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MODULE IN ABNORMAL PSYCHOLOGY CHILDHOOD DISORDERS

Attention Deficit Hyperactivity Disorder (ADHD) Lisa's son Jack had always been a handful. Even as a preschooler, he would tear through the house like a tornado, shouting, roughhousing, and climbing the furniture. No toy or activity ever held his interest for more than a few minutes and he would often dart off without warning, seemingly unaware of the dangers of a busy street or a crowded mall. It was exhausting to parent Jack, but Lisa hadn't been too concerned back then. Boys will be boys, she figured. But at age 8, he was no easier to handle. It was a struggle to get Jack to settle down long enough to complete even the simplest tasks, from chores to homework. When his teacher's comments about his inattention and disruptive behavior in class became too frequent to ignore, Lisa took Jack to the doctor, who recommended an evaluation for attention deficit hyperactivity disorder (ADHD). ADHD is a common behavioral disorder that affects an estimated 8% to 10% of school-age children. Boys are about three times more likely than girls to be diagnosed with it, though it's not yet understood why. Kids with ADHD act without thinking, are hyperactive, and have trouble focusing. They may understand what's expected of them but have trouble following through because they can't sit still, pay attention, or attend to details. Of course, all kids (especially younger ones) act this way at times, particularly when they're anxious or excited. But the difference with ADHD is that symptoms are present over a longer period of time and occur in different settings. They impair a child's ability to function socially, academically, and at home. The good news is that with proper treatment, kids with ADHD can learn to successfully live with and manage their symptoms.

Symptoms
ADHD used to be known as attention deficit disorder, or ADD. In 1994, it was renamed ADHD and broken down into three subtypes, each with its own pattern of behaviors: 1. an inattentive type, with signs that include:

inability to pay attention to details or a tendency to make careless errors in schoolwork or other activities difficulty with sustained attention in tasks or play activities apparent listening problems difficulty following instructions problems with organization avoidance or dislike of tasks that require mental effort tendency to lose things like toys, notebooks, or homework distractibility forgetfulness in daily activities fidgeting or squirming difficulty remaining seated excessive running or climbing difficulty playing quietly always seeming to be "on the go" excessive talking blurting out answers before hearing the full question difficulty waiting for a turn or in line problems with interrupting or intruding

2. a hyperactive-impulsive type, with signs that include:

3. a combined type, which involves a combination of the other two types and is the most common

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Although it can be challenging to raise kids with ADHD, it's important to remember they aren't "bad," "acting out," or being difficult on purpose. And they have difficulty controlling their behavior without medication or behavioral therapy.

Diagnosis
Because there's no test that can determine the presence of ADHD, a diagnosis depends on a complete evaluation. Many children and adolescents diagnosed with ADHD are evaluated and treated by primary care doctors including pediatricians and family practitioners, but your child may also be referred to one of several different specialists (psychiatrists, psychologists, neurologists) especially when the diagnosis is in doubt, or if there are other concerns, such as Tourette syndrome, a learning disability, anxiety, or depression. To be considered for a diagnosis of ADHD:

a child must display behaviors from one of the three subtypes before age 7 these behaviors must be more severe than in other kids the same age the behaviors must last for at least 6 months the behaviors must occur in and negatively affect at least two areas of a child's life (such as school, home,

daycare settings, or friendships) The behaviors must also not only be linked to stress at home. Kids who have experienced a divorce, a move, an illness, a change in school, or other significant life event may suddenly begin to act out or become forgetful. To avoid a misdiagnosis, it's important to consider whether these factors played a role in the onset of symptoms First, your child's doctor may perform a physical examination and take a medical history that includes questions about any concerns and symptoms, your child's past health, your family's health, any medications your child is taking, any allergies your child may have, and other issues. The doctor may also check hearing and vision so other medical conditions can be ruled out. Because some emotional conditions, such as extreme stress, depression, and anxiety, can also look like ADHD, you'll likely be asked to fill out questionnaires to help rule them out. You'll be asked many questions about your child's development and behaviors at home, school, and among friends. Other adults who see your child regularly (like teachers, who are often the first to notice ADHD symptoms) probably will be consulted, too. An educational evaluation, which usually includes a school psychologist, may also be done. It's important for everyone involved to be as honest and thorough as possible about your child's strengths and weaknesses.

Causes of ADHD
ADHD is not caused by poor parenting, too much sugar, or vaccines. ADHD has biological origins that aren't yet clearly understood. No single cause has been identified, but researchers are exploring a number of possible genetic and environmental links. Studies have shown that many kids with ADHD have a close relative who also has the disorder. Although experts are unsure whether this is a cause of the disorder, they have found that certain areas of the brain are about 5% to 10% smaller in size and activity in kids with ADHD. Chemical changes in the brain also have been found. Research also links smoking during pregnancy to later ADHD in a child. Other risk factors may include premature delivery, very low birth weight, and injuries to the brain at birth. Some studies have even suggested a link between excessive early television watching and future attention problems. Parents should follow the American Academy of Pediatrics' (AAP) guidelines, which say that children under 2 years old should not have any "screen time" (TV, DVDs or videotapes, computers, or video games) and that kids 2 years and older should be limited to 1 to 2 hours per day, or less, of quality television programming.

