Transcript Child Psychiatry

‫ِب ْس ِم ه ِ‬
‫الر ِح ِيم‬
‫الر ْحمـ َ ِن َّ‬
‫اّلل َّ‬
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‫ين‬
‫ب ْالعَالَ ِم َ‬
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‫مـن َّ‬
‫َّ‬
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‫ين‬
‫َمـا ِل ِك يَ ْو ِم ال ِده ِ‬
‫َّاك نَ ْست َ ِع ُ‬
‫ين‬
‫َّاك نَ ْعبُدُ و ِإي َ‬
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‫ص َرا َ‬
‫يم‬
‫اه ِدنَــــا ال ِ ه‬
‫ط ال ُمست َ ِق َ‬
‫ص َرا َ‬
‫ين‬
‫ض ِاله َ‬
‫ط الَّ ِذ َ‬
‫علَي ِه ْم َواَ ال َّ‬
‫ين أَنعَ َ‬
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‫ضو ِ‬
‫ب َ‬
‫مت َ‬
‫ِ‬
‫علَي ِه ْم غ ِ‬
Child Psychiatry The Basics
Dr. M.Nasar Sayeed Khan
13-B, Aibak Block, garden town
03328440242
[email protected]
Is Infant &Toddler Mental Health
Really a Problem?
• Yes!
• Young children do experience
problems in social emotional
competency and even
psychopathology
• We are better able to understand and
measure these problems
Why we resist this…
• We are too worried about cognitive
skills (“ready to learn”)
• Stigma associated with mental health
issues
• Myth of childhood
• Our own discomfort with the idea
Prevalence
• Best estimates of serious behavior
concerns in children 2 to 3 years fall
between 10 to 15%
• Parent and pediatrician report behavior
problems in 10% of 1 to 2 year olds
But won’t these problems go
away?
• No!
• 37% of 18 mos with extreme
behavior/emotional problems continue
to have problems at 30 mos
• Over ½ of 2-3 with psychiatric d/o still
have symptoms 2 years out
Long Term Effects
• Exposure to poor caregiving, abuse, or
domestic violence can lead to
developmental and mental health
problems in young children
• Babies, toddlers, and preschoolers can
demonstrate depression, PTSD, and
disruptive behaviors
The Science of Early
Childhood Development
• Babies brains are growing at a
phenomenal rate
• The infant brain is “experience
expectant”
• Both positive and negative experiences
have significant and long lasting effects
The Science of Early
Childhood Development
• Experience, especially social
experiences, change the way the brain
is shaped and functions
• Babies who experience or witness
violence have behavioral and
physiological changes
MH Challenges in Young
Children
• Are real
• Involve a substantial number of babies
• Can be assessed and treated
Areas to Consider When
Assessing Young Children
• Developmental Levels of Infant or Child
• Quality of Important Relationships
• Parent Status (Capacity for
Relationship)
• Family Situations
Infant & Child Development
• A good working knowledge of typical
development is needed when you
assess young children
• You can’t tell what is atypical if you
don’t know what is typical
Infant & Child Development
• Expected order of milestones is known
Skills are traditionally divided into 5
areas
There is much overlap between the
areas
Uneven development across areas is
concerning
Infant & Child Development
Ways to learn about development
• Have a great memory from college
• Get a child development text
• Watch some babies
• Review some developmental checklists
online
Infant & Child Development
• Cognitive
• Receptive, Expressive, and Pragmatic
Communication
• Fine & Gross Motor
• Social-emotional and behavior
• Adaptive Skills (Self Help)
Cognitive Skills
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Thinking
Problem Solving
Memory
Attention
Imitation
Communication
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Use of gestures and facial expressions
Understanding speech
Expressive language
Social or pragmatic aspects of
communication
Fine & Gross Motor Skills
• Use of hands and arms to manipulate
objects
• Balance
• Strength and tone
• Walking, running, jumping
Social-emotional and
behavior
• Eye contact
• Social smile
• Relationships/
attachment
• Regulation
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Sleep
Feeding
Aggression
Compliance
Self-Help/Adaptive
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Eating
Dressing
Participation in grooming
Toileting
Ways development can be
atypical
• Global delays in development
• Inconsistent development
• Atypical, unusual behaviors—red flags
Red Flags in 6 Month Olds:
• Inability to Read Signals
• Persistent Sleep Problems
• Lack of Predictability
• Failure to Imitate Sounds and Gestures
• No Affect, Range of Feelings
• Lack of Stranger Anxiety (8 months)
Red Flags 12-18 Month Olds:
• No Words
• No Separation Distress
• Persistent Sleep
Problems
• Immobile, Low Activity
• Withdrawn
• Excessive Rocking
• Prolonged Fears
• No Social Engagement
• Predominant Anger
