ADHD, Conduct Disorder, Oppositional Defiant Disorder, and Childhood Enuresis PDF

ADHD, CONDUCT DISORDER, OPPOSITIONAL DEFIANT DISORDER, AND CHILDHOOD ENURESIS PSYCHIATRY Dr. Hajer sabri Lecturer of physical therapy [email protected]  ATTENTION DEFICIT HYPERACTIVITY DISORDER (ADHD) Definition: ADH...

ADHD, CONDUCT DISORDER, OPPOSITIONAL DEFIANT DISORDER, AND CHILDHOOD ENURESIS PSYCHIATRY Dr. Hajer sabri Lecturer of physical therapy [email protected]  ATTENTION DEFICIT HYPERACTIVITY DISORDER (ADHD) Definition: ADHD is characterized by inattention, hyperactivity, and impulsivity that interfere with social or academic function. Symptoms last for at least 6 months, and onset occurs before age 12. Symptoms are present in multiple settings. Subtypes are based on the predominance of symptoms of inattention or of hyperactivity and impulsivity. Risk Factors/Etiology: No specific etiologies have been identified. Other CNS pathology and disadvantaged family and school situations are sometimes present. Prevalence: 5% of school-age children and 2.5% of adults. Male-to- female ratio is 2:1 in children and 1.6:1 in adults. Family history: ADHD, mood and anxiety disorders, usually first recognized when a child enters school, and symptoms usually persist throughout childhood. ADHD, particularly the attention deficit, persists into adulthood in most but not all affected individuals. Hyperactivity tends to diminish in adolescence and adulthood. Symptoms: Short attention span, constant fidgeting, inability to sit through cartoons or meals, inability to wait in lines, failure to stay quiet or sit still in class, disobedience, shunning by peers, fighting, poor academic performance, carelessness, and poor relationships with siblings. Common Associated Problems: Low self-esteem, mood lability, conduct disorder, learning disorders, clumsiness, communication disorders, drug abuse, school failure, and physical trauma as a result of impulsivity. Physical Examination: Perceptual: motor problems and poor coordination may be present. Diagnostic Tests: IQ tests and various structured symptom-rating scales for use by teachers and parents are often used. 1 Differential Diagnosis: Major rule-outs are age-appropriate behavior, response to environmental problems, ID, ASD, and mood disorders. Treatment: Target symptoms are defined before initiating treatment. Psychological, social, and educational interventions include adding structure and stability to home and school environments. Specialized educational techniques include the use of multiple sensory modalities for teaching, instructions that are short and frequently repeated, immediate reinforcement for learning, and minimization of classroom distractions. Pharmacotherapy of choice is stimulant medications, such as methylphenidate and dextroamphetamine. Non-stimulants such as atomoxetine may also be used. They are usually effective in decreasing hyperactivity, inattention, and impulsivity. Other medications include antidepressants and clonidine. 2  CONDUCT DISORDER Definition: Persistent violations over at least 6 months in 4 areas: aggression, property destruction, deceitfulness or theft, and rules. Risk Factors/Etiology: Genetic influences play a role by affecting temperament. Stressful family and school environments have also been implicated. Prevalence: 4% of school-age children. Seen more in males. Family History. Antisocial personality disorder, conduct disorder, ADHD, mood disorders, and substance-related disorders. Onset: Most often during late childhood or early adolescence. In most individuals, symptoms gradually remit. Key Symptoms: Bullying, fighting, cruelty to people or animals, and rape, vandalism, fire setting, theft, robbery, running away, school truancy. Complications: Substance-related disorders and school failures Outcome: Often, antisocial personality disorder, somatic symptom disorders, depressive disorders, and substance-related disorders Differential Diagnosis: Major rule-outs are environmental problems, ADHD, and oppositional defiant disorder. Treatment: Healthy group identity and role models are provided by structured sports programs and other programs (e.g., Big Brothers). Structured living settings that place value on group identification and cooperation are useful. Punishment and incarceration are not often effective. 3  OPPOSITIONAL DEFIANT DISORDER Definition: Persistent pattern lasting at least 6 months of negativistic, hostile, and defiant behaviors toward adults, including arguments, temper outbursts, vindictiveness, and deliberate annoyance. Risk Factors/Etiology: High reactivity and increased motor behavior are innate features of temperament that may predispose to this disorder. Inconsistent or poor parenting may also contribute. Prevalence: 3% of school-age children. Male-to-female ratio is 1:1 after puberty but boys more than girls before puberty. Onset: Usually in latency or early adolescence and may start gradually. Onset later in girls. Associated Problems: Family conflict and school failure, low self- esteem and mood lability, early onset of substance abuse, ADHD and learning disorders. Course: Family conflict often escalates after the onset of symptoms. Outcome: Conduct disorder may follow. Treatment: Parents should be advised to spend time interacting with a child, to reward desired behavior and not simply punish undesired behavior, and to be consistent in statements and deeds. Alternative caregivers may be indicated in some cases. Differential Diagnosis. Conduct disorder 4  CHILDHOOD ENURESIS Definition: The disorder is characterized by repeated voiding of urine into the patient’s clothes or bed in a child at least 5 years of age. It is diagnosed only if the behavior is not due to a medical condition. Risk Factors/Etiology: Current psychological stress, family history of enuresis, and urinary tract infections. Prevalence: 3–5% of children aged 10. Slightly more common in boys. May occur only at night, only during daytime, or both. Often causes emotional turmoil in the child or parents. Physical Examination: Assessment for urinary tract infection or abnormalities should occur. Treatment: Appropriate toilet training and avoiding large amounts of fluids before bed are important, as are decreasing emotional stressors. A bell-pad apparatus is the best treatment. Pharmacotherapy includes imipramine and desmopressin (DDAVP) (1‐deamino‐8‐D‐arginine vasopressin) for short-term treatment. 5