Click here to view next page of this article


Child and Adolescent Development


Emotional Milestone: Attachment

Cognitive Development: Sensorimotor (Piaget)

Motor Development: Sits(6 mos), Walks(13 rnonths), Stacking (2 3)

(Denver Developmental)

Language Development: MaMa, DaDa (12 mos), 2-Word Sentences (22 mos), (Denver Developmental)

Play Development: Social Smile (6wks), Peekaboo (7mos),

Imitates(16 mos)

Freud: Oral Stage

Erikson: Trust vs Mistrust

DSM IV Diagnoses

Reactive Attachment Disorder: Inhibited or Disinhibited  

Before age 5

Result of Pathogenic Care: Abuse or Neglect 

Markedly Disturbed Social Relatedness 

Not as a Result of MR or PDD

Pervasive Developmental Disorders (PDD)


Impaired Social Interaction

Impaired Communication (Includes Abnormal Play)

Restricted, Repetitive Interests, and Behaviors.

Onset by 3 years

Prevalence 2-5/10,000

4-5 Males: 1 Female

Rett's Disorder

Normal First 5 mos

Normal Head Circumference at Birth

Losses After 5 mos.

Head Growth, Hand Skills, Social Skills, Gait and Trunk

Coordination, Impaired Language and Motor Retardation.

Childhood Disintegrative Disorder

Losses Occur after age 2 and Before age 10

Asperger's Disorder

Impairment in Social Interaction

Stereotyped. Restricted Behavior

Impairment in Social Function

Language and Cognitive Development Normal

Feeding and Eating Disorder of Infancy


Persistent Eating of Nonfood Substances for More Than I Month 

Requires Intervention For Safety (eg Lead Paint Chips) 

Assoc. with MR, Poverty, Vitamin Deficiency

Rumination Disorder

Repetitive Regurgitation, Rechewing, Reswallowing for More Than I Month, After Normal Eating Achieved

Not Secondary to GI Problem

May be Associated with Neglect, Developmental Delay, Significant Weight Loss 

Usual Onset at 3-12 months

Malnutrition May Lead to Death (25% Mortality)

Feeding Disorder of Infancy or Early Childhood

Inadequate Eating for More Than 1 Month With Significant Weight Loss

Before Age 6 and Not Secondary to GI Problem


Emotional Milestone: Magical Thinking, Body Wholeness 

Cognitive Development: Preoperational, Associative Logic 

Moral Development: Preconventional

Gross Motor Development: Balance on I Foot/Hop

Fine Motor Development: Draw a Circle (3yo), a Square (4yo) Language Development: Plurals (3yo), 3 of 4 Colors (4yo) Play Development: Fantasy Play, Parallel Play, Interactive Games (4 -5yo) (eg Tag, Circle Games) 

Freud: Anal Stage (2-3yo), Oedipal (4-6yo) 

Erikson: Autonomy vs Shame/Doubt (2-3yo), Initiative vs Guilt (4-6yo)

DSM IV Diagnoses

Communication Disorders

Expressive Language Disorder

Standardized Testing Significantly Below Scores for Nonverbal

IQ, and Receptive Language Development.

Immature Language, Limited Vocabulary, Errors in Tense Functionally Limiting

Not MR, or Mixed Receptive-Expressive 

Usually Diagnosed Before Age 3 

Familial Association

Mixed Expressive-Receptive Language Disorder 

Measured With Standardized Testing

Expressive Language Disorder plus Comprehension Deficit 

Less Common than Expressive Disorder 

Prevalence 3% of School Age Children 

Usually Diagnosed by Age 4 

Familial Association

Phonological Disorder

Errors in Production of Speech Sounds

Functionally Limiting

Not Explained by MR, or Environmental Deprivation

Prevalence of 2-3% of Preschoolers (0.5% of 17 yo) 


Disturbance in Fluency

Functionally Limiting

Onset 2-7yo With Peak Onset of 5yo.

3 Males: 1 Female

Prevalence of 1% Prepubertal 

80% Remits by Adolescence 

Familial Association 

Other Disorders Including Anxiety 

Selective Mutism

Will Not Speak in Specific Social Settings 

Speaks in Other Settings 

Functionally Limiting

Durations of More Than 1 Month

Usually Communicate Nonverbally

Associated With Anxiety and Shyness

Less than 1% of Children in Mental Health Clinic 

Onset Usually Before Age 5

Duration of Months Usually, But Continue For Years 

Separation Anxiety Disorder

Early Onset Subtype with Onset Before 6 yo 

Developmentally Excess Fear of Separation >From Home and Family or Attachment Figures

Duration of More Than I Month 

Onset Before Age 18 

Functionally Limiting

Prevalence of 4% of Children and Adolescents

Familial Association

May Follow Life Stressor

Elimination Disorders


Passing of Feces in Inappropriate Places For Age 

At Least One Time Per Month for 3 Months 

Chronological and Developmental Age of 4 or Older 

Primary Type: Never Toilet Trained

Secondary Type: Toilet Trained and Then Regressed 

Prevalence of 1% of 5 yo

More Common in Males Than Females


Repeated Voiding of Urine Into Bed or Clothing

At Least Twice a Week For Three Months or Causing Significant Distress or Social Impairment

Chronological and Developmental Age of at Least 5 yo May Be Nocturnal, Diurnal or Both 

Primary and Secondary Types

Prevalence at Age 5: Males 7%, Females 3%; at Age 10: Males 3%, Females 2%; at Age 18: Males 1%, Females Less than 1% 

