Stages of Psycho-Social Development and Childhood Disorders
***Stages of Psycho-Social Development (E.Ericson)
5 Stages:
Stage 1- Trust vs Mistruct (0-18M)
-0-18M
-Most fungamental Stage in Life
-Because infant is developing is based on Trust/ Dependable/Quality of Child Caregiver
-If child develops trust They will Feel Secure and Safe in the World!
-if caregiver is unavailable/ ejectin ..
…Failure to develop trust will result in Fear and world is unpredictable
Stage 2- Autonomy vs Shame& Doubt
-18M-3 Y
-Greater sense of PErsonal Control
-Toilet Training, Learnign body function
-Food choices
-Toy preferance
-Cloth
-if Stage is ocmpleted=Secure+ Confidents
-WORD ” NO”
Stage 3- Initiative vs Guilt
-3-5 YO
-Asset power + control
-Social interaction
-Sucess—>Capable to lead others
Stage 4- Industry vs Inferiority :
-6-11 YO
-Children Begin to Develop a Sense of PRide in accomplishements
-if + develop Feeling of confidence and Bleeif in SKill-
-if (-) —->doubt
Stage 6:- Indentity s Confusion
-12-18 YO
-Children Explore their Independeant And developing sense of Self!
– encouragment—–>Sense of Secure+ control
-lack encourgamens—–>insecure!!
***Sepcfici Development Disorder od scholastic skill!
-specific LEarning disavility affect the language Learning/ Doing Math/Calculation
-Child needs to hear in order to learn language
1-Dyslexia—–>Problem Reading
2-Phonologic Dyslexia—->problems with sound analysis memory!
3-Surface dyslexia—->problems with visual Recognition of Form+ Wrod structure
4-Dysgraphia—->Problem wil spelling/writtn experission
5-Duscalculla———->Poblem with Math/ problem solving
6-Ageometria————>PRoblem with disturbed mathemetical Reasoning
7-Anarithmia———>Disturbance in basic concept formation
8-Dysnomia—–>Difficulty Recalling Word From meory
-Trouble learning alphabet
-speech perception limited!
-language slower
-Problems understanding whati s read
^^T”
1-psychological therapy!
2-Specialized Instructions
3-Seperate and intense educational programs
(some children)
***119(DONE)
****120 Childhood autism: Sx/correction/ pervasice development!
| ASperger Syndrome | -Language and cognition better then autism -Social isolation -odd -eccentric -clumsins -repetivie patten/ beavior -atypical snesory response -Pregamatic defitic |
| Autism | -3 YO -(-) social interaction -reptieive behavior -intellectual disaility -severe regresson in lang& socialibty bwn 18-24 |
| Childhood disintegrative disorder | -maked regression after 2YO -more severe then autism -may mimic schizo Affected ares: -social skill/LAng/bladder/ motor skill |
| Pervasive development disorder | Does not meet criteria of any other subtypes widerange of cogntiive& behavioral poblems |
| Rett Syndrome | -Affects after 6 Moof Normal development -Decelerated of hed growth -severe intellectual disbility -(-) social interaction -loss of speech and purpos use fo 1 hand -siezures -autsitic features -ataxia -MOSTLY girls |
^^Tx:
1-b
Bahvioral Tx—>psychologist+educator
2-Speech & language Tx
————>should being early via use of media,singing, picture exchange
3-Physical occupation therapy!
4-X therapy!—>SSRI to imrpove bahvor
***ADHD Px/Dx:
^^Px:
-loss of normal assymetry in the brain
-Smaller brain volume of specific structues
(prefrontal cortex+ basal ganglia)
-reduction 5-10%
-Low BF to Staitum
-Prefrontal cortex and ganglia rixh with dopamine receptor
-Dopamine hypotheiss
—->dstubance of Dopamine systems leads to ADHD
^^DX:Criteri 1 or 2)
+ of the following Sx of inattention in last 6 mo toa degree that is maldaptive & inconsistent: INATTENTION A-fail to give close attention ,Makes Carless mistakess B-diffiulty susteinaing attnetion in task/ play activites C-Does not seem to listen when spoken to directly! D-does not follow through instruction! E-diffuclty organising task& activieS! F-avoids mental effort task Geasily disrtracted by ext stimuli I-forgetfull |
hyperactivity: -Figits with hands/feet -leaves seat when shou.dnt -runs round -difficulty playing engaging with other activities!! -talks excessively Imprulsice: -Blurts ouf answers before Q is complete -difficulty waiting turn -iterupts the intruders! |
***Conduct disorder(CD)
-rerrent persistant behavor that violetes right of othes!
