Dsm: 01 Infancy, Childhood & Adolescent Disorders

Front 1

what are three different categorizations of mental disorders that affect children?

Back 1

1. internalization d.o. (i.e. depression, anxiety, eating d.o.

2. Disruptive Behavior D.O. (ADHD, conduct d.o., Oppositional defiant, substance use)

3. Developmental d.o. - mental retardation, pervasive developmental d.o., LD, elimination d.o.)

Front 2

What is the range of mental retardation diagnoses

Back 2

- mild, moderate, severe, profound, severity unspecified

Front 3

What are the essential features?

- below what IQ threshold?
- when is onset?
- what do you need to look for?

Back 3

- IQ below 70
- before age 18
- concurrent deficits or impairments in adaptive functioning

Front 4

What are the indicators for mental retardation?

Back 4

1. Inability to function independently, reliance on caretakers, history of failure in school, special placement

Front 5

What is the prevalence rate for mental retardation?

What is the likelihood that indviduals with mental retardation have comorbid disorders?

What are the most commonly associated mental d.o. with mental retardation?

Back 5

- 1%
- 3 to 4 times more likely
- ADHD, mood d.o., pervisive dev, stereotype movement d.o.

Front 6

What are the Learning Disorder diagnoses?
When are LD diagnosed?
What are some indicators?
What is the prevlance?

Back 6

- reading d.o., mathematics, written expression, learning d.o. NOS

- when achievement scores are substantially below for age, schooling, and level of intelligence
- poor academic performance, low self esteem, withdrawal, behavioral disturbances
- 2 to 10%

Front 7

What is autistics d.o. characterized by?
What are the indicators?

Back 7

- impairment in social interaction
-impairment in communications
- restricted repetoire of activities

- indicators: lack of friends, lack of desire to interact with others, head banging or rocking, difficulty talking

Front 8

299.00 Autistic Disorder

Back 8

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):

(1) qualitative impairment in social interaction, as manifested by at least two of the following:
(a) 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
(b) failure to develop peer relationships appropriate to developmental level
(c) 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)
(d) lack of social or emotional reciprocity

(2) qualitative impairments in communication as manifested by at least one of the following:
(a) 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)
(b) in individuals with adequate speech, marked impairment in the ability to initiate or sustain a conversation with others
(c) stereotyped and repetitive use of language or idiosyncratic language
(d) lack of varied, spontaneous make-believe play or social imitative play appropriate to developmental level

(3) restricted repetitive and stereotyped patterns of behavior, interests, and activities, as manifested by at least one of the following:
(a) encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus
(b) apparently inflexible adherence to specific, nonfunctional routines or rituals
(c) stereotyped and repetitive motor mannerisms (e.g., hand or finger flapping or twisting, or complex whole-body movements)
(d) 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.

Front 9

What is aspergers d.o. characterized by?
What are the indicators?

Back 9

- impairment in social interaction
-restricted repetoire of activities
-NO LANGUAGE DELAYS

Indicators: lack of friends, lack of desire to interact, stereotyped interests.

Front 10

299.80 Asperger's Disorder

Back 10

A. Qualitative impairment in social interaction, as manifested by at least two of the following:
(1) 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
(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

B. Restricted repetitive and stereotyped patterns of behavior, interests, and activities, as manifested by at least one 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

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.

Front 11

Diagnostic criteria for ADHD & Subtypes

Back 11

- persistent period of: inattention and/or hyperactivity/impulsivity
-in at least 2 settings
-symptoms present for at least 6 months
-some of which were present before age 7

-inattentive type (6+ sxs of inattention & >6 sxs of hyper-impulsive)

-hyperactive-impulsive type(6 + sxs of hyper-impulsive & >6 symptoms of inattention)

-combined (6+ sxs of inatteniton & 6+ sxs of hyper-impulsivity)

Front 12

Sxs of hyperactivity-impulsivity

Back 12

Hyperactive
-fidgeting
-remaining seated
-excessive running
-difficulty playing quietly,
-excessive talking

Impulsivity
-blurting out answers
-difficulty waiting turns
-interrupting others

Front 13

What are the indicators of ADHD
(8)

Back 13

GRABS CAP

- inability to Complete tasks
- poor Grades
- Restlessness
- Acting out
- Aggressiveness
- poor Social skills
- Boredom with many activities
- Parents inability to manage child's behavior

Front 14

Sxs of Inattention

Back 14

-lack of attention to details & careless errors
-difficulty sustaining attention in work or play
-prob following through on instructions & completing tasks, being easily distracted by extraneous stimuli
-forgetfulness
-losing things
-trouble organizing tasks

Front 15

What is the prevalence of ADHD in school children?

What are the gender differences?

IQ differences?

What are the most common comorbid disorders?

