psychiatric disorders in childhood & adolescence
Conduct Disorder (CD)
-most frequent reason for psychiatric hospital admins for children & teens -CD develops as a result of biological risk & childhood experiences, so there are opportunities fr early intervention -treatment includes family therapy, behavioral management training, social skill group, teaching problem solving skills
predominantly hyperactive/impulse presentation( ADHD)
diagnosed if >6 symptoms of hyperactivity/ impulsivity ( but <6 symptoms of inattention) have been presented for >6 months
predominantly inattentive presentation ( ADHD)
diagnosed if >6 symptoms of inattention ( but <6 symptoms of hyperactivity/impulviity) have persisted of >6 months
bipolar medications
only 4 meds currently approved for kids -risperidone( 10-17 yrs) -lithium( >12) -aripoprazole( 11-17yrs) -olanzapine( 13-17 yrs) -mostly treated w/ off label mood stabilizing meds
types of bullying
-being subject of rumors & lies( 13.4%) -being made fun of, called names, o insulted( 13%) -pushed, shoved, tripped, or spit on ( 5.3%) -leaving out/ exclusion( 5.2%) -threatened w/ harm(3.9%) -pushing to do thing they don't want to do( 1.9%) -property was destroyed on purpose( 1.4%)
recognizing tics
-brief clonic movements or eyes, face, neck, shoulders -common: eye blinking, facial grimacing, head jerking -vocal tics involve throat clearing, grunting, barking -can be brief or complex
Treatment for ADHD( psychoeducational interventions)
-cognitive behavioral therapy ( improves impulse control) -class room strategies & modifications -parent education & empowerment
major depression treatment
-cognitive therapy -interpersonal therapy -group therapy -family therapy -medication if needed
possible causes of bullying
-cold & uninvolved parents -overly permissive parents -some bullies parents often don't know what their children are doing -some bullies parents may have physically or emotionally punitive -may be victims or neglect &/ or abuse -may have family background w/ substance abuse, psychiatric disorder & /or incarceration
when is therapy needed for bullying?
-depression -suidice/ homicide -anxiety -acting out( anger, aggression; preoccupation w/ violence) -drug use -cutting -eating problems
modd disorder
-depression frequency varies w/ age & gender preschool (0.3%) prepubertal children(0.4-3%) teens(0.4-6.4) - rates in males & females are equal util adolescence when females outnumber males 2-3:1
separation anxiety criteria
-developmentally inappropriate, excessive worry concerning separation from the whom person is attached -duration of disturbance is at least 4 weeks onset before age 18 yrs disturbance causes clinical distress or impairment in social, academic or other important areas of functioning
Other meds of ADHD stimulants
-dextroamphetamine sulfate( DEXEDRINE or DEXTROSTAT) -dextroamphetamine/amphetamine formulation ( Aderall) -methyphenidate( CONCERTA, DAYTRANA) -atomosetine( STRATTERA marked as non stimulant even though S/E & MOA are )
generalized anxiety disorder
-excessive anxiety/ worry that's hard to control -anxiety/ worry last AT LEAST 6 MONTHS & creates impairment in functioning -accompanied by at least 1 of these: restlessness, fatigue, difficulty , concentrating, irritability, muscle tension, sleep disturbance -mean onset b/w 10-13 years old -worry themes: academics, natural disasters, social life, physical assault
major depression criteria
-fatigues/loss of energy -feelings of worthlessness or guilt -inability to concentrate; indecisiveness -recurrent thoughts of death( not just fear of dying), suicidal ideation w/o specific plan or suicide attempt or specific plan -symptoms cause distress or impairment -symptoms don't meet criteria for bipolar mixed episode -symptoms not better accounted for by bereavement( >2 months after loss)
bystader
-being a bystander can itself cause mental health problems -bystanders having increased fears of being bullied, more nervousness & worry -bystanders may have a drop in attendance too
mild conduct disorder
-few if any conduct problems in excess of those required for diagnosis conduct problems cause relatively minor harm to others ( ex lying, truancy, staying out after dark, rule breaking)
MILD severity level DSM 5 for neurodivergent children
-few if any symptoms in excess of those required to make the diagnosis are present & symptoms result in no more than MINOR impairments in social or occupational functioning
non tics include
-habits like hair twisting, skin picking( these are not tics) -compulsions are NOT tics -allergic throat cleaning & sniffing ARE NOT TICS
sources of resilience
-high intelligence -even temperament -physical attractiveness -special skills & abilities -commitment of caretaker to child's well being & development -string social support for family & caretaker
major depression symptoms
-symptoms that decrease w/ age but seen in children somatic complaints( her, stomach, muscle aches) behavioral problems guilt, irritability hallucinations symptoms that increase w/ age: sleep/appetite changes fatigue anhedonia psychomotor retardation hopelessness delusions Symptoms that consist across age groups: depressed mood impaired concentration suicidal ideation
moderate conduct disorder
-the # of conduct problems & the effect on others intermediate n/w those specified as mild & severe ( ex, stealing w/o confronting victim, vandalism)
externalizing disorders ( type of child & teen mental health problems)
-attention deficit hyperactivity disorder (adhd) -conduct disorder
