Common Childhood and

adolescent Psychiatric disorders

Ruth owusu-Antwi
Psychiatrist
KATH
 Why discuss child & adolescent psychiatric disorders?

• High prevalence of mental health problems among adolescents

and young adults; estimated at 20%.

• Half of all lifetime cases of mental illness are now recognized to

begin by age 14.

• The median number of years from the time a child first

experiences psychiatric disturbance and receives treatment is 9
years.

• Suicide, the most feared and tragic outcome of psychiatric

disorders, is the third most common cause of death among
adolescents preceded only by accidents and homicide.
FOCUS OF TODAY’S LECTURE:
• To Identify and manage the following common
childhood and adolescent psychiatric disorders:
1. DEVELOPMENTAL DISORDERS
2. ASS
3. ADHD
4. CONDUCT DISORDERS
5. DEPRESSION IN CHILDREN AND ADOLESCENTS
6. SLEEP DISORDERS
7. ENURESIS
8. ENCOPRESIS
3. Attention deficit hyperactivity disorder (ADHD)
• ADHD is characterized by the three core symptoms:
• inattention,
• hyperactivity and
• impulsiveness.

There are 3 subtypes:

• a combined subtype where all 3 features are
present,
• an inattentive subtype (ADD) and
• a hyperactive-impulsive subtype.
 ADHD
• Symptoms must be present for a minimum
of 6 months to a degree that is maladaptive
and inconsistent with the developmental
level of the child
• Clear evidence of clinically significant
impairment present in two or more settings
• Onset of impairment must be before age 7,
even if it was not diagnosed until later.
• It is at least 4 times commoner in males.
 ADHD

six (or more) of the following symptoms of inattention have

persisted for at least 6 months.

Inattention Symptoms (6 of 9):

Careless mistakes
Attention difficulty
Listening problem
Loses things
Fails to finish things
Organizational skills lacking
Reluctance in tasks requiring sustained mental effort
Forgetful in Routine activities
Easily Distracted
 ADHD
• Hyperactive-Impulsive Symptoms (6 of 9):
Runs about, climbs excessively or is restless
Unable to wait his/her turn
Not able to play quietly
On the go
Fidgets with hands or feet
Blurts out answers
Staying seated is difficult
Talks excessively
Tends to interrupt
• Aetiology:
Proposed to be due to inadequate acetylcholine and
dopamine in the frontal lobe
1. 80% of cases are genetically inherited, and risk of
ADHD in siblings 2-3 times increased.
2. low birth-weight babies born to mothers who used
drugs, alcohol or tobacco during pregnancy
3. following head injury
4. some genetic disorders
5. metabolic disorders.

• Differential diagnosis:
attachment disorder; learning difficulty; anxiety
disorder; medication side-effects (e.g. antihistamines).
Management
• Psycho-education
• Medication
• Behavioral interventions, e.g. positive reinforcement of
desired behaviors (small immediate rewards), and
consistent contingency management across home and
school; break down tasks; reduce distraction.
• School intervention
• Treat co morbidity
• Evidence base for dietary changes and fish oils poor at
present.
• Voluntary organizations, e.g. ADDISS – Attention
Deficient Disorder information and support service.
Drug treatment of ADHD
Two main classes of medication; stimulants and non-
stimulants
1. Stimulants
-Methylphenidate A central nervous system stimulant
licensed for treatment of ADHD in children over 6 years.
Side-effects: abdominal pain; nausea and vomiting; dry
mouth; anxiety; insomnia; headaches; anorexia and
reduced weight.

- Dexamfetamine; A central nervous system stimulant

licensed for the treatment of ADHD in children whose
symptoms are refractory to the other drugs. Side-effects
are similar to those of Methylphenidate
2. non-stimulant
-Atomoxetine (Strattera®) A non-stimulant. NA
reuptake inhibitor licensed for the treatment of
ADHD. Taken once daily, providing 24-hour
cover. May take up to 6 weeks to have a full
effect.

Side-effects: anorexia; dry mouth; nausea and

vomiting; headache; fatigue.
•Question?
•THANK U