psychiatric disorders in childhood and adolescence robert l. hendren, d.o. professor of psychiatry...
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PSYCHIATRIC DISORDERS PSYCHIATRIC DISORDERS IN CHILDHOOD AND IN CHILDHOOD AND
ADOLESCENCEADOLESCENCE
Robert L. Hendren, D.O.Professor of Psychiatry and
PediatricsUMDNJ-RWJMS
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Developmental Model of Psychopathology
2 4-5 6-7 12 14 21
0
Autism SchizoidReactiveAttachmentSeparationAnxiety
ODDConductDisorder
TourettesPDDMentalRetardationAnxiety
ODDADHDSeparationAnxietyOveranxious
ConductDisorder
EatingDisorderSchizophreniaDepression
EatingDisorderIdentityDisorder
6MOS
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Mental Retardation Retardation
• Mild (50-55 to 70)• Moderate (35-40 to 50-55)• Severe (20-25 to 35-40)• Profound (<20-25)
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Etiology Etiology Unknown 30-40%Genetic 5%Prenatal 30%Perinatal medical conditions
and complications -15%Environmental influences 15 -
20%
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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
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Autistic DisorderAutistic Disorder
•Reciprocal interaction
•Communication
•Stereotypes
•Brain changes
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Pervasive Developmental Pervasive Developmental DisordersDisorders
Asperger’s DisorderRett’s DisorderChildhood Disintegrative
DisorderPDD NOS
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Elimination DisordersElimination Disorders
Encopresis Enuresis
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Concept of Impulse Control Disorder
Common etiology
Diagnostic overlapCo-morbidity
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Attention Deficit Hyperactivity Attention Deficit Hyperactivity DisorderDisorder
Over vs. under diagnosis controversy
Subtypes include inattentive, impulsive/hyperactive and combined
Similar life cycle except hyperactivity and co-morbidity
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ADHD PrevalenceADHD Prevalence
•3 - 5% school-aged children•Boys more than girls, but may be under-diagnosed in girls
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ADHD Biologic EtiologyADHD Biologic EtiologyGenetic riskPrenatal stress and toxinsFrontal lobe, basal ganglia and RAS implicatedNorepinepherine - inattentionSerotonin - impulsivity
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ADHD Psychosocial ADHD Psychosocial EtiologyEtiology
Poor social relatednessPeer/Authority rejectionGoodness of fit
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ADHD AssessmentADHD Assessment
Context and developmentLife cycle issuesFamily issues
Rule out medical causes
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Rating Scales - ADHDRating Scales - ADHD
ConnorsAcTERSContinuous PerformanceWender Utah Rating Scale for
retrospective diagnosis
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Alternative Diagnoses
SchizophreniaPTSDBipolar Disorder
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ADHD Co-morbidityADHD Co-morbidity
DepressionTics and TourettesConduct DisorderSubstance Use DisorderLearning Disability
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ADHD OutcomeADHD Outcome
Normal 15%Continued Problems 50%Significant pathology 25%Substance abuse
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Conduct DisorderConduct DisorderRepetitive persistent pattern of
violation
Childhood vs. adolescent onset9% males; 2% femalesCo-morbidity
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CD - Biologic EtiologyCD - Biologic Etiology
Temperament
Genetics
Serotonin
•Developmental instability
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CD - Psychosocial CD - Psychosocial EtiologyEtiology
•Cognitive factors
•Family factors
•Peer group
•SES
•Culture
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“You left your goddam car in the driveway again!”
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Oppositional Defiant Oppositional Defiant DisorderDisorder
Recurrent pattern greater than 6 months
Evident by age 8Non-aggressive grow out
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Substance Use DisorderSubstance Use Disorder
Prevalence
Co-morbidity
Type I/Type II