Common Childhood Mental

Disorders
Presented by:
Merilyne Msmawii Beiho
Psychiatric Nurse
DMHP, Siaha
 INTRODUCTION
• ICD-10 blocks F80-F89 (disorders of psychological
development) and F90-F98 (behavioural and emotional
disorders with onset usually occurring in childhood and
adolescence) cover only those disorders that are specific to
childhood and adolescence.
• A number of disorders placed in other categories can also
occur in children, and therefore should be used as and when
required. Examples are disorders of eating (F50.-), sleeping
(F51.-) and gender identity (F64.-), etc.
 Importance of Child and
Adolescent Mental Health

½ of mental illness in adults has

started before the age of 15
 AETIOLOGY
• Child
– boys
– low intelligence
– difficult temperament
– physical illness
– developmental delay
– genetic factors
• Family
– traumatic stress
– parenting issues
– marital disharmony
– maternal ill-health
– parental psychiatric disturbance/substance misuse issues
– abuse
• Environment
– peer relationship problems
– social deprivation
– school factors
– stresses resulting from accidents
 Common Childhood Mental Health
Problems
A. Neuro-developmental Disorders
1. Specific Learning Disorders
a. Dyslexia
b. Dyscalculia
c. Dysgraphia
2. Pervasive Developmental Disorders/ Autism Spectrum
Disorders
a. Classic Autistic Disorder
b. Asperger Syndrome
c. Rett’s Syndrome
d. Childhood Disintegrative Disorder
e. PDD-NOS
3. Attention Deficit Hyperactivity Disorder (ADHD)
B. Behaviour and emotional disorders
1. Habit disorders
2. Anxiety disorders
3. Conduct disorders
A. NEURO-DEVELOPMENTAL DISORDERS

1. SPECIFIC LEARNING DISORDERS

Specific learning disorder (often referred to as
learning disorder or learning disability) is a neuro-
developmental disorder that begins during school-
age, although may not be recognized until
adulthood. Learning disabilities refers to ongoing
problems in one of three areas, reading, writing
and math, which are foundational to one’s ability
to learn.
Epidemiology
• An estimated 5 to 15 percent of school-age
children struggle with a learning disability.
• An estimated 80 percent of those with
learning disorders have reading disorder in
particular (dyslexia).
• One-third of people with learning disabilities
are estimated to also have attention-deficit
hyperactivity disorder (ADHD).
 Diagnosis
Learning disorder can only be diagnosed after formal education starts.
To be diagnosed with a specific learning disorder, a person must meet
four criteria.
1) Have difficulties in at least one of the following areas for at least six
months despite targeted help:
– Difficulty reading (e.g., inaccurate, slow and only with much effort)
– Difficulty understanding the meaning of what is read
– Difficulty with spelling
– Difficulty with written expression (e.g., problems with grammar,
punctuation or organization)
– Difficulty understanding number concepts, number facts or
calculation
– Difficulty with mathematical reasoning (e.g., applying math concepts
or solving math problems)
 Diagnosis
2) Have academic skills that are substantially below what is
expected for the child’s age and cause problems in school,
work or everyday activities.
3) The difficulties start during school-age even if in some
people don’t experience significant problems until adulthood
(when academic, work and day-to-day demands are greater).
4) Learning difficulties are not due to other conditions, such as
intellectual disability, vision or hearing problems, lack of
instruction, or difficulties speaking/understanding the
language.
A diagnosis is made through a combination of observation,
interviews, family history and school reports.
 Types of Learning Disorders
1. Dyslexia (Impairment in reading)
2. Dyscalculia (impairment in understanding
of number and maths facts)
3. Dysgraphia (impairment in handwriting
ability & fine motor skills)
2. PERVASIVE DEVELOPMENTAL
DISORDER/AUTISM SPECTRUM DISORDER

