DEFINITION & NATURE

Mental health movement & availability of child guidance centres in 1920s &
1930s brought about conversations of, treating, & understanding maladaptive bhvr
patterns of children & adolescents.
Approx. 49.5 % of children & adolescents experience at least one mental disorder
by age of 18
Onset of mental disorders: Anxiety disorders typically start around age 6, followed
by behavior disorders at age 11, mood disorders at age 13, and substance use
disorders at age 15
Field of Dev. psychopathology focuses on determining what is abnormal at any point
in developmental process by comparing & contrasting it with normal & expected
changes that occur.
Neurodevelopmental disorders are a group of conditions characterized by an early
onset & persistent course that are believed to be result of sig. delays/disruptions to
normal brain development.

INTELLECTUAL DISABILITY

Definition
AKA Intellectual Development Disorder
Disorder with onset in developmental period that includes both intellectual (GMA)
& adaptive functioning deficits in conceptual, social, & practical domains.
Intellectual disability is defined in terms of both intelligence & performance level.
The diagnosis to apply these problems must begin before the age of 18.

Diagnostic Criteria

Deficits in intellectual functions, such as reasoning, problem solving, planning,

abstract thinking, judgment, academic learning, & learning from experience,
confirmed by both clinical assessment & individualized, standardized intelligence
testing.

Deficits in adaptive functioning that result in failure to meet developmental &

sociocultural standards for personal independence & social responsibility. Without
ongoing support, adaptive deficits limit functioning in 1 or more activities of daily
life, such as communication, social participation, & independent living, across multiple
environments, such as home, school, work, & community.
Onset of intellectual & adaptive deficits during developmental period.

SPECIFY: Current severity

Mild : IQ scores ranging from 50-55 to approx 70
Moderate : IQ scores ranging b/w 35-40 & 50-55
Severe : IQ scores ranging from 20-25 to 35-40
Profound : IQ scores below 20-25
Nature & Age of Onset
Initial diagnoses most frequently occur at ages 5-6 (around time schooling begins
for most children), peak at age 15, & drop off sharply after that.
One with mild intellectual impairment often appear normal during early childhood.
Intellectual functioning below average becomes noticeable when school difficulties
prompt diagnostic evaluation.
Course of Illness & Prognosis
Intellectual disability usually begins during development, with signs varying based
on severity & cause.
Severe cases may show delays in milestones within first 2 years, while mild cases
might become noticeable in school.
Most cases, lifelong condition, although severity may change over time due to
various factors & additional conditions like epilepsy.
Early and continuous interventions can improve adaptive abilities, sometimes leading
to significant improvements in intellectual functioning.
Diagnosis in young children might be delayed until after intervention to evaluate
its effect on their skills.
For older individuals, assessments are vital to discern if improved abilities are due
to new skills or ongoing support.

Differential diagnosis
Genetic or medical conditions: Genetic syndromes associated with intellectual
disability are considered concurrent diagnoses
Major & mild neurocognitive disorders: Neurocognitive disorders involve cognitive
function loss, unlike intellectual disability categorized neurodevelopmental disorder.
Communication & specific learning disorders: These focus on communication &
learning domains, not affecting intellectual & adaptive behavior.
Autism spectrum disorder: Assessment of intellectual ability may be complex due to
social-communication & behavioral challenges inherent in autism spectrum disorder,
potentially affecting test compliance & understanding.

Comorbidity
Common co-occurring conditions include:
ADHD disorder
Depressive & bipolar disorders
Anxiety disorders
Autism spectrum disorder
Aggression & disruptive behaviors, including harm to others or property destruction,
may occur, especially in severe intellectual disability cases.

Prevalence
Gen population prevalence approx 1%.
Estimated diagnosed ID prevalence in US: approx 1%,
India's overall prevalence of ID: 10.5/1000.
Slightly higher prevalence in urban populations compared to rural areas

Risk Factors
People with genetic syndromes, inborn errors of metabolism, brain malformations,
maternal disease & env influences.
 People with a variety of labor & delivery-related events lead to neonatal
encephalopathy.
People with traumatic brain injury, infections, seizure disorders, severe & chronic
social deprivation, & toxic metabolic syndromes & intoxications

Gender Ratio:
Males are more likely than females to be diagnosed with both mild & severe forms
of intellectual disability.

