DEVELOPMENTAL PSYCHPATHOLOGY - MODULE 3: CHILDHOOD DISORDERS.

1. Intellectual Disability (ID)

- A. Deficits in intellectual functions, such as

1. Reasoning,
2. Problem-solving,
3. Planning,
4. Abstract thinking,
5. Judgment,
6. Academic learning, and
7.Learning from experience, confirmed by both clinical assessment and individualized, standardized intelligence
testing.

- B. Deficits or impairments in adaptive functioning (i.e., the individual's effectiveness in meeting the standards
expected for their age across various daily activities), resulting in dependence on others for support.
- C. Onset of intellectual and adaptive deficits during the developmental period.
- D. The intellectual and adaptive deficits result in significant functional limitations in daily life and across
multiple environments, such as home, school, work, or community.

Causes of Intellectual Disability:

1. Genetic Factors: Down syndrome, fragile X syndrome, and other chromosomal disorders.
2. Prenatal Factors: Exposure to toxins, infections, or maternal substance abuse during pregnancy.
3. Perinatal Factors: Complications during childbirth, premature birth, or low birth weight.
4. Postnatal Factors: Traumatic brain injury, infections, and environmental toxins during early childhood.
5. Metabolic Disorders: Conditions like phenylketonuria (PKU) if not treated early.
6. Malnutrition: Inadequate nutrition during critical developmental periods.

Early Identification:
1. Developmental Monitoring: Regular assessment of milestones during infancy and early childhood.
2. Developmental Screening: Formal tools used by healthcare professionals
3. Educational Assessments: Teachers' observations of academic and adaptive functioning.
4. Parental Concerns: Parental observations and discussions with healthcare professionals.

Management:
1. Early Intervention Services: Specialized therapies in early childhood.
2. Educational Support: Individualized Education Programs (IEPs) and special education services.
3. Behavioral Therapies: Applied behavior analysis to manage behaviors.
4. Medical Management: Treating underlying conditions and medications if necessary.
5. Family Support: Involvement, education, and emotional support for families.
6. Community Integration: Encouraging participation in community activities.
7. Advocacy and Legal Protections: Ensuring rights, accommodations, and legal protections.

2. Specific Learning Disorders (SLD)

- A. Difficulties in learning and using academic skills, as indicated by the presence of at least one of the
following symptoms that have persisted for at least 6 months, despite intervention:
1. Inaccurate or slow and effortful word reading (dyslexia).
2. Difficulty understanding the meaning of what is read (reading comprehension).
3. Difficulties with spelling (dysgraphia).
4. Difficulties with written expression.
 5. Difficulties mastering number sense, number facts, or calculation (dyscalculia).

- B. The affected academic skills are substantially below the expected level for the individual's chronological
age, and cause significant interference with academic or occupational performance or with activities of daily
living requiring these skills.
- C. If a sensory deficit is present, the difficulties with academic skills are in excess of those usually associated
with it.
- D. The learning difficulties are not better explained by intellectual disabilities, uncorrected visual or auditory
acuity problems, other mental or neurological disorders, psychosocial adversity, lack of proficiency in the
language of academic instruction, or inadequate educational instruction.

Causes of Specific Learning Disorder:

1. Genetic Factors: Inherited factors may contribute to difficulties in academic skills.
2. Neurobiological Factors: Differences in brain structure and function, affecting learning processes.
3. Environmental Factors: Lack of early stimulation, limited educational resources, or adverse experiences.
4. Pre- and Perinatal Factors: Complications during pregnancy and childbirth affecting brain development.

Early Identification:
1. Developmental Monitoring: Regular assessment of early academic milestones.
2. Screening Tools: Use of standardized screening tools to identify learning difficulties.
3. Early Educational Interventions: Immediate implementation of targeted interventions, such as tutoring.
4. Individualized Education Plans (IEPs): Creation of customized plans to address specific learning needs.

Management of Specific Learning Disorder:

1. Educational Support Services: Access to special education programs and resources.
2. Behavioral Interventions: Implementation of strategies to address behavioral challenges.
3. Multisensory Approaches: Teaching methods incorporating multiple senses to enhance learning.
4. Technological Support: Use of assistive technologies to facilitate learning.
5. Parental Involvement: Collaboration with parents to reinforce skills at home.
6. Psychoeducational Assessments: Periodic assessments to track progress and adjust interventions.
7. Counseling Services: Emotional support and coping strategies to manage frustration.

Specific Learning Disorder with Impairment in Reading (Dyslexia)

- A. Persistent difficulties in word reading accuracy, fluency, and/or reading comprehension as manifested by at
least one of the following symptoms:
1. Inaccurate or slow and effortful word recognition.
2. Difficulty understanding the meaning of what is read.
3. Difficulty with spelling.

- B. The reading difficulties significantly interfere with academic achievement or activities of daily living that
require reading skills.
- C. The difficulties with reading are not solely due to intellectual disabilities, visual or auditory acuity problems,
neurological or motor disorders, or inadequate educational opportunities.

Developmental Spelling Disorder (SD):

- A. Persistent difficulty with spelling, as evidenced by errors in spelling that are unexpected in relation to the
individual's age, cognitive abilities, and the opportunities provided for learning spelling skills.
- Errors may involve omissions, substitutions, additions, or distortions of written letters or words.
- B. The spelling difficulties lead to persistent academic underachievement as measured by standardized tests.
 - The individual's spelling skills are significantly below the expected level for their age and cognitive abilities.
- C. The difficulties with spelling are not better explained by intellectual disabilities, visual or auditory acuity
problems, or inadequate educational opportunities.

Specific Learning Disorder with Impairment in Written Expression (Dysgraphia)

- A. Difficulties in the basic mechanics of writing, as manifested by at least one of the following symptoms:
1. Inaccurate or inconsistent spelling.
2. Poor grammar and punctuation.
3. Difficulty with the organization and coherence of written expression.

- B. The individual's writing skills are significantly below what is expected for their chronological age and cause
significant academic and functional challenges.
- C. The difficulties with written expression are not solely due to intellectual disabilities, visual or auditory acuity
problems, neurological or motor disorders, or inadequate educational opportunities.

