Title: Disorders Usually First Diagnosed in Infancy, Childhood, or Adolescence Cognitive Disorders
1Disorders Usually First Diagnosed in Infancy,
Childhood, or Adolescence/ Cognitive Disorders
2Diagnosis and Decision Making
- Importance of evidence based decision making
- In making a diagnostic decision
- How do you know if your correct?
- What the clinician believes vs. What is
true/accurate - Research on clinical decision making
3Decision Making
- Decision Making
- False Positives say it is, but it isnt (Type I
error) - False Negatives say it isnt, but it is (Type II
error) - True Positives say it is, and it is (Hit)
- True Negatives say it isnt, and it isnt (Hit)
- Symptom
- Sensitivity symptom-disorder correlation
- Specificity symptom discrimination from other
disorders, uniqueness
4Beliefs and Reality
5Bayesian Decision Making
- Methodology to combine what is discovered
- Modify prior beliefs based on new information
- Mathematical optimal approach to combine prior
information (base rates) with criteria
sensitivity (empirical liklihood) - Bayes Theorem
Base Rate
Liklihood
Probability of having Disorder, given observed
symptom
6(No Transcript)
7- Suppose a client was being evaluated for
depression, which occurs in about 8 of 1000
people in the population. You select a test that
is 90 accurate in detecting depression (Full
DSM-IV criteria). Your client meets all criteria.
What is the probability the person has
depression? - 90 or greater
- 70
- 50
- Less than 50
Answer 9
8P(D/S) 7 / 7 70 .09
9Core Concepts of the Diagnostic Group
- Primarily categorized by time of onset rather
than phenomenology. - Predominantly disorders of abnormal development
and maturation. - Emphasis on inability to attain certain normal
developmental milestones - Common for individuals to have comorbid disorders
10Necessary Clinical Information
- Times of developmental milestones (i.e., talking,
walking) - Capacity to communicate with other people
- Language impairment (expressive, receptive, and
articulation). - Capacity for human relationships
- Quality of social interaction
- Abnormal motor movements (e.g., tics, clumsiness)
- Hyperactivity, inattention, or poor impulse
control - Abnormal behaviors (e.g., fire setting, animal
cruelty) - Enuresis or encopresis
1110 Subgroups of Diagnoses
- Mental Retardation
- Learning Disorders
- Motor Skills Disorders
- Communication Disorders
- Pervasive Developmental Disorders
- Attention-Deficit Disorders and Disruptive
Behavior Disorders
- Feeding and Eating Disorders of Infancy and Early
Childhood - Tic Disorders
- Elimination Disorders
- Other Disorders of Infancy, Childhood, or
Adolescence
12Groupings by Prominent Symptoms
- DISORDER GROUPS
- Intellectual and Cognitive Impairment
- Motor Function Impairment
- DIAGNOSES
- All Mental Retardation and Learning Disorders
- All Motor Disorders, Tic Disorder Subcategories,
Sterotypic Movement Disorder
13Groupings by Prominent Symptoms
- All Attention-Deficit
- Disorders and Disruptive
- Behavior
- All Feeding and Eating
- Disorders of Childhood
- All Elimination Disorders
- Separation Anxiety Disorder
- Reactive Attachment
- Disorder of Childhood
- Disruptive or Self-Injurious Behavior
14Groupings by Prominent Symptoms
- All Pervasive Developmental Disorders
- All Communication Disorders
- Selective Mutism
15Mental Retardation
- Mild Mental Retardation (IQ 50 - 70)
- Moderate Mental Retardation (IQ 35 - 55)
- Severe Mental Retardation (IQ 20 -3 5)
- Profound Mental Retardation (IQ below 20)
- Mental Retardation, Severity Unspecified
(untestable by standard tests) - Adaptive behavior
- Listed on Axis II (all other childhood Axis I)
16Learning Disorders
- Reading Disorder
- Mathematics Disorder
- Disorder of Written Expression
- Learning Disorder NOS
- Below expectations in academic areas
- Not due to sensory problems
- Video 10
17Motor Function Disorders
- Characterized by problems in motor coordination,
abnormal involuntary movement, and stereotypic
movements that interfere with the patients usual
activities.