Strong Familial Association for Primary Type

Attention Deficit Hyperactivity Disorder


Hyperactivity/ Impulsivity

Impairment Before Age 7

Present in More Than One Setting 

Functional Impairment 

Predominantly Inattention Type 

Predominantly Hyperactive-Impulsive Type 

Combined Type

Prevalence 3-5% in School Age Children 4-9 Males: 1 Female 

Familial Association

School Age/Latency 6-12 yo

Emotional Milestones: Chumships, Agency, Self Esteem 

Cognitive Development: Causal Logic, Concrete Operations 

Gross Motor Development: Swimming, Riding a Bike

Fine Motor: Writing, Tying Shoes, Stringing Small Beads 

Moral Development: Conventional

Language Development: Mature, Read, Write, Express Feeling 

Play Development: Board Games, Sports, Word Games

Freud: Latency

Erikson: Industry vs Inferiority

DSM IV Diagnoses

Learning Disorders: Common Features

Measured by Standardized Tests

Well Below What is Expected For Age, IQ, and Education

Functional Impairment

Not Explained by a Sensory Deficit

Reading Disorder

More Males than Females

Prevalence of 4% of School Age Children

Diagnosed After First Grade

Familial Association

Mathematics Disorder

Prevalence of Approximately 1%

Usually Diagnosed After First Grade

Disorder of Written Expression

Usually Diagnosed After the First Grade

Motor Skills Disorder

Developmental Coordination Disorder

Performance of Daily Activities is Below Expected Due to Coordination Difficulties Not Attributable to a Medical Condition (eg Cerebral Palsy, Hemiplegia)

Functional Impairment

Prevalence 6% of School Age Children (5-11 yo)

Variable Course of Resolution or Continued Clumsiness 

Conduct Disorder

Pattern of Behavior in which Rights of Others and Rules are Disregarded For Over a Year's Time

Aggression Toward People and Animals 

Destruction of Property 

Lying and Stealing

Serious Violation of School and Family Rules

Functional Impairment

Childhood Onset: Some Symptoms by Age 10 

Adolescent Onset Type: No Symptom by Age 10 Severity: Mild, Moderate, Severe

Prevalence in Males greater than Females

Genetic and Environmental Contributants

Early Onset Suggests Worse Prognosis

Oppositional Defiant Disorder

Pattern of Negative, Hostile and Defiant Behavior Directed at Authority Figures (eg Parents and Teachers)

At Least 6 Months Durations

Functional Impairment

Not in Context of Mood or Psychotic Disorder

Does Not Meet Criteria for Conduct Disorder 

Prevalence of 2-16% 

Onset Usually by Age 8

Associated With Parental History of Psychiatric Disorder and Marital Discord

Tic Disorders

Tourette's Disorder

Multiple Motor Tics and at Least One Vocal Tic at Some Time 

Tics Occur Many Times Usually Daily For More Than One Year 

No Three-Month Period of Being Tic Free 

Functional Impairment 

Onset Before 18 yo

Not Due to Medical Illness or Substance 

Onset as Young as 2 yo Median Age of Onset 7 yo

Often Diminishes in Intensity in Adolescence Prevalence 4-5/10,000 

1.5-3 Males: 1 Female

Chronic Motor or Vocal Tic

Similar to Tourette's Except Either Motor or Vocal Tic Not Both 

Transient Tic Disorder

Single or Multiple Tics

Tics Occur Many Times Daily, Most Days For More Than 4 Weeks 

Less Than 12 Months Duration

Adolescence (12-19 yo)

Emotional Milestones: Identity Formation, Separation/Differentiation from Parents, Body Image Focus

Cognitive Development: Abstract Thinking, Formal Operations

Motor Development: Increased Strength, Drive a Car

Moral Development: Post Conventional

Language Development: Mature, Jargon of Peer Group, Philosophy/ Existential

Freud: Moving Toward Genital Maturity

Erikson: Identity vs Identity Confusion


See Adult Psychiatric Disorders


Bipolar Disorder

Psychotic Illness

Anxiety Disorders

Substance Abuse

Anorexia Nervosa

Review of Child Psychotherapies

Play Therapy treats a symptomatic young child utilizing fantasy play to work through anxieties, or traumas in displacement (play).

Family Therapy treats a symptomatic child who is acting out the tensions in the family by addressing the family problems, or secrets.

Parent Guidance Therapy offers support and new strategies to parents, so they can better parent their symptomatic children.

Children's Therapy Groups offer children of a particular age, symptom profile or set of experiences (eg, cancer, substance abuse) a setting to work through the experience with a peer group.

Pediatric Psychopharmacotherapy is the use of psychotropic medications to diminish the symptoms of a psychiatric disorder.

Psychiatric Hospitalization, Day Treatment, Acute Residential Treatment, and Residential Treatment provide different levels of supervision and care of varying duration for children who cannot be managed in outpatient treatment and/ or at home.

Special Classrooms, and Specialized Schools meet the needs of children who because of behavior and/ or learning disorders cannot learn in a mainstream classroom

Filing a Report with the Department of Social Services with Suspicion about a Child Who Is at Risk of Abuse or Neglect is a mandate to all physicians who must report suspicion, without needing unequivocal evidence, of potential abuse or neglect to a 

Care and Protection is court ordered change of custody for a child who is at immediate risk (eg, a child who needs emergency surgery to save her life, refused by the guardian, making the hospital the