- Developmental Dyscalculia (Arithmetic Disorder)

- A. Difficulty in learning and comprehending basic arithmetic concepts, accurate and fluent calculation, and/or
accurate math reasoning, as manifested by at least one of the following:
1. Marked difficulties with arithmetic fluency and accuracy.
2. Difficulty understanding numerical concepts, number facts, or calculations.
3. Impaired ability to apply mathematical concepts to solve quantitative problems.

- B. The mathematical learning difficulties are not solely the result of intellectual disabilities, uncorrected visual
or auditory acuity, other mental or neurological disorders, or inadequate educational instruction.
- C. If a sensory deficit is present, the difficulties with mathematics are in excess of those usually associated
with it.

3. Autism Spectrum Disorder (ASD)

DSM-5 Criteria:
- A. Persistent deficits in social communication and interaction, as shown by:
1. Impaired social-emotional reciprocity.
2. Deficits in nonverbal communicative behaviors.

- B. Restricted, repetitive patterns of behavior, interests, or activities, demonstrated by at least two of the
following:
1. Stereotyped or repetitive motor movements, speech, or object use.
2. Insistence on sameness or inflexible adherence to routines.
3. Highly restricted, fixated interests or abnormal sensory responses.

- C. Symptoms present in the early developmental period, causing significant impairment.

- D. Symptoms not better explained by intellectual disability or global developmental delay.

Causes of Autism Spectrum Disorder (ASD):

1. Genetic Factors: Genetic mutations and hereditary factors contribute to the risk of ASD.
2. Neurobiological Factors: Differences in brain structure and function, including abnormal neural connectivity.
3. Prenatal Factors: Exposure to certain medications, toxins, or infections during pregnancy.
4. Perinatal Factors: Complications during childbirth, such as oxygen deprivation.
5. Environmental Factors: Factors like advanced parental age and certain prenatal complications.
6. Risk Factors: Having a sibling with ASD increases the likelihood.
Early Identification (ASD):
1. Early Screening: Systematic screening for ASD during routine developmental check-ups.
2. Parental Concerns: Addressing and investigating any concerns raised by parents regarding developmental
delays.
3. Early Intervention Services: Implementing specialized therapies, such as Applied Behavior Analysis (ABA),
speech therapy, and occupational therapy, as early as possible.
4. Individualized Support: Creating tailored educational and behavioral interventions to address specific needs.

Management (ASD):
1. Behavioral Therapies: Applied Behavior Analysis (ABA) to enhance adaptive behaviors and reduce
challenging behaviors.
2. Speech and Language Therapy: Addressing communication challenges and improving social communication
skills.
3. Occupational Therapy: Enhancing fine motor skills, sensory processing, and daily living skills.
4. Educational Support: Individualized Education Programs (IEPs) and specialized educational strategies.
5. Pharmacological Interventions: Medications to manage specific symptoms or co-occurring conditions, if
necessary.
6. Family Involvement: Including families in treatment planning, providing education, and offering emotional
support.
7. Community Integration: Encouraging participation in community activities for socialization.
8. Advocacy and Legal Protections: Ensuring access to rights, accommodations, and legal protections for
individuals with ASD.

4. Asperger's Disorder (No longer a distinct diagnosis in DSM-5)

- A developmental disorder within the Autism Spectrum.

- Characterized by social difficulties, repetitive behaviors, and intense interests.
- Often involves normal to above-average intelligence and language skills.
- No longer a separate diagnosis in DSM-5; included under Autism Spectrum Disorder.

5. Rett's Disorder (RD)

- Rare neurodevelopmental disorder, primarily affecting females.

- Involves a loss of acquired motor and communication skills after a period of normal development.
- Hallmarked by repetitive hand movements, motor difficulties, and social withdrawal.
- Caused by genetic mutations, particularly in the MECP2 gene.

6. Childhood Disintegrative Disorder (CDD) (Now considered part of ASD) - Heller’s Syndrome

- A. Apparently normal development for at least the first 2 years after birth as manifested by the presence of
age-appropriate verbal and nonverbal communication, social relationships, play, and adaptive behavior.

- B. Clinically significant loss of previously acquired skills (before age 10) in at least two of the following areas:
1. Expressive or receptive language.
2. Social skills or adaptive behavior.
3. Bowel or bladder control.
4. Play.
5. Motor skills.

- C. Abnormalities in at least two of the following areas:

 1. Qualitative impairment in social interaction.
2. Qualitative impairments in communication.
3. Restricted, repetitive, and stereotyped patterns of behavior, interests, and activities, including motor
stereotypes and mannerisms.

- D. The disturbance is not better explained by another medical or neurological condition.

MODULE 4: EXTERNALISING DISORDERS

1. Attention-Deficit/Hyperactivity Disorder (ADHD)

DSM-5 Criteria for ADHD:
- A. Persistent pattern of inattention and/or hyperactivity-impulsivity.
- Inattention symptoms (need at least six):
1. Often fails to give close attention to details.
2. Often has difficulty sustaining attention.
3. Often does not listen when spoken to directly.
4. Often does not follow through on instructions.
5. Often has difficulty organizing tasks.
6. Avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort.
7. Often loses things necessary for tasks.
8. Easily distracted by extraneous stimuli.
9. Forgetful in daily activities.

- Hyperactivity and impulsivity symptoms (need at least six):

1. Often fidgets or taps hands/feet.
2. Unable to stay seated.
3. Runs or climbs in inappropriate situations.
4. Unable to play or engage in activities quietly.
5. Talks excessively.
6. Often interrupts others.
7. Difficulty waiting for one's turn.

- B. Several inattentive or hyperactive-impulsive symptoms were present prior to age 12.

- C. Symptoms present in two or more settings (e.g., home, school).
- D. Clear evidence that symptoms interfere with or reduce the quality of social, academic, or occupational
functioning.
- E. Symptoms do not occur exclusively during the course of schizophrenia or another psychotic disorder.

Causes of ADHD:
1. Genetic Factors: Strong hereditary component, with a higher likelihood in individuals with a family history of
ADHD.
2. Brain Structure and Function: Abnormalities in brain regions regulating attention, impulse control, and
executive function.
3. Prenatal Factors: Exposure to maternal smoking, alcohol, or drugs during pregnancy.
4. Premature Birth and Low Birth Weight: Increased risk for ADHD in children born prematurely or with low birth
weight.
5. Environmental Factors: Lead exposure, high levels of family stress, and chaotic home environments.