18Major Function Disorders
- Developmental Coordination Disorder (impairment
in motor coordination) - Tourettes Disorder (multiple motor and vocal
tics) - Chronic Motor or Vocal Tic Disorder (either motor
or vocal tics but not both) - Transient Tic Disorder (at least 4 weeks less
than 12 months) - Tic Disorder NOS
19Disruptive and Self-Injurious Behavior Disorders
(ADHD, CD, ODD)
- Characterized by behaviors that are socially
unacceptable or potentially harmful to the
individual. These include hyperactive,
impulsive, inattentive, oppositional, defiant,
and disruptive behavior as well as
abnormalities of eating and elimination.
20Attention-Deficit Disorders
- ADHD
- Predominantly Inattentive Type
- Predominantly Hyperactive-Impulsive Type
- Combined Type
- Video 15, 18, 21
21Disruptive Behavior Disorders
- Conduct Disorder (violating rights of others or
societal rules and norms) - Oppositional Defiant Disorder (negativistic,
hostile, defiant behavior) - Disruptive Behavior Disorder NOS
22Feeding and Eating Disorders of Infancy or Early
Childhood
- Pica (eating nonnutritive substances)
- Rumination Disorder (regurgitate and rechew food)
- Feeding Disorder of Infancy or Early Childhood
(not eating adequately) - Encopresis (inappropriately passing feces - gt 4
years old) - Enuresis (urinating in bed or clothes - gt 5 years
old)
23Other Disorders
- Separation Anxiety Disorder (excessive anxiety
about separation) - Reactive Attachment Disorder
- Pathological care
- Inhibited type
- hypervigilant, or ambivalent and contradictory
responses to social interactions - Disinhibited type
- diffuse, indiscriminate attachments to other
people)
24Information Exchange Disorders
- Autistic Disorder
- Retts Disorder
- Childhood Disintegrative Disorder
- Aspergers Disorder
- Pervasive Developmental Disorder NOS
- Expressive Language Disorder
- Mixed Receptive-Expressive Language Disorder
- Phonological Disorder
- Stuttering
- Communication Disorder NOS
- Selective Mutism
- Disorder of Infancy, Childhood, or Adolescence NOS
25Autistic Disorder
- Impairment in social interaction
- Language delay/impairment
- Restricted repetitive behavior and interests
- Video 330
- Aspergers differential dx by language
26Making a Diagnosis
- Is the childs predominant symptom an impairment
of learning or intellectual functioning? - Is the childs predominant symptom abnormal motor
activity? - Is the childs predominant symptom socially
inappropriate or self-injurious behavior? - Is the childs predominant symptom an impairment
in the ability to communicate or exchange
meaningful information with other people?
27- Joey is a 14-year-old boy with an IQ of __who has
had academic difficulty in school and is
currently reading and writing at a fifth-grade
level. He has also had some difficulty making
friends and fitting in with his peer group. Over
the last 2 months Joey has become unusually
irritable and his school work has begun to
deteriorate. He has difficulty sleeping, has
little appetite, and no longer enjoys playing
ball or sharing other activities with his father.
Recently, his younger sister started teasing him
at the dinner table saying, "Joey's in love,
Joey's in love." Joey exploded and began
screaming, "You think I'm just dumb and no one
likes me!" and ran out of the room. A few minutes
later his mother tried to talk with him. In
response to her repeated questions Joey replied,
"Everyone knows. I' m dumb. None of the girls
talk with me like they do with the other guys.
I'm not worth .anything. I wish I was dead." His
mother became alarmed and called Joey's
therapist. What is Joey's diagnosis(es)?
Key symptoms other info
IQ61
DX Mild MR depressive disorder single episode
28- A 7-year-old' boy -with a mild to moderate speech
deficit was tested and found to have an IQ of 57
A subsequent examination demonstrated that he
.has a moderate .hearing impairment. What is the
best diagnosis for the patient?
IQ cannot be adequately determined in the
presence of a sensory deficit such as deafness
unless compensation is made.-for the' deficit
Mental Retardation cannot be made under these
circumstances
29- Steven is a 13-year-old boy who is known as a
chronic bully in his neighborhood. He delights in
fighting with .other adolescents and hurting
them. He continually defies his parents and
refuses to follow school rules. Steve has been
suspended from school twice in the past for
fighting and hurting another student. When Steve
wants something he can be exceedingly charming
until he gets it. He compulsively lies to friends
and parents. What is his diagnosis(es)?
Ho Oppositional Defiant Disorder .and 'Conduct
'Disorder
Key repeated violations of the rights of other
people
DX Conduct Disorder would take precedence over
ODD