A pervasive developmental disorder defined

by the presence of abnormal and/or impaired
development that is manifest before the age
of 3 years, and by the characteristic type of
abnormal functioning in all three areas of
social interaction, communication, and
restricted, repetitive behaviour.
 Epidemiology
• According to the CDC, one in 59 children is
estimated to have autism.  
• It is three to four times more common in boys
than in girls, and many girls with ASD exhibit
less obvious signs compared to boys.
• Autism is a lifelong condition.
 Diagnosis & Risk factors
The Centers for Disease Control and Prevention (CDC)
have identified possible red flags for autism spectrum
disorder in young children, including:
– Not responding to his/her name by 12 months of age
– Not pointing at objects to show interest by 14 months
– Not playing "pretend" games by 18 months
– Avoiding eye contact or preferring to be alone
– Getting upset by minor changes
– Flapping their hands, rocking their body or spinning in
circles
– Having unusual and sometimes intense reations to the
way things smell, taste, feel and/or look
Types of PDD
Types of PDD
Types of PDD
Types of PDD
Types of PDD
 3. ATTENTION DEFICIT HYPERACTIVITY
DISORDER
• ADHD includes a combination of persistent problems, such as
difficulty sustaining attention, hyperactivity and impulsive
behavior that interferes with functioning or development
• Present before age 12 and manifests in two or more settings
(home, school, work, with friends or relatives)
• The symptoms persisted for atleast 6 months (DSM-V)
• Three subtypes within the disorder
– Predominantly Inattentive
– Predominantly Hyperactive/Impulsive
– Combined

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 Symptoms
1. Inattention
A child who shows a pattern of inattention may often:
• Fail to pay close attention to details or make careless mistakes in
schoolwork
• Have trouble staying focused in tasks or play
• Appear not to listen, even when spoken to directly
• Have difficulty following through on instructions and fail to finish
schoolwork or chores
• Have trouble organizing tasks and activities
• Avoid or dislike tasks that require focused mental effort, such as homework
• Lose items needed for tasks or activities, for example, toys, school
assignments, pencils
• Be easily distracted
• Forget to do some daily activities, such as forgetting to do chores
 Symptoms
2. Hyperactivity and impulsivity
A child who shows a pattern of hyperactive and impulsive symptoms
may often:
• Fidget with or tap his or her hands or feet, or squirm in the seat
• Have difficulty staying seated in the classroom or in other situations
• Be on the go, in constant motion
• Run around or climb in situations when it's not appropriate
• Have trouble playing or doing an activity quietly
• Talk too much
• Blurt out answers, interrupting the questioner
• Have difficulty waiting for his or her turn
• Interrupt or intrude on others' conversations, games or activities
 ADHD: Prevalence and Risk
• 5 percent of children/adolescents diagnosed with
ADHD
• Girls most commonly diagnosed with inattentive subtype
• Environmental
– Low birth weight
– History of maltreatment or multiple foster placements,
drinking/smoking/toxin exposure (lead) during pregnancy
• Genetic
– Higher in first-degree relatives

(American Psychiatric Association)

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 B. BEHAVIOUR AND EMOTIONAL
DISORDERS
1. HABIT DISORDER
a. Finger (Thumb) sucking & Nail Biting:
It is a sensory solace for children
Predisposing factors:
 Developmental delay, Neglect
Management:
 Most give up by 2 yrs
 Reassure parents that it’s transient.
 Improve parental attention / nurturing.
 Teach parent to ignore.
 Provide child praise / reward.
 Bitter salves, thumb splints, gloves may be used
b. Temper Tantrums
Child displays defiance, negativism / oppositionalism by
having temper tantrums.
Management
• In general, advised parents to:
• Set a good example to child, Pay attention to child
• Spend quality time, Have consistency in behavior
• Have open communication
• During temper tantrum teach parents to
• Ignore child
• Verbal reprimand should not be abusive
• Never beat or threaten child
• Impose “Time Out”
c. Pica
Repeated or chronic ingestion of non-
nutritive substances like mud, paint, clay,
plaster, charcoal.
Predisposing factors : Parental neglect,
Poor supervision, MR, Autism, etc
Management:
• Screening
• Treat cause accordingly.
d. Breath Holding Spasms
It is reflexive events in which typically
there is a provocative event that causes
anger, frustration or pain and the child
starts crying.
Management
 Parents' worries are allayed.
 Both parents should be counseled
together.
 During the episode, they should pinch the
child at the onset of the spell
e. Stuttering / Stammering
• It is a defect in speech. It usually begins
between 2 – 5 yrs.
• Reminding and ridiculing aggravate the
condition.
Management:
• Parents should be reassured.
• Children should be given emotional support
• Older children should be referred to speech
therapist
2. ANXIETY DISORDERS
• Excessive fear
(emotional response to
real or perceived
imminent threat)

