CHILDHOOD PSYCHIATRIC

DISORDERS

ELISHA C V
Childhood psychiatric disorders encompass
neurodevelopmental, emotional and behavioural disorders
that have broad and serious adverse impacts on
psychological and social well-being.
This presentation has its focus on the following six
psychiatric disorders:
Pervasive developmental disorder, autism spectrum
disorder, attention deficit disorder, speech disorders,
conduct disorders and learning disorders.

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 Pervasive Development Disorder (PDD)

This disorder has variously been described as autistic disorder, pervasive developmental
disorder, childhood autism, childhood psychosis and pseudo- defective psychosis.

PDD is an autism spectrum disorder generally marked by severe deficits in social interaction
and communication as well as limited behaviours and interests.

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 Epidemiology

This disorder is more common (3-4 times) in males and has a prevalence rate of 0.4-0.5 per 1000 population.
Typically, the onset occurs before the age of 2 1⁄2 years though in some cases, the onset may occur later in childhood.

Causes
Exact causes are unknown to the scientific world
Some supposed risk factors include:
• Genetic mutations
• Being born to older parents
• Metabolic imbalances
• Low birth weight

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 Clinical Manifestations

Children with PDD have problems with social communication and interactions, and they often repeat
certain behaviours. They may also:
• Avoid eye contact
• Not able to express what they are thinking through language
• Usually have a high-pitched or flat voice
• Find it hard to keep up conversation
• Have trouble in controlling emotions
• Perform repetitive behaviours
• Obsession with strict and routine schedules

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 Course

• Manifestation of the disorder in infancy are more subtle and difficult to define than those seen
in after age 2-3 years
• Occasionally PDD is diagnosed in one’s teen years and in adulthood as well
• It follows a continuous course
• The communicative and behavioural difficulties usually remain relatively constant throughout
life

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 Treatment & Different Treatment Modalities

1. Behaviour Therapy:- Development of a regular routine, Structured class room training,

Positive reinforcements to teach self-care skills
2. Psychotherapy:- Parental counselling and supportive psychotherapy can be very useful in
allaying parental anxiety and guilt
3. Pharmacotherapy:- No direct medications for PDD. However, other conditions such as anxiety,
depression and seizures may occur along with PDD. So anti-convulsants, anti –hypertensives, etc.
4. Dietary changes:- This can include things like gluten or casein-free diets or using vitamins or
probiotic supplements
5. Applied Behavioural Analysis (ABA):- It is concerned with reinforcing positive behaviours
while discouraging negative behaviours.
6. Occupational/Physical Therapy:- These can help with co-ordination issues and also with
learning day-to-day tasks such as getting dressed and bathing etc.

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 Outcome

• There is no known cure for PDD; yet still therapies, medications and dietary changes are
effective to certain extent minimising the symptoms and maximising the social functioning of
the children with PDD.
• They benefit from specialised classrooms and standard special education classes or even
regular classes with additional support where they receive one-to-one basis instruction and
assistance.

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 Autism Spectrum Disorder (ASD)

Autism spectrum disorder (ASD) refers to a

range of conditions characterised by some
degree of impaired social behaviour,
communication and language, and a narrow
range of interests and activities that are both
unique to the individual and carried out
repetitively.

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 Epidemiology
❑ It is estimated that worldwide one in 160 children has an ASD

❑ The prevalence of ASD in many low- and middle-income countries is so far unknown.

