CHDS 68067 78067 Counseling Children Childhood Assessment Dx

1
CHDS 68067 / 78067Counseling ChildrenChildhood
AssessmentDx Tx Planning

• Dr. Jason M. McGlothlin
• Kent State University

2
Diagnostic Statistical Manual of Mental
Disorders (4th Edition) Text Revised DSM-IV-TR

• Disorders Usually First Diagnosed in Infancy,
  Childhood, or Adolescence
• Separate section in the DSM only for ease
• No clear distinction between childhood adult
  disorders
• Even though disorders present in youth,
  frequently they are not DX until adulthood
• The disorders covered in this lecture are not the
  only DX during childhood (see other sections of
  DSM)

3
Diagnostic Statistical Manual of Mental
Disorders (4th Edition) Text Revised
DSM-IV-TRGeneral Topics

• Mental Retardation
• Characterized by significantly subaverage
  intellectual functioning (IQ less than 70)
• Onset before age 18 years
• Concurrent deficits or impairments in adaptive
  functioning
• Learning Disorders
• Characterized by academic functioning
  substantially below what is expected given
  persons chronological age, measured
  intelligence, age appropriate education

4
Diagnostic Statistical Manual of Mental
Disorders (4th Edition) Text Revised
DSM-IV-TRGeneral Topics

• Motor Skills Disorders
• Motor coordination that is substantially below
  that expected of chronological age measured
  intelligence
• Communication Disorders
• Characterized by difficulties in speech or
  language
• Pervasive Developmental Disorders
• Characterized by severe deficits pervasive
  impairment in multiple areas of development
  These include
• Impairment in social interaction,
• Impairment in communication,
• The presence of stereotyped behavior, interests,
  activities

5
Diagnostic Statistical Manual of Mental
Disorders (4th Edition) Text Revised
DSM-IV-TRGeneral Topics

• Attention-Deficit Disruptive Behavior
  Disorders
• Characterized by prominent symptoms of
  inattention / or hyperactivity-impulsivity
• Also may be characterized by behavior that
  violates the basic rights of others or
  norms/rules
• Also may be characterized by a pattern of
  negativistic hostile defiant behavior
• Other Disorders in Infancy, Childhood, or
  Adolescence
• Not covered in the previous sections

6
Diagnostic Statistical Manual of Mental
Disorders (4th Edition) Text Revised
DSM-IV-TRGeneral Topics

• Mood Anxiety Disorders
• Separation Anxiety Disorder
• Depression
• Dysthymic Disorder

7
Diagnostic Statistical Manual of Mental
Disorders (4th Edition) Text Revised
DSM-IV-TRMental RetardationIssues with Mental
Retardation

• Measured IQ is needed but a lot can be done with
  the adaptive functioning or ADL
• No specific behavioral features some
  passive/placid others may be aggressive/impulsive
• Vulnerable to exploitation by others
• Approx. 1 of population has a form of M.R.
• Familial pattern not needed for DX
• Onset before age 18

8
Diagnostic Statistical Manual of Mental
Disorders (4th Edition) Text Revised
DSM-IV-TRMental RetardationIssues with Mental
Retardation

• Predisposing Factors include
• Heredity typically inborn errors of metabolism,
  autosomal recessive mechanisms (Tay Sachs
  disease, Down syndrome, etc.)
• Early alterations of embryonic development Down
  Syndrome, maternal alcohol consumption,
  infections, etc.)
• Environmental Influences deprivation of
  nurturance and social, linguistic stimulation
• Mental Disorders autistic disorders, etc.
• Pregnancy Prenatal Problems fetal
  malnutrition, hypoxia, infections, trauma, etc.
• General Medical Conditions poisoning (lead),
  traumas, etc.