• Anxiety (anticipation of
future threat)

• Behavioral responses
(fight, flight, freeze)

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Prevalence
 6-7% of children may develop and, of these,
1/3 may be over-anxious while 1/3 may have
some phobia.
Generalised anxiety disorder, childhood-onset
social phobia, separation anxiety disorder,
obsessive compulsive disorder and specific
phobia are demonstrated.
School phobia occurs in 1-5% of children
a. Separation Anxiety: Symptoms
• Excessive distress when anticipating or experiencing separation
from home or from attachment figures
• Excessive worry about
– Losing attachment figures or possible harm to them
– Experiencing an untoward event that causes separation from
attachment figures
– Being alone or without attachment figures
• Reluctance or refusal to go out, away from home, to school
• Reluctance or refusal to sleep alone
• Nightmares with them of separation
• Repeated complaints of physical symptoms

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b. Social Anxiety: Symptoms
• Fear or anxiety about social situations with peers
and adults (conversations, meeting people,
performance in front others, being observed)
• Fears of being negatively evaluated by others
• Expressed in children through crying, tantrums,
freezing, clinging, or failing to speak in social
situations
• Social situations are avoided or endured with
intense fear or anxiety
• Lasting for six months or more

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 Anxiety Disorders: Assessment and
Treatment
• Assessment
– Comprehensive evaluation
– Sometimes use self-report measures completed
by both the parent and child (if the child is old
enough to self report on symptoms)
• Treatment
– Cognitive behavioral therapy
– Medication (antianxiety and antidepressant)

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3. CONDUCT DISORDER
Conduct disorder involves a repetitive and
persistent pattern of behavior in which the basic
rights of others or major age-appropriate societal
norms or rules are violated in the past 12
months(DSM-V). The symptoms fall into four
general categories:
Aggression to people and animal
Destruction of property
Deceitfulness of theft
Serious violation of rules
 TYPES
The DSM-V divides this disorder into two subtypes
based on the age at onset.
Childhood-Onset Type:
• This subtype is defined by the onset of at least one
criterion characteristic of conduct disorder prior to
age 10.
Adolescent-Onset Type:
• This subtype is defined by the absence of any
criteria characteristic of conduct disorder prior to
age 10.
 Epidemiology
• Occasional rule breaking and rebellious behavior
is common
• Rates among the general population range from
1 to 10 %, approximately 5 %.
• 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.
TREATMENT

– Family therapy
– Cognitive behavioral therapy
– Anger management
– No specific type of medication for CD
– Medications used to treat co-existing
conditions, such as depression, ADHD, or
anxiety

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ASSESSMENT
Main areas to cover in assessment.

i) Description and history of main problems

ii) Child’s peri-natal, developmental, medical, educational
and social history
iii) Family history including any psychological health
problems and information regarding parents own
experience of being parented
iv) Mental state of the child
v) Family communication and relationships
An assessment also offers the opportunity to engage
therapeutically with a family.
TREATMENT APPORACHES
• Parental counselling
• Psycho-education
• Behaviour therapy
• Cognitive-behavioural therapy
• Family therapy
• Pharmacotherapy
• Individual psychotherapy
• Group therapy
• Liaison with other agencies
– (education, social services, Paediatrics)
• Usually out-patient
– Also day hospital or in-patient
STRATEGIES FOR BEHAVIOR MANAGEMENT OF
CHILDREN
• Respond warmly to a child's positive behaviors.
• Communicate approval
• Express excitement
• Ignore negative behavior
• Refrain from giving unnecessary commands.
• Respond calmly
• Use time-outs when necessary and appropriate.
• Avoid making unrealistic demands of a child.
• Avoid negative remarks about the child.
• Communicate often