CHAPTER 21: BEHAVIORAL AND PSYCHIATRIC

DISORDERS IN CHILDREN WITH DISABILITIES

Pages 297-311

Presented By Sonya Felmly

OBJECTIVES After this presentation you will be able to….

1. Describe different psychiatric and behavioral disorders

2. Match treatment with the correct disorder

WHY? Dual Diagnosis is a term applied to the co-

existence of the symptoms of both intellectual or developmental disabilities and mental health problems

Causes: Stress- in social situations

These negative social conditions include social rejection, stigmatization, and the lack of acceptance in general.

Lack of communication skills Heredity Limited coping skills unknown

STATISTICS

Wright, Rutter, Graham, and Yule found emotional disturbances in 7%-10% of children who do not have any disabilities.

They also found 30%-42% of children with intellectual disabilities had psychiatric disorders

Gillberg found 57% of children and adolescents with mild intellectual disabilities and 64% with severe intellectual disabilities met the criteria for psychiatric disorders.

OPPOSITIONAL DEFIANT DISORDER Children must exhibit negative, hostile, and

defiant behaviors for at least six months. Children must have at least four of the eight

symptoms.1. Often loses temper2. Often argues with adult3. Often breaks rules or fails to comply with adult requests4. Deliberately annoys people5. Blames others for one’s mistakes6. Is touchy or easily annoyed7. Is angry and resentful8. Is spiteful and vindictive

Most diagnosis are usually given to preadolescent children.

CONDUCT DISORDER To be diagnosis with conduct disorder the

child must exhibit behaviors in which peoples rights are violated, norms are ignored, and rules are broken for at least 12 months.

Four main problem areas include1. Aggression towards people and animals2. Destruction of property3. Deceitfulness or theft4. Serious violation of rules

TREATMENT FOR ODD AND CD Same behavior management techniques that

are used for children with ADHD. Medication Behavioral Therapy

Includes setting consistent limits, behavioral expectations, and consequences for violating the limits

Expectations must be the same at home and school

Positive Reward System Prize box at the end of the week Tokens to buy time at the computer or in front of

the TV

IMPULSE CONTROL DISORDERS

Explosive Disorder Diagnosis after the child demonstrates several

episodes of failing to resist aggression Example: A child wants to go outside instead of eating

their dinner. The child's parent tells them they can go outside after dinner. The child throws their food across the room, throws their chair, and hits their baby brother.

Treatment Beta blockers such as propranolol, and certain

antiepileptic/mood stabilizers.

IMPULSE CONTROL DISORDERS Trichotillomania

Child pulls out their hair and sometimes eats it There is a sense of relief when the child pulls out

their hair. Eating hair can be very dangerous and might

require surgery to get it out of the body

Treatment Medicine Cognitive- Behavior Therapy

GENERALIZED ANXIETY DISORDER Children have at least six months of anxiety and worry about situations.

Situations include school, play, sports, friends, and family

Other symptoms can include.. Being keyed up, being easily fatigued, having

problems concentration, and experiencing irritability, muscle tension, and disturbed sleep.

Treatment Cognitive-Behavioral Therapy

To reduce worry Medication

PANIC DISORDER Panic Attacks usually do not begin until

puberty Panic Attacks include at least four of these

symptoms1. Rapid or racing heartbeat2. Sweating, trembling, or shaking3. Feeling short of breath or as it smothering4. Feeling as if choking5. Chest pain or discomfort6. Nausea or abdominal distress7. Feeling dizzy, lightheaded, or faint8. Feeling of unreality or detachment9. Fear of losing control or going crazy10. Fear of dying11. Numbness and tingling12. Hot flashes or chills

PANIC DISORDER

Treatment- High-potency benzodiazepines such as alprazolam (Xanax) and clonazepam (Klonopin) Cognitive- behavioral therapy

Develop a list of things that triggers panic attacks Patients work through the list (facing the different issues)

SOCIAL PHOBIA A fear of doing something embarrassing in

front of others including strangers. In order to be diagnosed with social phobia

the child has appropriate relationships with family and friends but is afraid of other peers and adults.

The child might cry, have a tantrum, freeze or shrink from situations with unfamiliar people.

Symptoms must last for more than 6 months. Treatment-

Cognitive-behavioral therapy Reduce anxiety in social settings

Speech classes/acting classes

OBSESSIVE-COMPULSIVE DISORDER A child with OCD has obsessions,

compulsions, or both. Obsessions are reoccurring thoughts, images,

or impulses that cause anxiety. Compulsions are repetitive behaviors or

mental acts that are done to neutralize and obsession. Hand washing, counting, arranging,

tapping, touching, and hoarding To be diagnosed with OCD the obsessions

and compulsions must occupy more than one hour per day and interfere with everyday functioning.

OBSESSIVE-COMPULSIVE DISORDER Treatment

Cognitive-behavioral Therapy Exposure and Response Prevention

Example- A child with a fear of germs would be asked to touch a doorknob and then they are not permitted to wash their hands.

Medications Zoloft, Prozac, Luvox

POSTTRAUMATIC STRESS DISORDER Anxiety disorder that happens after a

traumatic event in which a person witnesses a death, serious injury, or threat.

Children with a developmental disability might occur after physical abuse or after the injury that caused the disability.

Children with intellectual disorders are more prone to PTSD because they have limited coping skills.