Early Management of ADHD:

1. Early Identification: Recognizing symptoms in preschool years, including inattention, hyperactivity, and
impulsivity.
2. Parental Education: Providing parents with information about ADHD, strategies for managing behavior, and
parenting techniques.
3. Behavioral Interventions: Implementing behavior modification strategies, consistent routines, and clear
expectations.
4. Preschool Programs: Enrolling children in structured and supportive preschool programs.

Management of ADHD:
1. Medication: Stimulant medications (e.g., methylphenidate, amphetamine) to enhance focus and reduce
hyperactivity.
2. Behavioral Therapy: Teaching coping strategies, organizational skills, and social skills.
3. Educational Support: Individualized education plans (IEPs) and classroom accommodations.
4. Parent Training: Teaching parents effective strategies for managing ADHD-related behaviors.
5. Counseling: Providing emotional support and addressing comorbid conditions.
6. Environmental Modifications: Creating a structured and supportive environment at home and school.
7. Multimodal Approach: Combining medication, behavioral therapy, and educational interventions for
comprehensive management.

2. Oppositional Defiant Disorder (ODD)

DSM-5 Criteria for ODD:
- A. Pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness lasting at least six months.
- B. Four (or more) of the following symptoms exhibited during interaction with individuals other than siblings:
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 others.
5. Often blames others for his or her mistakes.
6. Is often touchy or easily annoyed by others.
7. Is often angry and resentful.
8. Is often spiteful or vindictive.

- C. The disturbance in behavior causes clinically significant impairment in social, academic, or occupational
functioning.
- D. Behaviors do not occur exclusively during the course of a psychotic or mood disorder.

Causes of Oppositional Defiant Disorder:

1. Genetic Factors: Family history of disruptive behavior disorders may contribute.
2. Environmental Factors: Exposure to inconsistent discipline, family conflict, or abuse.
3. Neurobiological Factors: Brain structure and function abnormalities may play a role.
4. Temperamental Factors: A difficult temperament or impulsive traits.
5. Parenting Style: Inconsistent discipline or lack of positive reinforcement.

Early Identification:
1. Behavioral Observations: Persistent patterns of defiance, anger, and irritability.
2. School Reports: Feedback from teachers regarding disruptive behavior.
3. Parental Concerns: Parents noticing consistent and severe behavioral challenges.
4. Psychological Assessment: Structured assessments to evaluate behavior and emotional functioning.

Management of Oppositional Defiant Disorder:

1. Parent-Child Interaction Therapy (PCIT): Teaches parents effective communication and discipline strategies.
2. Cognitive-Behavioral Therapy (CBT): Targets distorted thought patterns and promotes positive behavior.
3. Social Skills Training: Develops adaptive social behaviors and problem-solving skills.
4. Family Therapy: Addresses family dynamics and improves communication.
5. School-Based Interventions: Collaborative efforts involving teachers and support staff.
6. Medication: In some cases, prescribed to manage coexisting conditions like ADHD or mood disorders.
7. Parent Training Programs: Equips parents with skills to manage challenging behaviors.

3. Conduct Disorder (CD)

DSM-5 Criteria for CD:
- A. Repetitive and persistent pattern of behavior where the basic rights of others or major age-appropriate
societal norms or rules are violated.
- B. Three or more of the following 15 criteria in the past 12 months, with at least one criterion present in the
past six months:
1. Aggression to people and animals.
2. Destruction of property.
3. Deceitfulness or theft.
4. Serious violations of rules.

- C. Significant impairment in social, academic, or occupational functioning.

- D. If the individual is 18 years or older, criteria are not met for antisocial personality disorder.

Causes of Conduct Disorder:

1. Genetic Factors: Family history of conduct disorder or other mental health issues.
2. Environmental Influences: Exposure to violence, abuse, or neglect in the family or community.
3. Neurobiological Factors: Abnormalities in brain structure or function affecting impulse control.
4. Psychosocial Factors: Poor parenting, inconsistent discipline, or lack of positive role models.
5. School Factors: Academic difficulties, peer rejection, or involvement with delinquent peers.
6. Individual Factors: Temperamental traits, low empathy, or callous-unemotional traits.

Early Identification:
1. Behavioral Observations: Persistent aggression, rule violation, or cruelty to animals.
2. School Assessments: Academic and behavioral difficulties in the school environment.
3. Parental Reports: Information from parents regarding behavioral concerns at home.
4. Peer Relationships: Persistent difficulties in forming and maintaining peer relationships.
5. Clinical Interviews: Conducting interviews with the child, parents, and teachers.

Management:
1. Behavioral Therapy: Cognitive-behavioral interventions targeting behavior modification.
2. Parent Training: Teaching parents effective discipline strategies and communication.
3. School Interventions: Collaborating with teachers to create a positive school environment.
4. Individual Therapy: Addressing underlying emotional issues and building coping skills.
5. Medication: In some cases, medication may be considered for specific symptoms.
6. Family Therapy: Involving the family in treatment to improve relationships and communication.
7. Community Programs: Participation in community-based programs to promote positive behavior.
8. Legal Interventions: In severe cases, legal measures may be necessary for public safety.

4. Alcohol and Substance Abuse Disorder

DSM-5 Criteria for Substance Use Disorders:
- A. Impaired control.
- B. Social impairment.
- C. Risky use.
- D. Pharmacological criteria (tolerance and withdrawal).
- E. The presence of at least two of the following in a 12-month period:
 1. Substance taken in larger amounts or over a longer period than intended.
2. Persistent desire or unsuccessful efforts to cut down or control use.
3. A great deal of time spent in activities necessary to obtain, use, or recover from the substance's effects.
4. Craving or a strong desire to use the substance.
5. Recurrent use resulting in failure to fulfill major role obligations.

