Monday, January 28, 2013

Disorders Usually First Diagnoses in Infancy, Childhood, or Adolescence


Mental Retardation (Now called Intellectual Disabilities) – must be proven with IQ testing and can be mild, moderate, severe, or profound dependent on the IQ level. Mild 50/55 to 70; Moderate 35/40- 50/55; Severe 20/25 to 35/40; Profound below 20 or 25. It may also be Severity Unspecified if ID is suspected but the person cannot be tested due to impairments.
Learning Disorders – can be diagnosed when a child fails to meet achievement levels or age, grade, and level of intelligence (those with ID or PDD would not be included). These disorders can include Reading Disorder, Mathematics Disorder, Disorder of Written Expression, & Learning Disorder, NOS.
Motor Skills Disorders
                Developmental Coordination D/o – only diagnosed if impairs academic achievement or daily functioning
Communication D/o’s – Expressive Language D/o, Mixed Receptive-Expressive Language Disorder, Phonological Disorder, Stuttering, & Communication Disorder, NOS
Pervasive Developmental Disorders (PDD) – severe and pervasive impairment in several of the following: reciprocal social interaction skills, communication skills, presence of stereotyped behavior, interests, activities
Autistic Disorder – probably the most diagnosed of PDD. The client must meet at least 6 of the following criteria before the age of 3 (with specific requirements each category):
Meet 2 impairment on social interactions:
                Impairment in use of multiple nonverbal bxs
                Failure to develop socially according to age
                Does not seek to share enjoyment, interests, or achievements with others
                Lacks social or emotional reciprocity
Meet one impairment in communication:
                Delay or lack of spoken language (w/o gestures)
                If they do have speech, impairment in initiation or sustaining conversation w/ others
                Stereotyped and repetitive use of language or personal language
                Lack of spontaneous fantasy play or imitation play (dependent on developmental level)
Meet 1 of repetitive and stereotyped patterns of bx, interests, and activities
                Encompasses preoccupation  with stereotyped and restricted patterns of interest and is abnormal in intensity or focus
                Refusal to disengage in adherence to specific and nonfunctional routines or rituals
                Stereotyped and repetitive motor mannerisms (hand flapping/twisting)
                Preoccupation with parts of objects
Differential diagnoses includes Rett’s d/o or Childhood Disintegrative D/o

Rett’s Disorder – deceleration of growth after normal prenatal development, normal dimensions upon birth, and motor development up to 5 months after birth

Childhood Disintegrative D/o – normal development for 2 years after birth, loss of previously acquired skills (before age 10), abnormal functions in social interactions, communication, and/or repetitive patterns

Asperger’s Disorder – impairments in social interactions, repetitive and stereotyped patterns but no cognitive delays or general delay in language.

PDD, NOS (includes atypical autism)

Attention-Deficit and Disruptive Behavior Disorders
Attention-Deficit/Hyperactivity Disorder (ADHD )– characterized by inability to pay attention. There are 3 subtypes:
ADHD, Combined Type -  meets 6 or more of both sets of symptoms
ADHD, Predominantly Inattentive Type – meets 6 or more of the inattention symptoms but fewer than 6 of the hyperactivity-impulsivity symptoms
ADHD, Predominantly Hyperactive-Impulsive Type – meets 6 or more of the hyperactivity-impulsivity symptoms but fewer than 6 of the inattention
Criteria of ADHD:
                Inattention:
                                Fails to pay attention to details (careless mistakes)
                                Difficulty keeping attention on tasks or play activities
                                Does not seem to listen when spoken to directly
                                Does not follow through on instructions and fails to finish tasks
                                Has difficulty organizing tasks and activities
                                Avoids, dislikes, or is reluctant to do tasks that require significant mental effort
                                Loses things for tasks and activities
                                Easily distracted by external stimulus
                                Forgetful in daily activities
                Hyperactivity-impulsivity:
                Hyperactivity:
                                Fidgets/squirms
                                Leaves seat in situations in which they should remain seated
                                Runs or climbs in situations it is inappropriate
                                Difficulty playing or engaging in leisure activities QUIETLY
                                On the go
                                Talks excessively
                Impulsivity:
                                Blurts out answers before hearing the entire question
                                Difficulty awaiting turn
                                Interrupts or intrudes on others
Treatment of ADHD:
-                Implement behavioral modification
o        Establish routine - visual
o        Increase parent’s praise and positive verbalizations
o        Teach how to give directions
§  Gain client’s attention
§  Make one request at a time
§  Clear away distractions
§  Repeat instructions
§  Obtain feedback from client
o        Identify rules and boundaries
o        Reward system and/or contract to reinforce client’s desired positive bx and deter impulsive bx
o        Identify positive reinforcers
o        Natural, logical consequences
-          Individual
o        Increase study skills
o        Teach test-taking strategies
o        Teach meditational and self control (stop, look, listen, think)
o        Teach problem solving skills
ADHD, NOS – age is after 7 years or don’t meet criteria but inattention is still present; bx might be more marked by sluggishness, daydreaming, and hypoactivity
Conduct Disorder -  behaviors typically fall into these areas: aggression to people and animals, destruction of property, deceitfulness or theft, serious violations of rules
Oppositional Defiant Disorder -  bx lasting at least 6 months: loses temper, argues with adults, actively defies or refuses to comply with requests/rules, deliberately annoys people, blames others for mistakes or misbehavior, touchy/easily annoyed with others, angry/resentful, spitreful/vindictive.
Disruptive Behavior Disorder, NOS
Feeding and Eating Disorders of Infancy or Early Childhood – Pica, Rumination Disorder, Feeding Disorder of Infancy or Early Childhood
Tic Disorders – Tourette’s Disorder, Chronic Motor or Vocal Tic Disorder, Transient Tic Disorder, Tic Disorder, NOS
Elimination Disorders – Encopresis (inability to retain poop and release in toilet), Enuresis (inability to retain urine and release in toilet)
Other Disorders of Infancy, Childhood, or Adolescence
Separation Anxiety Disorder – excessive anxiety w/ separation from home or attachment figures when separation is anticipated, fearful of losing attachment figures, event will separate self from attachment figures, reluctance to go to school or elsewhere, refusal to go to sleep or to sleep away from home, nightmares surrounding separations, somatic complaints during anticipation of seperation
Selective Mutism
Reactive Attachment Disorder of Infancy or Early Childhood – can be characterized by failure to initiate or respond to social interactions or excessive ‘familiarity’ with strangers (no boundaries). The care provided to these children showed disregard for child’s emotional needs, physical needs, or there were repeated changes of primary caregiver. RAD formulates that the care (or lack thereof) provided causes the behavior of child.
Stereotypic Movement Disorder
Disorder of Infancy, Childhood, or Adolescence, NOS


American Psychiatric Association. (2000). Diagnositc and Statistical Manual of Mental Disorders Text Revision, 4th ed. Jaypee Brothers Medical Publishers.

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