Back 15

3-7 %

6-9 times more common in males

IQ is lower

ODD, Conduct DO, and Mood do, anxiety do, LD,

Front 16

What is the diagnostic criteria for Conduct DO?

Subtypes?

Back 16

3 must be present w/in 12 mo, w/ @ least 1 present in past 6 mo.

- violates right of others
- age appropriate societal normals or rules are broken
- aggression to people or animals
-destruction of property
- theft

SUBTYPES
-childhood onset type (1+ criteria @ age >10)
-adolescent onset (no criteria met before age 10)

Front 17

What are the indicators of Conduct D.O. (5)

Back 17

- criminal activity
- severe acting out
- school problems
- substance abuse
- severe family discord

Front 18

312.xx Conduct Disorder

Back 18

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

(1) often bullies, threatens, or intimidates others
(2) often initiates physical fights
(3) has used a weapon that can cause serious physical harm to others (e.g., a bat, brick, broken bottle, knife, gun)
(4) has been physically cruel to people
(5) has been physically cruel to animals
(6) has stolen while confronting a victim (e.g., mugging, purse snatching, extortion, armed robbery)
(7) has forced someone into sexual activity

Destruction of property

(8) has deliberately engaged in fire setting with the intention of causing serious damage
(9) has deliberately destroyed others' property (other than by fire setting)

Deceitfulness or theft

(10) has broken into someone else's house, building, or car
(11) often lies to obtain goods or favors or to avoid obligations (i.e., "cons" others)
(12) has stolen items of nontrivial value without confronting a victim (e.g., shoplifting, but without breaking and entering; forgery)

Serious violations of rules

(13) often stays out at night despite parental prohibitions, beginning before age 13 years
(14) 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)
(15) 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.

Front 19

What is the prevalence of Conduct D.O.

Gender difference in CD?

Concommitant Diagnoses?

Back 19

- 1 to 10%

- more common in males

- ADHD, LD, Mood DO, Anxiety, AOD

Front 20

What are the essential features and the sxs of ODD?
How many sxs present for how long

Back 20

- negativistic, defiant, disobedient, and hostile behaviors toward authority figures. 4 sxs must be present for 6 months

SXS = loss of temper, arguing with adults, actively defying adults, annoying others on purpose, blaming others for own mistakes, frequent anger and resentfulness, spitefulness

Front 21

313.81 Oppositional Defiant Disorder

Back 21

A. A pattern of negativistic, hostile, and defiant behavior lasting at least 6 months, during which four (or more) of the following are present:
(1) often loses temper
(2) often argues with adults
(3) often actively defies or refuses to comply with adults' requests or rules
(4) often deliberately annoys people
(5) often blames others for his or her mistakes or misbehavior
(6) is often touchy or easily annoyed by others
(7) is often angry and resentful
(8) 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.

B. 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.

Front 22

What are the indicators of ODD?

What is the prevlance of ODD?
Gender of ODD?
Age of onset?

Back 22

- Refusal to do tasks, bossiness toward parents, sulky & irritable behavior, temper tantrums (behaviors occur mostly @ home

2-16%

- Before puberty it is more prevalent in males, rates are equal after puberty

Front 23

307.59 Feeding Disorder of Infancy or Early Childhood

Back 23

A. Feeding disturbance as manifested by persistent failure to eat adequately with significant failure to gain weight or significant loss of weight over at least 1 month.

B. The disturbance is not due to an associated gastrointestinal or other general medical condition (e.g., esophageal reflux).

C. The disturbance is not better accounted for by another mental disorder (e.g., Rumination Disorder) or by lack of available food.

D. The onset is before age 6 years.

Front 24

307.52 Pica

Back 24

A. Persistent eating of nonnutritive substances for a period of at least 1 month.

B. The eating of nonnutritive substances is inappropriate to the developmental level.

C. The eating behavior is not part of a culturally sanctioned practice.

D. If the eating behavior occurs exclusively during the course of another mental disorder (e.g., Mental Retardation, Pervasive Developmental Disorder, Schizophrenia), it is sufficiently severe to warrant independent clinical attention.

Front 25

307.53 Rumination Disorder

Back 25

A. Repeated regurgitation and rechewing of food for a period of at least 1 month following a period of normal functioning.

B. The behavior is not due to an associated gastrointestinal or other general medical condition (e.g., esophageal reflux).

C. The behavior does not occur exclusively during the course of Anorexia Nervosa or Bulimia Nervosa. If the symptoms occur exclusively during the course of Mental Retardation or a Pervasive Developmental Disorders, they are sufficiently severe to warrant independent clinical attention

Front 26

307.22 Chronic Motor or Vocal Tic Disorder

Back 26

A. Single or multiple motor or vocal tics (i.e., sudden, rapid, recurrent, nonrhythmic, stereotyped motor movements or vocalizations), but not both, have been present at some time during the illness.