Causes of Alcohol and Substance Use Disorder:

1. Genetic Factors: Predisposition through family history and genetic vulnerabilities.
2. Environmental Factors: Exposure to substance use at an early age, peer influence, societal norms.
3. Mental Health Factors: Co-occurring mental health disorders may contribute to substance use.
4. Neurobiological Factors: Changes in brain chemistry affecting reward and pleasure mechanisms.
5. Trauma: Exposure to trauma, abuse, or significant life stressors.
6. Psychosocial Factors: Lack of family support, socioeconomic factors, and inadequate coping skills.

Early Identification:
1. Screening Tools: Use of standardized assessments to identify problematic substance use.
2. Clinical Assessment: Healthcare professionals evaluating patterns of use and associated behaviors.
3. Behavioral Changes: Sudden shifts in behavior, mood, or performance at work or school.
4. Social Withdrawal: Isolation from friends and family or changes in social circles.
5. Physical Signs: Decline in physical health, changes in appearance, or unexplained injuries.

Management of Alcohol and Substance Use Disorder:

1. Detoxification: Medically supervised withdrawal to manage physical dependence.
2. Behavioral Therapies: Cognitive-behavioral therapy, motivational enhancement therapy, and contingency
management.
3. Pharmacotherapy: Medications to reduce cravings and support recovery.
4. Support Groups: Involvement in 12-step programs (e.g., Alcoholics Anonymous, Narcotics Anonymous).
5. Counseling: Individual or group counseling to address underlying issues.
6. Dual Diagnosis Treatment: Addressing co-occurring mental health disorders
7. Family Involvement: Support and education for family members.
8. Rehabilitation Programs: Inpatient or outpatient programs for intensive treatment.
9. Relapse Prevention: Developing strategies to prevent relapse and maintain recovery.
10. Community Resources: Accessing community-based support and resources.

5. Juvenile Delinquency
Note: Juvenile delinquency is a legal rather than a clinical term, and its diagnosis is not explicitly covered in the
DSM-5. However, certain behaviors may be associated with legal consequences.

- Juvenile delinquency refers to the participation in illegal behavior by minors.

- Behaviors may include theft, vandalism, assault, or substance abuse.
- Legal consequences and involvement with law enforcement are often defining factors.

Causes of Juvenile Delinquency:

1. Family Environment: Dysfunction, abuse, or neglect within the family.
2. Peer Influence: Association with delinquent peers or gangs.
3. Socioeconomic Factors: Poverty, lack of access to education or employment opportunities.
4. Psychological Factors: Mental health issues, behavioral disorders.
5. Substance Abuse: Drug or alcohol abuse contributing to delinquent behavior.
6. School Environment: Academic failure, truancy, or disciplinary issues.
Early Identification of Juvenile Delinquency:
1. School Monitoring: Identifying academic or behavioral issues in school settings.
2. Community Programs: Early involvement in community-based programs and activities.
3. Behavioral Changes: Recognizing sudden shifts in behavior or attitudes.
4. Parental Involvement: Monitoring and addressing issues within the family environment.
5. Peer Intervention: Identifying negative peer influences and addressing them.

Management of Juvenile Delinquency:

1. Counseling and Therapy: Individual or family counseling to address underlying issues.
2. Juvenile Justice System: Intervention through appropriate legal channels.
3. Educational Support: Tailored educational programs to address learning difficulties.
4. Community Programs: Involvement in positive community activities and mentorship.
5. Substance Abuse Treatment: Interventions to address and manage substance abuse.
6. Family Interventions: Strengthening family relationships and support systems.
7. Skill Development: Building social and coping skills through targeted interventions.

MODULE 5: INTERNALISING DISORDERS.

Anxiety Disorder
DSM-5 Criteria:
- A. Marked and persistent fear or anxiety related to specific situations, manifested by at least three of the
following:
1. Restlessness or feeling on edge.
2. Easily fatigued.
3. Difficulty concentrating or mind going blank.
4. Irritability.
5. Muscle tension.
6. Sleep disturbance.
- B. Anxiety or avoidance causing clinically significant distress or impairment.
- C. Not attributable to the physiological effects of a substance or another medical condition.
- D. Symptoms not better explained by the presence of another mental disorder.

Causes of Anxiety Disorders:

1. Genetic Factors: Family history of anxiety disorders can contribute to susceptibility.
2. Brain Chemistry: Imbalances in neurotransmitters, such as serotonin and gamma-aminobutyric acid (GABA),
may play a role.
3. Environmental Stressors: Traumatic experiences, life events, or chronic stress can trigger anxiety.
4. Medical Conditions: Certain medical conditions and medications may be associated with anxiety symptoms.
5. Personality Factors: Traits like perfectionism or a tendency to be overly sensitive can contribute.

Early Identification of Anxiety Disorders:

1. Behavioral Observations: Recognizing excessive worry, restlessness, or avoidance behaviors.
2. Self-Reported Symptoms: Open communication about feelings of anxiety and their impact.
3. Physical Symptoms: Identifying physiological signs like increased heart rate or muscle tension.
4. Screening Tools: Questionnaires and assessments administered by healthcare professionals.

Management of Anxiety Disorders:

1. Counseling and Therapy: Cognitive-behavioral therapy (CBT) and other therapeutic approaches to address
underlying issues.
2. Medications: Antidepressants, benzodiazepines, or beta-blockers may be prescribed in some cases.
3. Lifestyle Changes: Regular exercise, balanced diet, and sufficient sleep can positively impact anxiety.
4. Stress Management Techniques: Relaxation exercises, mindfulness, and stress reduction strategies.
5. Support Groups: Connecting with others experiencing similar challenges can provide valuable support.
6. Education and Psychoeducation: Understanding anxiety and developing coping strategies through education.
7. Workplace Accommodations: Implementing accommodations for individuals dealing with workplace-related
anxiety.

1. Separation Anxiety Disorder

DSM-5 Criteria:
- A. Excessive fear or anxiety about separation, manifested by at least three of the following:
1. Distress during or anticipating separation.
2. Worry about harm to attachment figures.
3. Reluctance to go out or be alone.
4. Fear of being alone without attachment figures.

- B. Persistent worry and avoidance causing significant impairment.

- C. Fear not related to a medical condition or other mental disorder.
- D. Symptoms not better explained by another disorder.

