DR/KHALID ALHARBY
Main types of childhood psychiatric
disorder
Disorders of older
children.
•Emotional disorder.
•Disorders of
sleeping & elimination.
•Conduct disorder.
•Hyper kinetic syndrome.
Disorders of
pre-school children.
•Temper tantrums
•breath holding.
•Sleep problems.
•Feeding problems
DR/KHALID ALHARBY
Main types of childhood psychiatric
disorder
Disorders of development:
•Childhood autism.
•Specific developmental disorders.
•Gender identity disorders
DR/KHALID ALHARBY
Causes
Family factors.
- Separation.
- Illness of parent.
- Parental relations.
- Personality deviance
of parent.
- Large family size.
- Child abuse and
neglect.
Social and cultural
factors.
•Overcrowded living
conditions.
•Inadequate social
amenities.
•Lack of community
involvement.•Heredity.
•Physical
disease
•Environment
DR/KHALID ALHARBY
Assessment of Psychiatric problems
in childhood
Interviewing the parents.
Interviewing the child.
Interviewing other informants.
DR/KHALID ALHARBY
Interviewing parents:
THE MAIN ITEMS FOR ASSESSMENT
The presenting
problem.
Nature, severity,
frequency.
Situations in which
it occurs.
Factors which make it
worse or better
Family history:separations from
and illness of parents.
Quality of relations
with
parents and siblings.
Personal history of
the child.
- Pregnancy - Birth
- Development
- Past illness and injury
- Attendance and
attainments at school
Other current
problems.Mood, activity,
concentration.
Physical symptoms.
Eating, sleeping,
elimination.
•Relationships,
particularly with
parents and siblings.
•Antisocial behavior.
•School
performance.
DR/KHALID ALHARBY
Principle observations of a child’s
behavior & emotional state
Appearance.
Activity level.
Mood.
Rapport with the interviewer.
Relationship with parents.
Habits, mannerisms
DR/KHALID ALHARBY
Indications for In-patient Care
Severe behavioral disorder.
For observation.
To separate the child.
To observe relationship with mother
DR/KHALID ALHARBY
Temper Tantrum
Temper tantrums range from whining and crying to screaming, kicking, hitting, and breath-holding.
Equal in girls and boys, age: 1-3 y.
Even the most good-natured toddlers has an occasional temper tantrum (normal development)
Tantrum Tactics:
Keep cool ( do not complicate the problem with your own frustrations)
Assess the situation
Take the child to a quite, secluded place to calm down
DR/KHALID ALHARBY
Breath holding spells (BHS)
a benign, involuntary recurring condition of childhood in which anger or pain produce crying that culminates in noiseless expiration and apnea.
5% of all children ageing (6m-6y)
Most common in 12-18 months
Boys and girls are affected equally
+ ve family history is found in 25%
One of the nonepileptic paroxysmal disorders of childhood
2 types: cyanotic, and pallid
DD: epileptic seizures, syncope, benign paroxysmal vertigo, cataplexy, central or obstructive apnea
DR/KHALID ALHARBY
Breath holding spells (BHS)
Rx.
- parents respond calmly.
- it disappears with time.
No drug is needed: although atropine sulfate may be considered in the management of children with frequent pallid BHS ( because of its anticholinergic action)
Spontaneous resolution in the vast majority of children by the age of 5-6 years
About 50% of cases resolve by the age of 4 years
DR/KHALID ALHARBY
Awake fullness
1/5 of aged 1 - 2 y.
Rx.:
- reassure parents.
- Advice:
* don't: 1. Respond as soon as he cries.
2. Spend long periods on his bed side.
3. Take the child to their own bed.
* do: 1. Establish a consistent bed time routine.
2. Avoid reinforcement of the behavior.
3. Improve the appearance of the child’s
bed.
DR/KHALID ALHARBY
Nightmares
Awakening from REM sleep (which constitute
<25 % in children above age of 6 years and
adults) to full consciousness with recall of
unpleasant dreams.
Common in children 5 - 6 yrs. of age.
Stimulated by frightening experience during the
day.(If frequent: day time anxiety).
Rx.
- causes of anxiety. - Re assurance .
DR/KHALID ALHARBY
Night terrors
Awakening from stage 3 or 4 of NREM sleep (usually 90 min. after going to sleep).
Terrified, confused, and cry for 5-30min.
No recall of dream.(and at morning no recall of the episode)
Settle slowly in few minutes & return to normal calm sleep.
Not persisting to adult life.
Occur in 5-15% of children 4-6 y. (though they can appear in babies as young as 9 m)
Rx: Not specific
(? Awake him shortly before the usual time of terror).
DR/KHALID ALHARBY
Sleep walking(somnambulism)
Walk as if he is awake.(for few minutes).
? Anxious, not answering questions.
Difficult to awaken him, but easy to “drive”
Occurs usually during deep NREM sleep <stage 3 or stage 4 sleep> (early part of the night).
Age 5 - 12 yrs. (at least once in 15% of them).