To be diagnosed with PTSD the child must demonstrate symptoms for at least one month and symptoms must interfere with daily life functioning.

POSTTRAUMATIC STRESS DISORDER

Symptoms-Reexperiencing the trauma

-Dreams, flashbacksAvoidance and numbing

-avoids thoughts, feelings, people, places -unable to recall important aspects of the event -decreased interest or participation in activities Increased arousal -difficulty sleeping -angry outburst -difficulty concentrating

Treatment psychotherapy and play therapy -patients must talk through thoughts and

events that remind them of the trauma

MAJOR DEPRESSION Children with major depression exhibit a 2

week period with at least five of the following symptoms

1. Depressed mood by subjective report or as observed by others2. Decreased interest or pleasure in most activities3. Significant change in weight or appetite4. Insomnia or hypersomnia5. Psychomotor agitation or retardation6. Fatigue or loss of energy7. Feelings of worthlessness or guilt8. Decreased concentration or indecisiveness9. Recurrent thoughts of death and dying

Treatment Medicine Psychotherapy

BIPOLAR DISORDER Consists of changes between depression and mania or

both together A manic episode consists of a period of abnormally

and persistently elevated, expansive, or irritable mood lasting at least 1 week.

Mood disturbance must have at least three of the following if happy and four if irritable. 1. Inflated self-esteem 2. Decreased need for sleep3. More talkative 4. Flight of ideas 5. Distractibility6. Increased goal directed activity or psychomotor agitation7. excessive involvement in pleasurable activities that have

high potential for painful consequences

BIPOLAR DISORDER

Treatment Mood stabilizers Antipsychotic medications

Risperdal, Abilify, Zyprexia, Seroquel, Geodon Children with bipolar must have consistent

bedtimes and routines so the lack of sleep does not participate to manic or a mixed episode.

PSYCHOTIC DISORDERS Schizophrenia

Two or more of the following symptoms for at least a one month period

1. Delusions (someone is following you)2. Hallucinations (hearing voices when no one is talking)3. Disorganized speech and grossly disorganized or catatonic

behavior

Treatment -antipsychotic medication

**Youtube the 20/20 on children with schizophrenia

EATING DISORDERS Rumination

Repeatedly regurgitate without nausea or gastrointestinal illness for at least 1 month

Self-stimulatory behavior for children with intellectual disabilities

Binge Eating Large amounts of food during a short period of

time Do not use purging Risk for choking, and death Obesity

MALADAPTIVE BEHAVIOR DISORDERS Self-Stimulating Behavior

Biting their hands, banging their heads, picking at their skin, poking their eyes, and hitting themselves with their fist.

May do this once or twice a day or several hundred times an hour

Tissue destruction, infection, internal injury, loss of vision , and even death

Occur in fewer than 5% of people with disabilities

TREATMENT Educational Interventions

-self-contained classroom -one on one support -therapy sessions with the school counselor and

a behavioral psychologist Rehabilitation Therapy

- language impairments contribute to behavior problems

- teaching functional communication skills - speech-language therapy and other

communication systems (PECS) -Physical and Occupational Therapy

-motor function

TREATMENT Psychotherapy

- Table 21.2 on page 306 - The table shows the different types psychotherapy

and uses in different disorders -Goals of therapy are to relieve symptoms and help

the child to understand the nature of his or her disability. -Including feelings to recognize their strengths.

- social skills - peer pressure, rejection, stigmatization, and

exploitation Behavior Therapy (most widely researched

psychotherapeutic intervention for children and adolescents with disabilities.

TREATMENT Pharmacotherapy

-use of medicine - table 21.3 on page 308 gives all of the different

medicines and which psychiatric disorder it treats

Antidepressants Treat major depression and anxiety disorders

(OCD, generalized anxiety disorder, separation anxiety)

Antihypertensive - beta blockers - explosive and aggressive behavior, tourette

syndrome, ADHD

TREATMENT Benzodiazepines

-reduces anxiety - children with developmental disabilities may become

agitated rather than clam and sleepy -can not be used over a longer period of time

Mood Stabilizers -Treat bipolar disorder and aggressive behaviors

Stimulants and Atomxetine - Treats ADHD and ASD - side effects include loss of appetite, insomnia, tics,

headache, and gastrointestinal side effects - controls hyperactive/impulsive symptoms

PHYSICAL EDUCATION Modify Rules of the game so students are

very successful

Modify Equipment Soft Can not eat

Consistency Routines are the same Kids know what to expect!

SUMMARY Children with developmental disabilities are

more likely to develop psychiatric and behavioral disorders.

Psychiatric and behavioral disorders can interfere with the child’s daily living if it goes untreated.

Behavioral disorders include oppositional defiant, conduct , intermittent explosive, and trichotillomania.

Anxiety disorders include panic disorder, social phobia, obsessive-compulsive disorder, and posttraumatic stress disorder

SUMMARY Mood disorders included major depression

and bipolar disorder. Other disorders that were discussed was

schizophrenia, eating disorders, adjustment disorders, and maladaptive behavior disorders.

There are several different ways to help treat all of these disorders. Some ways can include rehabilitation therapy, psychotherapy, and pharmacotherapy.

Don’t forget to look at page 308 in your book to see the table of medications used to treat psychiatric disorders!