and Outbursts
Red Flags in 18 Months to 3 Year
olds
• Eating Problems
• No Enjoyment in Play
• Non Speaking
• Poor Problem Solving
• Extreme Shyness
• Total Lack of Self
Control
• Lack Autonomy
• Failure in Gender
Identification
• Chaotic Behavior
Screening & Referral
• Screening methods tell you if the child
needs further assessment in a given
developmental area
• Many screening tools use caregiver
report
• Do not use social-emotional screener
for CPS population
Do’s and Don’ts
• Infants and Toddlers must be evaluated
within the context of relationships with their
primary caregivers
• Assessment should always include
collaboration with parents and caregivers
• Multiple assessments over time are
recommended
• Information from Multiple sources is
recommended
Do’s and Don’ts
•Standardized Instruments May be used
but not be the sole basis of the Evaluation
•Young Children Should Never be Challenged
by Separation from Primary Caregivers
•Evaluation should utilize the DSM V
Etiology
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Brain damage
Lead intoxication
Family
Divorce
Death
Problems with preschoolers
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Bed wetting
Over activity
Difficulty in settling at night
Fears
Disobedience
Attention Seeking
Temper tantrums
Poor prognosis if persists beyond
3 and require intervention
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over-activity
conduct disorder
speech difficulty
effeminacy
autism
Pica
• Is the eating of items considered as inedible
Common causes include:
• brain damage
• autism
• mental retardation
• emotional distress
• usually diminishes as the child grows
Hyperkinetic and Attention Deficit disorders
Classification
• F90
Hyperkinetic disorders
• F90.0 Disturbance of activity and
attention
• F90.1 Hyperkinetic conduct disorder
• F90.8 Other hyperkinetic disorders
• F90.9 Hyperkinetic disorder,
unspecified
Conduct and Oppositional disorders
Classification
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Conduct disorder confined to the family
Unsocial zed conduct disorder
Socialized conduct disorder
Oppositional defiant disorder
Other conduct disorders
Conduct disorder, unspecified
F84 Pervasive
Developmental Disorders
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F84.0
Childhood Autism (Kanner, 1943)
Epidemiology
prevalence of 2 per 10,000
M:F=3:1
Clinical features
Kanner described four main features of autism:
autistic aloneness
delayed or abnormal speech
an obsessive desire for sameness
onset in the first two years of life
F93Emotional Disorders with
specific onset in childhood
• Maternal overprotection (Levy, 1943)
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excessive contact
prolongation of infantile care
prevention of independence
fathers were generally submissive
overprotected children had three times as many
operations
• Separation Anxiety Disorder
– onset is before the age of six
– diagnosis is not made when there is a
generalized disturbance of personality
development
School refusal
• Clinical features:
– there are often somatic symptoms - complaints occur on school
days but not at other times
– the final refusal may occur after several events:
– following a period of increasing difficulty
– after an enforced absence such as respiratory infection
– after an event at school such as change of class
– following a problem in the family such as illness of another family
member
• Treatment
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an early return to school is important (The Kennedy Approach)
discussion with teachers is needed
depressive disorder should be treated
it has been reported that antidepressants are effective for school
refusal, even when there is no depression
• Prognosis
Elective Mutism
• The child refuses to speak in certain circumstances, although
he does so normally in others
• usually, speech is normal in the home but lacking in school
• often associated with other negative behaviours such as
refusing to sit down or play when invited to do so
• Epidemiology
• usually begins between 3 and 5 years, after normal speech
has been acquired
• prevalence of approx. 1 in 1000
• Treatment
• no evidence that treatment is effective
• Prognosis
• can persist for months or years
• a five- to ten-year follow-up showed that only 50% had
improved
Stammering
Disturbance of the rhythm and fluency of speech
• Epidemiology
• M:F = 4:1
• affects about 1% of children
• Treatment
• speech therapy
• Prognosis
• most children improved whether treated or not
Mujtaba Nasar
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