9
Diagnostic Statistical Manual of Mental
Disorders (4th Edition) Text Revised
DSM-IV-TRMental RetardationMild Mental
Retardation

• IQ level 50 - 55 to approximately 70
• These children are educable
• Makes up about 85 of M.R. DX
• Typically develop social communication skills
  during the preschool years
• Have minimal impairment in sensorimotor areas
• Often are not distinguishable from children
  without M.R. until later age
• During late teens, academic skills sixth grade
• During adult years, achieve minimal social /
  vocational skills but need supervision guidance
• Work well in supervised community

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Diagnostic Statistical Manual of Mental
Disorders (4th Edition) Text Revised
DSM-IV-TRMental RetardationModerate Mental
Retardation

• IQ level 35 - 40 to 50 55
• Constitutes about 10 of entire M.R. population
• Acquire communication skills during early
  childhood years
• Profit from vocational training moderate
  supervision
• They can attend to their personal care
• Skills rarely go beyond 2nd grade level
• During adolescence, trouble with awareness of
  social norms
• Adult years, may be able to do unskilled or
  semiskilled labor.

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Diagnostic Statistical Manual of Mental
Disorders (4th Edition) Text Revised
DSM-IV-TRMental RetardationSevere Mental
Retardation

• IQ level 20 - 25 to 35 40
• Constitutes 3 - 4 of M.R. population
• Early childhood acquire little or no
  communicative speech
• School-age period may learn to talk learn
  self-care skills
• Gain little from academic subjects
• Can learn by sight survival signs
• Adult years, may perform simple tasks with close
  supervision
• Can adapt well to highly supervised community /
  residential settings

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Diagnostic Statistical Manual of Mental
Disorders (4th Edition) Text Revised
DSM-IV-TRMental RetardationProfound Mental
Retardation

• IQ level below 20 or 25
• Constitutes approx. 1 - 2 of M.R. population
• Have an identified neurological condition that
  accounts for their M.R.
• Considerable impairments in sensorimotor
  functioning in early childhood
• Learning may occur but only in high structured
  settings
• Need constant supervision
• Need continual training in self-care skills
• Some perform simple tasks with supervision

13
Diagnostic Statistical Manual of Mental
Disorders (4th Edition) Text Revised
DSM-IV-TRMental RetardationMental Retardation,
Severity Unspecified

• When there is strong presumption of Mental
  Retardation but the persons intelligence is
  untestable by standard tests

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Diagnostic Statistical Manual of Mental
Disorders (4th Edition) Text Revised
DSM-IV-TRLearning DisordersIssues with Learning
Disorders

• Formally Academic Skills Disorder
• Achievement on individually administered,
  standardized tests in reading, math, or written
  expression is substantially below what is
  expected for age, schooling, IQ.
• Demoralization, low self-esteem, deficits in
  social skills.
• 40 of those with L.D. drop out of school
• May be underlying cognitive processing.
• 5 of those in public schools in US have a form
  of LD

15
Diagnostic Statistical Manual of Mental
Disorders (4th Edition) Text Revised
DSM-IV-TRLearning DisordersReading Disorder

• Reading achievement that falls substantially
  below that expected of age, IQ, education
• Reading accuracy
• Speed
• comprehension
• Interferes with academic achievement or ADLs
• 60 - 80 are males
• But more equally spread between genders when
  specific DX criteria is used
• May occur as early as kindergarten
• More prevalent between first-degree biological
  relatives

16
Diagnostic Statistical Manual of Mental
Disorders (4th Edition) Text Revised
DSM-IV-TRLearning DisordersMathematics Disorder

• Math achievement that falls substantially below
  that expected of age, IQ, education
• Math calculation
• Reasoning
• Interferes with academic achievement or ADLs
• May occur as early as kindergarten
• Approx. 1 of school age children

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Diagnostic Statistical Manual of Mental
Disorders (4th Edition) Text Revised
DSM-IV-TRLearning DisordersDisorder of Written
Expression

• Writing skills that falls substantially below
  that expected of age, IQ, education
• Functional assessment of writing skills
• Interferes with academic achievement or ADLs
• Difficulty in copying ability
• Inability to remember letter sequences in common
  words
• Poor handwriting

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Diagnostic Statistical Manual of Mental
Disorders (4th Edition) Text Revised
DSM-IV-TRMotor Skills DisordersDevelopmental
Coordination Disorder

• Marked impairment of motor coordination
• Significantly interferes with academic
  achievement or ADLs
• Coordination difficulties are not due to a
  general medical condition (i.e., cerebral palsy,
  muscular dystrophy, etc.)
• Younger children may display clumsiness delays
  in achieving developmental motor milestones
  (e.g., walking, crawling, sitting, tying
  shoelaces, buttoning shirt, etc.)