❑ Epidemiological studies conducted over the past 50 years, the prevalence

of ASD appears to be increasing globally

Causes

Genetic & Environment Factors

❑ advanced parental age at the time of conception

❑ prenatal exposure to air pollution or certain pesticides
❑ maternal obesity, diabetes, or immune system disorders
❑ extreme prematurity/very low birth weight
❑ any birth difficulty leading to periods of oxygen deprivation to the baby’s brain (asphyxiation)

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 Clinical Manifestations

• Delayed milestones
• Delayed movement skills
• Delayed cognitive or learning skills
• Epilepsy or seizures
• Depression
• Hysterics (Impulsive emotional reactions)
• Gastrointestinal issues (eg: constipation)
• Difficulties in normal back and forth conversation
• Reduced sharing of interests and emotions
• Challenges in grasping and responding to social cues
• Restricted and repetitive patterns of behaviours, interests or activities

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 Course

• Outward manifestation of the disorder in infancy are minimal and subtle

• ASD follows a continuous course
• The communicative and behavioural difficulties usually remain relatively constant throughout
life
• Modest developmental gains due to various types of treatment interventions

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 Treatment & Different Treatment Modalities

1. Occupational/Physical Therapy:- This type of therapy helps with activities of daily living
and the use of everyday objects. The focus depends on the child’s needs and goals.
2. Speech Therapy:- This helps children with speaking, as well as communicating and
interacting with others. It can involve non-verbal skills, like making eye contact, taking turns
in a conversation, and using and understanding gestures.
3. Applied Behavioural Analysis (ABA):- It is concerned with reinforcing positive
behaviours while discouraging negative behaviours.
(A) Discrete trial training (DTT) - This breaks desired behaviour into the simplest steps
(B) Early Intensive Behavioural Intervention (EIBI) - This form of ABA is designed
for young children, usually under age five.

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 Treatment & Different Treatment Modalities

4. Social Skills Class:- It is group or one-on-one instruction at home, in school, or in the

community. It aims to improve how a child interacts socially and forms bond with others. It is
usually learning through role playing or practice.
5. Pharmacological Treatment:- There is no direct medication that can cure ASD. But some
can help treat certain symptoms especially certain behaviours.
• Stimulants - increase focus and decrease hyperactivity
• Anti-anxiety medications - relieve anxiety and panic disorders
• Anti-convulsants - treat seizures
• Psychoactive/anti-psychotic medications - decrease hyperactivity, reduce stereotyped
behaviours and minimise withdrawal and aggression
6. Nutritional Therapy:- Design a nutritional meal plan

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 Outcome

• There is no known cure for ASD.

• Children with ASD benefit from the combination of varies therapies,
A. They become more independent
B. Acquisition of basic knowledge and tactics of everyday living
C. Relief from pressures, irritability and restlessness to a certain degree

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 Attention Deficit Disorder (ADD)

• Attention deficit disorder or inattentive ADHD is a subtype of Attention deficit hyperactivity

disorder (ADHD).
• ADHD is the official, medical term for the condition regardless of whether patient
demonstrates symptoms of hyperactivity.
• ADD is now an outdated term that is typically used to describe inattentive type - ADHD

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 Four clinical types of ADD

1. Attention deficit disorder with hyperactivity (Hyperkinetic disorder): This is the commonest type with the
features like poor attention span with distractibility, hyperactivity and impulsivity.
2. Attention deficit disorder without hyperactivity: It is a rare disorder with similar clinical features, except
hyperactivity.
3. Residual type: It is usually diagnosed in a patient in adulthood, with a past history of ADD and presence of a
few residual features in adult life.
4. Hyperkinetic disorder with conduct disorder (Hyperkinetic conduct disorder).

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 Epidemiology
❑ A 2015 meta-analysis of 175 studies found that an estimated 7.2 % of children aged 18 and under have
ADHD- 129 million worldwide.
❑ National Center for Biotechnology Information, U. S. (NCBI) studies state that globally ADHD prevalence
rates range from 2 % to 7 %.
❑ On average, 5 % of children around the world are inattentive, impulsive and hyperactive, which meets the
diagnostic criteria for ADHD.