-Dx is by Hx
-Tx : needs superviison\
-10% of popullaion during Childood early adolescne
-Byos>>Girls
^^Etioloy:
-Genetic+ enviromental Factors!
-parents engaged in usbstance ubse
-parents risk of ADD ,Schizophrenia,antisocial
^^SX:
-Lack snesiiticity /Feelingj welll being of others
-mispercieve behavcior of others as threatening
-may be aggressive
-Bully
-Making Threats
-Crutely to animals
-In adolsent destroy propery
-Poor olerance ot frustration
-Boys Tend to Fight , girls Lie Run away
***ADHA +Hyperactivty Tx:
^^ADHD Tx:
1-Bahvioral Tx
2-X
-behavioral Tx+ X is more succesgull!
-X ae used to alleivate Sx and sop cycle of inapproptite behvor!
^^X”
-stimulate preparation = methylphenitide/ dextraamphetamine!
-Resposne is dose depndent
1-methyphenidate start -0.3 mg/kg/day!
…and then inreased!
2-Detroamphetamine:
-0.15-0.2 mg/kg
./..then cna be raised
-once the optimal dose is reached ,
3-atomexatine :
-SelectiveN E reuptake(-)
-ADR nausea/sedatio .irritability /temper/ tnatrum !/Liver toxicity!
-Atypical starting Dose 0.5mg/kg!/day
4-antidepressentbupropion2 agonist):
-clonicine+ guanfacine!
^^Behavior:
-Counselling
-ognitive bahvir therapy!
-Classromm behavior is improved by envirmental contol!
-tachniques for parent1!
-Eliminateion Diets
-megavitamin Tx
-Antioxidantss!
^^Coduct Tx:
-X—->comorbid disorder
-psychotherapy
-resicential Center
…helps self esteem/self control/
-X such as stimules mmood stabilziesm antipsyhotics
^^DO NOT:
moralize+ dire admonition NO efective!
***Substance use Disorder:
^^Gx:
-common among children adolescent
-X : OH / Tobacco/Marijuana
-other X: Amphetamine/ Methamphemin/ cocain/ ….
^^Causes:
-reason for ubstance use to to escape PRessure/Challenge authority/
-Just novel expeirene
^^Dx:
I-Screneing:
-screen adolenes for ue of OH + X
-provide oucnelling
-Referala to Tx service & resouces!
-CRAFFT quesional
-2 + means further Evaluation!
^^CRAFT:
1-C
( Ride in a Car driven (including themselves) who is “high” or has been drinking alcohol or using)
drugs
2- R:
( Drink alcohol or use drugs to Relax,)
( feel better about themselves, or fit in)
3-A:
( Drink alcohol or use drugs while they are Alone)
4-F:
( Forget things they did while drinking or using drugs)
5-F:
( Are ever told by family members or Friends)
( that they should drink or use drugs less)
6- T:
( Get into Trouble while drinking or using drugs)
****Depression in childhood (RF)
^^Gx:
-Peristant sadness and loss of interest+ pleasure
-Decreased sleep
^^prevelnace :
-2% chjildren
2-8% in dults
Male: female 1:1
^^Etiology:
1-genetics —->first level relative risk2-4x
2-Enviorment:
-Parent bahvioir
-substance abuse
-Lack of family cohesion
-neglect!!
Low unctioning NE+ serotnin are believed to be important markers of Depression!!!