Related Problems
One of the difficulties in diagnosing ADHD is that it's often found in conjunction with other problems. These are called coexisting conditions, and about two thirds of kids with ADHD have one. The most common coexisting conditions are:

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Oppositional Defiant Disorder (ODD) and Conduct Disorder (CD) At least 35% of kids with ADHD also have oppositional defiant disorder, which is characterized by stubbornness, outbursts of temper, and acts of defiance and rule breaking. Conduct disorder is similar but features more severe hostility and aggression. Kids who have conduct disorder are more likely to get in trouble with authority figures and, later, possibly with the law. Oppositional defiant disorder and conduct disorder are seen most commonly with the hyperactive and combined subtypes of ADHD. Mood Disorders About 18% of kids with ADHD, particularly the inattentive subtype, also experience depression. They may feel inadequate, isolated, frustrated by school failures and social problems, and have low self-esteem. Anxiety Disorders Anxiety disorders affect about 25% of kids with ADHD. Symptoms include excessive worry, fear, or panic, which can also lead to physical symptoms such as a racing heart, sweating, stomach pains, and diarrhea. Other forms of anxiety that can accompany ADHD are obsessive-compulsive disorder and Tourette syndrome, as well as motor or vocal tics (movements or sounds that are repeated over and over). A child who has symptoms of these other conditions should be evaluated by a specialist. Learning Disabilities About half of all kids with ADHD also have a specific learning disability. The most common learning problems are with reading (dyslexia) and handwriting. Although ADHD isn't categorized as a learning disability, its interference with concentration and attention can make it even more difficult for a child to perform well in school. If your child has ADHD and a coexisting condition, the doctor will carefully consider that when developing a treatment plan. Some treatments are better than others at addressing specific combinations of symptoms.

Treating ADHD
ADHD can't be cured, but it can be successfully managed. Your child's doctor will work with you to develop an individualized, long-term plan. The goal is to help a child learn to control his or her own behavior and to help families create an atmosphere in which this is most likely to happen. In most cases, ADHD is best treated with a combination of medication and behavior therapy. Any good treatment plan will require close follow-up and monitoring, and your doctor may make adjustments along the way. Because it's important for parents to actively participate in their child's treatment plan, parent education is also considered an important part of ADHD management.

Medications
Several different types of medications may be used to treat ADHD:

Stimulants are the best-known treatments they've been used for more than 50 years in the treatment of

ADHD. Some require several doses per day, each lasting about 4 hours; some last up to 12 hours. Possible side effects include decreased appetite, stomachache, irritability, and insomnia. There's currently no evidence of longterm side effects.

Nonstimulants represent a good alternative to stimulants or are sometimes used along with a stimulant to

treat ADHD. The first nonstimulant was approved for treating ADHD in 2003. They may have fewer side effects than stimulants and can last up to 24 hours.

Antidepressants are sometimes a treatment option; however, in 2004 the U.S. Food and Drug

Administration (FDA) issued a warning that these drugs may lead to a rare increased risk of suicide in children and teens. If an antidepressant is recommended for your child, be sure to discuss these risks with your doctor. Medications can affect kids differently, and a child may respond well to one but not another. When determining the correct treatment, the doctor might try various medications in various doses, especially if your child is being treated for ADHD along with another disorder.

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Behavioral Therapy
Research has shown that medications used to help curb impulsive behavior and attention difficulties are more effective when combined with behavioral therapy. Behavioral therapy attempts to change behavior patterns by:

reorganizing a child's home and school environment giving clear directions and commands setting up a system of consistent rewards for appropriate behaviors and negative consequences for

inappropriate ones Here are examples of behavioral strategies that may help a child with ADHD:

Create a routine. Try to follow the same schedule every day, from wake-up time to bedtime. Post the

schedule in a prominent place, so your child can see what's expected throughout the day and when it's time for homework, play, and chores.

Get organized. Put schoolbags, clothing, and toys in the same place every day so your child will be less likely Avoid distractions. Turn off the TV, radio, and computer games, especially when your child is doing Limit choices. Offer a choice between two things (this outfit, meal, toy, etc., or that one) so that your child Change your interactions with your child. Instead of long-winded explanations and cajoling, use clear, Use goals and rewards. Use a chart to list goals and track positive behaviors, then reward your child's Discipline effectively. Instead of yelling or spanking, use timeouts or removal of privileges as consequences

to lose them. homework. isn't overwhelmed and overstimulated. brief directions to remind your child of responsibilities. efforts. Be sure the goals are realistic (think baby steps rather than overnight success). for inappropriate behavior. Younger kids may simply need to be distracted or ignored until they display better behavior.

Help your child discover a talent. All kids need to experience success to feel good about themselves.

Finding out what your child does well whether it's sports, art, or music can boost social skills and self-esteem.

Alternative Treatments
Currently, the only ADHD therapies that have been proven effective in scientific studies are medications and behavioral therapy. But your doctor may recommend additional treatments and interventions depending on your child's symptoms and needs. Some kids with ADHD, for example, may also need special educational interventions such as tutoring, occupational therapy, etc. Every child's needs are different. A number of other alternative therapies are promoted and tried by parents including: megavitamins, body treatments, diet manipulation, allergy treatment, chiropractic treatment, attention training, visual training, and traditional one-on-one "talking" psychotherapy. However, scientific research has not found them to be effective, and most have not been studied carefully, if at all. Parents should always be wary of any therapy that promises an ADHD "cure." If you're interested in trying something new, speak with your doctor first.

Parent Training
Parenting a child with ADHD often brings special challenges. Kids with ADHD may not respond well to typical parenting practices. Also, because ADHD tends to run in families, parents may also have some problems with organization and consistency themselves and need active coaching to help learn these skills. Experts recommend parent education and support groups to help family members accept the diagnosis and to teach them how to help kids organize their environment, develop problem-solving skills, and cope with frustrations. Training can also teach parents to respond appropriately to a child's most trying behaviors with calm disciplining techniques. Individual or family counseling can also be helpful.