Causes
• Genetics- ADD/ADHD can run in families
• Having significant traumatic experience as a child
• Premature birth
• Brain injury
• Exposure to environmental toxins
• Extreme stress
• Drinking and smoking during the pregnancy

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 Clinical Manifestations

• Often fails to give close attention to details or makes careless mistakes in schoolwork, at work, etc.
• Has trouble holding attention on tasks or activities
• Does not seem to listen when spoken to directly
• Does not follow through on instructions and fails to finish schoolwork, chores or other duties
• Lose things necessary for tasks and activities
• Often forgetful in daily activities
• Often distracted by stimuli
* The clinical picture varies with the developmental stage.
Pre-school - Excessive physical activity, non-compliance, etc.
School age - Inattention, impulsivity and oppositional behaviour (apart from basic symptoms)
Adolescence - Conflict with parents tend to rise and high risk behaviours as well

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 Course

• Generally, ADD symptoms start before age 12, and in some children they are noticeable as
early as 3 years of age
• Symptoms can be mild, moderate or severe and they may continue into adulthood
• It was considered as a typical childhood disorder, but studies reveal that an important
percentage of children grew as adults with ADD.

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 Treatment & Different Treatment Modalities

1. Pharmacotherapy:- Not all children with ADD need medicines, but for many they are
necessary. Medicines can reduce hyperactivity and impulsivity. The most common medicine
used to treat ADD are,
• Stimulants - such as methylphenidate (Ritalin)
• Anti-depressants
2. Psychotherapy:- Experts, parents and teachers help the child to gain control over their
behaviour by establishing clear rules, list of chores and other structured routines.

3. Education and Training:- Experts, teachers and parents gives training to children in social
skills, communication, performance of daily activities, etc.

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 Outcome

• Medications can reduce hyper-activity and impulsivity, improve the child’s ability to focus,
work and learn and improve their physical coordination
• Psychotherapy will help children and their parents cope better with everyday tasks and
problems
• The developments of social skills through education and training will help children to be better
socially adjusted.

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 Speech Disorders

Speech disorders affect a person’s ability to form the sounds that allow them to communicate,
articulate or convey something with other people.
They prevent people from forming correct speech sounds and make it difficult for a person to
express his/her thoughts, feelings and ideas to others.
They are not the same as language disorders which affect a person’s ability to learn words or
understand what others say to them.

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 Types of speech disorders

1. Stuttering - it s interruption of the flow of speech. People who stutter experience the following types of disruptions:
repetitions, blocks and prolongations.
2. Apraxia of speech - It refers to the impairment of motor skills due to brain damage that cause inability to form the sounds of
speech correctly.
3. Dysarthria - It occurs when damage to the brain causes muscles weakness in person’s face, lips, tongue, throat or chest.
Muscle weakness in these parts of the body can make speaking very difficult.
4. Orofacial myofunctional disorder - It might interfere with the development of bones and muscles in a person’s face and
mouth.
5. Voice disorders - An abnormal production or absence of vocal quality, pitch volume and resonance inappropriate for the
person’s age and sex.
6. Fluency disorders - interruptions in the flow of a person’s speech, such as uncommon rate, rhythm or repetition of sounds,
syllables, words or phrases.

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 Epidemiology
❑ Certain studies show that the highest prevalence of communication disorders is among children of age 3-6
(11 percent), compared to 9.3 percent of children of age 7-10, and 4.9 percent of children 11-17.

❑ Studies also noted that prevalence to decrease with age.

Causes

• Brain damage
• Muscle weakness
• Damaged vocal cords
• Mouth/throat cancer
• Autism
• Hearing loss

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 Clinical Manifestations

The symptoms of speech disorders vary widely depending on the cause and severity of the disorder.
The general symptoms are:
• Repeating or prolonging sounds
• Distorting sounds
• Adding sounds or syllables to words
• Rearranging syllables
• Having difficulty pronouncing words correctly
• Struggling to say the correct word or sound
• Speaking with a hoarse or raspy voice
• Speaking very softly

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 Course

• May children with early speech impairments do eventually outgrow them by the time they
are ready for kindergarten. Some speech disorders may simply go away.
• Some speech disorders can improve over time with the aid and assistance of various speech
therapies.
• Some of the speech disorders are permanent if they are caused by brain damage or autism.