**Deression Sx by age:
ICD-10 derpeesive episodes:
– depressed mood
– loss of interest and enjoyment
– reduced energy and increased fatigability
(at least 2 of these)
Other :
1- ↓ concentration
2- ↓ self esteem and self confidence
3- ideas of guilt and unworthiness
4- bleack and pessimistic views of the future
5- ideas of self harm and suicide
– disturbed sleep
– decreased apatite
*minimum duration of whole episode is about 2 weeks
not depressed —–> fewer than 4 symptoms
mild depression ———> 4 symptoms
moderate depression ——–> 5-6 symptoms
major depression ———–> 7 or more with or without psychotic symptoms
| Infant | preschool | school |
increased crying – ↓ expressiveness – increased irritability – altered eating behavior – lack of interest in play | preschooler depression: – seems sad – psychomotor inhibition – anguish, phobias – diminished appetite – sleep disturbance – aggressiveness | preschooler depression: – seems sad – psychomotor inhibition – anguish, phobias – diminished appetite – sleep disturbance – aggressiveness |
^^Adolense:
↓ self confidence
– apathy lack of interest
– concentration problems
– psychomotor complains
– loss of weight
– sleep disturbance
– circadian oscillations
***Suicide bahviors Sx/RF/Tx
^^Sx:
I-genetics
-Twin studies tat control for life events
-more common in monoczygotic twins than dizygotics!
-Pedgree nalyzes confirm
II-serotnon System:
-Heridatory alteration in serotonin System!
-Seortonin is imp for regulation of Impulse/aggression/mood!
III-male> Female:
-Revsere in adolexcentS!
-male are mroe agggressive+ impulse than Females!
-males have conduct disorder+ chroni naxiety!
-in female chronic anxiety is related to suicide!
IV-Psychological and social factoerrs:
-hx of child mistreaement
-sxual assault
-DFamiyl conflict
^^In older Adosleent:
-relationship reakup
-Homosxual behavior
-geder dysphroia!
-hopelessness
-Psychological State
^^Intervetion:
Ist Pinciple:
1-take Suicide deation SERIOUSLT!
(No sarcasm, no joking, no belittling)
2-Hx of ingestion is necc
3-aggressive amangement o posoning!
II2nd ricniples:
-biopscyhococial framekwork
-Psychitry status is primary concern!
-Careful pscyhaitry hx!
128****Anorexia nervosa:
^^Etiology:
| I-Biological vulnerability: | II-Social influences: | III-Family |
Changes in NE or DA (endorphin neurotransmission) – Changes in endocrine – Reversible CT changes – Unclear mechanisms | Slender—> attractive – Dieting for professional – Advertisements – Requirements for social achievments for children | Avoiding Conflict Rigidity Emeshment |
IV-Psychological Predisposiion:
-perfectionism
-lowself eseem
-sexual physixal abuse!
-Phobic food avoidance
-Alexitymia
^^DX:
I-Hx+ compl;ain
-2 sources :pts/parent/ friens
-Inquiry about eaint habits/phsycial acitivty!
-Somatic complait: aryhtmia
II-Sx:
-Intense fear of becomming obese
-Claiming to” Feel Fat”
-Refusal to maintain normal weight for age_+ Height
–denial of hunger
-weird eating bahviors!
-Purging ( hiding food/indue vommit)
-Restrictos( limit carbs)
III-ASses heigh+ weight wrt nromal curve
IV-test
CBC : leukocytosis ,leukopenia , thrombocytosis, anemia (result of malnutrition)
– Serum electrolytes : hypokalemic alkalosis
– Glucose tolarence test : Oral glucose tolarence test to asses the ability of the body to metabolize
glucose
– Secritin-CCK test : to asses function of pancreas and gall bladder
– Serum cholinesterase test : to test liver function
– LH response to GnRH
– CK test
– BUN test for kidney function
– Thyroid screen : TSH,T4,T3
^^Diff Dx:
1-Mental disorder: dperession/somatization/anxiety
2-chrni mental illner: IBG
^^TX:
-Team of profesional
-Depends on severity of illness!
I- Ind for hospitlaizatoion:
-weight loss > 4 kg/month, systolic bp<80 , Temp < 36 , Pulse < 40
– Suicidal behaviour
– Sevier depression
– Ineffective outpatient treatment
II-Goals:
-Weight Resotration
-Nutriant rehab!
