Psychiatric Disorders in
Childhood and
Adolescence
Dr. Ravichandra Karkal
Assistant Prof. Psychiatry
Yenepoya University
Overview
– Variation in symptoms from adult psychiatric
disorders
– Reflection of family and parents
– Developmental stage
– Children are less able to express themselves in
words
• A 5-year-old boy shows no interest in
other children and ignores adults other
than his parents. He spends hours lining up
his toy cars or spinning their wheels but
does not use them for “make-believe” play.
He rarely uses speech to communicate.
Physical examination indicates that his
head is of normal circumference and his
gait is normal. Which is the most likely
diagnosis for this boy?
Childhood autism
• 3 years
• Boys 3-4x
• Inadequate appreciation of
socio-emotional cues
• Lack of modulation of
behaviour according to
social context
Leo Kanner
Clinical features
• impairment in make-believe and social
imitative play
• poor synchrony and lack of
reciprocity in conversation
• lack of emotional response to other
people's verbal and nonverbal
overtures
• tendency to impose rigidity and
routine
• stereotyped preoccupations with
interests such as dates, routes or
timetables
• specific interest in nonfunctional
elements of objects (such as their
smell or feel)
• Nonspecific problems
– Fear/phobias, sleeping and eating
disturbances, temper tantrums, and
aggression
– Self-injury
• Asperger's syndrome
– No delay in language development
• A 4-year-old girl is brought to her pediatrician
because her parents think she does not seem to
be “developing normally.” The girl’s mother states
that her daughter seemed normal for at least the
first 2 to 3 years of her life. She was walking and
beginning to speak in sentences. She was able to
play with her mother and older sister. The mother
has been noticing that over the past 2 months her
daughter has lost these previously acquired
abilities. She will no longer play with anyone else
and has stopped speaking entirely. She has lost all
bowel control, when previously she had not needed
a diaper for at least a year. Which is the most
likely diagnosis?
• Rett’s syndrome
– onset is between 7 and 24 months
– apparently normal or near-normal early
development
– loss of purposive hand movements and
acquired fine motor manipulative skills
– loss, partial loss or lack of development
of language
– distinctive stereotyped tortuous
wringing or "hand-washing" movements
• A 5-year-old boy has difficulty
paying attention in school. He fidgets
and squirms and will not stay seated
in class. At home he talks excessively
and has difficulty waiting for his
turn. His language and motor skills
are appropriate for his age. Which is
the most likely diagnosis?
Attention deficit
hyperactivity disorder
– Inattention
– Impulsivity
– Hyperactivity
ADHD
Inattention Symptoms (6 of 9):
Careless mistakes
Attention difficulty
Listening problem
Loses things
Fails to finish things
Organizational skills lacking
Reluctance in tasks requiring sustained mental effort
Forgetful in Routine activities
Easily Distracted
ADHD
• Hyperactive-Impulsive Sx (6 of 9):
Runs about or is restless
Unable to wait his/her turn
Not able to play quietly
On the go
Fidgets with hands or feet
Blurts out answers
Staying seated is difficult
Talks excessively
Tends to interrupt
ADHD Epidemiology
• Occurs in 3-12% of school-aged
children
• Boys 4-9x > girls
• Most common type is combined
type
ADHD
Boys are diagnosed with all subtypes
more often than girls, but when girls
are diagnosed, they are most often
diagnosed inattentive type
Treatment
Stimulants, first line:
Methylphenidates
Atomoxetine
Clonidine
• A 15-year-old boy is arrested for shooting
the owner of the garments store he tried
to rob. He has been caught several times
for a variety of crimes against property,
possession of illegal substances, and
assault. He is cheerful and unconcerned
during the arrest, more worried about
losing his leather jacket than about the
fate of the man he has injured. Which is
the most likely diagnosis in this case?