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 Treatment & Different Treatment Modalities

Treatment will typically depend on the severity of the speech disorder and its underlying cause.
Treatments include:
• Speech therapy exercises - focus on building familiarity with certain words or sounds
• Physical exercises - focus on strengthening muscles that produce speech sounds
• Contrast therapy - involves saying word pairs that contain one or more different speech
sounds. Eg: ‘beat’ and ‘feet’ or ‘dough’ and ‘show’
• Oral motor therapy - focus on improving muscle strength, motor control and breath control
• Ear device - small electronic aids that fit inside the ear canal; these can help improve fluency in
people who have a stutter
• Medication - stressful situation can cause anxiety, resulting in more pronounced disorder
symptoms; anxiety medications may help reduce symptoms of speech disorders in some people

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 Outcome

General outcomes of treatment interventions are:

• Intelligible speech, so child is understood by others
• Improvement in the ability to understand and express thoughts, ideas and feelings
• Improved vocal quality
• Fluent speech
• Greater self-esteem
• Increased independence

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 Conduct Disorder
It is a group of behavioural and emotional problems that usually begins during childhood or adolescence. Children with
the disorder have a difficult time in following rule and behaving in a socially acceptable way.

Conduct disorder is characterised by a persistent and significant pattern of conduct, in which the basic rights of others are
violated or rules of society are not followed.

The children with conduct disorder may appear tough and confident. In reality, however, they are often insecure and
inaccurately believe that people are being aggressive and threatening toward them.

According to ICD-10, there are four subtypes of conduct disorder: Confined to the family context, unsocialised,
socialised and oppositional defiant disorder

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 Epidemiology
❑ According to the study of National Centre of Biotechnology Information (NCBI) in 2018, the prevalence
of conduct disorder is 2-5 % in children between 5-12 years and 5-9 % in adolescents between 13-18 years.

❑ Most studies show that boys are more likely to present with symptoms of conduct disorder than girls.

Causes
• Genetic Causes - damage to the frontal lobe of the brain has been linked to conduct disorder. It is the part of
your brain that regulates important cognitive skills such as problem-solving, memory and emotional
expression.
• Environmental Factors - Child abuse, a dysfunctional family, parents who use drugs and alcohol, poverty and
traumatic life experiences, etc.

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 Clinical Manifestations

• Aggressive conduct - intimidating/bullying others, physical harms, using weapon, committing rape,
etc.
• Deceitful conduct - lying, stealing, forgery and breaking and entering
• Destructive behaviour - include arson and other intentional destruction of property
• Violation of rules - skipping school, running away from home, drug and alcohol use and sexual
deviant behaviours at a very young age.

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 Course

Currently, two possible developmental courses are thought to lead to conduct disorder.

A. The first is known as the "childhood-onset type" and occurs when conduct disorder symptoms are present before the
age of 10 years. This course is often linked to a more persistent life course and more pervasive behaviours. 

B. The second developmental course is known as the "adolescent-onset type" and occurs when conduct disorder
symptoms are present after the age of 10 years. Individuals with adolescent-onset conduct disorder exhibit less
impairment than those with the childhood-onset type and are not characterised by similar psychopathology. At times,
these individuals will remit in their deviant patterns before adulthood.

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 Treatment & Different Treatment Modalities

• Cognitive behavioural therapy - restructuring thought patterns and behaviours with

the assistance of an expert
• Family therapy - helping to make changes in the family/family situations
• Psychotherapy - based on behavioural modification and problem - solving skills
• Parent-management training
• Medication - Not to treat conduct disorders directly, but used if there are other
symptoms or disorders such as ADHD, etc.

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 Outcome

• Through various therapies and assistance from the experts and family members child learns
how to better solve problems, communicate and handle stress.
• He or she learns how to control impulses and anger.
• Child develops communication skills and family interaction and also develops better social
and interpersonal skills.