-feeding 6/day
-start 1000-1200 kcal/day then increase 200-500 kcal / week
– enteric and parenteric feeding
– liquids-nutrition additives
– normal defication
Discharge if”
1-weight gain
2-No suicide Risk
3-normal wieght range(10% of normal)
III-PScyhaitry Tx:
-IV nsogastric tube
IV-nutritional counseling:
find target weight
educational diet information
-levels of Excercise!
V-X:
antidepressant SSRI
-Off label: olanzpin/clozapin/haloperidol!
129 *** Bulimia Nervosa:
(Etiology/Dx/Tx)
^^Etiology:
| biological Vunerability | Social Influence | Family character |
-Chage in NE or DA -change in Endocrine -Reversivle CT | Slender—>attractive -Diet | Avoid conflict -Ridigity |
| Pscyhological |
-Low Self esteem -sexual abuse |
+Inadequate Impulse Control (5-HT dysfunction)
+Strong Dependency needs with feeling ofl loneliness,Emptiness
^^Sx:
-Depression
-anxiety
-Impulse control(-)
-self Harm
-↓ Libido!
^^Dx:
-Episodes of Binge eating!
(2 x/week 300K-4000 Kcal week excess for 3 M)
-Not being able to Stop eating
-Self evaluation
-Feeling of Remorese Deprresion after episode
IT is hard to Dx because bulminic weight Can be N!
^^Types:
I-Purging:
Self induced vommiting , may excercise
II-non Purging:excercise excessible
^^Diff Dx:
1-anorexia nervoa:
-binges+ pureges can occur
-But Weight Low
-Menses irrgegular
2-Leikne-Levin:
-More Pscyhological features
3-Dperessive disorder:
-Patients doenst give to much concenr for body and weight!
^^Tx:
GOAL
1-Restore N Weight
2-Tx complication
3-↑ motivation to change
4- relapse prevention
5-getting family invovled
I-Hospitlization:
-if Sx are Severe
-Suicidal
-Psycitric Disturbance
-Pregnancy
-Tx (R)
II-outpatient
uncomplicated Cases
III=Pscyhotherapy:
cognitive behavioral Therapy
IV- Interpersona Therapy:
Focuses on relationship stressors!
V-Nutritional counceling:
↓ behavior of eating disrder
↓ Food restirction
↑ variety
VI-healthy excercise+behavior
VII-X :
1-Antidepressant/Tricyclics
2-SSTRI
***Somatic complication of Eating disorder Tx:
Eating disorder cause wide variety of complication
—–> some are Lfie thretning
1-Cachexia : ↓fat and muscle mass,/ thyroid function , cold intolerance
2- Cardiac :↓ in cardiac muscle , bradycardia , sudden cardiac death
3-Digestive – GI tract : bloating , constipation , abdominal pain
4-Reproductive : Amenorrhea , decrease in LH and FSH
5- Dermatologic : lanugo ( fur on body )
6- Hematologic : Leukopenia , anemia
7- Osteoporosis
8-Neuropsychiatric : seizures
9-Depression ,Suicidal thoughts or behavior
10- DM II
11- Gallbladder disease
12- Stunted growth
13- Kidney damage
14- Severe tooth decay
15 High or low blood pressure
16- Death
Tx same as Anorexia+ Bulemia
***Non organic encopeis:
Def :passage of feces in inppaorate place after >4YO
^^Cause:
1-PRimary:
———->Global development+enureisis
2-2nd :
——>high levels of psychosocial Stress+ conduct disorder!
3-Consitpation:
————->Witholding of Stool due to stressors
^^Forms:
1-Retentive:
—->conspiration + overflow incontinence
—->2/3 of cases
2-Nonretenve:
No conspitation & Ovrflow incontinance
3-Primary:
From infacy onwad
secondary:
appear after succesful toilet Training!
^^TX:
-clear fecal material + mineral oi/laxative to prevent conspitation
-behavior managemen
-postprandial Toilet Siting
-Mandual disimpaction(some cases)
-enoucrage the child to fo ot bathroom
-Biofeedback to train anal sphinter
-TCA in some cases!
