INFANCY, CHILDHOOD AND ADOLESCENCE DISORDERS

Mental retardation: this is a disorder which causes a level of intellectual functioning markedly below average, with concomitant deficits in adaptive behaviour and functioning and with onset before age 18. The first criterion for classification under the category of mental retardation is the subject’s intelligence quotient (IQ). By means of intelligence scales it is in fact possible to measure the cognitive capacity of an individual, and scores obtained in these tests can be used as a parameter of reference. The average of scores obtained in these scales varies from 85 to 115. A score below 85 indicates a level of intelligence lower than average, while a score below 75 indicates mental retardation. The second diagnostic criterion of mental retardation is that of a child’s adaptive behaviour. This refers to abilities that develop during infancy such as washing and putting on one’s clothes, understanding the concepts of time and money, knowing how to use simple tools, shopping and travelling on public transport vehicles, and also becoming capable of participating in social interaction. The final parameter for a diagnosis of mental retardation is the age of onset. The disorder must appear before age 18 in order to be confirmed.

The three Learning Disabilities categorised in the DSM are: Reading Disorder, Mathematics Disorder and the Disorder of Written Expression. These conditions are not related to difficulties due to sensory deficits such as hearing problems or impaired vision. Reading Disorder, generally referred to as dyslexia, produces in children severe difficulties in recognising words and in understanding what they are reading, and also in writing words correctly. In Mathematics Disorder, a child may have difficulty in recognising numerical symbols or, in simple calculations, in remembering to add a quantity to be carried forward, in counting objects or in following the steps of a mathematical calculation. Poor performance in mathematics is as common as poor results in reading and in written expression. The Disorder of Written Expression is characterised by an impairment of the capacity to compose a written text (indicated by numerous spelling mistakes, grammatical errors and erroneous punctuation), which is severe enough to interfere with scholastic achievement or with the activities of daily life that require writing skills.

Motor Skills Disorder. This anomaly, also referred to as the Developmental Coordination Disorder, causes an impairment in the development of motor coordination that cannot be explained by mental retardation or by a general medical condition such as cerebral paralysis. Children suffering from this disorder have difficulty for example in doing up their shoe-laces, buttoning up a shirt and, when they become older, in building models and playing with a ball.

Communication disorders: in the first disorder of this series - the Expressive Language Disorder - children have difficulty in expressing themselves through the use of language. They may give the impression that they wish to communicate with others but then they are incapable of finding the right words and use short sentences characterised by a grammatical structure far too simple in relation to their age. The second disorder, the Phonological Disorder, is characterised by adequate comprehension of language but the child’s speech resembles that of very small children. Words are thus simplified with substitutions and omissions (for example, 'blue' becomes 'boo' or 'shoes' becomes 'twos'). The third disorder is Stuttering, which is an anomaly in the normal flow of speech characterised by frequent repetitions or the lengthening of sounds, long pauses between words, the replacement of words difficult to articulate with other more simple words and the repetition of monosyllabic words (for example, <<a-a-a-a-a dog bit me!>>). Occasionally the stuttering is accompanied by muscular movements such as blinking of the eyes and tics.

Pervasive Developmental Disorders are characterised by severe deficits and a generalized impairment of various areas of development. These areas include impairment of the capacity to interact and communicate with others and the presence of stereotypical behaviour. Autism, which forms part of this category, is a serious anomaly of the process of development and for this reason is differentiated from mental disorders that occur during adulthood. Autism may appear in the very first months of life: already at the age of 3 months it is possible to detect the absence of any attachment to the mother in an autistic child. While other children of the same age smile, tend to move towards their mother and watch her movements, an autistic child presents no behaviour of this kind and may even refuse any contact with its parents, withdrawing and distancing itself by means of  physical movements aimed at minimizing body contact. Autistic children are moreover apt to emit none of the typical sounds of children of this age and do not cry unless they are being washed or feel hungry. They show no signs of affection towards the adults that look after them and can spend most of the day practically immobile in a single position without revealing any interest in what is going on around them. They show no signs of interest in others and almost never spontaneously initiate play activities with other children. These anomalous behaviour patterns are consequences of the isolation in which the autistic child is wrapped, which moreover also causes severe retardation in other areas such as language.