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ADHD in the Classroom


As your child's most important advocate, you should become familiar with your child's medical, legal, and educational rights. Kids with ADHD are eligible for special services or accommodations at school under the Individuals with Disabilities in Education Act (IDEA) and an anti-discrimination law known as Section 504. Keep in touch with teachers and school officials to monitor your child's progress. In addition to using routines and a clear system of rewards, here are some other tips to share with teachers for classroom success:

Reduce seating distractions. Lessening distractions might be as simple as seating your child near the Use a homework folder for parent-teacher communications.The teacher can include assignments and Break down assignments. Keep instructions clear and brief, breaking down larger tasks into smaller, more Give positive reinforcement. Always be on the lookout for positive behaviors. Ask the teacher to offer

teacher instead of near the window. progress notes, and you can check to make sure all work is completed on time. manageable pieces. praise when your child stays seated, doesn't call out, or waits his or her turn instead of criticizing when he or she doesn't.

Teach good study skills. Underlining, note taking, and reading out loud can help your child stay focused and Supervise. Check that your child goes and comes from school with the correct books and materials. Be sensitive to self-esteem issues. Ask the teacher to provide feedback to your child in private, and avoid Involve the school counselor or psychologist. He or she can help design behavioral programs to address

retain information. Sometimes kids are paired with a buddy to can help them stay on track. asking your child to perform a task in public that might be too difficult. specific problems in the classroom.

Helping Your Child


You're a stronger advocate for your child when you foster good partnerships with everyone involved in your child's treatment that includes teachers, doctors, therapists, and even other family members. Take advantage of all the support and education that's available, and you'll help your child navigate toward success.
Reviewed by: Richard S. Kingsley, MD Date reviewed: January 2012 http://kidshealth.org/parent/medical/learning/adhd.html#

Autism
When Stacey went over to her new friend Chelsea's house, she met Chelsea's 4-year-old brother, Shawn. "Hi," said Stacey, smiling. Shawn glanced at her and said nothing. Then he turned back to a toy he was holding. Later, in Chelsea's room, Stacey said, "I don't think your brother likes me." "It's not your fault," explained Chelsea. "Shawn has autism." Stacey wanted to know what autism meant, what causes it, what it's like to have autism, and more. Let's find out.

What Does Autism Mean?


Autism (say: aw-tih-zum) causes kids to experience the world differently from the way most other kids do. It's hard for kids with autism to talk with other people and express themselves using words. Kids who have autism usually keep to themselves and many can't communicate without special help. They also may react to what's going on around them in unusual ways. Normal sounds may really bother someone with autism so much so that the person covers his or her ears. Being touched, even in a gentle way, may feel uncomfortable. Kids with autism often can't make connections that other kids make easily. For example, when someone smiles, you know the smiling person is happy or being friendly. But a kid with autism may have trouble connecting that smile with the person's happy feelings.

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A kid who has autism also has trouble linking words to their meanings. Imagine trying to understand what your mom is saying if you didn't know what her words really mean. It is doubly frustrating then if a kid can't come up with the right words to express his or her own thoughts. Autism causes kids to act in unusual ways. They might flap their hands, say certain words over and over, have temper tantrums, or play only with one particular toy. Most kids with autism don't like changes in routines. They like to stay on a schedule that is always the same. They also may insist that their toys or other objects be arranged a certain way and get upset if these items are moved or disturbed. If someone has autism, his or her brain has trouble with an important job: making sense of the world. Every day, your brain interprets the sights, sounds, smells, and other sensations that you experience. If your brain couldn't help you understand these things, you would have trouble functioning, talking, going to school, and doing other everyday stuff. Kids can be mildly affected by autism, so that they only have a little trouble in life, or they can be very affected, so that they need a lot of help.

What Causes Autism?


Autism affects about 1 in every 150 kids, but no one knows what causes it. Some scientists think that some kids might be more likely to get autism because it or similar disorders run in their families. Knowing the exact cause of autism is hard because the human brain is very complicated. The brain contains over 100 billion nerve cells called neurons(say: nur-ahns). Each neuron may have hundreds or thousands of connections that carry messages to other nerve cells in the brain and body. The connections and the chemical messengers they send (called neurotransmitters) let the neurons that help you see, feel, move, remember, and work together as they should. For some reason, some of the cells and connections in the brain of a kid with autism especially those that affect communication, emotions, and senses don't develop properly or get damaged. Scientists are still trying to understand how and why this happens.

What Do Doctors Do?


Figuring out if a kid has autism can be difficult. A parent is usually the first to suspect that something is wrong. Maybe the kid is old enough to speak but doesn't, doesn't seem interested in people, or behaves in other unusual ways. But autism isn't the only problem that can cause these kinds of symptoms. For example, kids who have hearing problems might have trouble speaking, too. Usually, the results of lab tests and other medical tests are normal in kids with autism, but doctors may do them to make sure the kid doesn't have other problems. These medical tests can include blood and urine tests, a hearing exam, an EEG (a test to measure brain waves), and an MRI (a picture that shows the structure of the brain). Intelligence (IQ) tests also might be done. Often, specialists work together as a team to figure out what is wrong. The team might include a pediatrician, a pediatric neurologist, a pediatric developmentalist, a child psychiatrist, a child psychologist, speech and language therapists, and others. The team members study how the child plays, learns, communicates, and behaves. The team listens carefully to what parents have noticed, too. Using the information they've gathered, doctors can decide whether a child has autism or another problem.

How Is Autism Treated?


