A CHILDHOOD AND ADOLESENCE EMOTIONAL AND BEHAVIOURAL DISODER .

1. CHILDHOOD
DISORDER
PRESENTED BY
KOYEL THANDER (II PBBSC)

2. INTRODUCTION
 Child psychiatric is concerned with the assessment
and treatment of children’s emotional and
behavioural problems.
 Psychological disturbance in childhood causes
abnormality in emotions or behaviour
or relationship.

3. CLASSFICATION
F70- F79: MENTAL
RETARDATION
F70- Mild mental retardation
F71- Moderate mental
retardation.
F72- Severe mental
retardation
F73- profound mental
retardation
F80-F89 : DISODER OF
PSYCHOLOGICAL
DEVELOPMENT
F80- Specific developmental
disorders of speech and
language.
F81- Specific developmental
disorders of scholastic skill
F82- specific developmental
disorder of motor function
F83- Mixed specific
developmental disorder
F84- Pervasive developmental
disorder
F90-F98 : BEHAVIORAL AND
EMOTIONAL DISODER WITH
ONSET USUALLY OCCURING IN
CHILDHOOD AND ADOLESENCE
F90- Hyperkinetic disorders
F91- Conduct disorders
F93 – Emotional disorders with onset
specific to childhood
F94- Disorders of social functioning
with onset specific to childhood and
adolescence
F95- Tic disorder
F98- other behaviour and emotional
disorders

4. DISODER OF PSYCHOLOGICAL
DEVELOPMENT
SPECIFIC DEVELOPMENTAL DIORDERS OF SPEECH AND
LANGUAGE:
 These are disorders in which normal patterns of language acquisition are disturbed from
the early stages of development.
 It include developmental language disorder or dysphasia ,or phonological disorder or
dyslalia, expressive language disorder , receptive language disorder and developmental
disorders of speech and language.

5. SPECIFIC DEVELOPMENTAL DISORDER
OF SCHOLASTIC
 Its divided in to specific reading , specific spelling and specific arithmetic disorder.
 Specific reading disorders (dyslexia) : it is characterized by a slow acquisition of reading skills,
slow reading speed , impaired comprehension, word omissions , and letter reversals.
 Specific spelling disorder : impairment in development of spelling skills in the absence of a
history of specific reading disorder. The ability to spell orally and to write out words correctly
both affected.
 Specific arithmetic disorder: involves deficit in basic computational skills of addition ,
subtraction , multiplication and division.

6. SPECIFIC DEVELOPMENTAL DISODERS
OF MOTOR FUNCTION:
 Children with this disorder have delayed motor development ,which is
below the expected level on the basis of their age and general
intelligence.
 the main feature of this disorders is a serious impairment in the
development in clumsiness in school work or play.

7. PERVASIVE DEVELOPMENTAL DISORDER
 The term pervasive developmental disorder refers to a group of disorder
characterised by abnormalities in communication and social interaction
and by restricted repetitive activities and interests.
 PDD includes childhood autism , atypical autism , Rett’s syndrome,
Asperger’s syndrome , childhood disintegrative disorder , and other
pervasive developmental disorders.

8. A. CHILDHOOD AUTISM: Autism is a complex neurobehavioral disorder that includes
impairments in social interaction , verbal and nonverbal communication
combined with restricted and repetitive behaviour.
B. ATYPICAL AUTISM : A pervasive developmental disorder that differs from autism
in terms of either age of onset or failure to fulfil diagnostic criteria, i.e. disturbance
in reciprocal social interactions, communication and restrictive serotyped
behaviour.

9. C)RETT’S SYNDROME : It is characterized by apparently normal or near normal early
development which is followed by partial or complete loss of acquired hand skills and of
speech , together with deceleration in head growth , usually with an onset between 7 and 24
month of age.
D) ASPERGER’S SYNDROME : The condition is characterized by severe and sustained
abnormalities of social behaviour similar to those of childhood autism with stereotyped and
repetitive activities and motor mannerisms ,such as hand and finger twisting or whole body
movements .

10. BEHAVIORAL AND EMOTIONAL
DISORDERS WITH ONSET USUALLY
OCCURING IN CHILDHOOD AND
ADOLESCENCE

11. HYPERKINETIC DISORDER
 Hyperkinetic disorder (attention deficit disorder hyperactivity disorder or ADHD in
DSMIV) is a persistent pattern of inattention and / or hyperactivity more frequent
severe than is typical of children at similar level of development.
 Characteristics :
-neuro biological disorder
- marked by developmentally inappropriate inattention , impulsiveness and
in some cases, hyperactivity
-may progress to conduct disorder

12. ETIOLOGY
 Biological influences:
 Biochemical theory : A deficit of dopamine and norepinephrine has been
attributed in the over activity seen in ADHD .
 Pre , peri, and postnatal factors:
 Environmental influences :
 Psychosocial factors:

13. CLINICAL FEATURES
 Sensitive to stimuli , easily upset by noise, light , temperature and other environmental
changes.
 More commonly active in crib , sleep little
 General coordination deficit
 Short attention span, easily distractable
 Failure to finish tasks
 Impulsivity
 Memory and thinking deficit
 Specific learning disabilities
 Irritable
 Mood is unpredictable

14. TREATMENT
 PHARMACOTHERAPY:
 CNS stimulants
 Tricyclic antidepressant
 Antipsychotics
 SSRIs
 Clonidine
 Psychological therapies
 Behaviour modification techinques
 Cognitive behaviour therapy
 Social skill training
 Family education.