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 Learning Disorders

Learning disorders or learning disabilities are an umbrella term for a wide variety of learning problems.
A learning disorder is an information-processing problem that prevents a person from learning a skill
and using it effectively. Learning disorders generally affect people of average or above average
intelligence. As a result, the disorder appears as a gap between expected skills, based on age and
intelligence, and academic performance.

Common learning disorders affect a child's abilities in reading, written expression, math or nonverbal
skills.

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 Types of Learning Disorders

A. Dyslexia - A specific learning disability that affects reading and related language-based processing skills.
B. Dysgraphia - A specific learning disability that affects a person’s handwriting ability and fine motor skills; have trouble
converting their thoughts into writing.
C. Dyscalculia - A specific learning disability that affects a person’s ability to understand numbers and learn math facts.
D. Dyspraxia - A disorder which causes problems with movement and coordination, language and speech; affects an individual’s
ability to plan and process motor tasks.
E. Auditory processing disorder - Difficulty in processing sounds; children with this disorder may confuse the order of sounds
and will be unable to filter different sounds, like a teacher’s voice from background noise.
F. Language processing disorder - Specific challenges in processing spoken language, impacting both receptive and expressive
language.
G. Non-verbal learning disabilities - difficulties in decoding non-verbal or social cues.

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 Epidemiology
❑ Studies conducted to determine the prevalence of learning disorders (disabilities) have reported
prevalence rate ranging from 3-10 per cent among students in India.

❑ In a particular study conducted in Chandigarh, 1.58 % of 12-18 year old school students had
specific learning disability.

Causes
• Hereditary/Genetic link
• Illness during or after birth - physical trauma, premature or prolonged labor, low birth weight
etc.
• Stress during pregnancy
• Increased exposure to environmental toxins

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 Clinical Manifestations

• Delayed speech
• Pronunciation problems
• Difficulty in learning new words
• Difficulty in learning to read
• Trouble learning numbers, the alphabet, days of the week, colours or shapes etc.
• Poor concentration
• Difficulty in following directions

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 Course

• The diagnosis of specific learning disorders generally occur in elementary school as children are
required to begin learning reading, writing and math skills.

• As they progress into middle school, problem with reading or math comprehension may significantly
appear.

• Adolescents may continue to show these problems around comprehension, spelling and grammar rules
and be unable to master math facts.

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 Treatment & Different Treatment Modalities

Learning disorders have no cure as such, but early intervention can lessen their effects. People with learning
disorders, generally, develop coping mechanisms over a period of time.
Interventions vary depending on the nature and extent of the disorder.
• Special education services - Public schools provide free special education supports to children with learning
disabilities as well.
• Extra help - A reading specialist, math tutor or other trained professional can teach the child to improve his/her
academic, organisational and study skills.
• Accommodations - Classroom accommodations might include more time to complete assignments, tests or
such academic activities; providing audiobooks to supplement reading etc.
• Therapy - Occupational therapy might improve the motor skills of child who has writing problems. A speech -
language therapist can help addressing language skills of the child.

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 Treatment & Different Treatment Modalities

• Medication - Medication to manage depression or severe anxiety; medications for ADHD may
improve a child’s ability to concentrate in school.
• Complementary and alternative medicine - Further research is needed to determine the
effectiveness of alternative treatments, yet they are recommended, such as dietary changes, use of
vitamins, eye exercises etc.

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 Outcome

Children with learning disorders and disabilities experience almost everyday situations such as
shame, anxiety, frustration, social isolation, melancholy and lack of self-confidence.
Providing them aid and assistance to overcome their disabilities or improve conditions will make
significant changes in their lives.
• Progressive/gradual learning takes place
• Enhancement of self - esteem and self-confidence
• Motivation and enthusiasm to learn
• Medication provide better focus and concentration

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 References

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Thank you!