CLASSIFICATION OF CHILDHOOD AND ADOLESCENT MENTAL DISORDERS Mental retardation (F70-F79) F70 F71 F72 F73 F78 F79

Mild Mental retardation Moderate Mental retardation Severe Mental retardation Profound Mental retardation Other mental retardation unspecified Mental retardation

Disorders of Psychological Development (F80-F89) F80 F81 F82 F83 F84 F88 F89 Specific developmental disorders of speech and language Specific developmental disorders of scholastic skills Specific developmental disorder of motor function Mixed specific developmental disorders Pervasive developmental disorders Other disorders of psychological development Unspecified disorder of psychological development

Behavioural and Emotional Disorders with Onset Usually Occurring in Childhood and Adolescence (F90F98) F90 F91 F92 F93 F94 Hyperkinetic disorders Conduct disorders Mixed disorders of conduct and emotions Emotional disorders with onset specific to childhood Disorders of social functioning with onset specific to childhood and adolescence F95 Tic disorders F98 Other behavioural and emotional disorders with onset usually occurring in childhood and adolescence F98.0 - non organic enuresis F98.1 - non organic encopresis F98.2 feeding disorders of infancy & childhood F98.3 Pica F98.5 stuttering F98.6 cluttering F98.8 Other specified behavioural and emotional disorders with onset usually occurring

in childhood and adolescence

nail biting Thumb sucking Nose-picking

Childhood autism
Autism is a complex developmental disorder that begins in early childhood and has the following three defining core features: Problems with social interactions Impaired verbal and nonverbal communication

 A pattern of repetitive behavior with narrow, restricted interests The diagnosis of autism may not be made until a child reaches preschool or school age. Causes Genetics: In families with one child with autism, the risk of having another child with autism is 3% to 8%. A number of studies have found that first-degree relatives of children with autism also have an increased risk of autism spectrum disorders. Medical condition : autism is linked to an underlying medical condition e.g metabolic disorders (untreated phenylketonuria [PKU]), congenital infections (rubella, cytomegalovirus [CMV],toxoplasmosis), genetic disorders , developmental brain abnormalities (microcephaly, macrocephaly), and neurologic disorders acquired after birth (lead encephalopathy, bacterial meningitis). Environmental factors and exposures may interact with genetic factors to cause an increased risk of autism in some families. Emotional trauma: Some believed that emotional trauma at an early age, especially bad parenting, was to blame. Perinatal factors: maternal bleeding during gestation, use of medications during pregnancy.

Signs & symptoms Impaired reciprocal social interaction poor use of body language and nonverbal communication, such as eye contact, facial expressions, and gestures; lack of awareness of feelings of others and the expression of emotions, such as pleasure (laughing) or distress (crying), for reasons not apparent to others; remaining aloof, preferring to be alone; difficulty interacting with other people and failure to make peer friendships; may not want to cuddle or be cuddled; lack of or abnormal social play; not responding to verbal cues (acting as if deaf). Impaired communication delay in, or the total lack of, the development of spoken language or speech; if speech is developed, it is abnormal in content and quality; difficulty expressing needs and wants, verbally and/or nonverbally; repeating words or phrases back when spoken to (known as echolalia); inability to initiate or sustain conversation; Restricted repertoire of interests, behaviors, and activities insisting on following routines and sameness, resisting change; ritualistic or compulsive behaviors; repetitive body movements (hand flapping, rocking) and/or abnormal posture (toe walking); preoccupation with parts of objects or a fascination with repetitive movement (spinning wheels, turning on and off lights); Behavioral symptoms include: aggressive or self-injurious behavior; noticeable extreme underactivity or overactivity; throwing tantrums; short attention span;

 abnormalities in eating or sleeping; having no apparent fear of dangerous situations. Mood and affect

Mood and affect vary considerably, and may include being unaware of the feelings of others, withdrawn, or emotionally labile. Assessment & diagnosis The comprehensive evaluation of a child with autism might include: obtaining complete medical and family history; physical exam; formal audiology evaluation; selected medical/lab tests on an individual basis (for example, lead levels, genetic tests, metabolic tests, brain MRI, electroencephalogram [EEG]); speech, language, and communication assessment; cognitive and behavioral assessments (focus on social skills and relationships, problem behaviors, motivation and reinforcement, sensory functioning, and self-regulation); and academic assessment (educational functioning, learning style). Treatment Pharmacotherapy: it s a valuable treatment for associated symptoms like aggression, tempertantrums, hyperactivity, self-injurious behavior. Some drugs that have been used are risperidone, SSRIs, clomipramine and lithium. Behavioral therapies: Behavioral therapy is the foundation for most treatment programs for children with autism. It is based on the principle of reinforcement: that behavior can be changed by rewarding desired behavior and removing reinforcement for unwanted behavior. Contingency management may control some of the abnormal behavior of autistic children. Educational interventions : special schooling attempt to help children to learn academic subjects and gain, also to improve functional communication and spontaneity Social skill training: Teaching individuals many of the unwritten social rules and body language signals that people use in social interaction and conversation.. In very young child, they may be in the form of photographs or pictures and in others social stories can be used. Speech therapists typically work as part of the treatment team to help foster the development of language and communication skills. Counseling and supportive therapy: the family members needs considerable help to cope with the childs behavior, which is often distressing.