disorders of social interaction ( type of child & teen mental health problems)
-autism -aspergers syndrom
Major depression diagnostic criteria
- at least 5 of 9 symptoms for 2 week period casing a change in previous functioning - at least one symptom must be depressed mood ( irritable in children) or loss of interest or pleasure in usual activities -diminished interest or pleasure in most activities -weight gain/loss in children, failure to make expected weight gain -insomnia or hypersomnie nearly every day -psychomotor agitation or retardation nearly every day, observable by others
Attention deficit hyperactivity disorder (ADHD)
-3-6% of population -onset before age 7 -problems w/ concentration, activity level & organization -concerns at home, school & w/ peers -treatment includes stimulants educational support parental supervision consistency
suicide
-4th leading cause of death in children age 10-15 -3rd leading cause of death among adolescents & young adults aged 15-25 -rates of suicide attempts are 3 times higher than females -rates complete suicided are 5 times higher in males
internalizing disorders( type of child & teen mental health problems)
-anxiety disorders -depression -trauma responses
other types of children & teen mental health problems
-appetite disorders -eating disorders -substance abuse -self harming behavior -mental retardation -learning disability -early onset major mental illness -schizophrenia -bipolar disorder
psychological effects of bullying
-appetite problems -sleep problems -decreased concentration -achievement problems -school attendance issues -extreme cosequence: homicide
bullies
-are interpersonal terrorist -violate the right of other -may have issues w/ anger & relationships -may have trouble with empathy -may have an intolerance for difference
pediatric autoimmune neuropsychiatric disorders associated w/ group A streptococcus ( PANDAS)
-infection may precipitate abrupt tics, compulsions, emotional liability, episodic & reoccurant -if clinically indicated obtain step culture, ASO. titers & anti-DNAase B. If conformed penicillin can help w tics -TREATMENT educate family, patient, school personel pharmacology therapy - clonidine & guanfacine -resperidone -nicotine patched -start slow & go slow
severe conduct disorder
-many conduct problems in excess of those required to make diagnosis are present, -conduct problems cause considerable harm to other( forced sex, physical cruelty, use of weapon, stealing while confronting victim, breaking & entering)
SEVERE severity level DSM 5 for neurodivergent children
-may symptoms in excess of those required to make the diagnosis, or severe symptoms that are particularly severe, are present; or the symptoms result in marked impairment in social or occupational functioning
major depression treatment
-meds reserved for moderate to severe depression -weigh irsk & benefits of med & monitor for sucidality( q wk 4x, then q 2 wks x4, then q 3 months if stable) ESCITALOPRAM Is approves for treatmentt of depression in 12-17 year olds FLUOXETINE is only FDA approved antidepressant , down to age 8
bipolar disorder
-mood instability -temper tantrums -impulsivity -subtle depressive symptoms -can be difficult to treat BPD should be suspected when child does not respond to stimulants ( ADHD) OR antidepressants ( depression)
separation anxiety disorder
-most common anxiety disorder of childhood -most commonly occurs age 7 or 8 but may occur in teens -psychosocial theory is that angry feeling towards parents displaced, so environment is perceived as threatening
Tourette's disorder
-multiple motor & one or more vocal tics lasting more than 1 years, many ties a day, nearly every day w/o tic free period -onset before 18 ; peak onset age 5 -8 year severity peaks 9-11 years w/ improvement or even resolution during puberty resilient tics do occur -chronic tic disorder in 1-2% w/ 3:1 of boys: girls -tourrette not very common
anxiety disorders in children
-occur in 13% of children & teen -Etiology: Genetic( high heritability), environmental( rejection, assault), temperament( shy, inhibited) -excessive worry interfering w/ functioning -OCD most common -worry alleviated w/ rigid & time consuming compulsions, counting, washing & checking -social anxiety in teens is very troubling w/ social relationships & self esteem -treatment very effective
co morbidity of Tourette's disorder
-ocd -depression -anxiety -ADHD -impulsivity
unique characteristics of child mental health problems
-often represent gene-environmental interactions -symptoms of disorder often worse than disorder -impact development & overall skill acquisition -affect & are affected by family relationships & family behavior -early recognition & early effective treatment significantly reduce mortality & morbidity -sources of resilience & risk strongly influence the occurrence & course of child & adolescent mental health problems
conduct disorder childhood
-onset before age 10 -oppositional defiant disordering pre-school years develop into serious conduct disorder by teen years -2-3x likelihood of becoming juvenile offenders -adolescent onset ( no symptoms before age 10) behaved normally until middle school then symptoms become more prevent has more favorable prognosis: more likely to respond to treatment
seperation enxiety criteria continued
