Bobby is always late turning in his assignments. He needs to be told things repeatedly and he has poor grades. His parents say that they have to sit next to him to help him complete his homework. What is your diagnosis? What are the criteria for this diagnosis?
ADHD: inattentiveness, impulsivity and hyperactivity for at least 6 months, before age 12 and affects child in 2 separate settings.
Combined symptoms of inattentiveness and impulsivity or stronger one way or the other
ADHD risk factors
Low birth weight, smoking and being male
Things to rule out when considering ADHD
Medications, thyroid disorder, malnutrition, abuse, environmental (lead), hunger, constipation etc.
Bipolar, oppositional defiant, conduct and learning disorders. Psychosocial considerations.
Environmental changes, Stimulants (DA agonists), behavioral changes
Why it is necessary to treat ADHD in childhood
30%, resolve by adulthood, 30% residual, 30% worsen.
Poor prognosis for ADHD
Early presentation, co-morbid conduct disorder and worsening symptoms in adolescence
12-year-old boy set fires at school, beat up the neighbors kid and killed the class pet. Nothing has changed despite 200 hours of community service. What is your diagnosis?
Conduct disorder: characterized by aggression, destruction of property, deceitfulness, theft and serious violation of rules before age 13. Kid must be < 18 years old and have 12 months of symptoms.
Types of conduct disorders
Childhood onset (1 criterion b/f age 10), Adolescent onset (no criterion b/f age 10) and Unspecified onset. They are also characterized as mild, moderate and severe.
Conduct disorder specifiers
Limited pro-social emotions: lack of remorse, calloused and unconcerned about others.
Conduct disorder prognosis
40% go on to antisocial personality, high co-morbidity with ADHD. Worse prognosis w/early onset and greater frequency of events.
Conduct disorder Tx
Psychotherapy and drugs (mood stabilizers, beta-blockers and neuroleptics)
Charlie is rude, disobedient and cheeky. He throws tantrums and breaks things when confronted. He swears at his teachers and has been suspended from school. What is your diagnosis?
Oppositional defiant disorder. Must be < 18 yrs old, with six months of angry mood, defiant behavior and vindictiveness
Etiologies of oppositional defiant disorder
Inconsistent parenting, family history
Tx of oppositional defiant disorder
Similar to conduct disorder
Tim makes noises like barking and clearing his throat. What is your diagnosis?
Tic Disorder (can be motor or vocal). This is characterized by rapid recurrent movements or vocalizations preceded by an urge to do the tic. Note that functional impairment is not required to make this diagnosis.
Criteria for Tourette’s disorder
Motor and vocal tic. Occurs many times a day. > 1 year duration without > 3 months tic free. Onset b/f 18 years old. Not due to other disorder (Huntington, postviral encephalitis, stimulants)
Transient tic disorders
4 weeks – 12 months.
Prognosis of Tourette’s disorder
1/3 recover by adolescence, 1/3 improve by adulthood, 1/3 stay the same or get worse
Psychoeducation, drugs if bad (alpha-1 agonists, neuroleptics are the drug of choice)
Kid poops on mom’s pillow all the time
Encopresis: > 4 years old passage of feces into inappropriate places for at least 3 months
Kid wets the bed all the time
Enuresis: 2x/week for 3 consecutive months older than 5 years old.
Tx for elimination disorders
“Bell” sleeping pad that rings whenever it gets wet. Encopresis is treated w/behavioral modification.
Kid is overly concerned about mom’s safety
Separation anxiety disorder
8 year old girl talks to friends and family, but refuses to talk at school
Risk factor that goes with separation anxiety disorder?
Future anxiety disorders
5-year-old kid doesn’t play with other kids. Likes to line up his toys methodically and only wears clothes with no tags, laces or belts. What is your diagnosis?
Autism Spectrum Disorder: deficits in social communication, restrictive repetitive behavior, early in development.
Autism spectrum disorder specifiers
With or w/o intellectual impairment. With or w/o language impairment. Genetic association. Other disorder association. With catatonia.
Autism spectrum disorder children with highest need
Typical age of presentation of autism spectrum disorder
Risk factors for autism
Advanced paternal age, family history and low birthweight
Autism spectrum disorder poor prognosis
Intellectual disability, additional mental health disorders and epilepsy. Language by age 5 is a good prognosis.
Common comorbidities w/autism spectrum disorder
Other psychiatric disorder, anxiety disorder, intellectual impairment, ADHD and depression
Autism disorder Tx
Speech pathologist, PT, behavioral therapy, sleep specialist and treat with drugs when kids are aggressive (neuroleptics)