Childhood Psychiatric Disorders
Same broad range of etiological factors operates in childhood as in adulthood namely Bio-Psycho-Social factors
There is a genetic component to most disorders, mediated partly through its influence on intelligence & temperament.
Major environmental factors include Family & Social circumstances.
The family factors: Parenting styles, parental health,parental conflict/ separation and social factors include deprivation.
Other factors like medical disorder (Epilepsy) might also increase the risk
Assessment Process
Assessment of Childhood Psychiatric problems involve talking with the child, as well as parents supplemented by information from teachers
Try to obtain information from multiple informants about specific events & behaviours
Parents if available, can be interviewed alone first to
establish the history.
One may use Play & non-threatening conversation to gain trust with the child with ease .
Adolescents can be interviewed separately .
School reports, IQ testing and use of tools (CBCL) can supplement the information of child.
Key points to remember during assessment
Do not use stigmatizing words and phrases
Communication with the child should be clear and coherent
Identifying a child with having one or another problem behavior by no means is proof of a clinical diagnosis
Process of identification is only to help out children with possible underlying mental health problem
The identification of mental health problem should not lead to ‘labeling” a child or use of pejorative comments
Attention Deficit Hyperkinetic Disorder (ADHD)
Onset is usually in early childhood (before age 7) but the problem
is usually identified when the child starts going to school
Symptoms
occurs more commonly than usual
are inappropriate for the child’s age;
are of reasonable intensity;
persists for reasonable length of time;
Interferes with the child’s life
Range of childhood psychiatric disorders
Hyperkinetic Disorders (ADHD)
Conduct Disorder
Learning Disorders (SLD)
Pervasive Development Disorders (Autism)
Mental Retardation
Depression and associated suicide
Enuresis (bedwetting)
Substance Abuse
Anxiety Disorders
Psychosis (schizophrenia)
Tic Disorders (including Tourette’s Syndrome)
Attention Deficit Hyperkinetic Disorder (ADHD)
Onset is usually in early childhood (before age 7) but the problemis usually identified when the child starts going to school
Conduct disorder
These children may show any one or more of the following:
excessive level of fighting or bullying
cruelty to animals or other people
fire setting
stealing
repeated lying
truancy from school and running away from home
frequent and severe temper tantrums; defiant provocative behavior and persistent severe disobedience
Childhood Depression
May present with
Irritability
School refusal
Somatic complaints (Pain abdomen)
Friendship difficulties / social withdrawal
IMPORTANT:
Assess for suicide risk
Learning Disorders
Learning disorders are diagnosed when theindividual’s academic achievement in reading,mathematics, or writing is substantially below what would be expected for age, schooling and intellectual ability
Treatment is limited and basically school focused and aims at obtaining occupational self-sufficiency
Pharmacotherapy:
The CNS stimulants: These drugs reduce hyperactivity and
improve attention span
Methylphenidate (0.25-1 mg/kg/day )
Non-stimulant: Atomoxetine (1- 1.4 mg/kg qd)
Antidepressants, like imipramine in the dosage from 50 – 150
mg/day have been used
Psychological Treatment:
Behaviour Modification
Their hyperactivity could be channelized into outdoors sports
Role of Social skills training, and parent training.
Note: Combination of Pharmacological and psychological therapy is
better than either