There is no cure for autism, but doctors, therapists, and special teachers can help kids with autism overcome or adjust to many difficulties. The earlier a kid starts treatment for autism, the better. Different kids need different kinds of help, but learning how to communicate is always an important first step. Spoken language can be hard for kids with autism to learn. Most understand words better by seeing them, so therapists teach them how to communicate by pointing or using pictures or sign language. That makes learning other things easier, and eventually, many kids with autism learn to talk. Therapists also help kids learn social skills, such as how to greet people, wait for a turn, and follow directions. Some kids need special help with living skills (like brushing teeth or making a bed). Others have trouble sitting still or

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controlling their tempers and need therapy to help them control their behavior. Some kids take medications to help their moods and behavior, but there's no medicine that will make a kid's autism go away. Students with mild autism sometimes can go to regular school. But most kids with autism need calmer, more orderly surroundings. They also need teachers trained to understand the problems they have with communicating and learning. They may learn at home or in special classes at public or private schools.

Living With Autism


Some kids with mild autism will grow up and be able to live on their own. Those with more serious problems will always need some kind of help. But all kids with autism have brighter futures when they have the support and understanding of doctors, teachers, caregivers, parents, brothers, sisters, and friends.
Reviewed by: Steven Dowshen, MD Date reviewed: August 2009 Originally reviewed by: Wendelin A. Burdo-Hartman, MD http://kidshealth.org/kid/health_problems/brain/autism.html#

Mental retardation
Problems Learning and Functioning
There's a kid at school who seems different. You've heard people say he's "retarded," but you've also heard people use that word to make fun of each other. Mental retardation (say: ree-tar-day-shun) is a term that was once commonly used to describe someone who learns and develops more slowly than other kids. But it's not used as much anymore because it hurts people's feelings. Instead, you might hear terms like "intellectual disability" or "developmental delay." But all these words mean basically the same thing. Someone who has this kind of problem will have trouble learning and functioning in everyday life. This person could be 10 years old, but might not talk or write as well as a typical 10-year-old. He or she also is usually slower to learn other skills, like how to get dressed or how to act around other people. But having an intellectual disability doesn't mean a person can't learn. Ask anyone who knows and loves a person with an intellectual disability! Some kids with autism, Down syndrome, orcerebral palsy may be described as having an intellectual disability, yet they often have a great capacity to learn and become quite capable kids. Just like other health problems, an intellectual disability can be mild (smaller) or major (bigger). The bigger the disability the more trouble someone will have learning and becoming an independent person.

What Causes Intellectual Disabilities?


Intellectual disabilities happen because the brain gets injured or a problem prevents the brain from developing normally. These problems can happen while the baby is growing inside his or her mom, during the baby's birth, or after the baby is born. Many times, though, doctors don't know the cause. Here are some problems that can cause intellectual disabilities:

There's a problem with the baby's genes, which are in every cell and determine how the body will develop.

(Genes are inherited from both parents, so a baby might receive genes that are abnormal or the genes might change while the baby is developing.)

There's a problem during the pregnancy. Sometimes, the mom might get an illness or infection that can harm

the baby. Taking certain medicines while pregnant can cause problems for the baby. Drinking alcohol or taking illegal drugs can also damage a baby's developing brain.

During childbirth, the baby doesn't get enough oxygen. The baby is born way too early. After being born, the baby gets a serious brain infection. Any time in life, a serious head injury can hurt the brain and cause intellectual disabilities. Some of these

disabilities are temporary and others can be permanent. (That's why it's important to wear your bike helmet and always wear a seatbelt in the car!)

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Doctors figure out that someone has an intellectual disability by testing how well the person thinks and solves problems. If a problem is spotted, doctors and other professionals can work with the family to decide what type of help is needed.

What's It Like at School?


During school, a kid with an intellectual disability will probably need help. Some kids have aides that stay with them during the school day. They may be in special classes or get other services to help them learn and develop. Someone with an intellectual disability often gets help in learning "life skills." Life skills are the skills people need to take care of themselves as they get older, such as how to cook a meal or ride a public bus to get to work. Adults with intellectual disabilities often have jobs and learn to live independently or in a group home. Kids with intellectual disabilities want to develop their skills to the best of their abilities. They want to go to school, play, and feel support from loving families and good friends. What can you do? If you know someone who has an intellectual disability, be a friend. How? Sometimes, it might mean telling a teacher if you see this person being teased or bullied. Other times, it can be as simple as saying something kind, like "Hey, I like your hat!" If you can't think of anything, just say, "hi." It's a little word that could make that person's day.
Reviewed by: Mary L. Gavin, MD Date reviewed: April 2010 http://kidshealth.org/kid/health_problems/birth_defect/mental_retardation.html#

Down syndrome
You have probably seen people who have Down syndrome. They have certain physical features, such as a flatter face and upward slanting eyes. They may have medical problems, too, such as heart defects. Kids with Down syndrome usually have trouble learning and are slower to learn how to talk and take care of themselves. But despite their challenges, kids with Down syndrome can go to regular schools, make friends, enjoy life, and get jobs when they're older. Getting special help early often when they are just babies and toddlers can be the key to healthier, happier, more independent lives.

Chromosomes Are the Cause


To understand why Down syndrome happens, you need to understand a little about chromosomes. What are chromosomes? They're thread-like structures within each cell and are made up of genes. Genes provide the information that determines everything about people, from hair color to whether they are girls or boys. Most people have 23 pairs of chromosomes, for a total of 46. But a baby with Down syndrome has an extra chromosome (47 instead of 46) or one chromosome has an extra part. This extra genetic material causes problems with the way their bodies develop.

Health Problems Are Common


About half of babies with Down syndrome are born with heart defects, which means their hearts developed differently and don't work as they should. Usually, these problems can be corrected by surgery. Some babies may have intestinal problems that also require surgery to fix. Kids with Down syndrome are more likely to get infections that affect their lungs and breathing. When they do get infections, they often last longer. They may have eye or ear problems or digestion problems like constipation. Some may develop leukemia, a type of cancer. Each person with Down syndrome is different and may have one, several, or all of these problems. Kids with Down syndrome tend to grow and develop more slowly than other children do. They may start walking or talking later than other babies. Special help, such as physical therapy andspeech therapy, can give kids a boost with their walking and talking skills.

