Developmental & Behavioral

Disorders
Elmeida Effendy
 Diagnostic classification
according to ICD-10
• I.Disorders of psychological development
– 1. Specific developmental disorders of speech & language
• 1. Specific speech articulation disorder
• 2. Expressive language disorder
– 2. Specific developmental disorders of scholastic skills
• 1. Specific reading disorder
• 2. Specific spelling disorder
• 3. Specific disorder of arithmetical skills
• 4. Specific scholastic skills disorder

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– 3. Specific developmental disorder of motor
function
– 4. Mixed specific developmental disorder
– 5. Pervasive developmental disorder
• 1. Childhood autism
• 2. Rett’s syndrome
• 3. Asperger’s syndrome
– 6. Other disorders of psychological development
– 7. Unspecified disorder of psychological
development

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• II. Behavioral & emotional disorders with
onset usually occurring in childhood &
adolescence
– 1. Hyperkinetic disorders
• 1. Disturbance of activity & attention
• 2. Hyperkinetic conduct disorder
– 2. Conduct disorder
– 3. Mixed disorders of conduct & emotions
– 4. Emotional disorders with onset specific to
childhood
• 1.Separation anxiety disorder of childhood

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– 5. Disorders of social functioning with onset
specific to childhood & adolescence
• 1. Elective mutism
• 2. Reactive attachment disorder of childhood
– 6. Tic disorders
• 1. Transient tic disorder
• 2. de la Tourette’s syndrome

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– 7. Other behavioral & emotional disorders with
onset usually occurring in childhood &
adolescence
• 1. non organic enuresis
• 2. non organic encopresis
• 3. feeding disorder of infancy & childhood
• 4.stuttering

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 Attention Deficit Hyperactivity
Disorder
• Diminished sustained attention, higher level of
impulsivity in a child or adolescent than expected
for someone of that age & developmental level
• 3-7 % of pre pubertal elementary school
• Boys : girls : 2-9 : 1
• Symptoms must be present before age 7
• ( usually by age 3)

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 Autistic Disorder
• = early infantile autism
• = childhood autism
• = Kanner’s autism

• Characterized by deviant reciprocal social

interaction, delayed & aberrant
communication skills & a restricted repertoire
of activities & interests

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• Qualitative impairment in social interaction
• Qualitative impairment in communication
• Restricted repetitive & stereotyped patterns
of behavior, interests & activities

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 Qualitative impairment in social
interaction
• Marked impairment in the use of multiple non
verbal behaviors such as eye to eye gaze, facial
expression, body postures
• Failure to develop peer relationships
appropriate to developmental level
• A lack of spontaneous seeking to share
enjoyment interests or achievements with
other people

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 Qualitative impairment in communication

• Delay in the development of spoken language

• In individual with adequate speech, marked
impairment in the ability to initiate or sustain a
conversation with others
• Stereotyped & repetitive use of language or
idiosyncratic language
• Lack of varied, spontaneous make-believe play
appropriate to developmental level

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 Restricted repetitive & stereotyped patterns of
behavior, interests & activities
• stereotyped & repetitive motor mannerism :
hand or finger flapping or twisting or complex
whole body movements
• Persistent preoccupation with parts of objects

