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OBJECTIVES

Objectives

After studying this chapter, the student should be able to:

  • State the common types of social, emotional, and behavioral problems seen in childhood and adolescence.

  • Understand the causes and diagnoses of common disorders in child and adolescent psychiatry.

  • Describe the treatment modalities and different approaches required for children and adolescents with psychiatric issues.

PREVALENCE & BURDEN

Almost 1 in 5 children either currently or at some point during their life will have a severe mental disorder. Mental and substance use disorders are the leading cause of disability in children and youth worldwide, and depression is the number 1 cause of loss of disability-adjusted life-years. These conditions can affect children’s development, educational attainment, and potential to live fulfilling and productive lives.

DISORDERS

In this chapter, psychiatric disorders prevalent in child and adolescent years are discussed. Some disorders will gradually improve with maturation, some will persist through adulthood, and some will worsen without adequate intervention. We will also note the different presentations of some common psychiatric disorders in children and adolescents. Eating disorders are also included in this chapter because their onset often occurs in adolescence.

Neurodevelopmental Disorders

Neurodevelopmental disorders are characterized by developmental deficits of the central nervous system, which can have prominent effects on personal, social, academic, or occupational functioning. These can vary from very specific impairments (eg, communication disorder) to global impairments (eg, intellectual disability). It is common for these disorders co-occur (eg, intellectual disability with autism spectrum disorder, or attention-deficit/hyperactive disorder [ADHD] with a specific learning disorder). Because the etiology of these conditions varies, their presentation is also heterogeneous. There are few pharmacologic treatments indicated specifically for neurodevelopmental disorders, other than stimulants for ADHD. However, nonpharmacologic interventions such as speech therapy, occupational therapy, educational support, and psychotherapy can improve overall prognosis and daily functioning.

Intellectual disabilities are the result of a variety of prenatal, perinatal, and postnatal etiologies. Congenital causes include fetal alcohol syndrome (FAS), genetic conditions such as trisomy 21 and fragile X syndrome, and infections during pregnancy such as toxoplasmosis. In some cases, intellectual disability may result from severe head injury, infection, or other acquired factors after birth. Intellectual disability is characterized by deficits in general mental abilities and impairment in everyday adaptive functioning, compared with an individual’s age-, gender-, and socioculturally matched peers. Examples of areas of impaired functioning may include reasoning, problem solving, planning, abstract thinking, judgment, academic learning, and learning from experience. With severe intellectual disability, delay in major milestones in the motor, language, and social aspects can be identified within 2 years of life, but mild cases may not be diagnosed until school age. Approximately 1% of the general population is affected by intellectual disabilities, and severe intellectual disability is estimated to be present in approximately 6 per 1000 population. Males are more likely than females to be diagnosed ...

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