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Do a Lot of People Have Down Syndrome?


About 1 out of every 800 babies born has Down syndrome, no matter what race or nationality the parents are. It is not contagious, so you can't catch it from someone else. You are born with it. No one gets Down syndrome later in life. Now you know that Down syndrome is caused by a problem with a chromosome. You might already know that we get our chromosomes from our mother and father. Remember the 23 pairs of chromosomes half are from your mom and half are from your dad. But doctors aren't sure why this chromosome problem happens to some babies. It's nothing the mom or dad did before the child was born. Anyone can have a baby with Down syndrome. But the older the mother, the greater the risk.

Times Have Changed


At one time, most kids with Down syndrome did not live past childhood. Many would often become sick from infections. Others would die from their heart problems or other problems they had at birth. Today, most of these health problems can be treated and most kids who have it will grow into adulthood. Medicines can help with infections and surgery can correct heart, intestinal, and other problems. If the person gets leukemia, medical treatments can be very successful. Down syndrome is something a person will have all of his or her life. But scientists continue to do research in the hope of finding ways to prevent Down syndrome or at least improve the health and lives of people who have it.

What's Life Like for Kids With Down Syndrome?


Many kids with Down syndrome go to regular schools and may attend regular classes. Some need special classes to help them in areas where they have more trouble learning. Their parents work with teachers and others to come up with a plan for the best way for each child to learn. Kids with Down syndrome like their playtime, too. They play sports and participate in activities, such as music lessons or dance classes. Because they look different, some kids may tease or bully kids who have Down syndrome. But these kids have feelings just like anybody else. When they get teased, it hurts their feelings. They want to be accepted and have friends. If you know someone with Down syndrome, you can be a big help by not teasing him or her. Instead, offer a helping hand and a friendly word of encouragement.
Reviewed by: Mary L. Gavin, MD Date reviewed: February 2009 http://kidshealth.org/kid/health_problems/birth_defect/down_syndrome.html#

Cerebral palsy
Have you ever heard a family member talk about your first step or the first word you spoke? For kids with cerebral palsy, called CP for short, taking a first step or saying a first word is not as easy. That's because CP is a condition that can affect the things that kids do every day.

What's CP?
Some kids with CP use wheelchairs and others walk with the help of crutches or braces. In some cases, a kid's speech may be affected or the person might not be able to speak at all. Cerebral palsy (say: seh-ree-brel pawl-zee) is a condition that affects thousands of babies and children each year. It is not contagious, which means you can't catch it from anyone who has it. The word cerebral means having to do with the brain. The word palsy means a weakness or problem in the way a person moves or positions his or her body. A kid with CP has trouble controlling the muscles of the body. Normally, the brain tells the rest of the body exactly what to do and when to do it. But because CP affects the brain, depending on what part of the brain is affected, a kid might not be able to walk, talk, eat, or play the way most kids do.

Types of CP

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There are three types of cerebral palsy: spastic (say: spass-tick),athetoid (say: ath-uh-toid), and ataxic (say: ay-tak-sick). The most common type of CP is spastic. A kid with spastic CP can't relax his or her muscles or the muscles may be stiff. Athetoid CP affects a kid's ability to control the muscles of the body. This means that the arms or legs that are affected by athetoid CP may flutter and move suddenly. A kid with ataxic CP has problems with balance and coordination. A kid with CP can have a mild case or a more severe case it really depends on how much of the brain is affected and which parts of the body that section of the brain controls. If both arms and both legs are affected, a kid might need to use a wheelchair. If only the legs are affected, a kid might walk in an unsteady way or have to wear braces or use crutches. If the part of the brain that controls speech is affected, a kid with CP might have trouble talking clearly. Another kid with CP might not be able to speak at all. For some babies, injuries to the brain during pregnancy or soon after birth may cause CP. Children most at risk of developing CP are small, premature babies (babies who are born many weeks before they were supposed to be born) and babies who need to be on a ventilator (a machine to help with breathing) for several weeks or longer. But for most kids with CP, the problem in the brain occurs before birth. Often, doctors don't know why.

What Do Doctors Do?


Doctors who specialize in treating kids with problems of the brain, nerves, or muscles are usually involved in diagnosing a kid with cerebral palsy. These specialists could include a pediatricneurologist (say: nyoo-ral-uh-jist), a doctor who deals with problems of the nervous system and brain in kids. Three other kinds of doctors who can help kids with CP include a pediatric orthopedist (say: or-tho-pee-dist), who handles problems with bones or joints, a developmental pediatrician, who looks at how a kid is growing or developing compared with other kids the same age, and a pediatric physiatrist, who helps treat children with disabilities of many kinds. There is no special test to figure out if a kid has cerebral palsy. Doctors may order X-rays and blood tests to find out if some other disease of the brain and nervous system may be causing the problem. To diagnose CP, doctors usually wait to see how a kid develops to be sure. A case of cerebral palsy often can be diagnosed by the age of 18 months. For example, if a child does not sit up or walk by the time most kids should be doing these things, the kid might have CP or some other problem that is causing development to go more slowly. Doctors follow infant and child development closely and look for problems with muscle tone and strength, movement, and reflexes.

