Cultural understanding of disorders
Parenting varies across culture and sub-cultures;
Expectation of normal development changes across time
the case of Disruptive Mood Dysregulation Disorder
Key considerations of Pathology in Childhood
- The specific nature of problems in childhood;
- The complicating role of typical developmental factors
- Developmental roots of adult conditions
- The significance of early intervention and prevention
Wide Range of Typical Development
Object permanence (6-12 months)
Say Mama/Dada specifically (9-14 months)
Walking (9-17 months)
Toilet Training (24-36 months)
Changes that the DSM made for Neurodevelopmental disorders
🔹 Main goals
- Shift to a lifespan approach — shows developmental links between child, adolescent, and adult disorders.
- Reorganised and regrouped conditions to reflect this developmental focus.
🔹 New Disorders Added
- Social (Pragmatic) Communication Disorder (SCD)
For people with social communication difficulties without repetitive behaviours (not ASD). - Disruptive Mood Dysregulation Disorder (DMDD)
Chronic irritability and temper outbursts in children (under depressive disorders).
🔹 Adjustments
ADHD:
Later age of onset now allowed (not limited to early childhood).
PTSD:
New subtype for children under 6 years (trauma/stressor-related).
Autism Spectrum Disorder (ASD):
Subtypes removed (e.g., Asperger’s now part of ASD).
Can diagnose with later symptom onset and milder forms now included.
DIfferent forms of DSM-5 Disorders in Children
- Externalising Disorders
Oppositional defiant disorder, Conduct disorder - Internalising Disorders
Anxiety, Mood and Somatic Disorders - Disorders of Basic Functions
Sleeping, eating, toileting - Neurodevelopmental disorders
Intellectual disability, ASD, ADHD,
Disorders of Neglect
Abuse, Trauma and Adjustment Disorder
What are the two main features of diagnosis for Autism in the DSM
Social Communication and Interaction Deficit
Restricted and Repetitive Behaviours and Interests
what is ‘Social Communication and Interaction Deficit’ (one of the main characteristics of autism)
- Difficulty making and maintaining relationships
- Difficulty in developing theory of mind
- Lack of reciprocity in social interaction
what is ‘Restricted and Repetitive Behaviours and Interests’ (one of the main characteristics of autism)
- Stereotyped behaviour patterns, routines, rituals, tics and OCD-like symptoms
- Restricted interests and preoccupations
- Resistance to change
Other clinical features of Autism
Unique cognitive profile
Language delay
Difficulty appreciating humour
1/3 cases develop epilepsy
Poor motor co-ordination
Hypo- and hyper- sensitivity
Autism (ASD) Diagnostic criteria A
A. Persistent difficulties in social communication and interaction across settings, shown by:
- Social-emotional reciprocity:
Trouble with normal back-and-forth conversation, sharing emotions, or initiating interaction. - Nonverbal communication:
Poor eye contact, body language, gestures, or facial expression. - Relationships:
Difficulty making/keeping friends, adjusting to social contexts, or showing interest in peers.
Autism (ASD) Diagnostic criteria B
B: Restricted, Repetitive Patterns of Behaviour, Interests, or Activities
Must show at least 2 of the following (now or in the past):
- Repetitive movements, use of objects, or speech
- e.g., hand-flapping, lining up toys, repeating words/phrases (echolalia). - Insistence on sameness / routines
- e.g., distress with small changes, rigid routines, same route or food, fixed rituals. - Highly restricted or fixated interests
- e.g., intense focus on specific topics or objects, unusual preoccupations. - Sensory differences
- e.g., over- or under-reactive to sounds, textures, lights, pain, or temperature.
Criteria C,D and E for Austism
- Criterion C: symptoms must be present in the early developmental period (but may not become fully manifest until social demands exceed ‘limited’ capacities, or may be masked by learned strategies later in life).
- Criterion D: …causing clinically significant impairment
- Criterion E: …not better explained by intellectual developmental disorder or global developmental delay. Noting that ASD and intellectual developmental
disorder can frequently co-occur (comorbid), so careful consideration is needed to tease out if one or both diagnoses are justified.
Treatment of ASD
Psychoeducation
Family-based approach to management
Structured teaching
Behaviour support
Functional behavioural analysis + Positive behavioural plan
Planning for life transitions
Psychopharmacological treatment
Ineffective/unproven treatment or prevention
- Sensory integration training
- Facilitated communication
- Gluten- and casein-free diets
- Omega-3 fatty acids, vitamins, chelation, and immunoglobulin
- Reject vaccination
What is Neuroaffirming practices or interventions
(NAIs)
Neurodiversity affirming frameworks are a paradigm shift from a deficit-focused approach to autism to recognizing autism as a heterogeneous constellation of differences in abilities and strengths
What is the two main criteria for ADHD
- inattention
- Hyperactivity/impulsivity
What is meant by “inattention” in ADHD (main criteria)
- cannot sustain attention across contexts
- Overlooks details
- Seems to not be listening when being talked too
- Difficulty following instructions
- planning and organisational difficulties
What is meant by ‘hyperactivity/impulsivity” in ADHD (main criteria)
- fidgeting or squirming
- leaves seats, runs or climbs when they are expected to stay still/feels restless
- Talks excessively/interrupts others
Other clinical features of ADHD
-poor time estimation
- poor planning skills
-difficulty internalising routines, skills and rules
- delay in motor development and clumsiness
- low frustration tolerance and anger
Prognosis (outcome) of ADHD
- language delay
- difficulty learning
- conflictual relationship with their parents
- accidental injury or obesity
-low self-esteem and depression - possible conduct problems
ADHD treatment options
Psychoeducation
Medication
Family intervention
School intervention
Child-focused intervention
Artificial food colour [AFC] elimination
What is anxiety?
Fear is an adaptive response to danger
Normal adaptive fears become maladaptive if there
is an inaccurate appraisal of the threat to well-being
These maladaptive fears are referred to as anxiety
What is the most common anxiety disorder in children?
Phobias are the most common anxiety
disorders in children
Prognosis (outcome) of anxiety
- More common among girls
- High co-morbidity
- At risk of social isolation, educational underachievement and anxiety and mood disorder in adulthood
However: “The potential for early intervention can
reduce the lifelong impact of these disorders
