Mental Disorders_Developmental Period

Question 1

Types of neurodevelopmental disorders

Answer 1

1. Intellectual disability (Intellectual developmental disorder- as per WHO in the future)
2. Autism Spectrum disorders
3. Specific learning disorders
4. Attention Deficit/hyperactivity disorder

Question 2

Anxiety Disorders

Answer 2

1. Seperation Anxiety disorder

2. Selective Mutism

Question 3

Types of Trauma/Stressor related disorders

Answer 3

1. Reactive Attachment disorder

2. Disinhibition social engagement disorder

Question 4

Types of disruptive, impulse- control, and conduct disorders

Answer 4

1. Oppositional defiant disorder
2. Intermittent Explosive disorder
3. Conduct disorder

Question 5

Types of elimination disorders

Answer 5

1. Enuresis

2. Encopresis

Question 6

Intellectual Disability (ICD-Intellectual developmental disorders)

Answer 6

A. Deficits in intellectual functions, confirmed by clinical assessment and individualized, standardized intelligence testing.
AND
B. Deficits in adapative fx in conceptual, social, and practical domains that result in failure to meet developmental and sociocultural standards for personal independ and social responsibility; deficits limit fx in one or more activities of daly life, i.e communication, social participation, and/or independent living- across multiple environments (home, school, work, community)
AND
C. Onset is during developmental period.

Question 7

Intelligence tests

Answer 7

1. Wechsler adult intelligence Scale (WAIS)
2. Weschslet Intelligence scale for children (WISC)
3. Stanford-Binet Intelligence Scale

Question 8

Level of severity of intellectual disability based on adaptive fx

Answer 8

• Mild, appr 85%: Difficulties in learning-more support and more time needed; concrete approach to problems;immature in social interactions and judgments; age appropriate in personal care, needs support in complex tasks.
• Moderate, appr 10%): Marked lad in cognitive skills; ongoing assistance needed for conceptual tasks of daily life; communication and social limitations affect relationships; needed in work settings; extended teaching needed to care for personal needs, ongoing support needed to manage work and life.
• Severe, appr 3-4%: extensive support for problem solving throughout life, little understanding of written language or numerical concepts; limited spoken language, understand simple speech and gestures; support and supervision required for daily living, some maladaptive behaviors such as self injury may be presents
• Profound, app 1-2%: no understanding of symbolic processes; co-occurring motor or sensory impairments that limit fx; communication is largely non verbal and non symbolic, responds to social interactions through gestural and emotional cues; dependent on others for all aspects of daily life.

Question 9

Autism spectrum disorder

Answer 9

A. Persistent deficits in social communication and social interaction across multiple contexts, as manifested by:
1. Def. in social-emotional reciprocity
2. Deficits in nonverbal communicative behaviors used for social interactions.
3. Deficits in developing, maintaining, and understanding relationships
AND
B. Restricted repetitive patterns of behaviors, interests, or activities, as manifested by at least 2 of following:
1. Stereotypes or repetitive motor movements, use of objects, or speech
2. Insistence on sane ends, inflexible to routines, or ritualized patterns of verbal or nonverbal behaviors
3. Highly restricted, fixated interests that are abnormal in intensity or focus.
4. Hyper or Hypo- reactivity to sensory input or unusual interest in seneosry aspects of environment
AND
C. Symptoms must be present in the early developmental period , but may not fully manifest until social demands exceed limited capacities; Usually dx at age 2
And
D. Sx’s cause clinically significant impairment in social, occupational, or other important areas of current functioning.

