Child Psychiatry Disorders

• Inattentive type ADHD (6 or more of the following... persistent >6 months, problematic and inconsistent with development level)
• -impairment in two or more settings (school, work, home...)
• -Onset before the age of before the age of 7 years

• 1. Fails to attend to details
• 2. Fails to focus attention
• 3. Fails to listen if spoken to
• 4. Fails to follow through
• 5. Fails to organize
• 6. Avoids concentration
• 7. Loses things
• 8. Distracts easily
• 9. Forgets

• *Inattentive type is the most common
• -leads to academic and social problems
• -present at a later age (not disruptive, easier to miss)

Hyperactive-impulsive type ADHD (6 or more... hyperactive 1-6, impulsive 7-9)

• 1. Fidgets/squirms
• 2. Leaves seat
• 3. Runs/climbs
• 4. Does not play quietly
• 5. On the go
• 6. Talk excessively
• 7. Blurts answers
• 8. Does not wait turn
• 9. Interrupts

-presents earlier (easier to see)

• Combined type ADHD
• -meets criteria for both (less common)

• Prevalence in young and school-aged children: 6%
• Male>female (3:1)
• Genetics contribute ~70% of the risk
• -Dopamine transporter genes, dopamine receptor genes
• Environmental risk factors: 
• -Fetal alcohol syndrome
• -prematurity
• -Lead toxicity, nutritional deficiencies

• Clinical course:
• -dx in grades 1 through 6
• -hyperactivity decreases with age
• -60% have some persistence of symptoms into adulthood

• Evaluation:
• -assess current situation/risk factors
• -Rule out alternative causes (thyroid disorders, medications, absence epilepsy, hypoglycemia

• Treatment: 
• -Non-pharmacologic (education, behavior modification...)

• Pharmacological Tx:
• -Stimulants (know that AEs: decreased sleep, decreased appetite, irritability, anxiety, GI pain, headache, slow growth)
• -ADHD does not predict risk for substance abuse (non-conduct disorder ADHD)
• -Dose: dose only when needed (at school, not on the weekends); start low dose

• Stimulants
• -Methylphenidate (Ritalin)
• -Dexmethylphenidate (Concerta)
• -Mextroamphetamine (Dexedrine)
• -Dextroamphetamine plus amphetamine (Adderall)

• Non-stimulants:
• -Atomoxetine (Strattera)
• -Bupropion (Wellbutrin)
• -Tricyclics such as nortriptyline (Pamelor)
• -Clonidine (Catapres)

• -Repetitive and persistent pattern of violating rules or societal norms. 
• - "Childhood form of Antisocial Personality Disorder"
• - >3 of the following within the last year... that cause impairment

• 1. Bully
• 2. Fights
• 3. Weapon
• 4. Cruel
• 5. Animal cruelty
• 6. Steal/confront
• 7. Forced sex
• 8. Fires
• 9. Vandalism
• 10. Break-ins
• 11. Lies
• 12. Stealing 
• 13. Curfew (onset <13 years)
• 14. Runaway (more than once)
• 15. Truant (onset <13 years)

*Onset: prior to age of 10-13 (puberty)

• Prevalence: ~6%
• -Males > females (5:1)
• -Genetic and environmental
• -decreased function of the prefrontal cortex

• Clinical course: 
• -physical aggression often decreases with age
• -puberty can bring on increased violence in some
• -40% go on to develop ASPD
• -80% develop substance abuse disorder
• -individuals who have or had conduct disorder die earlier

• Tx: 
• mostly behavioral, education of family, structural changes

pattern of negative, hostile and defiant behavior lasting at least 6 months... >4 of the following

• 1. Temper
• 2. Argues
• 3. Refusals
• 4. Annoys
• 5. Blames
• 6. Annoyed
• 7. Anger/resentful
• 8. Vindictive

• Prevalence and causes:
• -~10% prevalence; Males = females
• -etiology not well studied

• Course and Treatment:
• -onset in age is 6 to 8 years
• -30% develop conduct disorder, 10% go on to develop ASPD
• -60% improve within 3 years
• -Tx: education, early, problem solving (worst first)

early onset of impaired communication, interaction, and interest:

• Autism: impaired social interactions (>2 from group 1), impaired communication (>1 criteria from group 2), and restricted behavior or interests (>1 criteria from group 3). Total of  6 or more criteria.
• -Pt has delays or abnormal functioning with onset before age 3 years in one of the following: social interaction, language as used in social communication, or symbolic or imaginative play

• 1a. Decreased use of nonverbal cues (such as eye contact)
• 1b. Decreased peer relationships
• 1c. Decreased shared interests
• 1d. Decreased social response
• 2a. Decreased development of language
• 2b. Decreased conversations
• 2c. Idiosyncratic/repetitive
• 2d. Decreased social play
• 3a. Preoccupied, restricted interests
• 3b. Nonfunctional routines, rituals
• 3c. Repetitive movements
• 3d. Preoccupied with objects

• Asperger's disorder: impaired social interactions and restricted/repetitive behaviors or interests ( >2 group 1 and >1 group 3 symptoms - No group 2)
• -No language delay, no delay in cognitive development

• Same criteria as for adults
• Onset: rare before puberty
• Incidence is increased if there is family hx of MDD or bipolar disorder
• Males = females (incidence)
• Clinical course is same as adult onset MDD
• Evaluation/tx is same

• 1. Separation anxiety: fear of leaving home and/or possible harm to parents
• -seen in 4% of school aged children; onset is age 6 to 9
• -disorder improves with age

• 2. Post-traumatic stress disorder (PTSD):
• -occurs in 8% of children
• -improves with age
• -tx is CBT and sometimes SSRIs

3. Obsessive compulsive disorder, gerealized anxiety disorder, and social phobia MAY start in childhood