Case Study:
Dylan, born to parents in 40s, exhibits classic colic as newborn, characterized by extended
periods of crying. He's noted for his large ears & strabismus in infancy, with routine checkup
at 2 months revealing a systolic heart murmur & mitral valve prolapse identified through
ECG
Throughout infancy, D displays slight developmental delays & shows signs of hyperactivity &
inattention compared to his peers. Psychological assessments indicate moderate delays in
cognitive, linguistic, & motor abilities, reflected in a developmental quotient(DQ) of 74.
Described as inattentive, shy, & anxious, Dylan faces challenges with eye contact & exhibits
pronounced deficits in long-term memory, expressive language, & visual-spatial functioning
despite avg. short-term memory functioning.
As Dylan progresses into older elementary grades, his social difficulties escalate, accompanied
by growing sense of anxiety. While his sensitivity to loud sounds slightly lessens, he develops
specific fears, particularly of storm clouds & dogs, & adamantly avoids riding elevators.
These fears become more prevalent in his behavior & interactions.

LEARNING DISABILITIES

Definition
Learning disorders are delays in cog. development in areas of language, speech,
mathematical, or motor skills that are not necessarily due to any demonstrable
physical or neurological defect.
Diagnosis of learning disorders is restricted to those cases in which there is clear
impairment in school performance or (if person is not a student) in daily living
activities-impairment not due to intellectual disability or to pervasive developmental
disorder such as Autism.

Diagnostic Criteria
Persistent difficulties in acquisition & use of language across modalities due to
deficits in comprehension or production that include following:
Reduced vocabulary (word knowledge & use).
Limited sentence structure (ability to put words & word endings together to form
sentences based on rules of grammar & morphology).
 Impairments in discourse (ability to use vocab & connect sentences to explain or
describe a topic or series of events or have a conversation).

Language abilities are substantially & quantifiably below those expected for age,
resulting in functional limitations in effective communication, social participation,
academic achievement, occupational performance, individually or in any combination.

Onset of symptoms is in early developmental period.

Difficulties are not attributable to hearing or other sensory impairment, motor dys-
function, or another medical or neurological condition & are not better explained by
intellectual disability or global developmental delay.

Specifiers:

Clinical Features
One of the markers of learning disabilities or disorders is disparity b/w children's
actual academic performance & expected academic performance as per their age

Psychological Consequences
Don't have obvious, crippling emotional problems, nor seem to be lacking in motivation,
cooperativeness, or eagerness to please their teachers & parents
Specific learning disorder is associated with increased risk for suicidal ideation &
suicide attempts in children, adolescents, & adults.

Cognitive Performance
Frequently but not invariably preceded, in preschool years, by delays in attention,
language, or motor skills that may persist & co-occur with disorder.
Eg, of symptoms that may be observed among preschool-age children include lack of
interest in playing games with language sounds & they may have trouble learning
nursery rhymes.
May frequently use baby talk, mispronounce words, & have trouble remembering
names of letters, numbers, or days of the week.
May fail to recognize letters in own names & have trouble learning to count.
Onset, Course & Prognosis
Usually identified during elementary school years when reading, writing, spelling,
& math skills are learned.
Language delays, counting/rhyming issues, & fine motor skill problems appear before
formal schooling.
Specific learning disorder is persistent but varies in its clinical expression & course
depending on various factors.
Reading fluency, comprehension, spelling, written expression, & numeracy issues often
continue into adulthood.
Symptoms may change over time, resulting in evolving set of learning difficulties
throughout the individual's life.

Differential diagnosis
Normal variations in academic attainment:
Distinguished due to external factors (lack of educational opportunity,
consistently poor instruction, learning in a second language),
Intellectual disability
Differs because learning difficulties occur in presence of normal levels of
intellectual functioning
Neurocognitive disorders
Distinguished because in learning disorder, clinical expression of specific
learning difficulties occurs during developmental period
ADHD
Distinguished because in ADHD problem rather may reflect difficulties in performing
those skills.
Psychotic disorders
Distinguished because with these disorders there is a decline (often rapid) in these
functional domains.

Comorbidity
Commonly occurs with neurodevelopmental (ADHD, communication disorders,
developmental coordination disorder, autistic spectrum disorder) or other mental
disorders (e.g., anxiety disorders, depressive & bipolar disorders).