Question 10

Severity levels for Autism spectrum

Answer 10

Level 1- some support needed
Level 2 - substantial support needed
Level 3 - Very substantial support needed

Question 11

Autism Spectrum Disorders

Answer 11

1. Autistic disorder
2. Pervasive developmental disorders
   - Asperger’s syndrome - ASD, without accompanying language or intellectual impairment; usually very intelligent with high vocabulary; focus on one interest which they know broadly about, i.e airplane engines.
   - Rett’s disorder- ASD, associated with Rhett syndrome.
   - Childhood disintegrative disorder

Question 12

Specific Learning Disorder

Answer 12

A. Difficulties in learning and applying academic skills, as indicated by the presence of one of the following sx’s persisting for at least 6 months, despite targeted interventions :
1. Inaccurate or slow effortful word reading
2. Difficulty understanding the meaning of words.
3. Difficulties with spelling and word expression
4. Difficulties with mastering number senses, facts, or calculations
5. Difficulties with mathematical reasoning
B. Affected skills are:
1.Substantially and quantifiable below those expected for the individ’s chronological age group.
2. Cause significant interference with academic or occupational fx’ing
3. Confirmed by individually administered achievement measures and comprehensive clinical assessment
C. Learning difficulties began during school age years but may not fully manifest until the academic demands exceed capacity

Question 13

Attention Deficit/Hyperactivity disorder (ADHD)

Answer 13

A. Persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with fx’ing or development

1. Inattention: 6 or more specific sx’s of inattention, persisting at least 6 mo, to a degree that is inconsistent with developmental level, and that negatively impacts directly on social and academic occupational activities; such as- lack of attention to details, difficulty in remaining focused, may seem not to be listening, lack of follow through, difficulty organizing tasks, avoidance of tasks req’ing sustained efforts, loses things, easily frustrated and distracted, forgetfulness.
2. Hyperactivity and impulsivity: 6 or more sx’s , for at least 6 months, to degree that is not consistent with developmental age group and causes social/academic/occupational constraints in fx; fidgets in seat, leaves seat when expected to be seated, runs about to remain quiet while at play or leisure, unusable to remain quiet while at play or leisure, on the go -motor driven, may talk excessively, blurts out- cannot wait for turn, intercepts /intrudes.

Question 14

ADHD- requirements for dx

Answer 14

A. Persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with fx/development
B. Some hyperactive-impulsive or inattentive sx’s that caused impairment were present before age 12.
C. Some impairment from symptoms is present in two or more settings, e.g school, work, home.
D. Clear evidence of clinically significant impairment in social, academic, or occupational fx’.
E. Symptoms do no occur exclusively during the course of another mental disorder.

Question 15

Types of ADHD dx

Answer 15

• ADHD, combined presentation: both criteria A1 (inattention) and A2(hyperactivity-impulsivity) are met for the past 6 mo.
• ADHD, predominantly Inattentive
• ADHD, predominantly hyperactive-Impulsive.

**Severity is specified: MILD, MODERATE, SEVERE

Question 16

Anxiety disorders

Answer 16

• Excessive fear (emotional response to real or perceived imminent threat)
• Excessive Anxiety (anticipation of future threat)

Question 17

Seperation Anxiety disorder

Answer 17

Developmentally inappropriate/excessive fear or anxiety concerning separation from attachment figures, as evidence by at least 3 of the following:
1. Recurrent excessive distress when anticipating or experiencing separation from home or attachment figures.
2. Persistent and excessive worry about losing attachment figures or possible harm to them.
3. Persistent and excessive worry about experiencing an largely unlikely event that would cause separation, i.e kidnapping, getting lost.
4. Persistent reluctance or refusal to leave home bc of fear of seperation
5. Persistent and excessive fear or reluctance about being alone- without attachment figure
6. Persistent reluctance or refusal to sleep away from home or to go to sleep in the absence of attachment figures.
7. Repeated nightmares with separation theme.
8. Repeated complains of physical symptoms with anticipated or actual separation.
B. Symptoms must be persistent , lasting at least 4 weeks in children/adolescents, and typically 6 mo or more in adults.
C. Disturbance causes significant distress or impairment in social, academic, occupational, or other important areas of fx.
D. Disturbance is not better explained by another mental disorder; i.e Resistance to change in ASD; delusions in psychotic disorders; agoraphobia, etc.)

