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Infancy
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
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)
Autism
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
PICA
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
Preschool
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)
Stuttering
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
Encopresis
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
Enuresis
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
Inattention
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
DSM IV
See Adult Psychiatric Disorders
Depression
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