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2. CHILDHOOD
PSYCHIATRIC
DISORDERS
Dr. Rebwar Ghareeb Hama
Psychiatrist
University of Sulaimani
School of Medicine
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3. Classification
1. Learning Disorders
2. Motor Skills Disorders
3. Communication Disorders
4. Pervasive Developmental Disorders
5. Attention Deficit Hyperactivity Disorders
6. Disruptive Behavior Disorders
7. Feeding & Eating Disorders
8. Tic Disorders
9. Elimination Disorders
10. Other Disorders: like separation anxiety
disorder, elective mutism ,etc…
11. Mood Disorders
12. Substance Abuse
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4.  Must be familiar with normal development and
remember what is normal for one age may be a
problem for another
◦ Example: Tantrum Behavior
 2 year old ~ normal and expected behavior
 12 year old ~ not expected within normal development
 Confidentiality directly related to age of
child/adolescent
◦ Young child ~ all information shared with caretaker
◦ Adolescent ~ try to establish privacy agreement between
caretaker and adolescent with understanding of what
must be shared (significant danger to self and/or others,
abuse)
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5. Motor Skills Disorders
 This is also called developmental
coordination disorders
 Its essential characteristic is a marked
impairment in the development of motor
coordination
 It is characterized by imprecise or clumsy
gross motor skill
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6. Communication Disorders
 This category includes disorders of speech & language
 They include:
1. Expressive language disorder:
the child skills in vocabulary ,the use of correct sentences ,the
production of complex sentences & the recall of words are
below the expected level for his or her age & intelligence
2 . Mixed receptive –expressive language disorder:
child is impaired in both understanding and expressing language
3 . Phonological disorder:
it is manifested by inappropriate or poor sound production
4 . Stuttering or Stammering:
disturbance in the fluency and time patterning of speech that is
inappropriate for the patient’s age
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7. Pervasive developmental disorders
 These disorders are severe ,pervasive
impairment in developmental areas ,such as
social interaction & communication ,or
stereotyped behavior ,interests and activities
 The impairments are deviant in comparison
to a person’s mental or developmental level
 These disorders include:
7. Autistic disorder
8. Rett’s disorder
9. Childhood disintegrative disorder
10. Asperger’s disorder
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8. Autistic disorder
 Sometimes called “childhood autism,
early infantile autism, Kanner’s
autism”
 Prevalence is 0.02-0.05 %
 In most cases it starts before the age of
36 months( 3 years)
 It is more frequent in boys
 The etiology of autistic disorder is not
clear but there is more reliance on 8

9. Clinical features
2. Impairment in social interaction: lacking social smile, fail to
show the usual relatedness to their parents and other
people, abnormal eye contact, …
4. Disturbance of communication &language
6. Stereotyped behavior :the activities &play are rigid
,repetitive & monotonous. Ritualistic and compulsive
phenomena are common
8. Unstability of mood
10. Abnormal response to sensory stimuli( either exaggerated
or decreased)
12. Other behavioral symptoms hyperkinesis or
hypokinesis ,aggressive behavior ,temper tantrums, self
injurious behavior
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10.  Prognosis is generally unfavorable
 The patient needs a complicated care
which include:
4. Educational therapy
6. Behavioral therapy
8. Pharmacotherapy: no specific therapy is
available. It can be only symptomatic
like anti-obsessive, antipsychotic and
antiepileptic 10

11. In the absence of specific treatment,
management has 6 main aspects:
 Management of abnormal behavior
 Education and social services
 Speech and language therapy ,occupational
therapy, dietary advice…
 Treat medical conditions (e.g. epilepsy ,GIT
problems)
 Help for families
 Pharmacotherapy :symptom management
(e.g. antipsychotic for stereotypes ),SSRI for
compulsive and self harming behaviors and
depression, and anxiety
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12. (Aspergers Syndrome( AS
A syndrome first described by Hans Asperger’s in 1944
,and sometimes called autistic psychopath ,is
characterized by:-
 The child develops normally until about the third year
when they begin to lack warmth in relationships, and
speak in monotonous stilted ways
 Severe persistent impairment in social interactions
,repetitive behavior patterns, and restricted interests
 IQ and language are normal or in some cases, superior
 Motor mannerisms such as hand and finger twisting, or
whole body movements
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13.  They are often clumsy and eccentric
 They are more interested in others than
autistic children
 The disorder is more common in boys than
girls
 A family history of autism may be present
 The cause of AS is unknown
 It differ from autism in that there is no general
delay or retardation of cognitive development
or language
 They are solitary, and embark on and spend
much time in narrow interests
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14. (Attention Deficit / Hyperactivity Disorder (ADHD
 This disorder is common ,appears more often in boys
than in girls and causes disruption in school and at
home
 It is characterized by:
4. Features of hyperactivity: age-inappropriate
hyperactivity which is mostly purposeless & intolerable
causing a lot of disturbance
5. Poor attention span
6. Impulsivity
 These symptoms should be present for at least 6
months before the diagnosis is made
 The symptoms should be present in more than one
setting ( home, school, work)
 And should be severe enough to cause significant
impairment
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15. 3%-7% of children suffer from ADHD
ADHD is diagnosed approximately three
times more often in boys than in girls
As many as half of those with ADHD also
have other mental disorders
Over half of the children diagnosed with
ADHD carry the disorder into adulthood
A large number of adults who were never
diagnosed as a child show clear symptoms
of ADHD 15

