Tiêu đề Child-and Adolescent Psychiatry a Pervasive-and-developmental-disorders.pdf ✅

TRANSCRIBERS 1 PSYCHIATRY DR. ETHEL PAGADDU NOVEMBER EXIMIUS 2021 CHILD AND ADOLESCENT PSYCHIATRY GROUP 10 A. PERVASIVE AND DEVELOPMENTAL DISORDERS Characterized by impaired reciprocal social interactions, aberrant language development, and restricted behavioral repertoire Typically emerge in young children before the age of 3 years, and parents often become concerned about a child by 18 months as language development does not occur as expected Not identified with problems until school age, because they make relatively few demands and have minimal conflicts with others owing to their infrequent social engagement Often exhibit idiosyncratic intense interest in a narrow range of activities, resist change, and are not appropriately responsive to the social environment The dsm-iv-tr includes five pervasive developmental disorders: a) Autistic disorder b) Rett's disorder c) Childhood disintegrative disorder d) Asperger's disorder e) Pervasive developmental disorder not otherwise specified AUTISTIC DISORDER Historically called early infantile autism, childhood autism, or Kanner's autism Characterized by symptoms from each of the following three categories: ü Qualitative impairment in social interaction ü Impairment in communication ü Restricted repetitive and stereotyped patterns of behavior or interests About 8 cases per 10,000 children (0.08 percent The onset of autistic disorder is before the age of 3 years, although in some cases, it is not recognized until a child is much older 4-5x more frequent in boys than in girls Girls with autistic disorder are more likely to have more severe mental retardation Fragile X syndrome, a genetic disorder in which a portion of the X chromosome fractures, appears to be associated with autistic disorder Tuberous sclerosis, a genetic disorder characterized by multiple benign tumors, with autosomal dominant transmission is found with greater frequency among children with autistic disorder Approx. 70% of children with autistic disorder have mental retardation About one third of these children have mild to moderate mental retardation, and close to half of these children are severely or profoundly mentally retarded. Unusual or precocious cognitive or visuomotor abilities occur in some autistic children. The abilities, which may exist even in the overall retarded functioning, are referred to as splinter functions or islets of precocity. DSM-IV-TR Diagnostic Criteria for Autistic Disorder A. A total of six (or more) items from (1), (2), and (3), with at least two from (1), and one each from (2) and (3): ¡ Qualitative impairment in social interaction, as manifested by at least two of the following: ¢ Marked impairment in the use of multiple nonverbal behaviors such as eye-to-eye gaze, facial expression, body postures, and gestures to regulate social interaction ¢ Failure to develop peer relationships appropriate to developmental level ¢ A lack of spontaneous seeking to share enjoyment, interests, or achievements with other people (e.g., by a lack of showing, bringing, or pointing out objects of interest) ¢ Lack of social or emotional reciprocity ¡ Qualitative impairments in communication as manifested by at least one of the following: ¢ Delay in, or total lack of, the development of spoken language (not accompanied by an attempt to compensate through alternative modes of communication such as gesture or mime) ¢ In individuals with adequate speech, marked impairment in the ability to initiate or sustain a conversation with others ¢ Stereotyped and repetitive use of language or idiosyncratic language ¢ Lack of varied, spontaneous make-believe play or social imitative play appropriate to developmental level ¡ Restricted repetitive and stereotyped patterns of behavior, interests, and activities, as manifested by at least one of the following: ¢ Encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus ¢ Apparently inflexible adherence to specific, nonfunctional routines or rituals ¢ Stereotyped and repetitive motor mannerisms (e.g., hand or finger flapping or twisting, or complex whole-body movements) ¢ Persistent preoccupation with parts of objects B. Delays or abnormal functioning in at least one of the following areas, with onset prior to age 3 years: (1) social interaction, (2) language as used in social communication, or (3) symbolic or imaginative play. C. The disturbance is not better accounted for by RETT'S disorder or childhood disintegrative disorder Course and prognosis: Generally a lifelong disorder with a guarded prognosis. With IQs above 70 and those who use communicative language by ages 5 to 7 years tend to have the best prognoses Symptom areas that did not seem to improve over time were those related to ritualistic and repetitive behaviors Prognosis is improved if the environment or home is supportive and capable of meeting the extensive needs of such a child About 4 to 32 percent have grand mal seizures in late childhood or adolescence, and the seizures adversely affect the prognosis