19
Diagnostic Statistical Manual of Mental
Disorders (4th Edition) Text Revised
DSM-IV-TRMotor Skills DisordersDevelopmental
Coordination Disorder

• Older children may display difficulties with the
  motor aspects of assembling puzzles, building
  models, playing ball, printing / handwriting.
• As high as 6 for children between 5 11 years.
• Usually occurs when the child first attempts such
  tasks as running, holding a knife fork,
  buttoning, etc.

20
Diagnostic Statistical Manual of Mental
Disorders (4th Edition) Text Revised
DSM-IV-TRCommunication DisordersExpressive
Language Disorder

• Scores obtained from standardized individually
  administered measures of expressive language
  development are substantially low
• The disturbance may be manifested clinically by
  symptoms such as having markedly limited
  vocabulary, making errors in tense, or having
  difficulty recalling words / producing sentences
  with developmentally appropriate length or
  complexity.
• Difficulties with expressive language interferes
  with academic, occupational, or social
  communication

21
Diagnostic Statistical Manual of Mental
Disorders (4th Edition) Text Revised
DSM-IV-TRCommunication DisordersExpressive
Language Disorder

• Disturbance in fluency language formation
  abnormally rapid rate, erratic rhythm of speech
  or language structure (cluttering)
• School learning problems include writing to
  dictation, copying sentences, spelling
• Must take into consideration culture!
• Children under age 3 10 to 15
• School age children 3 to 7
• Great prognosis!
• More likely to occur in families with
  communication disorders

22
Diagnostic Statistical Manual of Mental
Disorders (4th Edition) Text Revised
DSM-IV-TRCommunication DisordersMixed
Receptive-Expressive Language Disorder

• Impairment in both receptive expressive
  language development
• Interferes with academic, occupational, or social
  functioning
• Marked limited vocabulary, errors in tense,
  difficulty in recalling or producing words,
  difficulty expressing ideas understanding words
• More severe cases problems with understanding
  basic vocabulary, auditory issues (discrimination
  of sounds)
• Take into consideration culture!
• Up to 5 of preschool children 3 of school age
  children

23
Diagnostic Statistical Manual of Mental
Disorders (4th Edition) Text Revised
DSM-IV-TRPervasive Developmental
DisordersAutistic Disorder

• A total of 6 (or more) items from (1), (2),
  (3), with at least two from (1), one from each
  (2) (3)
• 1. Qualitative impairment in social interaction,
  as manifested by at least two of the following
• Marked impairment in the use of multiple
  nonverbal behaviors such as eye-to-eye gaze,
  facial expression, body postures, gestures to
  regulate social interaction
• Failure to develop peer relationships appropriate
  to developmental level
• A lack of spontaneous seeking to share enjoyment,
  interests, or achievements with other people
  (e.g., by a lack of showing, bringing, or
  pointing out objects of interest)
• Lack of social or emotional reciprocity

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Diagnostic Statistical Manual of Mental
Disorders (4th Edition) Text Revised
DSM-IV-TRPervasive Developmental
DisordersAutistic Disorder

• 2. Qualitative impairment in communication as
  manifested by at least one of the following
• Delay in, or total lack of, the development of
  spoken language (not accompanied by an attempt to
  compensate through alternative modes of
  communication such as gesture or mime).
• In individuals with adequate speech, marked
  impairment in the ability to initiate or sustain
  a conversation with others
• Stereotyped repetitive use of language or
  idiosyncratic language
• Lack of varied, spontaneous make-believe play or
  social imitative play appropriate to
  developmental level

25
Diagnostic Statistical Manual of Mental
Disorders (4th Edition) Text Revised
DSM-IV-TRPervasive Developmental
DisordersAutistic Disorder

• 3. Restricted repetitive stereotyped patterns
  of behavior, interests, activities, as
  manifested by at least one of the following
• Encompassing preoccupation with one of more
  stereotyped restricted patterns of interest
  that is abnormal either in intensity or focus
• Apparently inflexible adherence to specific,
  nonfunctional routines or rituals
• Stereotyped repetitive motor mannerisms (e.g.,
  hand or finger flapping or twisting, or complex
  whole body movements)
• Persistent preoccupation with parts of objects

