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PSYCHIATRIC DISORDERS IN CHILDHOOD AND ADOLESCENCE

PSYCHIATRIC DISORDERS IN CHILDHOOD AND ADOLESCENCE. Robert L. Hendren, D.O. Professor of Psychiatry and Pediatrics UMDNJ-RWJMS. Developmental Model of Psychopathology. 2 4-5 6-7 12 14 21. 6. MOS. 0. Eating Disorder Identity Disorder.

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PSYCHIATRIC DISORDERS IN CHILDHOOD AND ADOLESCENCE

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  1. PSYCHIATRIC DISORDERS IN CHILDHOOD AND ADOLESCENCE Robert L. Hendren, D.O. Professor of Psychiatry and Pediatrics UMDNJ-RWJMS

  2. Developmental Model of Psychopathology 2 4-5 6-7 12 14 21 6 MOS 0 Eating Disorder Identity Disorder Autism ODD Conduct Disorder Eating Disorder Schizophrenia Depression Schizoid Reactive Attachment Separation Anxiety Tourettes PDD Mental Retardation Anxiety ODD ADHD Separation Anxiety Overanxious Conduct Disorder

  3. Mental Retardation • Mild (50-55 to 70) • Moderate (35-40 to 50-55) • Severe (20-25 to 35-40) • Profound (<20-25)

  4. Etiology • Unknown 30-40% • Genetic 5% • Prenatal 30% • Perinatal medical conditions and complications -15% • Environmental influences 15 -20%

  5. Learning, Motor Skills, Communication Disorders • Reading disorder 7-9% • Mathematics disorder • Disorder of Written Expression 2-8% • Developmental Coordination Disorder 6% • Expressive Language Disorder 3-10% • Mixed Receptive - Expressive Language Disorder 3-10% • Phonological Disorder 5-10% • Stuttering

  6. Autistic Disorder •Reciprocal interaction • Communication •Stereotypes •Brain changes

  7. Asperger’s Disorder Pervasive Developmental Disorders • Rett’s Disorder • Childhood Disintegrative Disorder • PDD NOS

  8. Elimination Disorders • Encopresis • Enuresis

  9. Conceptof Impulse Control Disorder • Common etiology • Diagnostic overlap • Co-morbidity

  10. Attention Deficit Hyperactivity Disorder • Over vs. under diagnosis controversy • Subtypes include inattentive, impulsive/hyperactive and combined • Similar life cycle except hyperactivity and co-morbidity

  11. ADHD Prevalence • 3 - 5% school-aged children • Boys more than girls, but may be under-diagnosed in girls

  12. ADHD Biologic Etiology • Genetic risk • Prenatal stress and toxins • Frontal lobe, basal ganglia and RAS implicated • Norepinepherine - inattention • Serotonin - impulsivity

  13. ADHD Psychosocial Etiology • Poor social relatedness • Peer/Authority rejection • Goodness of fit

  14. ADHD Assessment • Context and development • Life cycle issues • Family issues • Rule out medical causes

  15. Rating Scales - ADHD • Connors • AcTERS • Continuous Performance • Wender Utah Rating Scale for retrospective diagnosis

  16. Alternative Diagnoses • Schizophrenia • PTSD • Bipolar Disorder

  17. ADHD Co-morbidity • Depression • Tics and Tourettes • Conduct Disorder • Substance Use Disorder • Learning Disability

  18. ADHD Outcome • Normal 15% • Continued Problems 50% • Significant pathology 25% • Substance abuse

  19. Conduct Disorder • Repetitive persistent pattern of violation • Childhood vs. adolescent onset • 9% males; 2% females • Co-morbidity

  20. CD - Biologic Etiology • Temperament • Genetics • Serotonin • Developmental instability

  21. CD - Psychosocial Etiology • Cognitive factors • Family factors • Peer group • SES • Culture

  22. “You left your goddam car in the driveway again!”

  23. Oppositional Defiant Disorder • Recurrent pattern greater than 6 months • Evident by age 8 • Non-aggressive grow out

  24. Substance Use Disorder • Prevalence • Type I/Type II • Co-morbidity

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