Transcript Child and Adolescent Psychopathology

Child and Adolescent
Psychopathology
Tomàs, J.
Child vs. Adult Psychopathology
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Disorders that occur or have onset
primarily in childhood
Disorders that can occur at all ages; kids
have same symptoms but manifest in
developmental context
Disorders that occur in all ages but
symptoms/presentation is different in kids
Why disorders may appear
differently in children?
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Neurodevelopmental factors (certain
neurocircuits not fully developed yet;
synaptic pruning)
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Cognitive maturity
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Social Context
Major classes of childhood
psychiatric disorders
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Developmental Disorders
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Disruptive Behavior Disorders (“externalizing”)
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Attention Deficit Hyperactivity Disorder
Oppositional Defiant Disorder; Conduct Disorder
Affective Disorders (“internalizing”)
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Autism; Pervasive Developmental Disorders
Language and Learning Disorders
Anxiety Disorders
Depression; Bipolar Disorder
Other disorders
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Tourette’s Disorder; Eating Disorders; Substance Use D/O’s
Epidemiology
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Overall Prevalence (over 3-6 month
period) of 15-20% of children &
adolescents
Comorbidity frequent (20 – 50%)
Anxiety: 3 - 8% (child > adol.)
Depression: 2 - 6% (adol. > child)
Disruptive Disorders: 5 – 15%
Issues in Making Psychiatric
Diagnoses in Kids
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Must rely on parents/caretakers/teachers for
much of the data – especially for externalizing
disorders
Though cognitive/language make interviewing
kids more difficult, it is important to do –
internalizing d/o’s, rule out abuse
Need to evaluate whether symptoms are
inappropriate for developmental level, and
whether they cause functional impairment or
clinically significant distress
Anxiety Disorders
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What is developmentally normal vs. pathological
Generalized anxiety disorder, Post-traumatic
stress disorder, Obsessive-compulsive disorder,
social phobia, specific phobia can all occur
Panic disorder – can occur, but rare
Separation Anxiety Disorder – prototypical
childhood anxiety disorder
Kids frequently have more than one
Most kids improve; may develop depression
when older
Separation Anxiety Disorder
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Prevalence of about 2%
Children aged 5 to 8 most commonly report unrealistic
worry about harm to parents or attachment figures and
school refusal.
Children aged 9 to 12 usually manifest excessive
distress at times of separation, whereas adolescents
most commonly manifest somatic complaints and school
refusal.
Boys and girls manifest similar symptoms of separation
anxiety disorder.
75% of children with separation anxiety disorder
manifest school refusal
Depression
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Irritability is often the primary symptom
Suicidality increases substantially after
age 10
Kids often brighten temporarily when in
positive environment or with friends
School performance often drops
(amotivation, poor concentration)
Attention-Deficit Hyperactivity
Disorder (ADHD)
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Hyperactivity
Inattention/Distractibility
Impulsivity
ADHD - Epidemiology
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Prevalence rates vary among studies
from 3 – 8% of school-age children
Ratio of male to female generally ranges
from 3:1 to 8:1.
Age of onset prior to age seven
Slightly more prevalent in lower
socioeconomic groups
Manifestations of Hyperactivity
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Unable to sit still in seat in the classroom
represents gross motor hyperactivity,
particularly in pre-pubertal children.