Attention Deficit-Hyperactivity Disorder (ADHD): hyperactive children reveal great difficulty in controlling their activities and gestures in those situations that would normally require tranquil behaviour. They are always fidgeting and cannot manage to maintain a stable position for more than just a few seconds; they tend to drum and beat surfaces with their fingers, swing their legs to and fro, push around their school companions for no apparent reason and speak out of turn. Hyperactive children have difficulty in getting on with children of their own age and find it hard to make friends. About 20-25% of hyperactive children present learning difficulties in the areas of arithmetic and mathematics, reading and writing (Barkley, DePaul and McMurray, 1990). There are three types of ADHD: 1) the Predominantly Inattentive type, in which difficulties in paying attention and concentrating predominate; 2) the Predominantly Hyperactive-Impulsive type, in which hyperactivity and impulsiveness predominate; 3) the combined type, in which both of the above phenomena can be found (see Hyperactivity Test).

Conduct Disorder: this disorder comprises a wide range of poorly-controlled behaviour patterns that present violations of the basic rights of others and the norms of society. They include hostile or aggressive attitudes towards people or animals, damage to the property of others, lying and theft. These actions are often accompanied a form of insensibility, cruelty and the absence of any feelings of remorse. The Conduct Disorder is frequently associated with ADHD, depression and anxiety. (see Conduct Disorder Test).

Oppositional-Defiant Disorder: this is a categorization very similar to that of the Conduct Disorder and is diagnosed when a child does not present the extreme forms of physical aggression which characterises the Conduct Disorder but behaviour such as loss of control, entering into arguments with adults, active opposition or reiterated refusals to satisfy the requests of adults and actions carried out deliberately in order to irritate and distress other people.

Feeding and Eating Disorders of Infancy or Early Childhood: these disorders affect children’s feeding and eating behaviour, for example resulting in the swallowing of inedible substances (a behaviour referred as ‘Pica’), repeated regurgitation and re-chewing of food (Rumination Disorder) or the persistent inability to eat in an adequate manner, which results in a significant loss of weight or in the inability to gain weight (Feeding Disorder of Infancy or Childhood).

Tic Disorders: these are characterised by movements or vocalisations that occur suddenly and rapidly and are recurrent, arrhythmic and stereotyped (e.g., Tourette’s Disorder).

Elimination Disorders are the repeated passing of faeces in places that are inappropriate after the age of 4 (encopresis) or urination into clothing or the bed after the age of 5 (enuresis).

Separation Anxiety Disorder: the main characteristic of this disorder is a disproportionate anxiety presented by a child when separated from a member of the family to whom it is deeply attached, such as the mother or a mother figure. Such anxiety is inadequate in relation to the attained level of development and appears for the first time before the age of 6. Children affected by this disorder usually present normal behaviour as long as they are in the presence of a parent or primary attachment figure but manifest strong and uncontrollable anxiety when they are separated from such figures. They also tend to express unrealistic and persistent fears concerning the occurrence of catastrophic events which might separate them forever from their parents. For example, they might be afraid of being killed or kidnapped or becoming a victim of some serious accident or disease if they are far away from their parents or they fear that something terrible might happen to their parents when they are not close to them. They usually try not to remain alone for even just a few minutes. They may also present an extreme reluctance to go to school as this will mean being separated from the mother or, more generally, from the primary attachment figure.

Selective Mutism: a persistent inability to speak in specific social situations (for example, at school) despite the fact that in other contexts they are capable of doing so (for example, with the patient’s parents).

Reactive Attachment Disorder (RAD) of Infancy or Early Childhood: a disorder characterised by a social relatedness markedly disturbed and inappropriate with respect to the level of development attained and which presents in most social contexts. The condition, which begins before the age 5, is associated with a largely inadequate and pathogenic form of care-giving on the part of the parents or other persons who take care of the child.

>>> (Delirium, Dementia and other Disorders)


Bibliographical references:

Barkley, R.A., DePaul, G.J. e McMurray, M.B. (1990). A comprehensive evaluation of attention deficit disorder with and without hyperactivity defined by research criteria. Journal of Consulting and Clinical Psychology, 58, 775-789.

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