***NonOrganic enuesis
Def:
-Boluntary/involuntary repeat dischange or urine in cloth /bed
>5 YO
-most children should control bladder by 5!
^^Etiology:
-Family Hx
(chromosome 22)
-Na /K exhcnage in kidney
-hyposecretion o arginine vasopressin
^^Forms:
I-primary Aneurisis:
—->dleayed maturation of bladder function
II-secodnary enuresis:
——>Stress Trauamtic event
IIII-PErsistant:
-Child has never Been Dru at Night
-90% of Cases
IV-noctural:
Voiding urine at Nigh
V-Diurinal enuresis:
-Voiding while awake
-Common in girls
^^Tx:
-Make child cooperate+reward
-Void before bedtime
-voiding devices!
-bathroom 1 /3 hours in sleep
-psychotherpay for traumatic
-ADhunvtie Tx: Increase bladder cpacity
NO punishment or humiliation
^^Tx (X):
-imipramine( Tofranile) :
10-25 mg>5YO
75 mg
-Desmopression
OP / Intranasaly
***TICS
-Sudden Rapid involunatry Movement of muscle group/Vocliazation!
^^Forms:
-Simple—>1 muslce group( eye blinking), shoulder Shrugging!
-Complex: x Muscle Group !
-simple Vocalization : grunting & throat lcearing
-Complex vocalization : repetitive obscentitis
-Trnasient: Motor/vocal Tixs
-Chronic : LAst >1 years
^^Dx:
-No Dc Lab test
-Physcal / neurolgcal cet
-Hx ( Prenatal events/ birth Hx/ encephalitits/ meningitis)
^^Diff Dx:
-Tics unlike dystonia dont stop in Sleep!
-Stress makes them worse
-fasculation onl few muscle
-MRI rule out bran abnormlaty
-TSH level for hypothyrodism
-Autism Spectrum (Hx)
-huntigtons
-Duchee msuclar dystrophy
-Acquired causes of Tics (Ecephalitits/ Trauma)
^^Tx:
-educating the pts abotu what is happeneing
-Doing Sx Test to rule out causes
-Assesment of Motor Skill/cognitice abiities!
-Cognitice therapy!
PANDA(pedaitric autoimmun Neuropsychiatri Disorder of strep)
–>pencillin//erythromycon!
***Children Psychaitry Crises:
^^DeF:
-Face-Face shrot term intensive Mental health servies
-Aim:
1- cope with immediate stressors and lessen suffering!
2-Id and use available resoueces and recepient strengths
3-Avoid unessesy Hospitlalization
4-Return to basesline function
^^Crises Intervention Tx:
-initial crises plan iwthin 24 Hours!
-List childs need & probllem in Crises assement
-ID Frequnecy and tp of Servies provdied
^^Short Term Goals:
-Specifcy Objectives
-Note cultural consideration
-crises staiblziation
-track progress
***Forms of Abuse In Children /Sx/ Tx:
I- Neglect :
-Child Neglect is where the Responsible Adult Does Not provide needs:
1-Physical( Food/ Cloth /Hygiene)
2-Emotional ( Nurture/Affection)
3-Educational (School)
4- Medical ( Not medical the child!
II-Physical abuse:
-Physical Aggression Toward child
..Any type of Biolence esp Physical!
III-Sexual Abuse:
IV-Physiological /Emotional Abuse:
-Name Calling /bullying/ Desturction
^^Physical Sx of Abuse:
-Severe : Bone Fracture
-Minor: Bruises/ Cuts
-Poor physical condition (arhtritis/ Asthma.Bronchitis/ hgih BP)
-Transmisison of Toxins to a child through mother
-Long Temrm:
Shakcing a child ,Shking baby syndrome!
—> increasee intercranail pressure
—>O2 dperie
—>failture to thrive
^^Psychological Sxo f abuse:
-Vitim Guilt , Trauma,Insominia
-Sx of child neglect
^^Tx:
-Tx physcical injires
-Trauma Focus on Cognitive behavioral therpay!
(PTSD. Depression anxiety)
-Abuse Focus ….