Causes of Separation Anxiety Disorder:

1. Genetic Factors: A family history of anxiety disorders may contribute to an increased risk.
2. Environmental Factors: Traumatic experiences, such as loss or significant life changes, can trigger separation
anxiety.
3. Temperamental Factors: Children with a naturally anxious temperament may be more prone to separation
anxiety.
4. Parental Influence: Overprotective parenting or a caregiver's anxious behavior can contribute.

Early Identification of Separation Anxiety Disorder:

1. Excessive Worry: Persistent and disproportionate worry about separation from attachment figures.
2. Physical Symptoms: Complaints of physical symptoms (headaches, stomachaches) when separation is
anticipated.
3. Avoidance Behaviors: Attempts to avoid situations that involve separation from caregivers.
4. School Refusal: Resistance or refusal to attend school due to separation concerns.

Management of Separation Anxiety Disorder:

1. Counseling: Cognitive-behavioral therapy (CBT) to address anxious thoughts and behaviors.
2. Gradual Exposure: Systematic desensitization to separation through gradual exposure.
3. Parental Involvement: Parent training to understand and appropriately respond to the child's anxiety.
4. School Support: Collaboration with educators to create a supportive school environment.
5. Medication: In severe cases, medication may be considered, typically in conjunction with therapy.
6. Routine and Predictability: Establishing consistent routines to create a sense of predictability.
7. Therapeutic Interventions: Play therapy or art therapy to help the child express and manage anxiety.

2. Social Anxiety Disorder

DSM-5 Criteria:
- A. Marked fear of social situations leading to:
1. Scrutiny and negative evaluation, with
2. Avoidance or endured anxiety.
- B. Anxiety provoked by exposure to feared social situations.
- C. Fear or anxiety not due to medical conditions or another mental disorder.
- D. Fear or anxiety not better explained by another disorder.
Causes of Social Anxiety Disorder:
1. Genetic Predisposition: Family history may contribute to a higher risk of social anxiety disorder.
2. Brain Structure and Function: Differences in brain structure and functioning, particularly areas related to fear
and anxiety, may play a role.
3. Environmental Factors: Traumatic or negative social experiences, such as bullying or humiliation, can
contribute to the development of social anxiety.
4. Neurotransmitter Imbalance: Imbalances in neurotransmitters, particularly serotonin, may be associated with
social anxiety.
5. Personality Factors: Individuals with certain personality traits, such as high levels of shyness or behavioral
inhibition, may be more prone to social anxiety.

Early Identification of Social Anxiety Disorder:

1. Observational Signs: Persistent avoidance of social situations, fear of judgment, and physical symptoms like
blushing or trembling.
2. Self-Reported Symptoms: Individuals expressing excessive worry or discomfort in social interactions.
3. Childhood Behavioral Indicators: Social withdrawal, reluctance to participate in group activities, or frequent
physical complaints in social situations.
4. Educational or Occupational Impairment: Difficulties in academic or work settings due to social
anxiety-related challenges.

Management of Social Anxiety Disorder:

1. Cognitive-Behavioral Therapy (CBT): Targeting negative thought patterns and gradually exposing individuals
to feared social situations.
2. Medications: Antidepressants, particularly selective serotonin reuptake inhibitors (SSRIs), may be prescribed
to alleviate symptoms.
3. Exposure Therapy: Systematic exposure to feared social situations in a controlled and supportive
environment.
4. Social Skills Training: Learning and practicing effective social skills to enhance confidence in social
interactions.
5. Mindfulness and Relaxation Techniques: Techniques such as deep breathing and mindfulness to manage
anxiety symptoms.
6. Support Groups: Joining groups where individuals share similar experiences can provide understanding and
encouragement.
7. Education and Psychoeducation: Understanding the nature of social anxiety and learning coping strategies.

3. Selective Mutism
DSM-5 Criteria:
- A. Consistent failure to speak in specific social situations.
- B. Interference with educational or occupational achievement.
- C. Duration of at least one month.
- D. Not due to lack of knowledge or comfort with the spoken language.
- E. Not exclusively related to autism spectrum disorder or psychosis.

Causes of Selective Mutism:

1. Social Anxiety: Fear of social interactions, scrutiny, or negative evaluation often contributes to selective
mutism.
2. Genetic Predisposition: A family history of anxiety disorders may increase the risk of developing selective
mutism.
3. Temperamental Factors: Individuals with an inhibited temperament may be more prone to selective mutism.
4. Environmental Stressors: Traumatic events, changes in the environment, or major life transitions can trigger
or exacerbate selective mutism.
5. Speech or Language Issues: Underlying speech or language difficulties may contribute to communication
challenges.

Early Identification of Selective Mutism:

1. Observation in Social Settings: Recognizing consistent and prolonged silence in social situations, especially
in contrast to comfort zones.
2. Communication with Parents and Caregivers: Gathering information about the child's behavior and
communication patterns at home.
3. Teacher and School Involvement: Collaboration with educators to identify mutism patterns in school settings.
4. Speech and Language Assessments: Evaluating speech and language development to rule out underlying
difficulties.
5. Mental Health Screening: Assessing for anxiety or other mental health concerns that may be associated with
selective mutism.

Management of Selective Mutism:

1. Behavioral Therapies: Gradual exposure and desensitization techniques to reduce anxiety in social
situations.
2. Cognitive-Behavioral Therapy (CBT): Addressing and challenging anxious thoughts and behaviors.
3. Speech and Language Therapy: Targeting communication skills and building confidence in verbal expression.
4. Parent and Teacher Training: Providing strategies to create a supportive environment and facilitate
communication.
5. Gradual Exposure: Incremental exposure to social situations to build comfort and confidence.
6. Medication (if necessary): In some cases, medications such as selective serotonin reuptake inhibitors
(SSRIs) may be considered.
7. Individualized Education Plan (IEP): Collaborating with schools to create supportive learning environments.

4. Obsessive-Compulsive Disorder (OCD)

DSM-5 Criteria:
- A. Presence of obsessions, compulsions, or both.
- B. Time-consuming or clinically significant distress or impairment.
- C. Symptoms not attributable to substance or medical condition.
- D. Disturbance not better explained by another mental disorder.

