FIRST DIAGNOSED IN
INFANCY,CHILDHOOD, OR
ADOLESCENCE
Important Facts
• Category of convenience
– – no intent of clear distinction between
“adult’/“childhood” disorders
• Primarily diagnosed in regard to age
– not phenomenology
• Usually identified by others
• Children regarded as more malleable
than adults
– thus more amenable to treatment
• Differential Diagnosis
– diagnosis which nearly fits symptoms but
must be ruled out
• Necessary information = Knowledge
of normal life-span development
Making a Diagnosis: 7 Steps
• Observation of diagnostic clues
– Focus on behavior, cognitive ability, verbal responses,
etc.
• Screen the problem
– Consider symptoms/behaviors indicating or excluding a
specific diagnosis
• Follow-up of preliminary impressions
– Testing or ruling out “your” diagnostic assumptions
• Confirmatory history
– Gather pertinent information
• Complete data base
– Specific info relevant to diagnosis under consideration
• Diagnosis
– All information, including DD
• Prognosis
– Consider individual’s response to & motivation for
Clinical Info Necessary for Diagnosis of
Disorders First Evidenced in Children &
Adolescents
• Times of developmental • Abnormal motor
milestones movements
• Capacity to • Hyperactivity,
communicate with other inattention, or poor
people impulse
• Language impairment • Abnormal behaviors
• Capacity for human (e.g., fire setting,
relationships cruelty to animals)
• Quality of social • Enuresis or encopresis
interaction
Understanding Normal Life-span
Development
Allows identification of
appropriate behaviors
at appropriate stages
Childhood problems
not to be viewed as downward
extension of adult issues
Possible to diagnose children
with some “adult” disorders as
major depression or PTSD if
adult criteria met
Subcategories of Diagnoses
• Mental Retardation • Attention-Deficit
& Disruptive Behavior
• Learning Disorders Disorders
• Motor Skills • Feeding & Eating
Disorders Disorders of Infancy &
• Communication Childhood
Disorders • Tic Disorders
• Elimination Disorders
• Pervasive
• Other Disorders –
Developmental
contains 5 diverse
Disorders disorders
Predominant Symptoms
or Deficits
• Intellectual & cognitive All MR & All LD
impairment
Pervasive Developmental,
• Information exchange Communication Disorders, &
Selective Mutism
MENTAL RETARDATION
(Axis II)
• Significantly subaverage intellectual functioning
• Based on test scores & adaptive behavior
• Check present adaptive functioning in various
areas
– communication, self-care, academics, social etc
• Cultural/ethnic considerations
• Onset before 18 years of age
• Criteria met for MR, diagnosis given regardless of
presence of another disorder
• Differentiate Mild MR from borderline intellectual
functioning
– careful consideration of all available information
Some MR Interventions
• Head Start Programs
– may help prevent Mild MR
• Applied behavior analysis (operant
conditioning)
– adaptive skills, communication, self-help,
social & vocational
• Cognitive behavior therapy
– self-instructional training as in “Little
Bear” pictures
• Computer-assisted instruction
– maintain attention, material
individualized, repetitions helpful without
boredom or loss of patience
Learning Disorders
(Academic Skills Disorders)
• Academic functioning
– below expected for chronological age,
measured IQ, & age-appropriate
education
• Reading Disorder
• Mathematics Disorder
• Disorder of Written Expression
• Learning Disorder NOS
– criteria for any specific LD not met
A Motor Skills Disorder
• Developmental Coordination Disorder
• Not due to general medical condition
• Substantial impairments in motor coordination
– Significantly interfering with academic
achievement or daily activities
– Marked delays in normal milestones as sitting,
crawling, walking
– Or clumsiness, poor performance in sports or poor
handwriting
Tic Disorders –
Motor Function Disorders
• Tourette’s Disorder
– Multiple motor tics & 1 or more vocal tics
– Occur many times a day, nearly every day or
intermittently for more than 1 year
• Chronic Motor or Vocal Tic Disorder
• Transient Tic Disorder
• Tic Disorder NOS
Another Motor Function Disorder in the “Other”
category
– Stereotypic Movement Disorder
Disruptive & Self-Injurious
Behavior Disorders
• Behaviors socially unacceptable or
potentially harmful
• Include:
– Hyperactive, impulsive, inattentive,
oppositional, defiant, impulsive, & disruptive
behavior