-Child Psychotherpay
-group therapy
-Art therapy
^^Prevention:
-Child protective Servies
-Contraceltive+ Pregnancy Planning!
***Delirium in Childre:
^^DEG:
Most common + severe Neuropsychiatirc sundrome!
-Acute onset
-A
^^CF:
attneion Devifict!
-Arousal Change( Hypo/Hyperactive)
-Perceptial deficit
-Alternd Sleep-wake cycle
-Psychotic feautes!
^^Causes:
1-Infection
———>acute systemic Viral Ifnecion / Acute systemic bacteiral infection/
Meningitis/ encephalitis/ Brain Abscess/ Malaria/ Rabies!
2-Metabolic:
—–>hypoglycemia/Diabetic Ketoacidocis/ Hyponatrueia / uremia!
3- cirulatory:
——>hypocia/Hea Stroke
4- structural Brain change
(Due to concuiso/bleeding)
5-Neutpogical
(epilepsie)
6-X
(opaites/ BZDS)
7- X:
(Oh / Anesthics)
8- Autoimmune:
SLE
9-Mental illness:
Manai Acute psychosis!
^^DX:
1-CF
(hyperitivue as +ve sign )
(hypoactiie as -ve signs)
2-PRevious assemsent andk noowledge of affeced person basleine
3- Diff Dx
^^Tx
-Tx underlying cause
-Optimising condition of brain
-O2
-hydrate
-Treat Pain
-Tx constipation
-Non X
(Avoid uneccassary movement)
-Verbal + non erbal de-excalatio
-X (depends on cause)
(include anti psychotics)
****Diff Dx of Acute Psychosis
^^Psychosis:
-Disruption in thinking ,Accompanied by delusion or hallucination!
^^Delusion:
-False , Fixed BeliefsThat cannot be resolved through logical arguments!
^^Halucinations :
False perception that have no basis in external stimuli!
^^Delisium:
Alternal Sensory with waxingwaning deficit!
Also consider Hypoglycemia/Cerebral Hypocia/X Toxicity!
^^Substrate Def :
1-hypoglycemia : rare but important Cause of psycosis + Hallucination!
—->Reuire immediate bedside cappillary glucose testing!
2-Cerebral Hpoxia( Lack of O2)
—>Alterned mental status
***Prcinciple of Early Schizo Tx:
-Early Schizo occurs in Puberty+ early Adolescence!
^^Sx:
-Social Withdraw
-Disruptive Behavior!
-Development Delay
-Speech + language!
^^Tx:
I-Parent Training to Teach effective Technique
II-Individual therapy to Build +ve alliance
III- Scheol And lesson work
IV- NEuroleptic therpy
—> For hallucination + Delusion
1-Risperidone
2-Olanzapine
***Somatization Disorder:
^^Gx:
-Presenting Complaint >13 Physical Sx
-Sx Not caused by physiological /Px Machnism
-Sx to need to matian sick role!
I-Pain SX:
Head
back
Joints
Chest
Rectum
Adomen
Extrmities
urination
mesnturation
II-GI Sx:
-Nausea
-Food Intolerance
III-Seual Sx:
-Sxual apathy
-Erectile dysfnction
-Vommit
IV-Pseudoneurological:
-Diff Swallowing
-Loss of Touch senstion
-Hallicunation
-Aphonia!
-Seizures
-Blindness
-Deafness
-Urinary retention
*** Somatization :PRinciple of Dx+ Tx
-Each of the folloign must be met
-4 Pain sx:
-Hx of pain in 4 Sites
-2 GI Sx :
(Nausea/bloating/ vommiting…)
-1 Sexual Symptomn :
(Sexual apathy , ejaculatory dysfunction)
-1 Pseudoneurologic Sx:
^^Dx:
1- check the Sx
2-check for Socialpx Causes ( if psosible)
3-Clinical assesment
^^Tx:
-where No PX finding avoid Tx!
-Intervention and address psychological Factor
-Psychoactive X may be useful for anxiety /Depression
-Talk to Pts and reaasure them!
—> Tell them they need to carr on living!