Causes (OCD):
1. Genetic Factors: Genetic predisposition may contribute to the development of OCD.
2. Neurobiological Factors: Imbalances in neurotransmitters, particularly serotonin
3. Environmental Factors: Stressful life events or trauma can trigger or exacerbate OCD symptoms.
4. Cognitive Factors: Maladaptive thought patterns and cognitive processes may contribute.

Early Identification (OCD):

1. Obsessive Thoughts and Compulsive Behaviors: Persistent, intrusive thoughts and repetitive behaviors.
2. Impact on Daily Functioning: Significant interference with daily activities and relationships.
3. Duration and Frequency: Presence of symptoms for an extended period and occurring frequently.
4. Seeking Professional Help: Recognizing signs and seeking consultation with mental health professionals.

Management (OCD):
1. Cognitive-Behavioral Therapy (CBT): Exposure and Response Prevention (ERP) is a key component.
2. Medication: Selective serotonin reuptake inhibitors (SSRIs) or other psychiatric medications.
3. Mindfulness and Relaxation Techniques: Practices to manage stress and anxiety.
4. Support Groups: Connecting with others experiencing similar challenges.
5. Family Involvement: Inclusion of family members in therapy and support.
6. Routine and Structure: Establishing predictable routines to alleviate anxiety.
7. Gradual Exposure: Systematic exposure to feared stimuli to reduce anxiety.
8. Therapeutic Lifestyle Changes: Promoting overall mental and physical well-being.

5. Depressive Disorder
DSM-5 Criteria:
- A. Presence of five or more symptoms during a two-week period, including at least one of the following:
1. Depressed mood.
2. Loss of interest or pleasure.
- B. Symptoms causing clinically significant distress or impairment.
- C. Not attributable to substance or medical condition.
- D. Not better explained by another mental disorder.

Causes of Depressive Disorder:

1. Biological Factors: Imbalances in neurotransmitters, genetic predisposition, or changes in brain structure can
contribute.
2. Psychological Factors: Trauma, chronic stress, and negative thought patterns may contribute to the
development of depressive disorder.
3. Environmental Factors: Life events, such as loss, financial difficulties, or interpersonal conflicts, can trigger
depressive episodes.
4. Medical Conditions: Chronic illnesses, certain medications, and hormonal imbalances may be linked to
depressive symptoms.
5. Genetic Factors: Family history of depressive disorders can increase susceptibility.

Early Identification of Depressive Disorder:

1. Self-Reflection: Awareness of persistent sad mood, loss of interest, and changes in sleep or appetite.
2. Screening Tools: Standardized questionnaires and assessments administered by healthcare professionals.
3. Clinical Evaluation: Mental health professionals assess symptoms, history, and functional impairment.
4. Observations by Others: Input from family, friends, or colleagues noting changes in behavior or mood.

Management of Depressive Disorder:

1. Psychotherapy: Cognitive-behavioral therapy (CBT), psychodynamic therapy, or interpersonal therapy.
2. Medication: Antidepressant medications to regulate neurotransmitter levels.
3. Electroconvulsive Therapy (ECT): In severe cases, ECT may be considered.
4. Lifestyle Changes: Exercise, adequate sleep, and a healthy diet contribute to overall well-being.
5. Social Support: Involvement of family and friends in the treatment process.
6. Mindfulness and Relaxation Techniques: Practices like mindfulness meditation to manage symptoms.
7. Hospitalization: In severe cases, hospitalization may be necessary for safety and intensive treatment.
8. Community Resources: Accessing community mental health services and support groups.

MODULE 6: OTHER PSYCHOTIC DISORDERS

1. Bipolar Affective Disorder

DSM-5 Criteria:
- A. Distinct periods of abnormally and persistently elevated, expansive, or irritable mood and increased activity
or energy, lasting at least one week.
- B. During the period of mood disturbance, three or more of the following symptoms are present (four if the
mood is only irritable):
1. Inflated self-esteem or grandiosity.
2. Decreased need for sleep.
 3. More talkative than usual or pressure to keep talking.
4. Flight of ideas or subjective experience that thoughts are racing.
5. Distractibility.
6. Increase in goal-directed activity or psychomotor agitation.
7. Excessive involvement in activities that have a high potential for painful consequences.

- C. Clear changes in functioning that are uncharacteristic of the individual's usual behavior.
- D. The mood disturbance is observable by others.
- E. Not attributable to the physiological effects of a substance or another medical condition.

Causes of Bipolar Affective Disorder:

1. Genetic Factors: Family history of bipolar disorder increases the risk.
2. Neurochemical Imbalances: Imbalances in neurotransmitters, particularly serotonin and dopamine.
3. Brain Structure and Function: Structural and functional abnormalities in the brain may contribute.
4. Environmental Factors: Stressful life events, trauma, or major life changes.
5. Hormonal Factors: Fluctuations in hormones may play a role.

Early Identification of Bipolar Affective Disorder:

1. Mood Monitoring: Regular tracking of mood swings, energy levels, and sleep patterns.
2. Recognition of Symptoms: Awareness of depressive and manic/hypomanic symptoms.
3. Family History: Understanding family history of mood disorders.
4. Consultation with Healthcare Professionals: Seeking professional help for accurate diagnosis.

Management of Bipolar Affective Disorder:

1. Medication: Mood stabilizers, antipsychotics, and antidepressants as prescribed.
2. Psychotherapy: Cognitive-behavioral therapy (CBT) and psychoeducation.
3. Lifestyle Modifications: Regular sleep patterns, stress reduction, and healthy lifestyle choices.
4. Supportive Therapies: Support groups and counseling for individuals and families.
5. Routine Monitoring: Regular follow-ups with healthcare professionals for symptom management.
6. Emergency Plans: Developing plans for managing severe mood episodes.

2. Psychotic Disorder
DSM-5 Criteria:
- A. Presence of one or more of the following symptoms:
1. Delusions.
2. Hallucinations.
3. Disorganized thinking (speech).
4. Grossly disorganized or abnormal motor behavior (including catatonia).
5. Negative symptoms (diminished emotional expression or avolition).