26
Diagnostic Statistical Manual of Mental
Disorders (4th Edition) Text Revised
DSM-IV-TRPervasive Developmental
DisordersAutistic Disorder

• Delays or abnormal functioning in at least one of
  the following areas, which onset prior to age 3
  years
• Social interaction
• Language as used in social communication
• Symbolic or imaginative play
• Typical behaviors also include hyperactivity,
  short attention span, impulsivity,
  aggressiveness, self-injurious behaviors,
  temper tantrums (especially in younger children)
• May have issues with eating, sleeping, mood /
  affect (giggling or weeping for no apparent
  reason, apathy, etc.)
• About 5 cases per 10,000 individuals

27
Diagnostic Statistical Manual of Mental
Disorders (4th Edition) Text Revised
DSM-IV-TRPervasive Developmental
DisordersChildhood Disintegrative Disorder

• Apparently normal development for at least the
  first 2 years after birth as manifested by the
  presence of age-appropriate verbal nonverbal
  communication, social relationships, play,
  adaptive behavior
• Clinically significant loss of PREVIOUSLY
  ACQUIRED skills (before age 10 years) in at least
  2 of the following
• Expressive or receptive language
• Social skills or adaptive behavior
• Bowel or bladder control
• Play
• Motor skills

28
Diagnostic Statistical Manual of Mental
Disorders (4th Edition) Text Revised
DSM-IV-TRPervasive Developmental
DisordersChildhood Disintegrative Disorder

• Abnormalities of functioning in at least two of
  the following areas
• Qualitative impairment in social interaction
  (e.g., impairment in nonverbal behaviors, failure
  to develop peer relationships, lack of social or
  emotional reciprocity)
• Qualitative impairments in communication (e.g.,
  delay or lack of spoken language, inability to
  initiate or sustain a conversation, lack of
  varied make-believe play)
• Restricted, repetitive, stereotyped patterns of
  behavior, interests activities, including motor
  stereotypes mannerisms

29
Diagnostic Statistical Manual of Mental
Disorders (4th Edition) Text Revised
DSM-IV-TRPervasive Developmental
DisordersAspergers Disorder

• A qualitative impairment in social interaction,
  as manifested by at least two of the following
• Marked impairment in the use of multiple
  nonverbal behaviors such as eye-to-eye gaze,
  facial expression, body postures, gestures to
  regulate social interaction
• Failure to develop peer relationships appropriate
  to developmental level
• A lack of spontaneous seeking to share enjoyment,
  interests or achievements with other people
  (e.g., by a lack of showing, bringing, or
  pointing out objects of interest to other people)
• Lack of social or emotional reciprocity

30
Diagnostic Statistical Manual of Mental
Disorders (4th Edition) Text Revised
DSM-IV-TRPervasive Developmental
DisordersAspergers Disorder

• Restricted repetitive stereotyped patterns of
  behavior, interests, activities as manifested
  by at least one of the following
• Encompassing preoccupation with one or more
  stereotyped restricted patterns of interest
  that are abnormal either in intensity or focus
• Apparently inflexible adherence to specific,
  nonfunctional routines or rituals
• Stereotyped repetitive motor mannerisms (e.g.,
  hand or finger flapping or twisting, or complex
  whole-body movements)
• Persistent preoccupation with parts of objects
• The disturbance causes clinically significant
  impairment in social, occupational, or other
  important areas of functioning

31
Diagnostic Statistical Manual of Mental
Disorders (4th Edition) Text Revised
DSM-IV-TRPervasive Developmental
DisordersAspergers Disorder

• There is no clinically significant general delay
  in language (e.g., single words used by age 2
  years, communicative phrases used by age 3 years)
• There is no clinically significant delay in
  cognitive development or in the development of
  age-appropriate self-help skills, adaptive
  behavior (other than social interaction), and
  curiosity about the environment in childhood.
• This is a continuous and lifelong disorder
• Some family data
• In adolescence individuals with this disorder
  use other areas to compensate for their symptoms
• May suffer from depression, isolation, low
  self-esteem, etc.