In post-pubertal children, usually more
subtle fidgetiness
Always on the go – “driven by a motor”
Talks excessively
ADHD - Inattention
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Cannot sustain attention compared to peers,
esp. at long, boring, or monotonous tasks
Disorganized; often loses things
Distractible
Cannot follow through on instructions
Doesn’t seem to be listening when spoken to
ADHD - Impulsivity
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Blurts out answers
Interrupts others
Intrudes on activities of others
Difficulty waiting turn
Can be verbal or physical
ADHD – Associated Symptoms
Difficulty getting along with others
Increase in behavioral problems due to
impulsivity
Difficulty learning due to inattention
Poor self-esteem – can lead to depression
Frequent Co-morbid Conditions (50-60%)
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Oppositional-Defiant Disorder (40%)
Conduct Disorder (30%)
Anxiety (15-20%) or Depression (15-20%)
ADHD – Clinical Course
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About 30% improve in adolescence
1/3 have symptoms as adults, but not
substantial impairment
1/3 still very symptomatic into adulthood
Sequelae include substance use, school
failure, antisocial behavior
Other disruptive behavior disorders
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More akin to syndromes or symptom clusters
Oppositional Defiant Disorder
Conduct Disorder (child vs. adolescent onset)
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Cruelty to animals
Fighting; assaulting others
Stealing, conning
Property Destruction
Many progress to antisocial behavior as adults
Pervasive Developmental
Disorders (PDD)
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Autism
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Impairment in Language
Deficits in social functioning
Abnormally restricted activities and interests
Likely a “spectrum” of PDD’s
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Profound autism to milder PDD NOS or
Asperger’s syndrome
Autism - Epidemiology
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Prevalence rate 1-2 in 1000 (may be
rising)
Age of onset before age 3 in 94% cases
Ratio of male: female = 4 - 5:1
Evenly distributed across socioeconomic
and ethnic groups
Autism – Impairment of Social
Interactions
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Limited awareness of the existence of others or
the feelings of others (lack of “theory of mind”)
Absent or abnormal seeking of comfort at times
of distress
Absence of sharing experiences with others
(“bring to show”)
Absent or abnormal social play
Gross impairment in ability to make peer
friendships
Impairment of Communication/Language
Abnormalities
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May have no mode of verbal communication
Markedly abnormal non-verbal communication
Absence of playacting, fantasy life, etc.
Abnormalities in the production of speech
Echolalia, or idiosyncratic use of words or
phrases
Impairment in ability to sustain a conversation
with others
Impaired Repertoire of
Activities/Interests
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Stereotyped body movements
Persistent preoccupation with parts of
objects
Marked distress over changes in trivial
aspects of environment
Unreasonable insistence on following
routines in precise detail
Markedly restricted range of interests
Autism – Associated symptoms
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75-80% have mental retardation
Higher incidence of abnormal EEG and
seizures
Self-injurious behavior
Unusual posturing and other motor
behaviors (repetitive, non-functional
movements)
Other Pervasive Developmental
Disorders
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Asperger’s Disorder
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Normal early language development and
intelligence
Impairment in social functioning and
restriction in interests like autism
PDD NOS
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Most common (1 in 200-500)
Meets some but not all criteria for autism
Tourette’s Syndrome
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Motor and vocal tics, lasting at least one year
in duration
Tics: sudden,
Tics vs. compulsions
Tic = repetitive, purposeless, non-goal
directed, involuntary, partially suppressible
Compulsion = repetitive, with purpose (to
relieve anxiety), goal-directed, quasivoluntary,
partially suppressible
Tourette’s - Epidemiology
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Prevalence rate at least 0.09%
Ratio of male:female = 3:1
Median age of onset is 6 years (range 117)
Tics
Motor Tics
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Simple motor tics (single muscle group) – e.g.: eye
blinking
Complex motor tics (multiple muscle groups) – e.g.:
kicking
Vocal Tics
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Simple vocal tics (noises) e.g. clicking
Complex vocal tics (words, phrases, or sentences)
Coprolalia (complex vocal tics made up of swear
words or other socially unacceptable
words/phrases, such as racial slurs)
Tourette’s – Clinical Course
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Waxes and wanes, may fluctuate with
"stress"
Tics are migratory (i.e. may change type,
location over time)
Usually symptoms stop worsening after
puberty, but are generally life-long
Tourette’s – Associated Symptoms
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Attention Deficit Hyperactivity Disorder
and other behavior disorders
Obsessive-Compulsive Disorder
Depression
Substance Abuse