B. The tics occur many times a day nearly every day or intermittently throughout a period of more than 1 year, and during this period there was never a tic-free period of more than 3 consecutive months.

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

D. The onset is before age 18 years.

E. The disturbance is not due to the direct physiological effects of a substance (e.g., stimulants) or a general medical condition (e.g., Huntington's disease or postviral encephalitis).

F. Criteria have never been met for Tourette's Disorder.

Front 27

307.23 Tourette's Disorder

Back 27

A. Both multiple motor and one or more vocal tics have been present at some time during the illness, although not necessarily concurrently. (A tic is a sudden, rapid, recurrent, nonrhythmic, stereotyped motor movement or vocalization.)

B. The tics occur many times a day (usually in bouts) nearly every day or intermittently throughout a period of more than 1 year, and during this period there was never a tic-free period of more than 3 consecutive months.

C. The onset is before age 18 years.

D. The disturbance is not due to the direct physiological effects of a substance (e.g., stimulants) or a general medical condition (e.g., Huntington's disease or postviral encephalitis).

Front 28

Encopresis

Back 28

A. Repeated passage of feces into inappropriate places (e.g., clothing or floor) whether involuntary or intentional.

B. At least one such event a month for at least 3 months.

C. Chronological age is at least 4 years (or equivalent developmental level).

D. The behavior is not due exclusively to the direct physiological effects of a substance (e.g., laxatives) or a general medical condition except through a mechanism involving constipation.

Front 29

307.6 Enuresis

Back 29

A. Repeated voiding of urine into bed or clothes (whether involuntary or intentional).

B. The behavior is clinically significant as manifested by either a frequency of twice a week for at least 3 consecutive months or the presence of clinically significant distress or impairment in social, academic (occupational), or other important areas of functioning.

C. Chronological age is at least 5 years (or equivalent developmental level).

D. The behavior is not due exclusively to the direct physiological effect of a substance (e.g., a diuretic) or a general medical condition (e.g., diabetes, spina bifida, a seizure disorder).

Front 30

313.23 Selective Mutism

Back 30

A. Consistent failure to speak in specific social situations (in which there is an expectation for speaking, e.g., at school) despite speaking in other situations.

B. The disturbance interferes with educational or occupational achievement or with social communication.

C. The duration of the disturbance is at least 1 month (not limited to the first month of school).

D. The failure to speak is not due to a lack of knowledge of, or comfort with, the spoken language required in the social situation.

E. The disturbance is not better accounted for by a Communication Disorder (e.g., Stuttering) and does not occur exclusively during the course of a Pervasive Developmental Disorder, Schizophrenia, or other Psychotic Disorder.

Front 31

What are the essential features of separation anxiety d.o.

What are the duration and age of onset of sxs?

What are the sxs? (8)

Back 31

- developmentally inappropriate and excessive anxiety about being away from home or away from caretakers

-duration of sxs is 4 weeks before 18 y.o.

Must have 3 or more:
-distress when separation from home or attachment figure
-excessive worry about loosing an attachment figure
-excessive worry that an event will cause separation
-reluctance to go to school
-relectance to be alone
-reluctance to go to sleep without being near the attachment figure
-nightmares about separation
-complaints of physical sxs when separation occurs

Front 32

What are the indicators of separation anxiety sxs (3)

What is the prevalence

What is the comorbid d.o. (3)

Differential Diagnosis: (4)

Back 32

- refusal to go to school
- nightmares
-clinginess

-4%

-mood d.o., anxiety d.o., panic d.o.

-differential: gen anxiety d.o., Adjustment d.o., Physical or Sexual Abuse

Front 33

309.21 Separation Anxiety Disorder

Back 33

A. 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:
(1) recurrent excessive distress when separation from home or major attachment figures occurs or is anticipated
(2) persistent and excessive worry about losing, or about possible harm befalling, major attachment figures
(3) persistent and excessive worry that an untoward event will lead to separation from a major attachment figure (e.g., getting lost or being kidnapped)
(4) persistent reluctance or refusal to go to school or elsewhere because of fear of separation
(5) persistently and excessively fearful or reluctant to be alone or without major attachment figures at home or without significant adults in other settings
(6) persistent reluctance or refusal to go to sleep without being near a major attachment figure or to sleep away from home
(7) repeated nightmares involving the theme of separation
(8) repeated complaints of physical symptoms (such as headaches, stomachaches, nausea, or vomiting) when separation from major attachment figures occurs or is anticipated

B. The duration of the disturbance is at least 4 weeks.

C. The onset is before age 18 years.

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

E. The disturbance does not occur exclusively during the course of a Pervasive Developmental Disorder, Schizophrenia, or other Psychotic Disorder and, in adolescents and adults, is not better accounted for by Panic Disorder With Agoraphobia.