Conduct Disorder
Repetitive behaviors that violate the rights of
others and/or societal laws:
–
–
–
–
–
Aggression or cruelty to people or animals
Destruction of property
Theft
Truancy
Running away
Conduct Disorder
-Affects 12% of boys and 7% of girls
-2-3 fold likelihood of becoming
juvenile offenders
Conduct DisorderPsychosocial Correlates
• Harsh punishment
• Institutional living
• Inconsistent
parental figures
(living with
different relatives
for years)
• Poor parental
monitoring in early
childhood
• Parental conflict
• Maternal
depression
• Paternal alcoholism
Conduct Disorder Risk
Factors
Fetal Alcohol Syndrome,
Prenatal drug exposure, ADHD
Conduct Disorder
• Treatment includes family therapy,
behavior management training, social skills
group, and teaching problem-solving skills
• A 13-year-old girl grunts and clears
her throat several times in an hour,
and her conversation is often
interrupted by random shouting. She
also performs idiosyncratic, complex
motor activities such as turning her
head to the right while she shuts her
eyes and opens her mouth. She can
prevent these movements for brief
periods of time, with effort.
Diagnosis?
Tourette’s Disorder
• Multiple motor and one or
more vocal tics lasting at
least 1 year, many times a
day, nearly every day,
without a tic-free period of
more than three
consecutive months
Georges Gilles de la Tourette
Recognizing Tics
Typically, brief clonic movements of
eyes, face, neck and shoulders
Most common: eye-blinking, facial
grimacing and head-jerking
Typically, vocal tics involve throatclearing, grunting or barking
Tics may be simple (brief) or complex
(elaborate)
Tourette’s Disorder
• Onset before age 18; peak onset at
age 5 to 8 years
• Severity tends to peak around 8 to 11
years, with improvement or even
resolution during puberty
Prevalence
• Transient tics occur in 6-13% of all
children
• Chronic tic disorder occurs in 1-2%,
with 3:1 ratio of boys:girls
• Tourette’s is much less common,
occurring in 5-10/10,000
• 40% of Tourette’s children also
meet criteria for OCD
• >20% of children with any tic
disorder have OCD
• Treatment- Low dose antipsychotics
(Haloperidol, Risperidone)
Intellectual disability
• Mental retardation
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Mild mental retardation (IQ range, 50 to 70)
Moderate mental retardation (IQ range, 35 to 50)
Severe mental retardation (IQ range, 20 to 35)
Profound mental retardation (IQ range below 20)
• Deficits in adaptive functioning in at
least two of the following areas:
– communication, self-care, home living,
social/interpersonal skills, use of community
resources, self-direction, functional academic
skills, work, leisure, health, and safety.
• The onset is before age 18 years.
• Hyperactivity and short attention
span, self-injurious behaviors (e.g.,
head-banging and self-biting), and
repetitive stereotypical behaviors
(hand-flapping and toe-walking)
• The parents of an 8-year-old boy with a normal
IQ are concerned because he is a very slow
reader and does not appear to understand what
he reads. When the boy reads aloud, he misses
words and changes the sequence of the letters.
They also note that he has problems with spelling,
though he is otherwise quite creative in his ability
to write stories. On examination, the child
displays verbal language defects as well, though
pri- marily he communicates clearly. His hearing
and vision are normal and he has no trouble with
motor skills. Which is the most likely diagnosis
for this child?
Specific Learning
Disability (Dyslexia)
• A child with Specific Learning
Disability (SLD) is one who does
poorly in schooling because of
impaired ability in learning the
academic skills of reading, writing,
arithmetic, and spelling.
• Reading problems: slowness, hesitancy, omission,
substitution, reading by guessing, reading the words
backwards (on for no), misreading (put for but)
• Writing problems: slowness, lack of regard for even basic
rules of grammar such as capitals and full stop, poor
handwriting, poor organization of the writing space, poorly
formed letters, words, and sentences.
• Spelling problems: writing letters in wrong order (child for
child), reversal of letters (b for d), inversion of letters (u
for n), mirror writing (no for on), omission (wet for went);
these are best elicited by asking the child to write to
dictation.
• Arithmetic difficulties: this is best elicited by asking the
child do simple mental arithmetic or written problems.
• Deficit in Phonological processing. In
simple words, this processing involves
splitting the words into simpler speech
units called phonemes and then associating
them with the appropriate symbols
(development of sound-symbol
correspondence).
• Left parieto-temporal region