Psychiatry Chapter 1: Children and Adolescents

Children and Adolescents Psychiatric Evaluation

• Comprehensive evaluation includes interviews with parents, child, and other family members
• Assesses current school functioning, intellectual level, academic achievement, developmental level, and neuropsychological factors
• Court or child protective services may initiate psychiatric evaluation in some cases
• Children can report on mood, psychotic symptoms, fears, anxiety but may have difficulty with symptom chronology
• Very young children express experiences through play rather than verbally

Assessing Infants and Young Children

• Interviews often start with parents present to assess parent-infant interaction
• Infants may be referred for high irritability, feeding/sleep issues, withdrawn behavior, developmental delays
• Assess motor, communication, play, problem-solving, relationships, social responsiveness

School-Age Children

• Some are comfortable conversing, others may show fear, anxiety, poor verbal skills, or oppositional behavior
• 45-minute session is typical, with room setup to allow child to move around

Adolescents

• Able to provide chronological account and distinct ideas about evaluation
• Value hearing adolescent's perspective, avoid blame or judgment
• Emphasize confidentiality, explore adolescent's beliefs about evaluation outcome

Mental Status Examination

• Detailed observations of child's physical appearance, affect, speech, language, cognition, judgment, insight
• Assess parent-child interaction, social relatedness, motor behavior

Neurodevelopmental Disorders

• Intellectual disability due to genetic and environmental factors, with cognitive and adaptive impairments
• Genetic disorders have characteristic behavioral phenotypes (e.g. Prader-Willi syndrome, fragile X, Rett syndrome)
• Other acquired disorders include infections, head trauma, asphyxia, lead exposure

Autism Spectrum Disorder

• Characterized by impairments in social communication and restricted/repetitive behaviors### Autism Spectrum Disorder

• Autism spectrum disorder is a phenotypically heterogeneous group of neurodevelopmental syndromes with polygenic heritability

• Before DSM-5, the spectrum included 5 overlapping disorders: autistic disorder, Asperger disorder, childhood disintegrative disorder, Rett syndrome, and pervasive developmental disorder not otherwise specified

• These differed in severity, specific syndrome, and underlying pathology

• Recent consensus has shifted to a continuum model where heterogeneity of symptoms is inherent

• DSM-5 collapsed the core impairments into 2 domains: deficits in social communication, and restricted/repetitive behaviors

• Aberrant language development is no longer a core feature but an associated feature in some individuals

Communication Disorders

• Range from mild delays to expressive/mixed receptive-expressive disorders, phonological disorders, and stuttering
• Language delay affects up to 7% of 5-year-olds, with rates up to 20% in 4-year-olds
• Children must develop mastery of multiple language aspects to communicate effectively
• DSM-5 includes Language Disorder and Speech Sound Disorder

Speech Sound Disorder

• Difficulty pronouncing speech sounds correctly due to omissions, distortions, or atypical pronunciation
• Includes omitting last sounds, substituting sounds, and distorting sounds due to interrupted airflow

Attention-Deficit/Hyperactivity Disorder (ADHD)

• Neuropsychiatric condition with diminished sustained attention and increased impulsivity/hyperactivity
• Biologic basis supported by family history, genotyping, and neuroimaging
• Affects up to 5-8% of school-age children, with 60-85% persisting into adolescence and 60% into adulthood
• Frequent comorbidities include learning disorders, anxiety, and mood disorders
• Core characteristics: hyperactivity, attention deficits, impulsivity, memory/thinking deficits, learning disabilities, speech/hearing deficits

Motor Disorders

• Developmental Coordination Disorder: Slower, less accurate, and more variable fine/gross motor coordination than peers
• Stereotypic Movement Disorder: Repetitive, rhythmic movements that seem self-soothing but can cause self-injury
• Tourette's Disorder: Tics characterized by brief, rapid motor movements or vocalizations

Depressive Disorders in Children and Adolescents

• Prevalent and have long-term adverse effects on cognitive, social, and psychological development
• Affect 2-3% of children and up to 8% of adolescents
• Core features resemble adult major depression, but influenced by developmental level
• Moderately heritable (40-50%), with environmental stressors and adverse events as significant contributors

Comprehensive evaluation of children and adolescents in psychiatry, including standardized measures and neuropsychological assessments. Learn about the importance of current school functioning and intellectual level in psychiatric evaluations.