Transcript Childhood Disorders - Santa Barbara Therapist

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
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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 DisabilitiesPublic 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
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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-selfstimulate intentionally to increase
stimulation
• Disorders of Infancy, Childhood, or
Adolescence NOS