– Also abnormalities of eating & elimination
Attention-Deficit Disorders
• Criteria with code based on type
– Attention-Deficit/Hyperactivity Disorder,
Combined Type
– Attention-Deficit/Hyperactivity Disorder,
Predominately Inattentive Type
– Attention-Deficit/Hyperactivity Disorder,
Predominately Hyperactive-impulsive Type
– Attention-Deficit/Hyperactivity Disorder NOS
Disruptive Behavior Disorders
(also NOS)
• Conduct Disorder • Oppositional Defiant
– Violation of basic Disorder
rights of others or – Persistent patterns of
– Major age-appropriate negativistic, hostile, &
societal norms abused defiant behaviors
• Disturbances of eating
– eating nonnutritive substances
– repeated regurgitation of food
– failure or refusal to eat
• Pica – repeatedly eating
nonnutritive substances
• Rumination Disorder –
regurgitate & rechew
• Feeding Disorder – failure to
gain wt. Or loss of significant
wt. over period of 1 mo. Due to
not eating adequately (onset
before 6)
Elimination Disorders
• Encopresis – passing feces
into inappropriate places
– Must be at least 4 yrs. old
• Enuresis – repeated
urination into beds or
clothes
– Criterion regulated
occurrence
– Or clinically significant
distress/impairment is
produced
– Must be at least 5 yrs. old
Pervasive Developmental Disorders
Autism, Rett’s, Childhood Disintegrative Disorder,
Asperger’s, & Pervasive Developmental NOS
Common elements:
• Broad based impairment or loss of
functions expected at that age
• Three components covered:
– social interactions
– communication
– patterns of behavior, interests, activities
• Patterns which may surface include:
– restricted, repetitive, stereotypic
Autism
• Named "early infantile autism" from observations
of an extreme autistic aloneness that, whenever
possible, disregards, ignores, shuts out anything
that comes to the child from the outside
• Prior to age three
• Abnormal functioning in at least one area:
– social interaction
– language by social communication
– symbolic/imaginative play
Autism Treatment
• Most successful technique is in intense
behaviorally oriented programs.
• -Goals to work with are: social skills, breaking
down tasks, eliminating maladaptive behaviors;
medication.
• -Try to relieve symptoms and improve
communication, social skills, and adaptive
behavior
• -Modeling and operant conditioning
• Drug treatment
– most common medication is haloperidol,
Rett's Disorder (females only)
• Normal functioning at birth & through first
5 months of life
– between ages 5 months - 48 months -
decelerated (decreased) head growth occurs
– loss of previously acquired hand movement.
– loss of social skills
– difficult gait/movement
• Usually medical intervention
Childhood Disintegrative
Disorder
• Rare
• Development normal first 2 years of life
(distinguishing feature from autism)
• A loss of ability (in autism abilities never
developed)
• Often symptoms first noticed by parents
Asperger’s Disorder
• Lack of interest in social action
• Severe & sustained impairment in social
interactions
• Different from autism because no significant delay
in language & communication
• Some idiosyncratic features similar to autism;
repetitive patterns of behavior, interests and
activities
Pervasive Developmental Disorder
Not Otherwise Specified (NOS)
• Severe & pervasive impairments in
– Reciprocal social interactions
– Communications skills
• Or stereotypical behavior, interests, or
activities
• Criteria for Pervasive Development
Disorder not met
Communication Disorders
check if acquired or developmental
• Expressive Language • Stuttering
Disorder • Communication
• Mixed Receptive- Disorder NOS
Expressive Language
Disorder
• Phonological Disorder
Other Subcategory –
5 Diverse Disorders
• Stereotypic Movement Disorder -- repetitive, seemingly
driven nonfunctional motor behavior
• Separation Anxiety Disorder -- Inappropriate or excessive
anxiety about separation from home or person of attachment
– Onset before 18 years of age
• Reactive Attachment Disorder of Infancy or Early
Childhood --Excessively inhibited, hypervigilant, ambivalent &
contradictory responses to most social interactions
– Or diffuse indiscriminate attachments to other people
– Associated with pathogenic care
• Selective Mutism – consistent failure to speak in speific social
situations yet speaking in others
• Disorder of Infancy, Childhood, or Adolescence NOS –
residual category where criteria for no specific disorder is met