Question 18

Selective mutism

Answer 18

*Not a language disorder
A. Consistent failure to speak in specific social situations in which there is an expectation for speaking, despite speaking in other situations
B. The disturbance interferes with educational or occupational achievement or with social communication.
C. Duration- at least one month.
D. Disturbance is not better explained by communication disorder ( childhood- onset of fluency disorder) , and does not occur exclusively during the course of ASD, schizophrenia , or another psychotic disorder.
**Onset typically before age 5 (dx at school age)
**Anxiety disorder,language skills are developing normally.

Question 19

Trauma/Stress-Related disorders

Answer 19

• Precipitated by exposure to a traumatic or stressful event.
• Psychological distress is variable : Anxiety based, fear based, Anhedonic and days-horizon sx’s, externalized angry and aggressive symptoms, dissociative symptoms.

**2 disorders in this category that are most likely to occur during the developmental period are ppt’ed by NEGLECT.

Question 20

Reactive Attachment Disorder

Answer 20

A. Consistent pattern of inhibited, emotionally-withdrawn behaviors toward adult caregivers, manifested by BOTH of the following:

1. Child rarely or minimally seeks comfort when distressed.
2. Child rarely or minimally responds to comfort when distressed.

B. Persistent social and emotional disturbance characht’d by at least 2:

1. Minimal social and emotional responsiveness to others
2. Limited positive affect.
3. Episodes of unexplained irritability, sadness, or fearfulness, even during nonthreatening interactions with caregivers.

C. Child has experienced a pattern of extremes of insufficiency care, as evidences by at least 1:

1. Social neglect or deprivation- basic emotional needs persistently not met for comfort, stimulation, and affection
2. Frequent changes in primary caregivers- limiting opportunities for stable attachments.
3. Rearing is unsual settings (institutions)- limits opportunity to form selective attachments

• *Symptoms evident prior to age 5
• *Child has a developmental age of at least 9 months.

Question 21

Disinhibited Social engagement disorder

Answer 21

A. Pattern in which child actively approaches and interacts with unfamiliar adults and exhibits at least 2:

1. Red’d or absent reticence in approaching unfamiliar adults
2. Overly familiar verbal and physical behaviors.
3. Reduced or absent checking back with adult caregiver after venturing away
4. Willingness to go off with unfamiliar adult with minimal or no hesitation.

B. Child has experienced a pattern of extremes of insufficiency care: social neglect/deprevation (emotional abuse), Frequent changes in primary caregivers- limiting opportunities for stable attachment, rearing in unusual settings that severely limit opportunities to for selective attachments

**Child has a developmental ae of at least 9 months.

Question 22

Disruptive, impulse-control, and conduct disorders

Answer 22

• Disorders in this category involve problems in self-control of emotions and behaviors
• problems are manifested in behaviors that : violate rights of others’ cause significant conflict with societal norms or authority figures

1. Intermittent explosive disorder
2. Oppositional defiant disorder
3. Conduct disorder

Question 23

1. Intermittent explosive disorder

Answer 23

• chronological age is at least 6 years old; onset - late childhood and persists for many years.
  A. Recurrent behavioral outbursts representing failure to control aggressive impulses, or manifested by either of the following:
  1. Verbal/physical aggression toward property , animal, or persons, occurring 2x /week for 3 months. **Aggression does not result in serious damage or injury
  2. Three behavioral outbursts involving damage to property or injury to animal or persons within a 12 month period.

B. Magnitude of the aggressiveness is grossly disproportional to the provocation or to the stressors.

C. Outburst are not premeditated - rather, anger based/impulsive- and are not goal oriented (no tangible objective)

D. Outburst cause either marked distress or impairment in fx, or are associated with financial or legal consequences .

Question 24

2. Oppositional defiant disorder

Answer 24

1. Angry/irritable mood- often loses temper; is touchy or easily annoyed, is often angry and resentful
2. Argumentative/Defiant: Often argues with adults/authority figures, actively defies rules and refuses to comply with request from authority figures, deliberately annoys others, blames others for his or her mistakes or misbehavior.
3. Vindictiveness- Has spiteful or vindictive at least twice in past 6 months.

Specifier : Mild- confined to one setting (usually home); Moderate (at lest 2 settings); Severe- 3 or more settings.