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 Mental Retardation
• IDIOT = SEVERE INTELLECTUAL IMPAIRMENT
• IMBECILE= MODERATE IMPAIRMENT
• MENTAL DEFICIENCY STIGMA
• MENTAL SUBNORMALITY
• MENTAL RETARDATION ICD 10 & DSM IV
• MENTAL HANDICAP
• LEARNING DISABILITY >> UK
• US: LEARNING DISABILITY APPLIED TO DYSLEXIA
 AETIOLOGY
• GENETIC FACTORS
– CHROMOSOME ABNORMALITIES
– FRAGILE SITE
– TRISOMY 21
– TRISOMY 18
– MICRODELETIONS
– METABOLIC DISORDER AFFECTING : AMINO ACID,
UREA, LIPID, CARBOHYDRAT
• INBORN ERRORS OF METABOLISM
– PHENYLKETONURIA
– HOMOCYSTINURIA
– GALACTOSEMIA
– TAY-SACHS- DISEASE
– HURLER’S SYNDROME
– LESCH-NYHAN SYNDROME
• ANTENATAL DAMAGE
– INFECTIONS (RUBELLA, CYTOMEGALOVIRUS, SYPHILIS,
TOXOPLASMOSIS)
– INTOXICATIONS (LEAD, ALCOHOL, CERTAIN DRUGS)
– PHYSICAL DAMAGE (INJURY, RADIATION, HYPOXIA)
– PLACENTAL DYSFUNCTION (TOXAEMIA)
– ENDOCRINE DISORDER(HYPOTHYROIDISM)
• PERINATAL DAMAGE
– BIRTH ASPHIXIA
– COMPLICATION OF PREMATURITY
– KERNICTERUS
– INTRAVENTRICULAR HAEMORRHAGE
• POSTNATAL DAMAGE
– INJURY (ACCIDENTAL, CHILD ABUSE)
– INTOXICATION (LEAD MERCURY )
– INFECTIONS (ENCEPHALITIS, MENINGITIS)
– IMPOVERISHED ENVIRONMENT
 CLINIAL FEATURES
• LOW PERFORMANCE ON ALL KINDS OF
INTELLECTUAL TASKS INCLUDING LEARNING,
SHORT TERM MEMORY, THE USE OF
CONCEPTS & PROBLEM SOLVING
• COMMON BEHAHAVIOUR PROBLEM
 MILD LEARNING DISABILITY
• IQ RANGE 69-50
• PERCENTAGE OF CASES 85 %
• ABILITY TO SELF CARE : INDEPENDENT
• LANGUAGE : REASONABLE
• READING & WRITING : REASONABLE
• ABILITY TO WORK : SEMI SKILLED
• SOCIAL SKILLS : NORAL
• PHYSICAL PROBLEM : RARE
• AETIOLOGY DISCOVERED : SOMETIMES
 MODERATE LEARNING DISABILITY
• IQ RANGE 49-35
• PERCENTAGE OF CASES : 10 %
• ABILITY TO SELF CARE : NEED SOME HELP
• LANGUAGE : LIMITED
• READING & WRITING : BASIC
• ABILITY TO WORK : UNSKILLED, SUPERVISED
• SOCIAL SKILLS : MODERATE
• PHYSICAL PROBLEMS : SOMETIMES
• AETIOLOGY DISCOVERED : OFTEN
 FEATURES OF DOWN SYNDROME

• MODERATE OR SEVERE LEARNIG DISABILITY

• PLACID TEMPERAMENT
• PHYSICAL FEATURES
– SLANTED EYES 7 EPICANTHIC FOLDS
– SMALL MOUTH WITH FURROWED TONGUE
– FLAT NOSE
– FLATTENED OCCIPIT
– STUBBY HANDS, FINGERS & SINGLE PALMAR CREASE
– HYPOTONIA
• ASSOCIATED MEDICAL PROBLEMS
– CARDIAC, GI ABNORMALITIES,IMPAIRED HEARING
 SEVERE /PROFOUND LEARNING DISABILITY

• SEVERE LEARNING DISABILITY : IQ 20-34

• PROFOUND LEARNING DISABILITY : IQ BELOW 20
• PERCENTAGE OF CASES : 5 %
• ABILITY TO SELF CARE :LIMITED
• LANGUAGE : BASIC OR NONE
• READING & WRITING : MINIMAL OR NONE
• ABILITY TO WORK : SUPERVISED BASIC TASKS
• SOCIAL SKILS : FEW
• PHYSICAL PROBLEMS : COMMON
• AETIOLOGY DISCOVERED : USUALLY
 Treatment
• Depends on the type of the disorders
• If the obtained symptom came from
environment or family, hence the effectiveness
of treatment determined by family or
environment that concerned in the treatment
strategy

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Treatment for child could be in form of
:
• 1. Family therapy
• 2. Environmental
manipulation
• 3. Play therapy
• 4. Behaviour therapy
• 5.Pharmacological
therapy
• 6. Psychotherapy

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• For child with education problems should be
overcome with special school

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 For several cases may be :

• 1. Cannot overcome the environment

• 2. Environment as the root cause of the
problems experienced by child
• 3. Dangerous child hurting others or own self
• For these kind of child treated in special place.

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