Childhood Disorders  by Dr. Len Brassard

Childhood disorders, often labeled as developmental disorders or learning disorders, most often occur and are diagnosed when the child is of school-age. Although some adults may also relate to some of the symptoms of these disorders, typically the disorder's symptoms need to have first appeared at some point in the person's childhood.

Asperger's Disorder

SYMPTOMS

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

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

The disturbance causes clinically significant impairment in social, occupational, or other important areas of functioning.

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).

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.

GILLBERG'S CRITERIA FOR ASPERGER'S DISORDER

1.    Severe impairment in reciprocal social interaction (at least two of the following)

(a) inability to interact with peers

(b) lack of desire to interact with peers

(c) lack of appreciation of social cues

(d) socially and emotionally inappropriate behavior

2.    All-absorbing narrow interest (at least one of the following)

(a) exclusion of other activities

(b) repetitive adherence

(c) more rote than meaning

3.    Imposition of routines and interests (at least one of the following)

(a) on self, in aspects of life

(b) on others

4.    Speech and language problems (at least three of the following)

(a) delayed development

(b) superficially perfect expressive language

(c) formal, pedantic language

(d) odd prosody, peculiar voice characteristics

(e) impairment of comprehension including misinterpretations of literal/implied meanings

5.    Non-verbal communication problems (at least one of the following)

(a) limited use of gestures

(b) clumsy/gauche body language

(c) limited facial expression

(d) inappropriate expression

(e) peculiar, stiff gaze

6.Motor clumsiness: poor performance on neurodevelopmental examination

(All six criteria must be met for confirmation of diagnosis.)

Attention Deficit/Hyperactivity Disorder (ADHD/ADD)

SYMPTOMS

ADHD or ADD is characterized by a majority of the following symptoms being present in either category (inattention or hyperactivity). These symptoms need to manifest themselves in a manner and degree which is inconsistent with the child's current developmental level. That is, the child's behavior is significantly more inattentive or hyperactive than that of his or her peers of a similar age.

Symptoms of 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

Symptoms of 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

Symptoms of 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)

Symptoms must have persisted for at least 6 months. Some of these symptoms need to have been present as a child, at 7 years old or younger. The symptoms also must exist in at least two separate settings (for example, at school and at home). The symptoms should be creating significant impairment in social, academic or occupational functioning or relationships.

Autistic Disorder

SYMPTOMS

(I) A total of six (or more) items from (A), (B), and (C), with at least two from (A), and one each from (B) and (C)

(A) qualitative impairment in social interaction, as manifested by at least two of the following:

1. marked impairments in the use of multiple nonverbal behaviors such as eye-to-eye gaze, facial expression, body posture, and gestures to regulate social interaction
2. failure to develop peer relationships appropriate to developmental level
3. 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)
4. lack of social or emotional reciprocity ( note: in the description, it gives the following as examples: not actively participating in simple social play or games, preferring solitary activities, or involving others in activities only as tools or "mechanical" aids )

(B) qualitative impairments in communication as manifested by at least one of the following:

1. 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)
2. in individuals with adequate speech, marked impairment in the ability to initiate or sustain a conversation with others
3. stereotyped and repetitive use of language or idiosyncratic language
4. lack of varied, spontaneous make-believe play or social imitative play appropriate to developmental level

(C) restricted repetitive and stereotyped patterns of behavior, interests and activities, as manifested by at least two of the following:

1. encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus
2. apparently inflexible adherence to specific, nonfunctional routines or rituals
3. stereotyped and repetitive motor mannerisms (e.g hand or finger flapping or twisting, or complex whole-body movements)
4. persistent preoccupation with parts of objects

(II) Delays or abnormal functioning in at least one of the following areas, with onset prior to age 3 years:

(A) social interaction
(B) language as used in social communication
(C) symbolic or imaginative play

Childhood Depression

What Is Depression?

Depression is a serious health problem that affects people of all ages, including children and adolescents. It is the persistent experience of a sad or irritable mood and the loss of interest or pleasure in nearly all activities. These feelings are accompanied by a range of additional symptoms affecting appetite and sleep, activity level and concentration, and feelings of self-worth.

Clinical depression is more than just "feeling blue" or having a bad day. And it's different from the feelings of grief or sorrow that might follow a major loss, such as a death in the family. It's not a personal weakness or a character flaw. Children and teens with clinical depression cannot simply "snap out of it."

Depression is a form of mental illness that affects the whole body — it impacts the way one feels, thinks and acts. If left untreated, depression can lead to school failure, alcohol or other drug use, and even suicide.