32
Diagnostic Statistical Manual of Mental
Disorders (4th Edition) Text Revised
DSM-IV-TRAttention-Deficit Disruptive Behavior
DisordersAttention Deficit/Hyperactivity Disorder

• Either (1) or (2)
• Six (or more) of the following symptoms of
  INATTENTION have persisted for at least 6 months
  to a degree that is maladaptive inconsistent
  with developmental level
• Often fails to give close attention to details or
  makes careless mistakes in schoolwork, work, or
  other activities
• Often has difficulty sustaining attention to
  tasks or play activities
• Often does not seem to listen when spoken to
  directly
• Often does not follow through on instructions
  fails to finish school-work, chores, or duties in
  the workplace
• Often has difficulty organizing tasks
  activities
• Often avoids, dislikes, or is reluctant to engage
  in tasks that require sustained mental effort
  (e.g., homework)
• Often loses things necessary for tasks or
  activities (e.g., toys, school assignments, etc.)
• Is often easily distracted by extraneous stimuli
• Is often forgetful in daily activities

33
Diagnostic Statistical Manual of Mental
Disorders (4th Edition) Text Revised
DSM-IV-TRAttention-Deficit Disruptive Behavior
DisordersAttention Deficit/Hyperactivity Disorder

• 2. Six (or more) of the following symptoms of
  HYPERACTIVITY - IMPULSIVITY have persisted for at
  least 6 months to a degree that is maladaptive
  inconsistent with developmental level
• HYPERACTIVITY
• Often fidgets with hands or feet or squirms in
  seat
• Often leaves seat in classroom or in other
  situations in which remaining seated is required
• Often runs about or climbs excessively in
  situations in which it is inappropriate
• Often has difficulty playing or engaging in
  leisure activities quietly
• Is often on the go or often acts as if driven
  by a motor
• Often talks excessively
• IMPULSIVITY
• Often blurts out answers before questions have
  been completed
• Often has difficulty awaiting turn
• Often interrupts or intrudes on others (e.g.,
  butts into conversations)

34
Diagnostic Statistical Manual of Mental
Disorders (4th Edition) Text Revised
DSM-IV-TRAttention-Deficit Disruptive Behavior
DisordersAttention Deficit/Hyperactivity Disorder

• Some hyperactive-impulsive or inattentive
  symptoms that caused impairment were present
  before age 7
• Some impairment from the symptoms is present in
  two or more settings
• There must be clear evidence of clinically
  significant impairment in social, academic, or
  occupational functioning

35
Diagnostic Statistical Manual of Mental
Disorders (4th Edition) Text Revised
DSM-IV-TRAttention-Deficit Disruptive Behavior
DisordersAttention Deficit/Hyperactivity Disorder

• Subtypes of Attention Deficit / Hyperactivity
  Disorder
• Combined Type 6 (or more) symptoms of
  inattention 6 (or more) symptoms of
  hyperactivity-impulsivity have persisted for at
  least 6 months. Mostly occurs in adolescents.
• Predominantly Inattentive Type 6 (or more)
  symptoms of inattention (but fewer than 6
  symptoms of hyperactivity-impulsivity) have
  persisted for at least 6 months.
• Predominantly Hyperactive-Impulsive Type 6 (or
  more) symptoms of hyperactivity-impulsivity (but
  fewer than 6 symptoms of inattention) have
  persisted for at least 6 months.

36
Diagnostic Statistical Manual of Mental
Disorders (4th Edition) Text Revised
DSM-IV-TRAttention-Deficit Disruptive Behavior
DisordersAttention Deficit/Hyperactivity Disorder

• Hard to diagnose under the age of 4-5 years
• 3-7 of school-aged children
• Typically seen as overactive during infancy
  What is this????
• More common in first degree biological relatives

37
Diagnostic Statistical Manual of Mental
Disorders (4th Edition) Text Revised
DSM-IV-TRAttention-Deficit Disruptive Behavior
DisordersConduct Disorder

• A repetitive persistent pattern of behavior in
  which the basic rights of others or major
  age-appropriate societal norms or rules are
  violated, as manifested by the presence of three
  (or more) of the following criteria in the past
  12 months, with at least one criterion present in
  the past 6 months

38
Diagnostic Statistical Manual of Mental
Disorders (4th Edition) Text Revised
DSM-IV-TRAttention-Deficit Disruptive Behavior
DisordersConduct Disorder

