DR/KHALID ALHARBY

CHILD PSYCHIATRY

Dr. KHALID AL-HARBY

MBBS,SBFM,ABFM

DR/KHALID ALHARBY

Main types of childhood psychiatric

disorder

Disorders of older

children.

•Emotional disorder.

•Disorders of

sleeping & elimination.

•Conduct disorder.

•Hyper kinetic syndrome.

Disorders of

pre-school children.

•Temper tantrums

•breath holding.

•Sleep problems.

•Feeding problems

DR/KHALID ALHARBY

Main types of childhood psychiatric

disorder

Disorders of development:

•Childhood autism.

•Specific developmental disorders.

•Gender identity disorders

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Causes

Family factors.

- Separation.

- Illness of parent.

- Parental relations.

- Personality deviance

of parent.

- Large family size.

- Child abuse and

neglect.

Social and cultural

factors.

•Overcrowded living

conditions.

•Inadequate social

amenities.

•Lack of community

involvement.•Heredity.

•Physical

disease

•Environment

DR/KHALID ALHARBY

Assessment of Psychiatric problems

in childhood

Interviewing the parents.

Interviewing the child.

Interviewing other informants.

DR/KHALID ALHARBY

Interviewing parents:

THE MAIN ITEMS FOR ASSESSMENT

The presenting

problem.

Nature, severity,

frequency.

Situations in which

it occurs.

Factors which make it

worse or better

Family history:separations from

and illness of parents.

Quality of relations

with

parents and siblings.

Personal history of

the child.

- Pregnancy - Birth

- Development

- Past illness and injury

- Attendance and

attainments at school

Other current

problems.Mood, activity,

concentration.

Physical symptoms.

Eating, sleeping,

elimination.

•Relationships,

particularly with

parents and siblings.

•Antisocial behavior.

•School

performance.

DR/KHALID ALHARBY

Principle observations of a child’s

behavior & emotional state

Appearance.

Activity level.

Mood.

Rapport with the interviewer.

Relationship with parents.

Habits, mannerisms

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Interviewing other informants

Teachers

social workers.

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Indications for In-patient Care

Severe behavioral disorder.

For observation.

To separate the child.

To observe relationship with mother

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Temper Tantrum

Temper tantrums range from whining and crying to screaming, kicking, hitting, and breath-holding.

Equal in girls and boys, age: 1-3 y.

Even the most good-natured toddlers has an occasional temper tantrum (normal development)

Tantrum Tactics:

Keep cool ( do not complicate the problem with your own frustrations)

Assess the situation

Take the child to a quite, secluded place to calm down

DR/KHALID ALHARBY

Breath holding spells (BHS)

a benign, involuntary recurring condition of childhood in which anger or pain produce crying that culminates in noiseless expiration and apnea.

5% of all children ageing (6m-6y)

Most common in 12-18 months

Boys and girls are affected equally

+ ve family history is found in 25%

One of the nonepileptic paroxysmal disorders of childhood

2 types: cyanotic, and pallid

DD: epileptic seizures, syncope, benign paroxysmal vertigo, cataplexy, central or obstructive apnea

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Breath holding spells (BHS)

Rx.

- parents respond calmly.

- it disappears with time.

No drug is needed: although atropine sulfate may be considered in the management of children with frequent pallid BHS ( because of its anticholinergic action)

Spontaneous resolution in the vast majority of children by the age of 5-6 years

About 50% of cases resolve by the age of 4 years

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Awake fullness

1/5 of aged 1 - 2 y.

Rx.:

- reassure parents.

- Advice:

* don't: 1. Respond as soon as he cries.

2. Spend long periods on his bed side.

3. Take the child to their own bed.

* do: 1. Establish a consistent bed time routine.

2. Avoid reinforcement of the behavior.

3. Improve the appearance of the child’s

bed.

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NIGHTMARES AND NIGHT

TERRORS

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Nightmares

Awakening from REM sleep (which constitute

<25 % in children above age of 6 years and

adults) to full consciousness with recall of

unpleasant dreams.

Common in children 5 - 6 yrs. of age.

Stimulated by frightening experience during the

day.(If frequent: day time anxiety).

Rx.

- causes of anxiety. - Re assurance .

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Night terrors

Awakening from stage 3 or 4 of NREM sleep (usually 90 min. after going to sleep).

Terrified, confused, and cry for 5-30min.

No recall of dream.(and at morning no recall of the episode)

Settle slowly in few minutes & return to normal calm sleep.

Not persisting to adult life.

Occur in 5-15% of children 4-6 y. (though they can appear in babies as young as 9 m)

Rx: Not specific

(? Awake him shortly before the usual time of terror).

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Sleep walking(somnambulism)

Walk as if he is awake.(for few minutes).

? Anxious, not answering questions.