-persistent/ excessive fearful or reluctance to be alone w/o attachment figure -reluctance/ refusal to got to sleep w/o attachment figure being home -repeated nightmares involving theme of separation -repeated physical symptoms: HA, stomachache, N/V) when separated from attachment figure -excessive fear/disrtess when separated form home or attachment figure -doesnt want to go anywhere like school b/c of fear of separation
anxiety symptoms
-physical: HA, stomachache, dramatic pain -difficulty falling asleep; nighttime awakening -overeating when mild; under-eating when severe -avoiding outside activities or social gatherings -poor school performance -INATTENTION; BEING DISTRACTED -excessive need for reasurrance
sources of risk
-poverty -recent move or immigration -marked marital or post separation conflict -family violence, abuse or neglect -community disruption -poor resource availability
major depression etiology
-psychosocial/life stressors -organis etiologies/ infections,meds, endocrine disorders, neurological disorders -lifetime risk of depression in children of depressed parents 15-45% Outcomes include -2/3 recover w/in year -reoccurant rate 70% in 5 years -prepubertal: 30% become bipolar -adolescents: 20% become bipolar -increased risk for depression as adults
OCD
-recurrent, time consuming obsession or compulsion that causes distress/impairment -sy,mptoms usually begin in childhood or teens years -high degree of genetic etiology -first line treatment is cognitive behavioral therapy -med includes SERTRALINE ( age 6+), FLUVOXAMINE ( age 8+), -MUST MONITOR DRUG INTERACTION
what is conduct disorder ( CD)
-repetitive behavior that violate the rights of others &/or societal laws w/ 3 or more of following in past 12 months w/ one in last 6 months aggression/ cruelty to ppl or animals destruction of property theft running away cruelty to animals often an early symptom can persist & develop into antisocial personality & lifelong criminality
depression
-risk for social behavior school failure poor relationship & occupational outcome -treatmetn: combination of psychotherapy & SSRI mediation -major issue: early detection appropriate treatment
PTSD
-significant trauma through abuse, neglect, illness, accident, other -symptoms include: arousal changes, avoidance, reexperincing -can be persistent & seriously disabling -complicated by depression, substance abuse, risk taking behavior psychotherapy highly effective especially if started early
SOCIAL PHOBIAS
-social phobias involves fera of embarrasser in social interactions, during performances, speaking inferno too group, starting conversations, or eating in public -social phobias more common in adults but can occur in children or teens & may interfere w/ school functioning -could also be mood disorder
mental health treatment options for children & adolescents
-special ed programs -treatment programs -inpatient residential -day treatment -detention -group homes -probation -individual psychotherapy -psychopharmacology -mentoring programs -police w/ special training
Autism and Asperger's Syndrome
-spectrum of poor socializing ability -generally require educational/ behavioral program -may required medication for anxiety, aggressiveness or hyperactivity -prognosis depends on language development & intellectual capacity
Treatment for ADHD pharmacological STIMULANTS FIRST LINE
-stimulants first line Methylphenidates( Ritalin, Ritalin SR, Ritalin LA) 0,3-1mg/kg/day Amphetamines 0.15-0.5 mg/kg/day common S/E: appetite loss, sleep disturbance, change in pulse /BP, dysphoria, irritability, precipitation or exacerbation of tics
MODERATE severity level DSM 5 for neurodivergent children
-symptoms or functional impairment b/w 'mild & 'severe' are present
ADHD criteria
-symptoms present for 6 MONTHS to a degree that is maladaptive/ inconsistent w/ the developmental level of the child -clear evidence of clinically significant impairment present in 2 more more settings negatively impacts directly on social & academic/occupational activities -symptoms don't occur exclusively during course of schizophrenia or other psychotic disorder & are not better explainer by another mental disorder ( ex mood disorder, anxiety disorder, dissociative disorder, personality disorder, substance intoxication or withdrawal) -ONSET OF IMPAIRMENT MUST BE BEFORE AGE 7, EVEN IF IT WAS OT DIAGNOSED UNTIL LATER
ADHD( hyperactive impulse symptoms)
MUST HAVE 6 OF 9 SYMPTOMS Runs about or is restless Unable to wait his/her turn Not able to play quietly On the go Fidgets w/ hands or feet Blurts out answers Staying seated is difficult Tends to interrupt
combined presentation( ADHD)
All 3 core features are present & ADHD is diagnosed when >6 symptoms of hyperactivity/impulsivity & >6 symptoms of inattention have been observed for >6 months
bipolar vs disruptive mood deregulation disorder
BIPOLAR -young as age 6 -ADHD med can trigger mania in bipolar kids -mani: hear voices & have hallucinations -depression: physical symptoms -cycles quicker than adults DMDD -AGE 6-18 -irritable/angry mood most of day , almost everyday -severe temper tantrums ( verbal/behavioral) at average 3 or more times a week) -trouble functioning due to irritability in more than one place( home, school, w/ peers)
ADHD( inattention symptoms)
MUST HAVE 6 OF 9 SYMPTOMS -Carless mistakes -Attention difficulty -Listening problem -Loses things -Fails to finish things -Organizational skills lacking -Reluctance in tasks requiring sustained mental effort -Forgetful in routine activities -Easily Distracted
ADHD co morbid conditions
children w/ ADHD often have other psychiatric disorder, w/ comorbidity rates b/w 50-90% most common: Oppositional defiant disorder(ODD) , Conduct disorder( CD)