• Aggression to people animals
• Often bullies, threatens, or intimidates others
• Often initiates physical fights
• Has used a weapon that can cause serious physical
  harm to others (e.g., bat, brick, knife, gun)
• Has been physically cruel to people
• Has been physically cruel to animals
• Has stolen while confronting a victim (e.g.,
  mugging, purse snatching, extortion, armed
  robbery)
• Has forced someone into sexual activity

39
Diagnostic Statistical Manual of Mental
Disorders (4th Edition) Text Revised
DSM-IV-TRAttention-Deficit Disruptive Behavior
DisordersConduct Disorder

• Destruction of Property
• Has deliberately engaged in fire setting with the
  intention of causing serious damage
• Has deliberately destroyed others property
• Deceitfulness or Theft
• Has broken into someone elses house, building,
  car
• Often lies to obtain goods or to avoid
  obligations (e.g., cons others)
• Has stolen items of nontrivial value without
  confronting a victim (e.g., shoplifting)

40
Diagnostic Statistical Manual of Mental
Disorders (4th Edition) Text Revised
DSM-IV-TRAttention-Deficit Disruptive Behavior
DisordersConduct Disorder

• Serious Violations of Rules
• Often stays out at night despite parental
  prohibitions, beginning before age 13 years
• Has run away from home overnight at least twice
  while living in parental or parental surrogate
  home (or once without returning for a lengthy
  period)
• Is often truant from school, beginning before age
  13 years
• This disturbance in behavior causes clinically
  significant impairment in social, academic, or
  occupational functioning

41
Diagnostic Statistical Manual of Mental
Disorders (4th Edition) Text Revised
DSM-IV-TRAttention-Deficit Disruptive Behavior
DisordersConduct Disorder

• Subtypes
• Childhood-Onset Type At least one criterion
  prior to age 10 years. Usually male, frequently
  display physical aggression, have disturbed peer
  relationships, ADHD is common, Antisocial
  Personality Disorder may be DX in future
• Adolescent-Onset Type Any criteria prior to age
  10. Less likely to display aggressive behaviors
  tend to have more normative peer relationships.
• Unspecified-Onset Type Used if age of onset is
  unknown

42
Diagnostic Statistical Manual of Mental
Disorders (4th Edition) Text Revised
DSM-IV-TRAttention-Deficit Disruptive Behavior
DisordersConduct Disorder

• Severity Specifiers
• Mild Few if any conduct problems in excess of
  those required to make the diagnosis are present,
  conduct problems cause relatively minor harm to
  others (e.g., lying, truancy, staying out after
  dark w/o permission)
• Moderate The number of conduct problems the
  effect on others are intermediate between mild
  severe (e.g., stealing w/o confronting a
  victim, vandalism)
• Severe Many conduct problems in excess of those
  required to make the diagnosis are present, or
  conduct problems cause considerable harm to
  others (e.g., forced sex, physical cruelty, use
  of a weapon, stealing while confronting a victim,
  breaking entering)

43
Diagnostic Statistical Manual of Mental
Disorders (4th Edition) Text Revised
DSM-IV-TRAttention-Deficit Disruptive Behavior
DisordersOppositional Defiant Disorder

• A pattern of negativistic, hostile, defiant
  behavior lasting at least 6 months, during which
  4 (or more) of the following are present
• Often loses temper
• Often argues with adults
• Often actively defies or refuses to comply with
  adults requests or rules
• Often deliberately annoys people
• Often blames others for his or her mistakes or
  misbehaviors
• Is often touchy or easily annoyed by others
• Is often angry resentful
• Is often spiteful or vindictive
• Consider these in relation to others at same
  chronological age development

44
Diagnostic Statistical Manual of Mental
Disorders (4th Edition) Text Revised
DSM-IV-TRAttention-Deficit Disruptive Behavior
DisordersOppositional Defiant Disorder

• The disturbance in behavior causes clinically
  significant impairment in social, academic, or
  occupational functioning
• 2 - 16 of population has been estimated

45
Diagnostic Statistical Manual of Mental
Disorders (4th Edition) Text Revised
DSM-IV-TROther Disorders in Infancy, Childhood,
or AdolescentsSeparation Anxiety Disorder

• Developmentally inappropriate excessive anxiety
  concerning separation from home or from those to
  whom the individual is attached, as evidenced by
  three (one or more of the following)

