Chapter 12 Pediatric Psychiatric Disorder 1 Autistic disorder

Chapter 12 Pediatric Psychiatric Disorder 1 -Autistic disorder -Characterized by a withdrawal of child into self & into fantasy world of his or her creation. -Disorder is rare, occurs three times more often in males than in females, & is more common in upper socioeconomic classes. -Course is chronic & often persists into adulthood. *Infantile onset (before 36 months of age). *Childhood onset (After 36 months of age).

Symptomatology (subjective & objective): 1 -Failure to form interpersonal r/s: *Characterized by unresponsiveness to people, lack of eye contact & facial responsiveness, indifferent affection. *In early childhood there is a failure to develop cooperative play & friendships.

2 -Impairment in communication (verbal & non verbal): -Characterized by absence of language or, if developed often an immature grammatical structure, incorrect use of words, echolalia, or inability to use abstract forms. -Accompanying nonverbal expressions may be inappropriate or absent.

3 -Bizarre responses to environment characterized by resistance or extreme rxns to minor occurrences, abnormal obsessive attachment to peculiar objects, ritualistic behavior. 4 -Extreme fascination for objects that move (ex. Ram trains) special interest in music, playing with water, buttons, or parts of body.

5 -Unreasonable insistence on following routines in precise detail (ex. insisting that exactly same route always be followed when shopping). 6 -Marked distress over change in trivial aspects of environment (Ex: When a case is moved from usual position). 7 -Stereotyped body movements (Ex: hand flicking or hand twisting, hand banging, complex whole body movement).

Prognosis: -Language skills and overall intellectual level are the strongest factors related to ultimate prognosis. -Only a small percentage of pts. with disorder go on to live and work independently as adults. -In about one third of cases, some degree of partial independence is possible. -The highest functioning adults with autistic disorder typically continue to exhibit problems in social interaction & communication together with restricted interests & activities.

2 - Attention-Deficit Hyperactivity Disorder (ADHD) -Often appears before age 4 & characterized by developmentally inattention, impulsively & hyperactivity. -In approximately one third of cases, sx persist into adulthood.

Symptomatology: -Often fidgets with hands or feet or squirms in seat. -Has difficulty remaining seated when required to do so. -Is easily distracted by extraneous stimuli. -Has difficulty awaiting turn in games or group situations. -Often blurts out answers to questions before they have been completed.

-Has difficulty following through on instructions from others. -Has difficulty sustaining attention in tasks play activities. -Often shifts from one uncompleted activity to another. -Has difficulty playing quietly. -Often talks excessively. -Often interrupts or intrudes on others.

-Often doesn’t seem to listen to what is being said to him or to her. -Often loses things necessary for tasks or activity at school or at home. -Often engages in physically dangerous activities without considering possible consequences (Ex: runs into street without looking).

Prognosis -In most cases, disorder is relatively stable through adolescence. -In most persons, sx are reduced into adolescence & adulthood, although few experience full range of sx into mid-adulthood. -Other adults retain only some of sx.

3 - Conduct disorder -Repetitive and persistent pattern of conduct in with the basic rights of others and major use – appropriate sour norms or rules are violated. -The conduct is more serious than the ordinary mischief and pranks of children and adolescents.

Symptomatology: 1 -Manipulation of others for fulfillment of own desire. 2 -Absence of guilt feelings in response to exploitation of others. 3 -Physical violence against persons or property -Examples include vandalism, rape, breaking and entering, fire setting , mugging, assault, cruelty to animals. -Child often initiates physical fights.

4 -Thefts outside the home involving confrontation with the victim. -Examples include extortion, purse snatching, armed robbery. 5 -Inability to from close peer relationships 6 -Chronic violations of reasonable, age-appropriate rules. -Examples include truancy, running away, persistent lying stealing, substance abuse. 7 -Failure to accept responsibility for consequences of own behavior.

Prognosis: -Less severe sx tend to emerge initially. -Males dominate in the childhood-onset grows & tend to exhibit more fighting, stealing, vandalism, & school discipline problems. -Females tend to have sx of lying, running away, substance use, & prostitution.

-Males tend to use more confrontational aggression, Female, uses non- confrontational behaviors. -An onset of conduct disorder before age 10 generally indicates more severe & persistent type & often develops into adult antisocial personality disorder. -These individuals typically are male, display more physical aggression.

4 - Oppositional defiant disorder - A pattern of negativistic, hostile, and defiant behavior without the more serious violations of the basic rights of others that are seem in those with conduct disorder. -The diagnosis is made only if the oppositional and defiant behavior is much more common than seen in other people of the same mental age. -The disorder most commonly begins in late childhood or early adolescence.

Symptomatology: 1 - Often loses temper. 2 - Often argues with adults. 3 - Often actively defies or refuses adult requests or rules. 4 - Often deliberately does things that annoy other people. 5 - Often blames others for his or her own mistakes.

6 - Is often touchy or easily annoyed by others. 7 - Is often angry and resentful. 8 - Is often spiteful or vindictive. 9 - Often swears or uses obscene language. Prognosis: -Onset is typically gradual, usually occurring over.