MENTAL DISORDER IN CHILDHOOD

Developmental Coordination Disorder

Children with Developmental Coordination Disorder (sometimes referred to as
Dyspraxia) show extreme clumsiness and/or significant impairment in motor
coordination. In order to be diagnosed with this disorder, the child's performance in
daily activities requiring motor coordination must be significantly below what is
expected based on their age and intelligence level. Examples of delays include
problems with achieving motor milestones (e.g., walking), dropping things, or poor
handwriting.
Symptoms of Developmental Coordination Disorder vary with age and
developmental stage. Young children may experience significant delays in walking,
tying shoelaces, buttoning, or zipping. Older children may have problems with the
motor aspects of activities like completing puzzles, building models, playing with
balls, or writing. Generally speaking, a child will show symptoms of the disorder
when they first attempt a complicated activity. It is less common that a child will
become proficient at one of these activities and then later develop difficulties
performing the skill required.
According to the DSM, approximately 6% of children meet the criteria for this
disorder. Usually, Developmental Coordination Disorder is diagnosed in children
who are 5-11 years old. Males may be more likely to be diagnosed with this
disorder, but prevalence information suggests that males and females are equally
affected.
LEARNING DISORDER
Children or adolescents may be diagnosed with a Learning Disorder when their
achievement on individually administered, standardized tests in reading,
mathematics, or written expression is significantly below what is expected for their
age, schooling, or level of intelligence. The umbrella term "Learning Disorders"
includes Reading Disorder, Disorder of Written Expression, and Mathematics
Disorder.
Estimates of prevalence rates for the learning disorders vary widely, ranging
between 2 and 10% of all children. Currently, more than half of all children who
receive special education services have been diagnosed with some sort of learning

disability. Males appear to be affected by learning disorders more frequently than

females.
These days, learning disorders are thought to be neurobiological in nature, meaning
they are problems that begin as a result of a brain development problem. Learning
disorders are not caused by other kinds of developmental delays, speech and
hearing problems, or by learning a second language as a child.

Disorders of Childhood: Communication Disorders

Andrea Barkoukis, M.A., Natalie Staats Reiss, Ph.D., and Mark Dombeck, Ph.D.
Updated: Feb 4th 2008
Communication Disorders are problems of childhood that affect learning, language,
and/or speech. Expressive Language Disorder, Phonological Disorder, ReceptiveExpressive Language Disorder, and Stuttering are all types of Communication
Disorders.
Certain characteristics are common to all Communication Disorders. First, the
diagnostic criteria for each require that the disorder must not be caused by mental
retardation or a neurological disorder (such as epilepsy, for example). In all
Communication Disorders, a child's communication ability resembles that of a much
younger child, which creates problems at school, at home and with peers
(particularly in school). These disorders may run in families (e.g., there may be a
genetic component to some communication disorders). They are more frequently
diagnosed in boys than in girls and are more common among younger children than
older children. Although the characteristics described above are common among all
Communication disorders, there are also a wide range of subtypes and varying
levels of severity among these disorders.

Disorders of Childhood: Pervasive Developmental Disorders

Andrea Barkoukis, M.A., Natalie Staats Reiss, Ph.D., and Mark Dombeck, Ph.D.
Updated: Feb 4th 2008
A child who demonstrates severe and persistent difficulties in several areas of
development (social interactions, language and communication, repetitive and
stereotypical behavior) may be affected by a Pervasive Development Disorder.
Generally, the problems appear in the first few years of life. Pervasive Development
Disorders are frequently, though not always, associated with some degree of

mental retardation. Autistic Disorder, Rett's Disorder, Childhood Disintegrative

Disorder, Asperger's Syndrome, and Pervasive Developmental Disorder Not
Otherwise Specified are all grouped under the category of Pervasive Developmental
Disorders.
Males are four times more likely to be affected by Pervasive Developmental
Disorders than females. However, according to the National Institute of Child Health
and Human Development, Rett's Disorder (approximately 1 out of 10,000 births) is
more commonly reported in females than males. Autism rates have increased
dramatically over the past few years. According to the Centers for Disease Control,
20 to 70 out of every 10,000 American children have autism. Asperger's Syndrome,
which may be characterized as a mild form of Autism, occurs in about 26 out of
every 10,000 children (according to the American Academy of Child and Adolescent
Psychiatry).