46
Diagnostic Statistical Manual of Mental
Disorders (4th Edition) Text Revised
DSM-IV-TROther Disorders in Infancy, Childhood,
or AdolescentsSeparation Anxiety Disorder

• Recurrent excessive distress when separation from
  home or major attachment figures occurs or is
  anticipated
• Persistent excessive worry that an untoward
  event will lead to separation from a major
  attachment (e.g., getting lost or being
  kidnapped)
• Persistent excessive worry about losing, or
  about possible harm befalling, major attachment
  figures
• Persistent reluctance or refusal to go to school
  or elsewhere because of fear of separation
• Persistently excessively fearful or reluctant
  to be alone or without major attachment figures
  at home or without significant adults in other
  settings
• Persistent reluctance or refusal to go to sleep
  without being near a major attachment figure or
  to sleep away from home
• Repeated nightmares involving the theme of
  separation
• Repeated complaints of physical symptoms (such as
  headaches, nausea, etc.) when separation from a
  major attachment figure occurs or is anticipated

47
Diagnostic Statistical Manual of Mental
Disorders (4th Edition) Text Revised
DSM-IV-TROther Disorders in Infancy, Childhood,
or AdolescentsSeparation Anxiety Disorder

• The duration of the disturbance is at least 4
  weeks
• The onset is before age 18 years
• The disturbance causes clinically significant
  distress or impairment in social, academic
  (occupational), or other important areas of
  functioning
• Specify EARLY ONSET if onset occurs before age
  6 years.
• Estimated at 4 of children adolescents

48
Diagnostic Statistical Manual of Mental
Disorders (4th Edition) Text Revised
DSM-IV-TROther Disorders in Infancy, Childhood,
or AdolescentsDepression

• Five or more of the following symptoms have been
  present during the same 2-week period and
  represent a change from previous functioning at
  least one of the symptoms is either (1) depressed
  mood or (2) loss of interest or pleasure

49
Diagnostic Statistical Manual of Mental
Disorders (4th Edition) Text Revised
DSM-IV-TROther Disorders in Infancy, Childhood,
or AdolescentsDepression

• Depressed mood most of the day, nearly every day,
  as indicated by self-report or observation by
  others (irritability in children)
• Markedly diminished interest or pleasure in most
  activities
• Weight loss/gain (not dieting) failure to make
  expected weight
• Insomnia
• Psychomotor agitation or retardation

50
Diagnostic Statistical Manual of Mental
Disorders (4th Edition) Text Revised
DSM-IV-TROther Disorders in Infancy, Childhood,
or AdolescentsDepression

• Fatigue/loss of energy
• feelings of worthlessness or excessive/inappropri
  ate guilt
• Diminished ability to think or concentrate/indecis
  iveness nearly every day.
• Recurrent thought of death/suicide or suicide
  attempt or plan for suicide

51
Diagnostic Statistical Manual of Mental
Disorders (4th Edition) Text Revised
DSM-IV-TROther Disorders in Infancy, Childhood,
or AdolescentsDysthymic Disorder

• Depressed mood for most of the day, for more days
  than not, for more than a year.
• Presence of two of the following
• Poor appetite/overeating
• Insomnia/hypersomnia
• Low energy/fatigue
• Low self-esteem
• Poor concentration/difficulty making decisions
• Feelings of worthlessness

52
Diagnostic Statistical Manual of Mental
Disorders (4th Edition) Text Revised
DSM-IV-TROther Disorders in Infancy, Childhood,
or AdolescentsDepression and Dysthymic Disorders

• The following criteria must be met for both
  Depression and Dysthymic Disorder
• Never been a Manic/Mixed/Hypomanic Episode
• Does not occur during a Psychotic Disorder
• Not related to substance abuse or general medical
  condition
• Must cause significant impairment in social,
  occupational (school) or other important areas of
  functioning.

53
Diagnostic Statistical Manual of Mental
Disorders (4th Edition) Text Revised
DSM-IV-TRREMEMBER

• These are not the ONLY diagnoses that can occur
  during childhood. There is also
• Substance-Related Disorders
• Schizophrenia / Psychotic Disorders
• Mood Anxiety Disorders
• Somatoform Dissociative Disorders
• Sexual Gender Identity Disorders
• Eating Sleep Disorders
• Adjustment Personality Disorders

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