Divorce Death

34. Problems with preschoolers Bed wetting Over activity Difficulty in settling at night Fears Disobedience Attention Seeking Temper tantrums

35. Poor prognosis if persists beyond 3 and require intervention over-activity conduct disorder speech difficulty effeminacy autism

36. Pica Is the eating of items considered as inedible Common causes include: brain damage autism mental retardation emotional distress usually diminishes as the child grows

37. Hyperkinetic and Attention Deficit disorders Classification F90Hyperkinetic disorders F90.0Disturbance of activity and attention F90.1Hyperkinetic conduct disorder F90.8Other hyperkinetic disorders F90.9Hyperkinetic disorder, unspecified

38. Conduct and Oppositional disorders Classification Conduct disorder confined to the family Unsocial zed conduct disorder Socialized conduct disorder Oppositional defiant disorder Other conduct disorders Conduct disorder, unspecified

39. F84 Pervasive Developmental Disorders F84.0Childhood Autism (Kanner, 1943) Epidemiology prevalence of 2 per 10,000 M:F=3:1 Clinical features Kanner described four main features of autism: autistic aloneness delayed or abnormal speech an obsessive desire for sameness onset in the first two years of life

40. F93Emotional Disorders with specific onset in childhood Maternal overprotection (Levy, 1943) –excessive contact –prolongation of infantile care –prevention of independence –fathers were generally submissive –overprotected children had three times as many operations Separation Anxiety Disorder –onset is before the age of six –diagnosis is not made when there is a generalized disturbance of personality development

41. School refusal Clinical features: –there are often somatic symptoms - complaints occur on school days but not at other times –the final refusal may occur after several events: –following a period of increasing difficulty –after an enforced absence such as respiratory infection –after an event at school such as change of class –following a problem in the family such as illness of another family member Treatment –an early return to school is important (The Kennedy Approach) –discussion with teachers is needed –depressive disorder should be treated –it has been reported that antidepressants are effective for school refusal, even when there is no depression Prognosis

42. Elective Mutism The child refuses to speak in certain circumstances, although he does so normally in others usually, speech is normal in the home but lacking in school often associated with other negative behaviours such as refusing to sit down or play when invited to do so Epidemiology usually begins between 3 and 5 years, after normal speech has been acquired prevalence of approx. 1 in 1000 Treatment no evidence that treatment is effective Prognosis can persist for months or years a five- to ten-year follow-up showed that only 50% had improved

43. Stammering Disturbance of the rhythm and fluency of speech Epidemiology M:F = 4:1 affects about 1% of children Treatment speech therapy Prognosis most children improved whether treated or not

44. 43 Mujtaba Nasar