Disorders of Childhood: Attention-Deficit and Disruptive Behavior

Disorders
Andrea Barkoukis, M.A., Natalie Staats Reiss, Ph.D., and Mark Dombeck, Ph.D.
Updated: Feb 4th 2008
Children who have chronic difficulties in maintaining attentional focus, completing
work, being impulsive, or repeatedly engage in antisocial behaviors such as lying
and cheating may have one or more Attention-Deficit and Disruptive Behavior
Disorders. The disorders in this category include Conduct Disorder, Attention-Deficit
Hyperactivity Disorder, and Oppositional Defiant Disorder. These three disorders
are grouped together within the same category because of similarities between
symptoms and prevalence rates For example, children with these disorders often
have academic difficulties, poor social skills, and impulsivity (i.e., a tendency to act
without thinking through potential consequences). In addition, boys far exceed girls
in terms of rates of occurrence (although some researchers suggest that girls with
ADHD may be overlooked because they tend to be more inattentive than
hyperactive).
The Attention Deficit and Disruptive Behavior Disorders are the most commonly
diagnosed disorders of childhood, and make up the majority of referrals of children
to mental health treatment services. It used to be thought that the majority of
children ultimately "grew out" of these disorders prior to the onset of adulthood.

Recently, however, there is an increasing awareness that these disorders often do

not disappear as children mature, but rather continue on into adulthood.

Feeding and Eating Disorders of Infancy or Early Childhood: Pica

Andrea Barkoukis, M.A., Natalie Staats Reiss, Ph.D., and Mark Dombeck, Ph.D.
Updated: Feb 4th 2008
Disorders in the "Feeding and Eating Disorders of Infancy or Early Childhood"
category include Pica, Rumination Disorder, and Feeding Disorder of Infancy or
Early Childhood.
Pica
Pica is a disorder that occurs when children persistently eat one or more non-food
substances over the course of at least one month. Pica may not sound like a
dangerous problem, but when you consider that the non-food substances that are
ingested are frequently toxic or otherwise harmful to the human body, the potential
for illness and even death becomes clear. Pica may result in serious medical
problems, such as intestinal blockage, poisoning, parasitic infection, and sometimes
death. This disorder has been described as one of the most serious forms of selfinjurious behavior (i.e., deliberate self-harm) because of the high risk of death from
this type of behavior.
The typical non-food substances that children with pica ingest tend to vary with
age. Younger children with Pica frequently eat paint, plaster, string, hair, or cloth.
In contrast, older children with Pica tend to eat animal droppings, sand, insects,
leaves, or pebbles. Adolescents affected by the disorder often consume clay or soil
substances.

Disorders of Childhood: Tic Disorders

Andrea Barkoukis, M.A., Natalie Staats Reiss, Ph.D., and Mark Dombeck, Ph.D.
Updated: Feb 4th 2008
Tics are the name given to sudden, rapid, recurrent, nonrhythmic, stereotyped and
involuntary behaviors that people may display. Examples of tics include repetitive
and involuntary eye blinking or twitching, and similarly involuntary vocalization of
words, Tics come in two flavors. They may be physical in nature, or vocal. Motor
and vocal tics may be simple (i.e. involving only a few muscles or sounds at a time)

or complex (i.e., involving multiple muscles, or full sentences and phrases). Tic
Disorders are diagnosed when people have chronic (i.e., repeated across time)
motor and vocal tics that interfere with their daily activities. Tourette's Syndrome,
Chronic Motor or Vocal Tic Disorder, Transient Tic Disorder, and Tic Disorder Not
Otherwise Specified (NOS) are all subtypes of Tic Disorders.
Children with a tic disorder may show repeated eye blinking; nose wrinkling; hand
gesturing; repetitious touching/smelling an object, throat clearing, grunting, or
sniffling. They may also have complex vocal tics such as vocal outbursts, repeating
sound or words again and again, repeating the last-heard sound or phrase, and
Coprolalia (suddenly saying socially unacceptable words or phrases) which is
characteristic of the most famous tic disorder, Tourette's Syndrome. Compulsive
behaviors (e.g., repeated tapping, counting, checking behaviors designed to reduce
anxiety) are common across Tic Disorders.