Difficult to awaken him, but easy to “drive”

Occurs usually during deep NREM sleep <stage 3 or stage 4 sleep> (early part of the night).

Age 5 - 12 yrs. (at least once in 15% of them).

Rx:

- Non specific - Reassurance

Mild: parents should maintain a consistent approach & set color limits to the child’s behavior.

- Close doors and windows - Avoid dangerous objects – hypnosis may be helpful - benzodiazepines

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Food Refusal

Brief periods are common in pre-school.

Rx:

- ignorance.

- don’t offer the child special food.

- don’t force him to eat.

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Pica (geophagy)

PIE-KAH, magpie

The craving or eating of items that are not food (for at least one month)

No specific test, no specific prevention

Age: 2-6 years (in 10-32% of this age group) , ? Family pet

Substances commonly ingested: Dirt

Clay

Chalk

Cigarette ashes

Sand

Paint

Plaster

Gravel

Rocks

Starch

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Pica

At risk people:Malnutrition or vitamin deficiency

Poor people

family history of pica

Mental retardation

Ethnic or cultural reasons

Complications:malabsorption

Lead poisoning

Intestinal obstruction

intestinal infection

Anemia

Mercury poisoning

Dental injury

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Pica

Not an eating disorder

Physiological theory: eating clay or dirt helps relieve nausea, control diarrhea, increase salivation, remove toxins, and alter odor or taste perception.

Psychological theory: a behavioral response to stress, a habit disorder, or a manifestation of oral fixation

Rx:

- Modify stress

- keep away

- reassure: with aging.

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School Refusal

The child may be Psychologically unable to attend school even though he wishes to do so.

C/P: - sudden refusal to attend school (complete)

- gradually increasing reluctant to leave home.

- somatic complaint. (Only on School days).

Causes:

- separation anxiety (normally at age 18-24 months when separated from caregiver but may persists).

- bullying by other children or failure in class.

- marital problems between parents, or illness of

a family member

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School Refusal

Prevention:

Toddlers and preschoolers can benefit from structured experiences with other adults.

Inform the child calmly that the parent will return and the child is to stay. Then leave quickly.

A firm, caring and quick separation is better.

Prognosis: most of them eventually return to school.

Rx:

Modify stress circumstances: helping the child to relax, develop better coping skills, using a contract,…..

Treat the underlying cause

.

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Hyper kinetic Syndrome (ADHD)

1/3 of children are described as overactive by their parents and 1/5 of school children by their teachers.

Incidence in USA is 3-7%

A developmental condition of inattention and distractibility with or without hyperactivity.

C/P: ( it should start before the age of 7 years).

- Extreme restlessness - Impulsiveness

- Sustained motor activity - Poor attention

- Learning difficulties - Temper and aggressive.

Etiology: not related to food (e.g. sugar)

- Genetic - Social - Lead intoxication

- intrauterine exposure to Food additives

DR/KHALID ALHARBY

Hyper kinetic Syndrome (ADHD)

Prognosis:

ê age.

usually ceases by puberty

associated learning difficulties are less likely to improve.

antisocial behavior has the worst prognosis.

Rx:

Stimulant drugs e.g. Methylphenidate

? Paradoxical effect.

No addiction by those children !!Family and social support.

DR/KHALID ALHARBY

CONDUCT DISORDER

DR/KHALID ALHARBY

CONDUCT DISORDER

Severe and persistent antisocial behavior.

The most common type of Psychiatric disorders among adolescents.

C/P: Disobedience, lying, aggressiveness, school problems, taunting, stealing, vandalism & fire setting, disapproved sexual behavior, alcohol & drug abuse.

Etiology:

environmental factors (important):

unstable, insecure, & rejecting families living in deprived areas.

Constitutional factors

speech & reading difficulties

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CONDUCT DISORDER

Prognosis:

if mild often improve

if severe could persist.

Rx:

Severe: 1). stressful circumstances.

2). Behavioral approach:

- Rewarding desirable behavior

- Ignoring undesirable behavior

NB/: No effective Medications

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JUVENILE DELINQUENCY

It is considered because some have conduct disorder.

Most common about 15-16 yrs. of age,

male > female.

Causes:

1. Low social class, poverty,poor housing and

poor education.

2. Poor parenting and shared attitudes to the law

Rx:

- improve family environment

- educate the child:

- improve skills

- harmful peer group influences

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AUTISM

Rare. C/P:

inability to relate

speech and language disorder.

resistant to change.

odd behavior and mannerism.

seizures (in adolescence)

Etiology:

unknown

? Genetic cognitive abnormalities thinking and language.

no rule for abnormal parenting

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AUTISM

Prognosis:

about 50% acquire some useful speech but may continue to show emotional coldness and odd behavior.

10 - 20% can attend ordinary school and later obtain work.

10 - 20% need special school.

60 - 80% are unable to lead an independent life.

DR/KHALID ALHARBY