Childhood Disorders

Childhood Disorders Disorders usually diagnosed in infancy, childhood and adolescence

Mental Retardation • IQ and deficits in adaptive functioning in at least 2 areas • Onset prior to 18 • Many causes possible • Mild 50-55 to 70 • Moderate 35-40 to 50-55 • Severe 20-25 to 35-40 • Profound below 20-25 • Severity Unspecified

TX MR • Diagnose early to treat and prevent • Many can be prediagnosed inutero to prevent MR: PKU, hypothyroidism, hydrocephalus, allergy to milk enzymes • Educate parents about tetrogens • Educational interventions • Family interventions • Medications

Learning Disabilities- Public Law 94-142 • Reading Disorder • Inaccurate reading, slow reading, poor reading comprehensions, along with spelling problems, poor writing, speech delay and dyspraxia • Switch from phonetic to holistic instruction, or the reverse • Tutoring and small group instruction • Mutisensory instruction long-term, patience with slow progress • Teacher plus comuter assisted instruction with repetition and practice

Mathematics Disorder • Difficulties with learning number names, rote counting, learning printed numerals, committing basic fact to memory, difficulties with concepts of combining and separating are just some of the initial symptoms • Tx: Drill and practice programs, determine strengths and weaknesses (concrete, semiconcrete, abstract), activities to help generalize concepts, clear teaching of “math vocabulary”, use of calculators when problems involve math reasoning, use of acronyms to remember math facts

Disorder of Written Expression (does not require testing due to lack of availability of tests to measure this-WoodCock Johnston can be helpful) • Handwriting problems • Spelling problems • Error in grammar and syntax • Learning Disorder NOS

How to test for an LD • Testing for LD (Achievement is >2 SDs below IQ-Woodcock Johnston and WISC. If IQ scores are compromised by LD or other issue, then a smaller discrepancy can be justified)

Motor Skills Disorder • Developmental Coordination Disorder • Fine or gross motor skill development is delayed, causing significant impairment in academics or daily activities • Remember that all children develop strengths and weaknesses while developing and this must be a MARKED delay

Communication Disorders • Expressive Language Disorder • Mixed Receptive-Expressive Language Disorder • Phonological Disorder-articulation • Stuttering • Communication Disorder NOS • Early dx and intervention can help

Pervasive Developmental Disorders • Autistic Disorder- impairments in social interactions soon after birth and persist thru out life (often MR) • Rett’s Disorder-Girl Disorder- Normal development for 6 months, then develop autistic like symptoms, language impairments, poor coordination, psychomotor retardation, and small head • Childhood Disintegrative Disorder- Two years normal, then become impaired in two major areas of functioning • Asperger’s Disorder- The Nerd- partial autism w/out cognitive and language delays • Pervasive Developmental Disorder Not Otherwise Specified (Including Atypical Autism)

Attention-Deficit and Disruptive Behavior Disorders • Attention-Deficit/Hyperactivity Disorder • Symptoms before age 7 • Test for using WMS, WISC, Digit Vigilance Test, Trails A&B • Medication and reduction of stimuli, small groups, and transitional cues • Family therapy, use cognitive therapy to teach to think before acting • No ADD dx in DSM • Biological underpinnings • ADHD NOS

A continuum of disorders • Oppositional Defiant Disorder- May have had ADHD. Angry child who ignores the rules, is spiteful and vindictive- but does not seriously violate the rights of others. Behavior may occur in one envir. but not another. Tends to begin prior to early adolescence. Outcome of Tx usually poor, may try parent training and paradoxal approaches. • Conduct Disorder- violate norms and the rights of others. Often have difficulties with abstract reasoning…may have been ADHD, ODD leading to missing cognitive skills development. Behavioral treatments are used, help develop empathy if possible to avoid Antisocial personality as adult. No proven Tx • Disruptive Behavior NOS

Feeding and Eating Disorders of Infancy or Early Childhood • Pica- At least one month eating nonfood items that is developmentally and culturally inappropriate. Not due to another disorder • Rumination Disorder- At least 1 month of regurgitating and rechewing food • Feeding Disorder of Infancy or Early Childhood- 1 month of failure to eat properly resulting in weight loss or lack of appropriate weight gain before age 6.

Tic Disorders • Stress makes them worse, sleep and absorbing activities-better • All may be variants of the same disorders • Tourette’s Disorder • Chronic Motor or Vocal Tic Disorder • Transient Tic Disorder • Tic Disorder NOS

Elimination Disorders • Encopresis- can dx at 4 yrs • Anxious vs defiant • May occur after life stress • Regular toilet times, muscle training, diet w/ high fiber to reduce constipation, medication (stool softeners, laxatives), stress management • Enuresis- can dx at 5 yrs, tends to be biological • Delay urination after large intake of liquid • Conditioning devices • Medication- imipraimine

Other Childhood Disorders • Separation Anxiety Disorder- • Fear harm to, or separation from major attachment figures. • Usually after a life stress. May turn into Dependent PD. • Use transitional objects and gradually increase length of separations, increase choices and autonomy behaviors, work with parents on their anxiety • Selective Mutism- Speaks in some E, but not others- usually lasts a few weeks

Other Childhood Disorders • Reactive Attachment Disorder of Infancy or Early Childhood- No/little attachment (orphanages) may form ODD, CD, APD. Controversial Tx • Stereotypic Movement Disorder-self-stimulate intentionally to increase stimulation • Disorders of Infancy, Childhood, or Adolescence NOS

Childhood Disorders