Elimination Disorders: Enuresis

Andrea Barkoukis, M.A., Natalie Staats Reiss, Ph.D., and Mark Dombeck, Ph.D.
Updated: Feb 4th 2008
Elimination disorders occur when children who are otherwise old enough to
eliminate waste appropriately repeatedly void feces or urine in inappropriate places
or at inappropriate times. The two disorders that fall under this category are
Enuresis and Encopresis.
Enuresis
Enuresis is diagnosed when children repeatedly urinate in inappropriate places,
such as clothing (during the day) or the bed (during the night). In most cases, the
child's urination problem is involuntary in nature, and is perceived by the child as
an unavoidable loss of urinary control.
There are three subtypes of Enuresis: Nocturnal (night-time) Only, Diurnal (daytime) Only, and Nocturnal and Diurnal. The DSM criteria for diagnosis state that the
urination problem (whether involuntary or intentional) must occur with regularity,
at least twice a week, for three consecutive months before the diagnosis applies.
The diagnosis cannot be made unless there is evidence that the urination problem
causes distress or impairment in the child's social or academic functioning.

In Nocturnal Only Enuresis, the most common form of enuresis, children wet
themselves during nighttime sleep. Typically, wetting occurs during the first third of
the night, but it is not uncommon for wetting to occur later, during REM sleep. In
this latter case, children may recall having a dream that they were urinating.

Elimination Disorders: Encopresis

Andrea Barkoukis, M.A., Natalie Staats Reiss, Ph.D., and Mark Dombeck, Ph.D.
Updated: Feb 4th 2008
Encopresis occurs when children who are old enough to eliminate waste
appropriately repeatedly defecate in inappropriate places such as inside clothing or
on the floor. DSM criteria for encopresis state that the behavior must occur once a
month for at least 3 months duration before the diagnosis applies. In addition, the
child must be at least 4 years old (or developmentally equivalent to a 4 year-old).
Generally, encopresis is an involuntary condition.
There are two different varieties of Encopresis: With Constipation and Overflow
Incontinence, and Without Constipation and Overflow Incontinence. Children with
the Constipation and Overflow Incontinence type produce less than three bowel
movements per week. Due to constipation, only part of the total available stool is
voided during each of these movements. Portions of the remaining stool then leak
out of the bowel, often during the child's daily activities. When the child's
underlying constipation problem is treated, this form of encopresis generally
resolves.
As the name suggests, children experiencing Encopresis without Constipation and
Overflow Incontinence show no evidence of constipation. Instead, the child's feces
are usually normal in form, and soiling is intermittent rather than regular. Feces
may be emitted in a prominent location (e.g., as an act of defiance) or may be an
unintentional consequence of anal self-stimulation (e.g., a variety of masturbation).
Encopresis without Constipation and Overflow Incontinence is less common than
the first type of Encopresis, and is often associated with Oppositional Defiant
Disorder and Conduct Disorder.
Encopresis is much less common than enuresis. According to the DSM,
approximately 1% of 5-year old children meet the diagnostic criteria for Encopresis.
About 3% of all children treated for a mental disorders meet criteria for the
condition. Encopresis is 3 to 6 times more common in males than in females.

Disorders of Childhood: Separation Anxiety Disorder

Andrea Barkoukis, M.A., Natalie Staats Reiss, Ph.D., and Mark Dombeck, Ph.D.
Updated: Feb 4th 2008
Children and adolescents affected by Separation Anxiety Disorder become severely
distressed when separated from their familiar surroundings and caregivers. The
very thought of being separated from family members may cause anxiety feelings,
and actual separation leads to pronounced distress and agitation. This distress is
persistent and frequent, and interferes with the child's ability to engage in normal
age-appropriate activities that require temporary separation from caregivers (e.g.,
attending school and community-based activities).
Separation Anxiety needs to be viewed in a developmental context in order to
differentiate what is normal and age-appropriate and what is disordered. The
amount of distress children with Separation Anxiety Disorder experience is
excessive in relation to the typical reaction a peer might have in similar
circumstances. For instance, it is developmentally normal for one year olds to
express some degree of distress when separated from caregivers. It is also normal
for children who are just beginning daycare, preschool, or kindergarten to
experience severe distress when first separated from their caregivers. Such anxiety
reactions normally diminish or go away altogether within a short period of time as
children become accustomed to these new environments. It is not typical for
children's anxiety reactions to persist after they have been at school for a week or
so. A Separation Anxiety Disorder diagnosis does not apply to developmentally
normal expressions of distress upon separation from caregivers. For more
information on the normal process of child development and the milestones
typically encountered at particular ages.