Nursing management: Nursing assessment: The following factors need to be assessed in an autistic child: Cognitive level Language ability Communication skills, social skills, play skills and repetitive behavior Stage of social development in relation to age, mental age Associated medical conditions Interventions: Work with the child on one-to-one basis

 Protect the child from self-mutilated behavior. Devices such as helmets, padded mittens and arm covers may be used. Try to determine if self-mutilated behavior occurs in response to increasing anxiety. Intervene client with diversion activities. Assign limited number of caregivers to the child. Ensure that warmth, acceptance are conveyed. Provide child with familiar objects such as familiar toys or blanket. Give positive reinforcement for eye contact with something acceptable to the child(e.g. food, familiar object) Fulfill the childs needs until communication can be established. Slowly encourage him to express his needs verbally. Seeks clarification & validation. Teach simple self-care skills by using behavior modification techniques. Language training plays an important part in teaching autistic child. At first they have to learn names of things by linking the name with actual objects. E.g when teaching the word table they must see and feel a real table and lots of different table. Ask the child to repeat the words. Show picture books and name the objects. The child should be helped to name own body parts. This can be done with the use of mirrors, drawings and pictures of himself. Role of parents is crucial for any intervention with autistic disorder; the parent acts as co-therapist in the treatment.

Attention deficit hyperactivity disorder

Attention deficit hyperactivity disorder (ADHD or AD/HD or ADD) is a developmental disorder. characterized primarily by "the co-existence of attentional problems and hyperactivity, with each behavior occurring infrequently alone" and symptoms starting before seven years of age. Causes Heredity. ADHD tends to run in families. Several genes that may be associated with ADHD are currently being studied Maternal smoking, drug use and exposure to toxins. Pregnant women who smoke are at increased risk of having children with ADHD. Alcohol or drug abuse during pregnancy may reduce activity of the nerve cells (neurons) that produce neurotransmitters. Childhood exposure to environmental toxins. Preschool children exposed to certain toxins are at increased risk of developmental and behavioral problems. E.g Exposure to lead, Food additives. Substances added to food, such as artificial coloring or food preservatives, may contribute to hyperactive behavior. Signs & symptoms Inattention Often does not give close attention to details or makes careless mistakes in schoolwork, work, or other activities. Often has trouble keeping attention on tasks or play activities. Often does not seem to listen when spoken to directly. Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (not due to oppositional behavior or failure to understand instructions). Often has trouble organizing activities. Often avoids, dislikes, or doesn't want to do things that take a lot of mental effort for a long period of time (such as schoolwork or homework). Often loses things needed for tasks and activities (e.g. toys, school assignments, pencils, books, or tools). Is often easily distracted.

 Is often forgetful in daily activities Hyperactivity Often fidgets with hands or feet or squirms in seat when sitting still is expected. Often gets up from seat when remaining in seat is expected. Often excessively runs about or climbs when and where it is not appropriate (adolescents or adults may feel very restless). Often has trouble playing or doing 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 finished. Often has trouble waiting one's turn. Often interrupts or intrudes on others (e.g., butts into conversations or games). Diagnosis To be considered for a diagnosis of ADHD: a child must display behaviors from one of the three subtypes before age 7 these behaviors must be more severe than in other kids the same age the behaviors must last for at least 6 months the behaviors must occur in and negatively affect at least two areas of a child's life (such as school, home, day-care settings, or friendships) Treatment 1. Medications Several different types of medications may be used to treat ADHD: Stimulants are the best-known treatments they've been used for the treatment of ADHD. E.g. Stratterra Nonstimulants were approved for treating ADHD .e.g. Ritalin, Methylin, Focalin Antidepressants are sometimes a treatment option. 2. Behavioral Therapy Behavioral therapy attempts to change behavior patterns by: reorganizing a child's home and school environment giving clear directions and commands setting up a system of consistent rewards for appropriate behaviors and negative consequences for inappropriate ones Techniques used are - Time-out, Token economy system and positive reinforcement. 3. Parent Training Parenting a child with ADHD often brings special challenges. Experts recommend parent education and support groups to help family members accept the diagnosis and to teach them how to help kids organize their environment, develop problem-solving skills, and cope with frustrations. 4. Individual or family counseling can also be helpful.

Nursing interventions Develop a trusting relationship with the child. Ensure that patient has a safe environment. Set realistic expectations and limits because the patient with attention deficit hyperactivity disorder is easily frustrated Always remain calm and consistent with the child. Ensure the childs attention by calling his name and establishing eye contact, before giving nstructions. Keep all your instructions to the child short and simple. Provide praise and rewards whenever possible. Provide the patient with diversional activities suited to his short attention span. Help the parents and other family members develop planning and organizing systems to help them cope more effectively with the child's short attention span. Explain & demonstrate positive parenting techniques to parents or caregivers such as time-in for good behavior, bring vigilant in identifying childs behavior and responding positively to that behavior.

Conduct disorder
Conduct disorder is a repetitive and persistent pattern of behavior in children and adolescents in which the rights of others or basic social rules are violated. Signs and symptoms Children or adolescents with conduct disorder may exhibit some of the following behaviors: Aggression to people and animals bullies, threatens or intimidates others often initiates physical fights has used a weapon that could cause serious physical harm to others (e.g. a bat, brick, broken bottle, knife or gun) is physically cruel to people or animals steals from a victim while confronting them (e.g. assault) forces someone into sexual activity Destruction of Property deliberately engaged in fire setting with the intention to cause damage deliberately destroys other's property Deceitfulness, lying, or stealing has broken into someone else's building, house, or car lies to obtain goods, or favors or to avoid obligations steals items (e.g. shoplifting, but without breaking and entering) Serious violations of rules often stays out at night despite parental objections runs away from home often truant from school Treatment

 Child Training Child training involves the teaching of new skills to facilitate the child's growth, development and adaptive functioning Family interventions The development of effective parenting skills has been considered as the primary mechanism for change in child conduct disorder. School based programmes School based programs have involved teaching the child interpersonal problem solving skills, strategies for increasing physiological awareness, and learning to use self talk and self control during problem situations.