TRANSCRIBERS 2 PSYCHIATRY DR. ETHEL PAGADDU NOVEMBER EXIMIUS 2021 CHILD AND ADOLESCENT PSYCHIATRY GROUP 10 Treatment: To target behaviors that will improve their abilities to integrate into schools, develop meaningful peer relationships, and increase the likelihood of maintaining independent living as adults Treatment interventions aim to increase socially acceptable and prosocial behavior, to decrease odd behavioral symptoms, and to improve verbal and nonverbal communication Educational and behavioral interventions are currently considered the treatments of choice. Structured classroom training, in combination with behavioral methods, is the most effective treatment for many autistic children ASPERGERS DISORDER Characterized by impairment and oddity of social interaction and restricted interest and behavior reminiscent of those seen in autistic disorder Unlike autistic disorder, in asperger's disorder no significant delays occur in language, cognitive development, or age- appropriate self-help skills Hans asperger, an austrian physician, described a syndrome that he named “autistic psychopathy” Original description of the syndrome applied to persons with normal intelligence who exhibit a qualitative impairment in reciprocal social interaction and behavioral oddities without delays in language development cause is unknown Family studies suggest a possible relationship to autistic disorder Clinical features include at least two of the following indications of qualitative social impairment: a) Markedly abnormal nonverbal communicative gestures, the failure to develop peer relationships, the lack of social or emotional reciprocity, b) Impaired ability to express pleasure in other persons' happiness DSM-IV-TR Diagnostic Criteria for Asperger's Disorder A. Qualitative impairment in social interaction, as manifested by at least two of the following: ¡ marked impairment in the use of multiple nonverbal behaviors such as eye-to-eye gaze, facial expression, body postures, and gestures to regulate social interaction ¡ failure to develop peer relationships appropriate to developmental level ¡ a lack of spontaneous seeking to share enjoyment, interests, or achievements with other people (e.g., by a lack of showing, bringing, or pointing out objects of interest to other people) ¡ lack of social or emotional reciprocity B. Restricted repetitive and stereotyped patterns of behavior, interests, and activities, as manifested by at least one of the following: ¡ encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus ¡ apparently inflexible adherence to specific, nonfunctional routines or rituals ¡ stereotyped and repetitive motor mannerisms (e.g., hand or finger flapping or twisting, or complex whole- body movements) ¡ persistent preoccupation with parts of objects C. The disturbance causes clinically significant impairment in social, occupational, or other important areas of functioning. D. There is no clinically significant general delay in language (e.g., single words used by age 2 years, communicative phrases used by age 3 years). E. There is no clinically significant delay in cognitive development or in the development of age-appropriate self-help skills, adaptive behavior (other than in social interaction), and curiosity about the environment in childhood. F. Criteria are not met for another specific pervasive developmental disorder or schizophrenia. Factors associated with a good prognosis are a normal IQ and high-level social skills Treatment of Asperger's disorder is supportive, and goals are to promote social behaviors and peer relationships. Some of the same techniques used for autistic disorder are likely to benefit patients with Asperger's disorder with severe social impairment B. ATTENTION DEFICIT DISORDERS ATTENTION-DEFICIT/HYPERACTIVITY DISORDER (ADHD) Characterized by a pattern of diminished sustained attention and higher levels of impulsivity in a child or adolescent than expected for someone of that age and developmental level The diagnosis of adhd is based on the consensus of experts that three observable subtypes: inattentive, hyperactive/impulsive, or combined are all manifestations of the same disorder. To meet the criteria for the diagnosis of adhd, some symptoms must be present before the age of 7 years, although adhd is not diagnosed in many children until they are older than 7 years when their behaviors cause problems in school and other places To confirm a diagnosis of adhd, impairment from inattention and/or hyperactivity-impulsivity must be observable in at least two settings and interfere with developmentally appropriate functioning socially, academically, or in extracurricular activities Adhd is not diagnosed when symptoms occur in a child, adolescent, or adult with a pervasive developmental disorder, schizophrenia, or other psychotic disorder. From 2 to 20 percent of grade-school children More prevalent in boys than in girls, with the ratio ranging from 2 to 1 to as much as 9 to 1 Siblings of children with adhd are also at higher risk than the general population to have learning disorders and academic difficulties The etiology of adhd involves complex interactions of neuroanatomical and neurochemical systems is based on twin and adoption family genetic studies, dopamine transport gene studies, neuroimaging studies, and neurotransmitter data