***Anxiety Disorder:
-if it itnervetion with everyday life!
-most common psychaitry Disorder in childhood!
^^Forms:
1-Seperation anxiry disorder(SAD)
2-Chilldhood-onset
3- general Anxiety disorder(GAD)
4-Phoias
5- PTSD
6-Panic disorder
^^Diff Dx:
I-Diff Tpes of Anxieties
(Stranger wariness 7-9 M)
(Prescool Fear of Dark/animal)
(Adolescene General worry)
I-SAD:
-unrealizric persistant of worry
of possible had!
-afraid to go to school
-Constant need to be clsoe to parents!
II-Childhood Onset Phobia:
-Ecessive Anxiety
-Leading sial isolation!
-still have want to be involevent!
III-Selective Mutism:
overlaps with Social phboia
***Tx of Anceity disorder:
I-Separation anxiety disorder
| cause Mothers of children with SAD are likely to have a history of an anxiety disorder.these children are at a risk of developing panic disorder in adolescence |
• screen for parental depression or anxiety. • When a child reports recurring acute severe anxiety, antidepressant or anxiolytic medication is often necessary.. Data support the use of selective serotonin reuptake inhibitors (SSRIs) . • Cognitive behavioral therapy benefits children with SAD, especially when the parents are |
II-childhood onset social phobia
| A family history of social phobia or extreme shyness is common. |
| • SSRIs are considered the treatment of choice. • Antianxiety agents are not effective. likely to have SAD, • Management of school refusal requires parent management or even family therapy. • Working with school personnel is always indicated; anxious children often require special attention from teachers, counselors, or school nurses • Parents who are coached to calmly • In cases of ongoing school refusal, referral to a child psychiatrist is indicated. |
III-Selective mutism
| Cause It is a disorder that overlaps with social phobia.Stressors exist such as a new classroom or parental or sibling conflict, will drive an already shy child to become reluctant to speak. |
• Fluoxetine in combination with behavioral therapy has been shown to be effective for children whose school performance is severely limited by their symptoms IV-Panic disorder Treatment • SSRIs have shown effectiveness in the treatment of adolescents .The recovery rate is |
IV-General anxiety disorder
Cause
– It has been linked to disrupted functional connectivity of the amygdala
– triggered in response to life stressors
– may run in families
– grows worse during stress.
Treatment
• cognitive-behavioral therapy (CBT),
• a trial of buspirone or an SSRI may be indicated when symptoms are particularly limiting.
Cause
– It has been linked to disrupted functional connectivity of the amygdala
– triggered in response to life stressors
– may run in families
– grows worse during stress.
Treatment
• cognitive-behavioral therapy (CBT),
• a trial of buspirone or an SSRI may be indicated when symptoms are particularly limiting.
V-Obssesive:
Cause • Neuroimaging studies have documented abnormalities in the frontal lobes, the basal ganglia, and their associated pathways. • symptoms are triggered or exacerbated by group A B-hemolytic streptococcal infection (GABHS). |
| Treatment • Combined treatment (CBT plus SSRI) experience remission in 50%, it is less successful if each therapy is taken alone . • Referral of patients with OCD to a mental health professional is always indicated. • The pediatrician should be aware of the infectious cause and follow management guidelines |
VI-Phobia:
| Cause Phobias are generally caused by an event recorded by the amygdala and hippocampus and labeled as deadly or dangerous; thus whenever a specific situation is approached again the body reacts as if the event were happening repeatedly afterward |
| Treatment • The parents of phobic children should remain calm in the face of the child’s anxiety or panic. • Systematic desensitization is a form of behavior therapy |
VII-PTSD:
| Previous trauma exposure, a history of other psychopathology, and parental symptoms of PTSD predict childhood- onset PTSD. PTSD is linked to mood disorders, disruptive behavior, and other diagnoses in childhood. |
| Treatment • Initial interventions after a trauma s • Aggressive treatment of pain • Long-rerm treatment may include individual, • Group work is also helpful for identifying which children may need more intensive assistance. • Clonidine or guanfacine may be helpful for sleep disturbance, persistent arousal, and exaggerated response. |