How Is CP Treated?
For a kid with CP, the problem with the brain will not get any worse as the kid gets older. For example, a kid who has CP that affects only the legs will not develop CP in the arms or problems with speech later on. The effect of CP on the arms or legs can get worse, however, and some kids may develop dislocated hips (when the bones that meet at the hips move out of their normal position) or scoliosis (curvature of the spine). That is why therapy is so important. Kids with CP usually havephysical, occupational, or speech therapy to help them develop skills like walking, sitting, swallowing, and using their hands. There are also medications to treat the seizures that some kids with CP have. Some medications can help relax the muscles in kids with spastic CP. And some kids with CP may have specialsurgeries to keep their arms or legs straighter and more flexible

Living With CP
Cerebral palsy usually doesn't stop kids from going to school, making friends, or doing things they enjoy. But they may have to do these things a little differently or they may need some help. With computers to help them communicate and wheelchairs to help them get around, kids with CP often can do a lot of stuff that kids without CP can do. Kids with cerebral palsy are just like other kids, but with some greater challenges that make it harder to do everyday things. More than anything else, they want to fit in and be liked.

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Be patient if you know someone or meet someone with CP. If you can't understand what a person with CP is saying or if it takes a person with CP longer to do things, give him or her extra time to speak or move. Being understanding is what being a good friend is all about, and a kid with CP will really appreciate it.
Reviewed by: Steven J. Bachrach, MD Date reviewed: April 2009 http://kidshealth.org/kid/health_problems/brain/cerebral_palsy.html#

Tourette Syndrome
Tics sudden, repetitive movements or sounds that some people make, seemingly without being aware of it are more common than you might realize. Indeed, many people have tics that go away in less than a year or mild tics that don't interfere with their lives. But in some kids, tics are more severe or long lasting. If a child has tics for more than a year, it is called a chronic tic disorder. In some cases, these tics can be part of a condition called Tourette syndrome. The tics associated with Tourette syndrome tend to get milder or go away entirely as kids grow into adulthood. Until that happens, though, parents can help their child cope with the condition.

About Tourette Syndrome


Tourette syndrome (TS) is named for French doctor Georges Gilles de la Tourette, who first described the condition in 1885. It's thought to be a genetic condition that's inherited in most cases. Experts don't know the exact cause of TS, but some research points to changes in the brain and problems with how nerve cells communicate. A disturbance in the balance of neurotransmitters chemicals in the brain that carry nerve signals from cell to cell might play a role. Symptoms of Tourette syndrome, which is not contagious, usually emerge in childhood or the teen years. TS isn't common only about 3 in every 1,000 people have it, and boys are more likely to be affected. To be diagnosed with Tourette syndrome, a person must have several different types of tics specifically, multiple motor tics and at least one vocal tic.

Signs and Symptoms


The main symptoms of TS are motor tics (sudden, apparently uncontrollable movements like exaggerated blinking of the eyes) or vocal tics (such as repeated throat clearing). At certain times, like when someone is under stress, the tics can become more severe, more frequent, or longer, or the type of tic may change altogether. (This is also true of people who have tics that are not part of Tourette syndrome.) Some kids can suppress their tics for a short time. But tension builds, and it eventually has to be released as a tic. And if a person is concentrating on controlling the tic, it may be hard to focus on anything else. This can make it hard for kids with TS to have a conversation or pay attention in class. Tics are classified as either simple or complex. Simple motor tics, for example, happen suddenly and separately from other tics and involve just a few muscles. Some examples are eye blinking and grimacing. In contrast, complex motor tics usually involve more muscle groups. For example, someone might touch a body part or another person repeatedly. In rare cases, people with TS might have a tic that makes them harm themselves, such as head banging. Simple vocal tics can be throat clearing, sniffing, or humming, whereas complex vocal tics can involve repeating other people's words (a condition called echolalia) or involuntary swearing (called coprolalia). In addition, many kids and teens with TS have other conditions, such as attention deficit hyperactivity disorder (ADHD) orobsessive-compulsive disorder (OCD). Learning disabilities and sleeping problems are also common in people with TS.

Diagnosing and Treating Tourette Syndrome

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Pediatricians and family doctors may refer a child with symptoms of TS to a neurologist, a doctor who specializes in problems with the nervous system. Before TS can be diagnosed, someone must have tics for at least a year. Although tics may occur every day or intermittently throughout the year, for TS to be diagnosed, there must not be a tic-free period longer than 3 months. The neurologist may ask you to keep track of the frequency and kinds of tics your child is having. There isn't a specific diagnostic test for TS instead, the doctor diagnoses it after taking a medical history and doing a physical exam. Sometimes, doctors use imaging tests like magnetic resonance imaging tests (MRIs), computerized tomography (CT) scans, electroencephalograms (EEGs), or blood tests to rule out other conditions that might have symptoms similar to TS. Just as TS is different for every person, the treatment for it varies, too. Most tics do not interfere with a child's life and do not require any medication. While there isn't a cure for TS, sometimes doctors suggest medications to help control symptoms that begin to interfere with someone's schoolwork or daily life. Talk to your doctor about whether medication would be right for your child. TS is not a psychological condition, but doctors sometimes refer kids and teens with TS to a psychologist or psychiatrist. Seeing a therapist won't stop tics, but it can help kids and teens to talk to someone about their problems, cope with stress better, and learn relaxation techniques.

Dealing With Tourette Syndrome


Many people don't understand what TS is or what causes it, so they might not know what to make of someone who has TS. And if people stare, kids and teens with TS can feel embarrassed and frustrated. Someone who has it might have to explain the condition to others or deal with teasing or gawking. The tics usually get milder as kids grow up and might go away in adulthood. But until then, these tips can help kids with TS cope:

Get involved. Some experts say that when kids and teens are engrossed in an activity, their tics are milder

and less frequent. Sports, exercise, or hobbies are great ways for kids to focus mental and physical energy. Some well-known athletes have TS, like soccer goalie Tim Howard, who plays for Everton (in the English Premier League) and for the U.S. national team.

Give a helping hand. Dealing with TS often makes kids and teens more understanding of other people's

feelings, especially other young people with problems. They might use that special sensitivity by volunteering. Knowing that they've helped others might help build confidence and lessen any self-consciousness about feeling different.