A. Five (or more) of the following symptoms have been present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either 

   (1) depressed mood or

   (2) loss of interest or pleasure. 

(1) depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad or empty) or observation made by others (e.g., appears tearful). Note: In children and adolescents, can be irritable mood. 

(2) markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation made by others) 

(3) significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day. Note: In children, consider failure to make expected weight gains. 

(4) Insomnia or Hypersomnia nearly every day 

(5) psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down) 

(6) fatigue or loss of energy nearly every day 

(7) feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick) 

(8) diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others) 

(9) recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide 

C. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. 

Know The Signs.

• Persistent sadness and hopelessness.
• Withdrawal from friends and activities once enjoyed.
• Increased irritability or agitation.
• Missed school or poor school performance.
• Changes in eating and sleeping habits (e.g. significant weight loss or insomnia).
• Indecision, lack of concentration or forgetfulness.
• Feelings of worthlessness or excessive guilt.
• Frequent physical complaints such as headaches and stomachaches.
• Lack of enthusiasm or motivation.
• Low energy and chronic fatigue.
• Drug and/or alcohol abuse.
• Recurring thoughts of death or suicide.

Know The Facts.

• As many as one in every 33 children and approximately one in eight adolescents may have depression. (Center for Mental Health Services, 1996).
• Treatment of major depression is as effective for children as it is for adults. (Dr. Graham Emslie, American Medical Association, Archives of General Psychiatry, November 15, 1997).

What are some of the risk factors for depression?

• Children under stress, who have experienced loss, or who have attention, learning, or conduct disorders are at a higher risk for depression (American Academy of Child & Adolescent Psychiatry).
• Adolescent girls are more likely than adolescent boys to develop depression (National Institute of Mental Health).
• Youth, particularly younger children, who develop depression are likely to have a family history of the disorder (National Institute of Mental Health).
• Four out of every five runaway youth suffer from depression (U.S. Select Committee on Children, Youth & Families).

What Can Parents/Adults Do?

If parents or other adults in a young person's life suspect a problem with depression, they should:

• Know the warning signs of depression and note how long problems have been going on, how often they occur, and how severe they seem.
• See a mental health professional or the child's doctor for evaluation and diagnosis.
• Get accurate information from libraries, hotlines and other sources.
• Ask questions about treatments and services.
• Talk to other families or find a family network organization.

It is important for people who have questions about, or are not satisfied with, the mental health care they receive to discuss their concerns with the provider, ask for more information and seek help from other sources.
Conduct Disorder

SYMPTOMS

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

The disturbance in behavior causes clinically significant impairment in social, academic, or occupational functioning.

If the individual is age 18 years or older, criteria are not met for Antisocial Personality Disorder.  

Mental Retardation

SYMPTOMS

Significantly subaverage intellectual functioning: an IQ of approximately 70 or below on an individually administered IQ test (for infants, a clinical judgment of significantly subaverage intellectual functioning).

Concurrent deficits or impairments in present adaptive functioning (i.e., the person's effectiveness in meeting the standards expected for his or her age by his or her cultural group) in at least two of the following areas: communication, self-care, home living, social/interpersonal skills, use of community resources, self-direction, functional academic skills, work, leisure, health, and safety.

The onset is before age 18 years.  

Oppositional Defiant Disorder

SYMPTOMS

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

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.

The behaviors do not occur exclusively during the course of a Psychotic or Mood Disorder (such as depression).

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.

Separation Anxiety Disorder

SYMPTOMS

Developmentally inappropriate and excessive anxiety concerning separation from home or from those to whom the individual is attached, as evidenced by three (or more) of the following:

·         recurrent excessive distress when separation from home or major attachment figures occurs or is anticipated

·         persistent and excessive worry about losing, or about possible harm befalling, major attachment figures

·         persistent and excessive worry that an untoward event will lead to separation from a major attachment figure (e.g., getting lost or being kidnapped)

·         persistent reluctance or refusal to go to school or elsewhere because of fear of separation

·         persistently and excessively fearful or reluctant to be alone or without major attachment figures at home or without significant adults in other settings

·         persistent reluctance or refusal to go to sleep without being near a near a major attachment figure or to sleep away from home

·         repeated nightmares involving the theme of separation

·         repeated complaints of physical symptoms (such as headaches, stomachaches, nausea, or vomiting) when separation from major attachment figures occurs or is anticipated

The duration of the disturbance is at least 4 weeks.

The onset is before age 18 years.

The disturbance causes clinically significant distress or impairment in social, academic (occupational), or other important areas of functioning.