TRANSCRIBERS 3 PSYCHIATRY DR. ETHEL PAGADDU NOVEMBER EXIMIUS 2021 CHILD AND ADOLESCENT PSYCHIATRY GROUP 10 DSM-IV-TR Diagnostic Criteria for Attention-Deficit/Hyperactivity Disorder A. Either (1) or (2): ¡ Six (or more) of the following symptoms of inattention have persisted for at least 6 months to a degree that is maladaptive and inconsistent with developmental level: Inattention ¢ Often fails to give close attention to details or makes careless mistakes in schoolwork, work, or other activities ¢ Often has difficulty sustaining attention in tasks or play activities ¢ Often does not seem to listen when spoken to directly ¢ Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (not due to oppositional behavior or failure to understand instructions) ¢ Often has difficulty organizing tasks and activities ¢ Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (such as schoolwork or homework) ¢ Often loses things necessary for tasks or activities (e.g., toys, school assignments, pencils, books, or tools) ¢ Is often easily distracted by extraneous stimuli ¢ Is often forgetful in daily activities ¡ Six (or more) of the following symptoms of hyperactivity-impulsivity have persisted for at least 6 months to a degree that is maladaptive and inconsistent with developmental level: Hyperactivity ¢ Often fidgets with hands or feet or squirms in seat ¢ Often leaves seat in classroom or in other situations in which remaining seated is expected ¢ Often runs about or climbs excessively in situations in which it is inappropriate (in adolescents or adults, may be limited to subjective feelings of restlessness) ¢ Often has difficulty playing or engaging in leisure activities quietly ¢ Is often “on the go†or often acts as if “driven by a motor†¢ Often talks excessively ¡ Impulsivity ¢ Often blurts out answers before questions have been completed ¢ Often has difficulty awaiting turn ¢ Often interrupts or intrudes on others (e.g., butts into conversations or games) B. Some hyperactive-impulsive or inattentive symptoms that caused impairment were present before age 7 years. C. Some impairment from the symptoms is present in two or more settings (e.g., at school [or work] and at home). D. There must be clear evidence of clinically significant impairment in social, academic, or occupational functioning. E. The symptoms do not occur exclusively during the course of a pervasive developmental disorder, schizophrenia, or other psychotic disorder and are not better accounted for by another mental disorder (e.g., mood disorder, anxiety disorder, dissociative disorder, or a personality disorder). Code based on type: ü Attention-deficit/hyperactivity disorder, combined type: if both Criteria A1 and A2 are met for the past 6 months ü Attention-deficit/hyperactivity disorder, predominantly inattentive type: if Criterion A1 is met but Criterion A2 is not met for the past 6 months ü Attention-deficit/hyperactivity disorder, predominantly hyperactive-impulsive type: if Criterion A2 is met but Criterion A1 is not met for the past 6 months ü Coding note: For individuals (especially adolescents and adults) who currently have symptoms that no longer meet full criteria, “in partial remission†should be specified. No specific laboratory measures are pathognomonic of ADHD. The course of ADHD is variable. Symptoms have been shown to persist into adolescence or adult life in approximately 50 percent of cases. Overactivity is usually the first symptom to remit, and distractibility is the last. Remission does occur, usually between the ages of 12 and 20. Most patients with the disorder, however, undergo partial remission and are vulnerable to antisocial behavior, substance use disorders, and mood disorders. Learning problems often continue throughout life. Children with the disorder whose symptoms persist into adolescence are at risk for developing conduct disorder. Children with both ADHD and conduct disorder are also at risk for developing a substance-related disorder. Pharmacologic treatment is considered to be the first line of treatment for ADHD. Central nervous system stimulants are the first choice of agents in that they have been shown to have the greatest efficacy with generally mild tolerable side effects. C. DISRUPTIVE BEHAVIOR DISORDERS Can Be Divided Into Two Distinct Constellations Of Symptoms Categorized As Oppositional Defiant Disorder And Conduct Disorder, Both Of Which Result In Impaired Social Or Academic Functioning In A Child OPPOSITIONAL DEFIANT DISORDER A child's temper outbursts, active refusal to comply with rules, and annoying behaviors exceed expectations for these behaviors for children of the same age An enduring pattern of negativistic, hostile, and defiant behaviors in the absence of serious violations of social norms or of the rights of others Can begin as early as 3 years of age, it typically is noted by 8 years of age and usually not later than adolescence Occur at rates ranging from 2 -16 % More prevalent in boys than in girls before puberty, and the sex ratio appears to be equal after puberty