Embrace creativity. Creative activities such as writing, painting, or making music help focus the mind on

other things and they help it develop. There's speculation that composer Mozart and British writer Samuel Johnson both had TS.

Find support. The Tourette Syndrome Association sponsors support groups with others who understand the Take control. People with TS can feel more in control of their lives by researching TS, asking their doctors

challenges of TS. plenty of questions, and taking an active role in their treatment. Each person with TS will cope differently with its physical, emotional, and social challenges. Because TS doesn't usually restrict activities, though, kids who have it should be able to enjoy and participate in the same activities as their peers, and not let it interfere with their everyday lives.
Reviewed by: Harry S. Abram, MD Date reviewed: September 2010 http://kidshealth.org/parent/medical/brain/tourette.html#

Obsessive-Compulsive Disorder (OCD) All kids have worries and doubts. But kids with obsessive-compulsive disorder (OCD) often can't stop worrying, no matter how much they want to. And those worries frequently compel them to behave in certain ways over and over again.

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About OCD
OCD is a type of anxiety disorder. Kids with OCD become preoccupied with whether something could be harmful, dangerous, wrong, or dirty or with thoughts about bad stuff that might happen. With OCD, upsetting or scary thoughts or images, called obsessions, pop into a person's mind and are hard to shake. Kids with OCD also might worry about things being not being "in order" or "just right." They may worry about losing "useless" items, sometimes feeling the need to collect these items. Someone with OCD feels strong urges to do certain things repeatedly called rituals or compulsions in order to banish the scary thoughts, ward off something dreaded, or make extra sure that things are safe or clean or right. Children may have a difficult time explaining a reason for their rituals and say they do them "just because." But in general, by doing a ritual, someone with OCD is trying to feel absolutely certain that something bad won't happen. Think of OCD as an "overactive alarm system." The rise in anxiety or worry is so strong that a child feels like he or she must perform the task or dwell on the thought, over and over again, to the point where it interferes with everyday life. Most kids with OCD realize that they really don't have to repeat the behaviors over and over again, but the anxiety can be so great that they feel that repetition is "required" to neutralize the uncomfortable feeling. And often the behavior does decrease the anxiety but only temporarily. In the long run, the rituals may worsen OCD severity and prompt the obsessions to return.

Causes and Diagnosis

Doctors and scientists don't know exactly what causes OCD, although recent research has led to a better understanding of it and its potential causes. Experts believe OCD is related to levels of a normal "transmitter" chemical in the brain called serotonin. When the proper flow of serotonin is blocked, the brain's "alarm system" overreacts and misinterprets information. Danger messages are mistakenly triggered like "false alarms." Instead of the brain filtering out these unnecessary thoughts, the mind dwells on them and the person experiences unrealistic fear and doubt. Evidence is strong that OCD tends to run in families. Many people with OCD have one or more family members who also have it or other anxiety disorders influenced by the brain's serotonin levels. Because of this, scientists have come to believe that the tendency (or predisposition) for someone to develop the neurotransmitter (serotonin) imbalance that causes OCD can be inherited. Having the genetic tendency for OCD doesn't mean people will develop OCD, but it means there is a stronger chance they might. An imbalance of serotonin levels can also result in other types of anxiety or depression. An estimated 1% (or more) of children in the United States experience OCD, which is characterized by a pattern of rituals and obsessive thinking that generally lasts more than an hour each day, causes distress, or interferes with daily activities. It's more common than many other childhood disorders or illnesses, but kids often keep the symptoms hidden from their families, friends, and teachers because they're embarrassed. OCD in kids is usually diagnosed between the ages of 7 and 12. Since these are the years when kids naturally feel concerned about fitting in with their friends, the discomfort and stress brought on by OCD can make them feel scared, out of control, and alone. It's important to understand that the obsessive-compulsive behavior is not something that a child can stop by trying harder. OCD is a disorder, just like any physical disorder such as diabetes or asthma, and is not something kids can control or have caused themselves. It is also not something that parents have caused, although life events may at times worsen or trigger the onset of OCD in kids who are prone to develop it.

Common OCD Behaviors in Kids


OCD can make daily life difficult for the kids that it affects and their families. The behaviors often take up a great deal of time and energy, making it more difficult to complete tasks, such as homework or chores, or to enjoy life.

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In addition to feeling frustrated or guilty for not being able to control their own thoughts or actions, kids with OCD also may suffer from low self-esteem or from shame or embarrassment about what they're thinking or feeling (since they often realize that their fears are unrealistic, or that their rituals are not realistically going to prevent their feared events). They also may feel pressured because they don't have enough time to do everything. A child might become irritable because he or she feels compelled to stay awake late into the night or miss an activity or outing to complete the compulsive rituals. Kids might have difficulties with attention or concentration because of the intrusive thoughts. Among kids and teens with OCD, the most common obsessions include:

fear of dirt or germs fear of contamination a need for symmetry, order, and precision religious obsessions preoccupation with body wastes lucky and unlucky numbers sexual or aggressive thoughts fear of illness or harm coming to oneself or relatives preoccupation with household items intrusive sounds or words grooming rituals, including hand washing, showering, and teeth brushing repeating rituals, including going in and out of doorways, needing to move through spaces in a special way, or checking rituals to make sure that an appliance is off or a door is locked, and repeatedly checking homework rituals to undo contact with a "contaminated" person or object touching rituals rituals to prevent harming self or others ordering or arranging objects counting rituals hoarding and collecting things cleaning rituals related to the house or other items