- B. Duration of at least one day but less than one month (brief psychotic disorder) or continuous signs of
disturbance for at least six months (schizophrenia spectrum and other psychotic disorders).
- C. Not attributable to the physiological effects of a substance or another medical condition.
- D. Not better explained by another mental disorder.

Causes of Psychotic Disorders:

1. Genetic Factors: Family history of psychotic disorders increases risk.
2. Neurochemical Imbalances: Dysregulation of neurotransmitters, such as dopamine.
3. Brain Structure Abnormalities: Changes in brain structure and function.
4. Prenatal Factors: Exposure to infections or stress during pregnancy.
5. Trauma and Stressors: Childhood trauma or significant life stressors.
6. Substance Use: Drug-induced psychosis due to substance abuse.

Early Identification of Psychotic Disorders:

1. Observational Signs: Unusual behavior, speech, or social withdrawal.
2. Cognitive Assessments: Evaluation of thought patterns and reasoning.
3. Family History: Identification of genetic predisposition.
4. Screening Tools: Psychiatric assessments and standardized screening tools.
5. Educational and Occupational Performance: Declines in functioning at school or work.

Management of Psychotic Disorders:

1. Medication: Antipsychotic medications to manage symptoms.
2. Therapy: Cognitive-behavioral therapy and psychosocial interventions.
3. Hospitalization: In severe cases or during acute episodes.
4. Community Support: Outreach programs and community mental health services.
5. Family Involvement: Education and support for families.
6. Substance Abuse Treatment: Addressing co-occurring substance use issues.
7. Rehabilitation Programs: Skills training and vocational rehabilitation.

3. Anorexia Nervosa
DSM-5 Criteria:
- A. Restriction of energy intake leading to significantly low body weight.
- B. Intense fear of gaining weight or becoming fat, even though underweight.
- C. Disturbance in the way in which one's body weight or shape is experienced, undue influence of body weight
or shape on self-evaluation, or denial of the seriousness of the current low body weight.
- D. In postmenarcheal females, the absence of at least three consecutive menstrual cycles.
- E. Specify the current severity:
1. Mild: BMI ≥ 17 kg/m².
2. Moderate: BMI 16-16.99 kg/m².
3. Severe: BMI 15-15.99 kg/m².
4. Extreme: BMI < 15 kg/m².

Causes of Anorexia Nervosa:

1. Genetic Factors: Family history may contribute to a predisposition for anorexia nervosa.
2. Psychological Factors: Perfectionism, low self-esteem, and body image dissatisfaction play a role.
3. Environmental Factors: Societal pressures, cultural ideals, and media influence can contribute.
4. Biological Factors: Neurobiological and hormonal imbalances may be involved.
5. Life Events: Traumatic events or significant life changes can trigger anorexia nervosa.

Early Identification of Anorexia Nervosa:

1. Physical Signs: Rapid weight loss, fatigue, dizziness, and changes in skin or hair.
2. Behavioral Signs: Excessive exercise, preoccupation with food, and avoiding meals.
3. Psychological Signs: Extreme fear of gaining weight, distorted body image, and denial of severity.
4. Social Withdrawal: Isolation, avoidance of social activities, and changes in relationships.

Management of Anorexia Nervosa:

1. Medical Stabilization: Addressing immediate health concerns through hospitalization if necessary.
2. Nutritional Rehabilitation: Establishing a balanced and healthy eating pattern.
3. Psychotherapy: Cognitive-behavioral therapy (CBT) to address distorted thoughts and behaviors.
4. Family-Based Treatment (FBT): Involving families in treatment, especially for adolescents.
5. Medication: Antidepressants or other medications to address co-occurring conditions.
6. Support Groups: Encouraging peer support and sharing experiences.
7. Nutritional Counseling: Working with dietitians to achieve a healthy and sustainable diet.
8. Long-Term Follow-Up: Continued monitoring and support to prevent relapse.

4. Bulimia Nervosa
DSM-5 Criteria:
- A. Recurrent episodes of binge eating characterized by:
1. Eating, in a discrete period of time, an amount of food that is definitely larger than what most individuals
would eat in a similar period.
2. Lack of control over eating during the episode.

- B. Recurrent inappropriate compensatory behaviors to prevent weight gain.

- C. Binge eating and inappropriate compensatory behaviors both occur, on average, at least once a week for
three months.
- D. Self-evaluation is unduly influenced by body shape and weight.
- E. Disturbance does not occur exclusively during episodes of anorexia nervosa.

Causes of Bulimia Nervosa:

1. Biological Factors: Genetic predisposition and neurobiological factors may contribute.
2. Psychological Factors: Body image dissatisfaction, low self-esteem, and perfectionism.
3. Environmental Factors: Societal pressure on appearance, trauma, or dysfunctional family dynamics.
4. Cultural Influences: Cultural emphasis on thinness and beauty standards.

Early Identification of Bulimia Nervosa:

1. Behavioral Signs: Frequent episodes of overeating followed by compensatory behaviors.
2. Physical Signs: Fluctuations in weight, dental issues, and gastrointestinal problems.
3. Psychological Signs: Preoccupation with body shape, mood swings, and social withdrawal.
4. Changes in Eating Habits: Frequent dieting or extreme food restriction followed by binge eating.

Management of Bulimia Nervosa:

1. Psychotherapy: Cognitive-behavioral therapy (CBT) to address distorted thoughts and behaviors.
2. Nutritional Counseling: Guidance on healthy eating patterns and addressing nutritional imbalances.
3. Medication: Antidepressants may be prescribed in some cases.
4. Support Groups: Group therapy for peer support and shared experiences.
5. Medical Monitoring: Regular medical check-ups to address physical health concerns.
6. Family Involvement: Family-based therapy for adolescents and involving families in the treatment process.
7. Education and Prevention: Promoting awareness and prevention programs in schools and communities.

5. Bowel & Bladder Control Disorder

DSM-5 Criteria:
- A. Recurrent inability to control bowel movements or urination.
- B. Inappropriate elimination occurring both during the day and at night.
- C. The behavior is not exclusively due to the direct physiological effects of a substance or another medical
condition.

