43 - 11. Disorders with childhood onset

11. Disorders with childhood onset

© SPMM Course 11. Disorders with childhood onset

Major ICD-10 categories in this chapter are highlighted in the table below: Divisions Subdivisions Hyperkinetic disorders (HKD) Rarely used (Attention and overactivity, hyperkinetic conduct disorder) Conduct disorders Conduct disorder & oppositional defiant disorder Emotional disorders specific to childhood Separation anxiety, phobias, social anxiety, sibling rivalry Social functioning disorders Elective Mutism, reactive attachment disorder Tic disorders Transient  tics,  Tourette’s  syndrome  (chronic  combined  motor   and vocal) Other behavioural and emotional disorders Enuresis, Encopresis, Pica, Stuttering

The hyperkinetic disorder is the ADHD equivalent in ICD-10. For ADHD/HKD, the diagnostic criteria are considered  to  be  more  ‘relaxed’  in  DSM  but  stricter  in  ICD-10. According to DSM-IV criteria, to meet the diagnosis of ADHD, some symptoms must be present before the age of 7 years, although ADHD is not diagnosed in many children until they are older than 7 years when their behaviours cause problems in school and other places. To confirm a diagnosis of ADHD, impairment from inattention and/or hyperactivity-impulsivity must be observable in at least 2 settings and interfere with developmentally appropriate functioning socially, academically, or in extracurricular activities and should persist for at least six months. ADHD is not diagnosed when symptoms occur in a child, adolescent, or adult with a pervasive developmental disorder, schizophrenia, or another psychotic disorder. Conduct disorder is an enduring set of antisocial and aggressive behaviours that evolves over time, usually characterized by aggression and violation of the rights of others. Diagnostic criteria: Children with conduct disorder are likely to demonstrate behaviours in the following four categories x Physical aggression or threats of harm to people, cruelty to people and animals x Destruction of their own property or that of others x Theft or acts of deceit x Frequent and serious violation of age-appropriate rules. (Like truanting or running away)

© SPMM Course Other features would include early sexual behaviour, lack of empathy, low self-esteem, and gang involvement. Usually, the features must be present for a substantial duration of minimum six months before entertaining the diagnosis. According to DSM-IV criteria, these behaviours should begin before the age of 13. [Childhood onset type – symptoms present before age 10, Adolescent onset type – symptoms develop after age 10] Oppositional Defiant Disorder: An enduring pattern of negative, hostile, disobedient and defiant behaviour, without serious violations of societal norms or the rights of others. Symptoms must be persistent and evident for at least 6 months. In oppositional defiant disorder, a child's temper outbursts, active refusal to comply with rules, tendency to blame others, spiteful and annoying behaviours exceed expectations for these behaviours for children of the same age. Oppositional Disorder is seen as a limited form of conduct disorder. According to ICD10, the oppositional disorder is a subtype of conduct disorder. DSM-IV excludes oppositional disorder if a conduct disorder is present. Separation anxiety disorder (SAD) is defined as developmentally inappropriate and excessive anxiety concerning separation from home or from those to whom the individual is attached. This anxiety will interfere with normal age appropriate functioning. The essential clinical feature of separation anxiety is excessive worry about losing or being permanently separated from a major attachment figure. Reactive attachment disorder: This disorder, occurring in infants and young children is characterised by persistent  abnormalities  in  the  child’s  pattern  of  social  relationships, which are associated with emotional disturbance and reactive to changes in environmental circumstances. Elective Mutism is a disorder characterized by a persistent failure to speak in specific settings (school) despite the full use of language at home or with family, may be found in younger children with social phobia. A child with selective mutism may remain completely silent or near silent, in some cases whispering instead of speaking out loud. Fear of strangers is a normal phenomenon in the second half of the first year of life. A degree of social apprehension is normal in early childhood in socially threatening/novel situations. Social anxiety disorder of childhood is a diagnosis that can be used before the age of 6 years, but only when the anxiety is unusual in degree and accompanied by problems in social functioning.

©"SPMM"Course" 57" Sibling!rivalry!disorder"is"characterized"by"“the"combination"of:"(a)"evidence"of"sibling"rivalry"and/or" jealousy;"(b)onset"during"the"months"following"the"birth"of"the"younger"(usually"immediately"younger)" sibling;"(c)emotional"disturbance"that"is"abnormal"in"degree"and/or"persistence"and"associated"with" psychosocial"problems”"(ICDL10)." " " " " " " " " " " " " " " " " " " DSM%5!AND!ADHD!! For'ADHD'the'onset'criterion'has'been' changed'from'“symptoms'that'caused' impairment'were'present'before'age'7' years”'to'“several'inattentive'or' hyperactive-impulsive'symptoms'were' present'prior'to'age'12”' Subtypes'have'been'replaced'with' presentation'specifiers'that'map'directly' to'the'prior'subtypes' A'comorbid'diagnosis'with'autism' spectrum'disorder'is'now'allowed' The'symptom'threshold'has'been' changed'for'adults'with'a'cutoff'for' ADHD'of'five'symptoms,'instead'of'six' required'for'younger'persons,'both'for' inattention'and'for'hyperactivity'and' impulsivity.' DSM%5!AND!CHIDHOOD!ONSET! DISORDERS!! A'new'diagnosis'“Disruptive'Mood' Dysregulation'Disorder”'has'been'added' to'reduce'the'misdiagnosis'of'Bipolar' Disorder'in'children.'Features'of' DMDD'include'a'persistent,'irritable' mood'and'frequent,'major'anger' outbursts'or'tantrums'three'or'more' times'a'week'for'more'than'a'year.' Separation'Anxiety'Disorder'and' Selective'Mutism'have'been'moved'from'' “Disorders'Usually'First'Diagnosed'in' Infancy,'Childhood,'or'Adolescence,”'to' “'Anxiety'Disorders”.'

© SPMM Course Notes produced using excerpts from: Cooper, J. E. (Ed.). (1994). Pocket Guide to the ICD-10 Classification of Mental and Behavioural Disorders: With Glossary and Diagnostic Criteria for Research: ICD-10/DCR-10. American Psychiatric Pub. American Psychiatric Association. (2013). DSM 5. American Psychiatric Association. First, M. B. (1994). Diagnostic and statistical manual of mental disorders. DSM IV-4th edition. APA. p, 97-327.

DISCLAIMER: This material is developed from various revision notes assembled while preparing for MRCPsych exams. The content is periodically updated with excerpts from various published sources including peer-reviewed journals, websites, patient information leaflets and books. These sources are cited and acknowledged wherever possible; due to the structure of this material, acknowledgements have not been possible for every passage/fact that is common knowledge in psychiatry. We do not check the accuracy of drug related information using external sources; no part of these notes should be used as prescribing information.