These compulsions are the most common among kids and teens:

rereading, erasing, and rewriting

Signs and Symptoms of OCD


Recognizing OCD is often difficult because kids can become adept at hiding the behaviors. It's not uncommon for a child to engage in ritualistic behavior for months, or even years, before parents know about it. Also, a child may not engage in the ritual at school, so parents might think that it's just a phase. When a child with OCD tries to contain these thoughts or behaviors, this creates anxiety. Kids who feel embarrassed or as if they're "going crazy" may try to blend the OCD into the normal daily routine until they can't control it anymore. It's common for kids to ask a parent to join in the ritualistic behavior: First the child has to do something and then the parent has to do something else. If a child says, "I didn't touch something with germs, did I?" the parent might have to respond, "No, you're OK," and the ritual will begin again for a certain number of times. Initially, the parent might not notice what is happening. Tantrums, overt signs of worry, and difficult behaviors are common when parents fail to participate in their child's rituals. It is often this behavior, as much as the OCD itself, which brings families into treatment. Parents can look for the following possible signs of OCD:

raw, chapped hands from constant washing unusually high rate of soap or paper towel usage high, unexplained utility bills a sudden drop in test grades

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unproductive hours spent doing homework holes erased through test papers and homework requests for family members to repeat strange phrases or keep answering the same question a persistent fear of illness a dramatic increase in laundry an exceptionally long amount of time spent getting ready for bed a continual fear that something terrible will happen to someone constant checks of the health of family members reluctance to leave the house at the same time as other family members

Environmental and stress factors can trigger the onset of OCD. These can include ordinary developmental transitions (such as starting school) as well as significant losses or changes (such as the death of a loved one or moving).

Diagnosing OCD
If your child shows signs of OCD, talk to your doctor. In screening for OCD, a doctor or mental health professional will ask about your child about obsessions and compulsions in language that kids will understand, such as:

Do you have worries, thoughts, images, feelings, or ideas that bother you? Do you have to check things over and over again? Do you have to wash your hands a lot, more than most kids? Do you count to a certain number or do things a certain number of times? Do you collect things that others might throw away (like hair or fingernail clippings)? Do things have to be "just so"? Are there things you have to do before you go to bed?

Because it might be normal for a child who doesn't have OCD to answer yes to any of these questions, the doctor also will ask about how often and how severe the behaviors are, about your family's history of OCD, Tourette syndrome, and other motor or vocal tic disorders or other problems that sometimes occur with OCD. Tic disorders often resemble OCD: up to half of people with Tourette syndrome also have OCD (but only a small percentage of kids with OCD also have Tourette syndrome). Other disorders that often occur with OCD include other anxiety disorders, depression, disruptive behavior disorders, attention deficit hyperactivity disorder (ADHD), learning disorders, and trichotillomania (compulsive hair pulling). In rare cases, OCD symptoms or tics that come on very suddenly may be associated with a recent group A streptococcus infection (strep throat or, less commonly, scarlet fever). This phenomenon is known as PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections). No one knows for sure why PANDAS occurs. One theory is that strep infections trigger an antibody response in some kids that causes changes in the basal ganglia, a part of the brain that has been implicated in OCD. Scientists are studying this to better understand the connection between streptococcus infections and OCD. Of course, a child who has had strep throat doesn't automatically develop PANDAS. Almost all school-age kids have strep throat at some point, and the vast majority recover with no complications. Similarly, most kids who have OCD or tics do not have PANDAS. The condition may be considered only if a child's OCD symptoms or tics are directly preceded by, or significantly worsen after, a strep infection.

Treating OCD
The most successful treatments for kids with OCD are behavioral therapy and medication. Behavioral therapy, also known as cognitive-behavioral psychotherapy (CBT), helps kids learn to change thoughts and feelings by first changing behavior. It involves gradually exposing kids to their fears, with the agreement that they will not perform rituals, to help them recognize that their anxiety will eventually decrease and that no disastrous outcome will occur. For example, kids who are afraid of dirt might be exposed to something dirty, starting with something mildly bothersome and ending with something that might be really dirty. For exposure to be successful, it must be combined

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with response prevention, in which the child's rituals or avoidance behaviors are blocked. For example, a child who fears dirt must not only stay in contact with the dirty object, but also must not be allowed to wash repeatedly. Some treatment plans involve having the child "bossing back" the OCD, giving it a nasty nickname, and visualizing it as something he or she can control. Over time, the anxiety provoked by dirt and the urge to perform washing rituals gradually disappear. The child also gains confidence that he or she can "fight" OCD. OCD can sometimes worsen if it's not treated in a consistent, logical, and supportive manner. So it's important to find a therapist who has training and experience in treating OCD. Just talking about the rituals and fears have not been shown to help OCD, and may actually make it worse by reinforcing the fears and prompting extra rituals. Family support and cooperation also go a long way toward helping a child cope with OCD. Many kids can do well with behavioral therapy alone while others will need a combination of behavioral therapy and medication. Therapy can help your child and family learn strategies to manage the ebb and flow of OCD symptoms, while medication, such as selective serotonin reuptake inhibitors (SSRIs), often can reduce the impulse to perform rituals.

Helping Kids With OCD


It's important to understand that OCD is never a child's fault. Once a child is in treatment, it's important for parents to participate, to learn more about OCD, and to modify expectations and be supportive. Kids with OCD get better at different rates, so try to avoid any day-to-day comparisons and recognize and praise any small improvements. Keep in mind that it's the OCD that is causing the problem, not the child. The more that personal criticism can be avoided, the better. It can be helpful to keep family routines as normal as possible, and for all family members to learn strategies to help the child with OCD. It's also important to not let OCD be the "boss" of the house and regular family activities. Giving in to OCD worries does not make them go away.
Reviewed by: David V. Sheslow, PhD Date reviewed: November 2011 http://kidshealth.org/parent/emotions/behavior/OCD.html#

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