Causes of Bowel and Bladder Control Issues:

1. Anatomical Abnormalities: Structural issues in the urinary or digestive tract can contribute to control
problems.
2. Neurological Disorders: Conditions affecting the nervous system, like spinal cord injuries or neurological
diseases.
3. Infections: Urinary tract infections (UTIs) can impact bladder control.
4. Psychological Factors: Stress, anxiety, or emotional issues may contribute to control difficulties.
5. Developmental Factors: Inadequate development of control mechanisms in childhood.

Early Identification:
1. Parental Observation: Monitoring for any signs of delayed or atypical bowel or bladder control in early
childhood.
2. Pediatric Assessments: Routine medical check-ups and assessments by pediatricians to identify
developmental concerns.
3. Educational Settings: Teachers may observe and report unusual bathroom behaviors in school-aged children.

Management of Bowel and Bladder Control Issues:

1. Medical Interventions: Addressing underlying medical conditions or anatomical abnormalities.
2. Behavioral Therapies: Implementing strategies to modify and improve bowel and bladder habits.
3. Medications: Prescribing medications to manage infections, muscle spasms, or other contributing factors.
4. Psychological Support: Counseling or therapy to address emotional factors affecting control.
5. Nutritional Interventions: Dietary adjustments to promote bowel regularity.
6. Education and Training: Teaching proper toileting habits and techniques.
7. Biofeedback: Utilizing biofeedback techniques to enhance muscle control.
8. Surgical Interventions: In cases of severe anatomical issues, surgical procedures may be considered.

6. Obesity
- A. Body mass index (BMI) of 30 or greater.
- B. Clinically significant impairment or distress related to the weight.
- C. The disturbance is not better explained by another mental disorder.

Causes of Obesity:
1. Genetic Factors: Predisposition influenced by family history and genetic factors.
2. Environmental Factors: Sedentary lifestyle, unhealthy eating habits, and access to high-calorie foods.
3. Psychological Factors: Emotional eating, stress, and mental health conditions can contribute.
4. Medical Conditions: Hormonal disorders, such as hypothyroidism, can contribute to weight gain.
5. Medications: Certain medications may have weight gain as a side effect.
6. Socioeconomic Factors: Limited access to nutritious foods in certain communities.

Early Identification:
1. Body Mass Index (BMI) Measurement: Regular monitoring of BMI in healthcare settings.
2. Health Screenings: Assessments of weight and related health indicators during routine check-ups.
3. Childhood Assessments: Monitoring childhood weight through growth charts.
4. Educational Programs: Teaching individuals and families about healthy lifestyles.

Management of Obesity:
1. Dietary Changes: Adopting a balanced and nutritious diet with portion control.
2. Physical Activity: Regular exercise and increased physical activity.
3. Behavioral Therapy: Addressing emotional eating and developing healthier habits.
4. Medical Interventions: Medications or surgical interventions in severe cases.
5. Nutritional Counseling: Guidance on healthy eating and lifestyle choices.
6. Support Groups: Engaging in communities that promote healthy living.
7. Public Health Initiatives: Policies promoting healthier food environments and physical activity.
7. Tourette's Disorder
- A. Multiple motor and one or more vocal tics present at some time during the illness, although not necessarily
concurrently.
1. Motor tics may include eye blinking, head jerking, shoulder shrugging, or facial movements.
2. Vocal tics may manifest as grunting, throat clearing, or the utterance of words or phrases.
- B. Tics may wax and wane in frequency but have persisted for more than one year since the first tic onset.
1. Tics can change in type, frequency, and intensity over time but persist for a minimum of one year.
- C. Onset before age 18.
- Symptoms typically begin in childhood, often between the ages of 5 and 10.
- D. Not attributable to the physiological effects of a substance or another medical condition.
- Tics are not caused by medications, drugs, or another medical condition.
- E. Tics not better explained by another mental disorder.
- The tics are not better accounted for by another mental disorder, such as a repetitive behavior in autism
spectrum disorder.

8. Tic Disorder

- A. Single or multiple motor or vocal tics (but not both) present at some time during the illness.
1. Motor tics involve sudden, rapid, repetitive movements, such as eye blinking or head jerking.
2. Vocal tics consist of sudden, rapid, and repetitive sounds or words.
- B. Tics may wax and wane in frequency but have persisted for more than one year since the first tic onset.
- Tics can vary in type and intensity but must be present for at least one year.
- C. Onset before age 18.
- The appearance of tics typically occurs in childhood or adolescence.
- D. Not attributable to the physiological effects of a substance or another medical condition.
- Tics are not caused by medications, drugs, or another medical condition.
- E. Tics not better explained by another mental disorder.
- The tics are not better accounted for by another mental disorder, such as a repetitive behavior in autism
spectrum disorder.

Causes of Tourette's Disorder and Tic Disorder:

1. Genetic Factors: Both disorders have a genetic component, with a higher likelihood if there's a family history
2. Neurological Factors: Abnormalities in brain structure or neurotransmitter function may contribute to tic
disorders.
3. Environmental Factors: Certain environmental factors, such as prenatal or perinatal complications, may
increase the risk.
4. Immune System Dysfunction: In some cases, immune system dysregulation has been linked to the onset of
tic disorders.

Early Identification of Tourette's Disorder and Tic Disorder:

1. Observation of Tics: Parents, teachers, or healthcare professionals observe and note the presence of motor
and vocal tics.
2. Clinical Assessment: Healthcare professionals conduct a thorough clinical assessment to identify the nature
and severity of tics.
3. Educational Setting Observation: Teachers play a key role in identifying tics that may affect academic
performance and social interactions.

Management of Tourette's Disorder and Tic Disorder:

1. Psychoeducation: Providing information and education about the nature of tics and the disorders to
individuals, families, and educators.
2. Behavioral Therapies: Behavioral interventions, such as Habit Reversal Training (HRT), can help manage
and control tics.
3. Medications: Certain medications, such as antipsychotics or alpha-adrenergic agonists, may be prescribed to
reduce tic severity.
4. Supportive Interventions: Supportive environments at home and school can help individuals cope with the
challenges associated with tics.
5. Cognitive-Behavioral Therapy (CBT): CBT techniques may be utilized to address the emotional and social
aspects of living with tic disorders.
6. Comprehensive Care: Collaboration between healthcare professionals, educators, and families to develop
and implement a comprehensive care plan.