16.  The symptoms of ADHD are present since the
early childhood (before the age of 7 years)
 The causes of ADHD are unknown ,but the
disorder is predictably associated with a variety
of other disorders that affect the brain function
,such as learning disorders
 The suggested contributory factors to ADHD
include prenatal toxic exposure, prematurity,
and prenatal mechanical insult to the fetal
nervous system
 Food additives ,colorings, preservatives, and
sugar have been suggested as possible causes
 There is evidence for a genetic cause
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17. Symptoms of Inattention
must have 6 or more
1. Often fails to give close attention to details or makes careless
mistakes in schoolwork, work, or other activities
3. Often has difficulty sustaining attention in tasks or play
activities
5. Often does not seem to listen when spoken to directly
7. Often does not follow through on instructions and fails to
finish school-work, chores, or duties in the workplace (not
oppositional)
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18. 5. Often has difficulty organizing tasks and activities
6. Often avoids, dislikes, or is reluctant to engage in
tasks that require a sustained mental effort
7. Often loses things necessary for tasks or activities
8. Often easily distracted by extraneous stimuli
9.Often forgetful in daily activities
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19. Symptoms of Hyperactivity-Impulsivity
Must have 6 or more
Hyperactivity
1. Often fidgets with hands or feet or squirms in seat
2. Often leaves seat in classroom or in other situations in
which remaining seated is expected
3. Often runs about or climbs excessively in situations in
which it is inappropriate (adolescents ~ may be subjective
feelings of restlessness)
4. Often has difficulty playing or engaging in leisure activities
quietly
5. Often “on the go” or often acts as if “driven by a motor”
6. Often talks excessively
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20. Impulsivity
2. Often blurts out answers before
questions have been completed
3. Often has difficulty awaiting turn
4. Often interrupts or intrudes on others
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21. Treatment of ADHD
1. Pharmacotherapy:
a. CNS stimulants: dextroamphetamine,
methylphenidate, and pemoline
b. Antidepressants
 Psychotherapy :
which include behavioral therapy , education
of parents and teachers
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22. Disruptive behavior disorders
 There are two types:
2. Oppositional defiant disorder:
described as a recurrent pattern of negativistic,
defiant, disobedient, and hostile behaviors
toward authority figures
5. Conduct disorder:
A repetitive & persistent pattern of behavior in
which the basic rights of others or major age-
appropriate societal norms or rules are
violated 22

23. Elimination Disorders
1. Enuresis :
The repeated voiding of urine into clothes or
bed ,whether, the voiding is involuntary or
intentional .The behavior must occur twice
weekly for at least 3 months or must cause
clinically significant distress or impairment
socially or academically. The child’s age must
be at least 5 years
 Encopresis:
Passing feces into inappropriate places whether
the passage is involuntary or intentional. The
pattern must be present for at least 3 months ;
the child’s age must be at least 4 years 23

24. Separation Anxiety Disorder
 Defined as an excessive anxiety about separation
from home or from those to whom the child is
attached
 This disorder must last for at least 4 weeks
 Must begin before age of 18 years
 Must cause significant distress or impairment
 Separation anxiety requires the presence of at
least three symptoms related to excessive worry
about separation from the major attachment
figures 24

25.  The worries may take the form of refusal to
go to school( school phobia, school refusal),
fears & distress upon separation ,repeated
complaints of such physical symptoms like
headaches & stomach aches when separation
is anticipated and night mares related to
separation issues
 The disorder is common and onset may occur
during preschool years but is most common in
7-8 years old
 Prevalence is 3-4% of all school children
 It occurs equally in males and females
 Treatment : behavioral therapy
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26. Pediatric Psychopharmacology
:Summary
 Substantial Empirical Evidence Currently Supports
◦ Stimulants for ADHD
◦ SSRI’s for OCD
 Well Designed Trials support
◦ Risperidone for aggression and self-injurious
behaviors in autism
◦ Fluvoxamine for Childhood Anxiety Disorders
◦ Fluoxetine for Moderate – Severe Major
Depression
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27. Pediatric Psychotherapy
:Summary
 Best Evidence for;
◦ CBT (cognitive behavioral therapy) for Depression,
Anxiety
◦ CBT/Behavioral Strategies for Conduct Problems
◦ Parent Training for Conduct Problems
◦ MST (multi systemic treatment) for Conduct
Problems
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28. THANK YOU
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