PSYCHIATRIC DISORDERS IN CHILDHOOD AND ADOLESCENCE

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
6
MOS
0
Autism
Eating Disorder Identity Disorder
ODD Conduct Disorder
Eating Disorder Schizophrenia Depression
Schizoid Reactive Attachment Separation Anxiety
Tourettes PDD Mental Retardation Anxiety
ODD ADHD Separation Anxiety Overanxious
Conduct Disorder
3
Mental Retardation
Mild (50-55 to 70)
Moderate (35-40 to 50-55)
Severe (20-25 to 35-40)
Profound (lt20-25)
4
Etiology

• Unknown 30-40

• Genetic 5
• Prenatal 30
• Perinatal medical conditions and complications
  -15
• Environmental influences 15 -20

5
Learning, Motor Skills, Communication Disorders

• Reading disorder 7-9
• Mathematics disorder
• Disorder of Written Expression 2-8
• Developmental Coordination Disorder 6
• Expressive Language Disorder 3-10
• Mixed Receptive - Expressive Language Disorder
  3-10
• Phonological Disorder 5-10
• Stuttering

6
Autistic Disorder
Reciprocal interaction

• Communication

Stereotypes
Brain changes
7
Pervasive Developmental Disorders

• Aspergers Disorder

• Retts Disorder

• Childhood Disintegrative Disorder

• PDD NOS

8
Elimination Disorders

• Encopresis
• Enuresis

9
Concept of Impulse Control Disorder

• Common etiology

• Diagnostic overlap

• Co-morbidity

10
Attention Deficit Hyperactivity Disorder

• Over vs. under diagnosis controversy
• Subtypes include inattentive, impulsive/hyperactiv
  e and combined
• 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

• Genetic risk
• Prenatal stress and toxins
• Frontal lobe, basal ganglia and RAS implicated
• Norepinepherine - inattention
• Serotonin - impulsivity

13
ADHD Psychosocial Etiology

• Poor social relatedness
• Peer/Authority rejection
• Goodness of fit

14
ADHD Assessment

• Context and development

• Life cycle issues

• Family issues
• Rule out medical causes

15
Rating Scales - ADHD

• Connors
• AcTERS
• Continuous Performance
• Wender Utah Rating Scale for retrospective
  diagnosis

16
Alternative Diagnoses

• Schizophrenia
• PTSD
• Bipolar Disorder

17
ADHD Co-morbidity

• Depression
• Tics and Tourettes
• Conduct Disorder
• Substance Use Disorder
• Learning Disability

18
ADHD Outcome

• Normal 15
• Continued Problems 50
• Significant pathology 25
• Substance abuse

19
Conduct Disorder

• Repetitive persistent pattern of violation

• Childhood vs. adolescent onset

• 9 males 2 females

• Co-morbidity

20
CD - Biologic Etiology

• Temperament

• Genetics

• 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

• Recurrent pattern greater than 6 months

• Evident by age 8

• Non-aggressive grow out

24
Substance Use Disorder

• Prevalence

• Type I/Type II

• Co-morbidity