Rx:
- Non specific - Reassurance
Mild: parents should maintain a consistent approach & set color limits to the child’s behavior.
- Close doors and windows - Avoid dangerous objects – hypnosis may be helpful - benzodiazepines
DR/KHALID ALHARBY
Food Refusal
Brief periods are common in pre-school.
Rx:
- ignorance.
- don’t offer the child special food.
- don’t force him to eat.
DR/KHALID ALHARBY
Pica (geophagy)
PIE-KAH, magpie
The craving or eating of items that are not food (for at least one month)
No specific test, no specific prevention
Age: 2-6 years (in 10-32% of this age group) , ? Family pet
Substances commonly ingested: Dirt
Clay
Chalk
Cigarette ashes
Sand
Paint
Plaster
Gravel
Rocks
Starch
DR/KHALID ALHARBY
Pica
At risk people:Malnutrition or vitamin deficiency
Poor people
family history of pica
Mental retardation
Ethnic or cultural reasons
Complications:malabsorption
Lead poisoning
Intestinal obstruction
intestinal infection
Anemia
Mercury poisoning
Dental injury
DR/KHALID ALHARBY
Pica
Not an eating disorder
Physiological theory: eating clay or dirt helps relieve nausea, control diarrhea, increase salivation, remove toxins, and alter odor or taste perception.
Psychological theory: a behavioral response to stress, a habit disorder, or a manifestation of oral fixation
Rx:
- Modify stress
- keep away
- reassure: with aging.
DR/KHALID ALHARBY
School Refusal
The child may be Psychologically unable to attend school even though he wishes to do so.
C/P: - sudden refusal to attend school (complete)
- gradually increasing reluctant to leave home.
- somatic complaint. (Only on School days).
Causes:
- separation anxiety (normally at age 18-24 months when separated from caregiver but may persists).
- bullying by other children or failure in class.
- marital problems between parents, or illness of
a family member
DR/KHALID ALHARBY
School Refusal
Prevention:
Toddlers and preschoolers can benefit from structured experiences with other adults.
Inform the child calmly that the parent will return and the child is to stay. Then leave quickly.
A firm, caring and quick separation is better.
Prognosis: most of them eventually return to school.
Rx:
Modify stress circumstances: helping the child to relax, develop better coping skills, using a contract,…..
Treat the underlying cause
.
DR/KHALID ALHARBY
Hyper kinetic Syndrome (ADHD)
1/3 of children are described as overactive by their parents and 1/5 of school children by their teachers.
Incidence in USA is 3-7%
A developmental condition of inattention and distractibility with or without hyperactivity.
C/P: ( it should start before the age of 7 years).
- Extreme restlessness - Impulsiveness
- Sustained motor activity - Poor attention
- Learning difficulties - Temper and aggressive.
Etiology: not related to food (e.g. sugar)
- Genetic - Social - Lead intoxication
- intrauterine exposure to Food additives
DR/KHALID ALHARBY
Hyper kinetic Syndrome (ADHD)
Prognosis:
ê age.
usually ceases by puberty
associated learning difficulties are less likely to improve.
antisocial behavior has the worst prognosis.
Rx:
Stimulant drugs e.g. Methylphenidate
? Paradoxical effect.
No addiction by those children !!Family and social support.
DR/KHALID ALHARBY
CONDUCT DISORDER
Severe and persistent antisocial behavior.
The most common type of Psychiatric disorders among adolescents.
C/P: Disobedience, lying, aggressiveness, school problems, taunting, stealing, vandalism & fire setting, disapproved sexual behavior, alcohol & drug abuse.
Etiology:
environmental factors (important):
unstable, insecure, & rejecting families living in deprived areas.
Constitutional factors
speech & reading difficulties
DR/KHALID ALHARBY
CONDUCT DISORDER
Prognosis:
if mild often improve
if severe could persist.
Rx:
Severe: 1). stressful circumstances.
2). Behavioral approach:
- Rewarding desirable behavior
- Ignoring undesirable behavior
NB/: No effective Medications
DR/KHALID ALHARBY
JUVENILE DELINQUENCY
It is considered because some have conduct disorder.
Most common about 15-16 yrs. of age,
male > female.
Causes:
1. Low social class, poverty,poor housing and
poor education.
2. Poor parenting and shared attitudes to the law
Rx:
- improve family environment
- educate the child:
- improve skills
- harmful peer group influences
DR/KHALID ALHARBY
AUTISM
Rare. C/P:
inability to relate
speech and language disorder.
resistant to change.
odd behavior and mannerism.
seizures (in adolescence)
Etiology:
unknown
? Genetic cognitive abnormalities thinking and language.
no rule for abnormal parenting
DR/KHALID ALHARBY
AUTISM
Prognosis:
about 50% acquire some useful speech but may continue to show emotional coldness and odd behavior.
10 - 20% can attend ordinary school and later obtain work.
10 - 20% need special school.
60 - 80% are unable to lead an independent life.
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