15. NURSING INTERVENTION
 Develop trusting relationship.
 Ensure that patient have safe environment
 Ensure the child’s attention by calling his name and establishing eye contact , before giving instructions.
 Ask the patient to repeat instructions before beginning task
 Establish goals that allow patient to complete a part if the task ,
 Provide assistance on a one-to-one basis , beginning with simple concentre instructions
 Help him learn how to take his turn , wait in line and follow rules
 Explain demonstrate positive parenting techniques to parents or caregivers.
 Educate child and family on the use of psychostimulants.
 Coordinate overall treatment plan with schools, collateral personnel , the child and the family

16. CONDUCT DISORDER:
 Conduct disorders are characterized by a persistent and significant pattern of
conduct in which the basis rights of others are violated or rules of society are not
followed.

17. JUVENILE DELIQUENCY
 Juvenile delinquency involves wrongdoing by a child or a young person who is
under an age specified by the law of the place concerned . From the legal point
of view , a juvenile delinquent is a person who is below 16 years of age (18 years
,in case of a girl) who indulges in antisocial activity.
 Recently, there was a clarification made by the supreme court in the existing
juvenile justice Act , that a regular court would try a juvenile if he is arrested
after crossing the age of 16 though he might have committed the crime ,when
he was under the age of 16.

18. SEPARATION ANXIETY DISORDER
 In these disorders , there is excessive anxiety concerning separation from those individuals to whom
the child is attached.
 An unrealistic worry about possible harm befalling major attachment figures or fears that they will
leave and not return
 Persistent inappropriate fear of being alone
 Repeated nightmares.
 Repeated occurrence of physical symptoms, for example nausea stomachache , headache etc.
 Excessive tantrums , crying and apathy immediately following separation from a major attachment
figure.
 Treatment: Individual counselling , parental counselling , family therapy , pharmacological
management.

19. PHOBIC ANXIETY DISORDER
 Minor phobic symptoms are common in childhood and usually concern animals
, insects , darkness , school and death.
 The prevalence of more severe phobias varies with age .
 In most cases , all fears decline by early teenage years.

20. SOCIAL ANXIETY DISORDER
 Children with this disorder show a persistent or recurrent fear and avoidance of
strangers which interferes with social functioning .
 Treatment includes simple behavioural methods, combined with reassurance and
support.

21. SIBLING RIVALRY
 Sibling rivalry / jealousy may be shown by marked competition with siblings for
the attention and affection of parents , associated with unusual patterns of
negative feelings.
 Onset is during the months following the birth of the younger sibling .
 In extreme cases , there is over-hostility, physical trauma towards and
undermining of the sibling , regression with loss of previously acquired skills and
a tendency to babyish behaviour.

22. ELECTIVE MUTISM
 This condition is characterized by marked , emotionally determined selectivity in
speaking such that the child demonstrates his language competence in some
situations, but fails to speak in other situations .
 Most typically , the child speaks at home or with close friends, and is mute at
school or with strangers.

23. TIC DISORDER
 Tic is abnormal involuntary movement, which occurs suddenly, receptively ,
rapidly and is purposeless in nature.
 It is two types :
1. Motor tics , characterised by repetitive motor movements.
2 . Vocal tics , characterised by repetitive vocalizations.

24. NONORGANIC ENURESIS
 It is disorder characterized by involuntary voiding of urine by day and /or night
which is abnormal in relation to the individual’s mental age and which is not a
consequence of lack of bladder control due to any neurologic disorder ,
epileptic attacks or any structural abnormality of urinary tract.

25. PICA
 Pica of infancy and childhood is characterized by eating non- nutritive
substances (soil, paint chipping ,paper etc )
 Treatment consists of common sense precautions to keep the child away from
abnormal items of diet.
 Pica usually diminishes as the child grows older.

26. STEREOTYPED MOVEMENT DISORDER
 These disorders are characterized by voluntary , repetitive , stereotyped , non
functional , often rhythmic movements that do not form part of any recognized
psychiatric or neurological condition.

27. STUTTERING(stammering)
 It refers to frequent hesitation or pauses in speech characterized by frequent
repetition or prolongation of sounds or syllables or words, disrupting rhythmic
flow of speech .
 The usual treatment is speech therapy.