TRANSCRIBERS 4 PSYCHIATRY DR. ETHEL PAGADDU NOVEMBER EXIMIUS 2021 CHILD AND ADOLESCENT PSYCHIATRY GROUP 10 DSM-IV-TR Diagnostic Criteria for Oppositional Defiant Disorder A. A pattern of negativistic, hostile, and defiant behavior lasting at least 6 months, during which four (or more) of the following are present: ¡ Often loses temper ¡ Often argues with adults ¡ Often actively defies or refuses to comply with adults' requests or rules ¡ Often deliberately annoys people ¡ Often blames others for his or her mistakes or misbehavior ¡ Is often touchy or easily annoyed by others ¡ Is often angry and resentful ¡ Is often spiteful or vindictive B. Note: Consider a criterion met only if the behavior occurs more frequently than is typically observed in individuals of comparable age and developmental level. The disturbance in behavior causes clinically significant impairment in social, academic, or occupational functioning. C. The behaviors do not occur exclusively during the course of a psychotic or mood disorder. D. Criteria are not met for conduct disorder, and, if the individual is age 18 years or older, criteria are not met for antisocial personality disorder. Most children who have ADHD and conduct disorder develop conduct disorder before the age of 12 years. Most children who develop conduct disorder have a history of oppositional defiant disorder. The primary treatment of oppositional defiant disorder is family intervention using both direct training of the parents in child management skills and careful assessment of family interactions. Children with oppositional defiant behavior may also benefit from individual psychotherapy. CONDUCT DISORDER Likely to demonstrate behaviors in the following four categories: physical aggression or threats of harm to people, destruction of their own property or that of others, theft or acts of deceit, and frequent violation of age- appropriate rules Conduct disorder is an enduring set of behaviors that evolves over time, usually characterized by aggression and violation of the rights of others Associated with many other psychiatric disorders including ADHD, depression, and learning disorders Also associated with certain psychosocial factors, such as harsh, punitive parenting; family discord; lack of appropriate parental supervision; lack of social competence; and low socioeconomic level DSM-IV-TR criteria require three specific behaviors of the 15 listed, which include bullying, threatening, or intimidating others, and staying out at night despite parental prohibitions, beginning before 13 years of age DSM-IV-TR also specifies that truancy from school must begin before 13 years of age to be considered a symptom of conduct disorder. The disorder can be diagnosed in a person older than 18 years only if the criteria for antisocial personality disorder are not met. Range from 1 to 10 percent, with a general population rate of approximately 5 percent More common among boys than girls, and the ratio ranges from 4 to 1 to as much as 12 to 1 Occurs with greater frequency in the children of parents with antisocial personality disorder and alcohol dependence than in the general population DSM-IV-TR Diagnostic Criteria for Conduct Disorder A. A repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate societal norms or rules are violated, as manifested by the presence of three (or more) of the following criteria in the past 12 months, with at least one criterion present in the past 6 months: Aggression to people and animals ¡ Often bullies, threatens, or intimidates others ¡ Often initiates physical fights ¡ Has used a weapon that can cause serious physical harm to others (e.g., a bat, brick, broken bottle, knife, gun) ¡ Has been physically cruel to people ¡ Has been physically cruel to animals ¡ Has stolen while confronting a victim (e.g., mugging, purse snatching, extortion, armed robbery) ¡ Has forced someone into sexual activity Destruction of property ¡ Has deliberately engaged in fire setting with the intention of causing serious damage ¡ Has deliberately destroyed others' property (other than by fire setting) Deceitfulness or theft ¡ Has broken into someone else's house, building, or car ¡ Often lies to obtain goods or favors or to avoid obligations (i.e., “cons†others) ¡ Has stolen items of nontrivial value without confronting a victim (e.g., shoplifting, but without breaking and entering; forgery) Serious violations of rules ¡ Often stays out at night despite parental prohibitions, beginning before age 13 years ¡ Has run away from home overnight at least twice while living in parental or parental surrogate home (or once without returning for a lengthy period) ¡ Is often truant from school, beginning before age 13 years B. The disturbance in behavior causes clinically significant impairment in social, academic, or occupational functioning. C. If the individual is age 18 years or older, criteria are not met for antisocial personality disorder. Code based on age at onset: ü Conduct disorder, childhood-onset type: onset of at least one criterion characteristic of conduct disorder prior to age 10 years ü Conduct disorder, adolescent-onset type: absence of any criteria characteristic of conduct disorder prior to age 10 years ü Conduct disorder, unspecified onset: age at onset is not known