Disorders Usually First Diagnosed in Infancy, Childhood, or Adolescence Cognitive Disorders - PowerPoint PPT Presentation

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Disorders Usually First Diagnosed in Infancy, Childhood, or Adolescence Cognitive Disorders

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Selective Mutism. Mental Retardation. Mild Mental Retardation (IQ ... Selective Mutism. Disorder of Infancy, Childhood, or Adolescence NOS. Autistic Disorder ... – PowerPoint PPT presentation

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Title: Disorders Usually First Diagnosed in Infancy, Childhood, or Adolescence Cognitive Disorders


1
Disorders Usually First Diagnosed in Infancy,
Childhood, or Adolescence/ Cognitive Disorders
2
Diagnosis 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

3
Decision 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

4
Beliefs and Reality
5
Bayesian 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
8
P(D/S) 7 / 7 70 .09
9
Core 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

10
Necessary 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

11
10 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

12
Groupings 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

13
Groupings 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

14
Groupings by Prominent Symptoms
  • Information Exchange
  • All Pervasive Developmental Disorders
  • All Communication Disorders
  • Selective Mutism

15
Mental 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)

16
Learning Disorders
  • Reading Disorder
  • Mathematics Disorder
  • Disorder of Written Expression
  • Learning Disorder NOS
  • Below expectations in academic areas
  • Not due to sensory problems
  • Video 10

17
Motor Function Disorders
  • Characterized by problems in motor coordination,
    abnormal involuntary movement, and stereotypic
    movements that interfere with the patients usual
    activities.

18
Major 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

19
Disruptive 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.

20
Attention-Deficit Disorders
  • ADHD
  • Predominantly Inattentive Type
  • Predominantly Hyperactive-Impulsive Type
  • Combined Type
  • Video 15, 18, 21

21
Disruptive Behavior Disorders
  • Conduct Disorder (violating rights of others or
    societal rules and norms)
  • Oppositional Defiant Disorder (negativistic,
    hostile, defiant behavior)
  • Disruptive Behavior Disorder NOS

22
Feeding 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)

23
Other 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)

24
Information 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

25
Autistic Disorder
  • Impairment in social interaction
  • Language delay/impairment
  • Restricted repetitive behavior and interests
  • Video 330
  • Aspergers differential dx by language

26
Making 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
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