Reactive Attachment Disorder of Infancy or Early Childhood

Andrea Barkoukis, M.A., Natalie Staats Reiss, Ph.D., and Mark Dombeck, Ph.D.
Updated: Feb 4th 2008
At a certain point in the normal course of interpersonal development, most children
form strong attachments to specific caregivers who take care of them. They
develop a clear preference for being with and interacting with those specific
caregivers over lesser-known individuals. In cases of Reactive Attachment Disorder
of Infancy or Early Childhood (hereafter called Reactive Attachment Disorder),
however, the normal attachment process does not occur. Instead, such children

develop abnormal relationships with caregivers that are described, in the language
of the DSM criteria for the disorder as either Inhibited or Disinhibited.
Children with Reactive Attachment Disorder of the Inhibited type remain
unresponsive and ambivalent towards their caregivers. In contrast, children with
Reactive Attachment Disorder of the Disinhibited type respond to caregivers, but
fail to discriminate them as special people and show a similar level of
responsiveness to strangers.
Inhibited type children don't seek out contact with their caregivers, and generally
won't respond to caregivers' attempts at making contact either. Such children may
come across as apathetic on occasion, but more frequently they appear to
simultaneously want and reject the possibility of social comfort. Such children may
be guarded, distant, and withdrawn when around caregivers. They may ignore a
caregiver's attempts to engage them in conversation, regarding the situation as a
threat to be warded off rather than as something safe to engage in. Inhibited type
children may actively push away caregivers' attempts to give them hugs or even
act aggressively. Instead of seeking comfort from caregivers (which is typical), such
children may instead engage in self-soothing behaviors (rocking back and forth or
engaging in other forms of self-stimulation)
Disinhibited type children seek out and accept are indiscriminant and may not show
a preference for social contact with caregivers vs. relative strangers. These children
may act as though they are familiar with strangers, seeking to hug, touch, or
otherwise obtain comfort or assistance from them. The interpersonal behavior of
Disinhibited type children may remain excessively childish and dependent (younger
than appropriate to their years). They may also appear chronically anxious.

Disorders of Childhood: Stereotypic Movement Disorder

Andrea Barkoukis, M.A., Natalie Staats Reiss, Ph.D., and Mark Dombeck, Ph.D.
Updated: Feb 4th 2008
Children with Stereotypic Movement Disorder can't seem to stop themselves from
engaging in repetitive, and seeming nonfunctional motor behavior. Children and
adolescents with this disorder may wave their hands, rock back and forth, twiddle
their thumbs, twirl objects, or kick (or contract muscles in) their legs. More severe
repetitive behaviors that children might engage in include banging their heads
against hard surfaces and slapping or punching themselves, both behaviors which
frequently lead to bruises, cuts, bleeding, infection and more serious injuries. These

behaviors are experienced as irresistible; children cannot stop themselves from

engaging in them for too long. Also, the behaviors serve no apparent function other
than allowing children to experience the sheer physical sensation of performing the
movement. Children are not trying to dry their hands, or get the attention of a
friend, for instance, when they wave their hands about.
In order to meet the criteria for diagnosis with Stereotypic Movement Disorder
children's odd motor behaviors must interfere with their ability to participate in
normal developmentally appropriate activities such as school, or they must be
dangerous enough that children will injure themselves if not restrained. The odd,
repetitive movements must not be caused by another more appropriate diagnosis,
such as Obsessive-Compulsive Disorder, or by a pervasive developmental disorder
such as Autism.
Stereotypic Movement Disorder is not very common in the general population of
children and adolescents. It is a fairly common occurrence within the population of
Mentally Retarded population, however. To a lesser extent, the behavior is also
more common in populations of sensory disabled children, such as blind children.
According to the DSM, between 2 and 3% of retarded children (who are capable of
living in the community) engage in stereotyped motor behavior. A far larger
percentage of the severely retarded population (up to 25%!) are diagnosed with
Stereotypic Movement Disorder. Head-banging is the most commonly acted out
self-injurious behavior.