Prevalence
Rate across academic domains of reading, writing, & mathematics is 5%-15%
among school-age children across different languages & cultures.
Prevalence in adults is unknown but appears to be approximately 4%.

Risk Factors
Prematurity or very low birth weight, prenatal exposure to nicotine.
Substantially higher (4-8 times higher) in 1st-degree relatives of individuals with
these learning difficulties compared with those without them.
 Case Study
Alice, a 20-year-old college student, sought help because of her difficulty in several of
her classes. She reported that she had enjoyed school and had been a good student until
about the sixth grade, when her grades suffered significantly.
Her teacher informed her parents that she wasn't working up to her potential and she
needed to be better motivated. Alice enrolled in the local community college and again
found herself struggling with the work. Over the years, she had learned several tricks
that seemed to help her study and at least get passing grades. She read the material
in her textbooks aloud to herself; she had earlier discovered that she could recall the
material much better this way than if she just read silently to herself. As suspected,
Alice had a specific learning disorder. Scores from an IQ test placed her slightly above
average, but she was assessed to have significant difficulties with reading. Her
comprehension was poor, and she could not remember most of the content of what she
read.

AUTISM SPECTRUM DISORDER (ASD)

Definition
Aka Autism
Neurodevelopmental disorder that involves wide range of problematic
behaviors including deficits in language, perceptual & motor development;
defective reality testing; & impairments in social communication.
It was first described by Kanner in 1943.

Diagnostic Criteria

Persistent deficits in social communication & social interaction across multiple con-
texts, as manifested by following, currently or by history:
Deficits in social-emotional reciprocity, ranging, for eg, from abnormal social
approach & failure of normal back-&-forth conversation; to reduced sharing of
interests, emotions, or affect; failure to initiate or respond to social interactions.
Deficits in NVCB used for social interaction, ranging, eg, from poorly integrated
verbal & NVC; to abnormalities in eye contact and body language or deficits in
understanding & use of gestures; to total lack of facial expressions & NVC
Deficits in developing, maintaining, & understanding relationships, ranging, eg,
from difficulties adjusting bhvr to suit various social contexts; to difficulties in
sharing imaginative play or in making friends; to absence of interest in peers.

Restricted, repetitive patterns of behavior, interests, or activities, as manifested by

at least 2 of the following, currently or by history
Stereotyped/repetitive motor movements, use of objects, or speech (simple motor
stereotypies, lining up toys or flipping objects, echolalia, idiosyncratic phrases).
 Insistence on sameness, inflexible adherence to routines, or ritualized patterns of
verbal or nonverbal behavior (extreme distress at small changes, difficulties with
transitions, rigid thinking patterns, greeting rituals, need to take same route or
eat same food every day).
Highly restricted, fixated interests that are abnormal in intensity or focus
(strong attachment to or preoccupation with unusual objects, excessively
circumscribed or perseverative interests).
Hyper or hyporeactivity to sensory input or unusual interest in sensory aspects of
the environment (apparent indifference to pain/temp, adverse response to specific
sounds or textures, excessive smelling or touching of objects, visual fascination
with lights or movement).

Symptoms must be present in early developmental period (may not become fully
manifest until social demands exceed limited capacities, or may be masked by
learned strategies in later life).

Symptoms cause clinically sig. impairment in social, occupational, or other important

areas of current functioning.

These disturbances are not better explained by intellectual disability or global

developmental delay. Intellectual disability & autism spectrum disorder frequently
co-occur; to make comorbid diagnoses of autism spectrum disorder & intellectual
disability, social communication should be below that expected for general
developmental level.

Clinical Features
Onset, Course & Prognosis
usually identified before child is 30 months of age &
diagnostic stability over childhood years is quite high
early signs of problems with social communication can be
detected in 1st 6 months of an infant's life
typically a lifelong, albeit heterogeneous, disorder with a
highly variable severity and prognosis.
Prognosis of given child with disorder is generally improved
if home environment is supportive.

Differential Diagnosis
Rett syndrome
most individuals improve their social communication skills, &
autistic features are no longer major area of concern.
Selective Mutism
early development is not typically disturbed.
ADHD
should be considered when attentional difficulties or hyperactivity exceeds
that typically seen in individuals of comparable mental age.
Schizophrenia
Hallucinations & Delusions

Comorbidity
Often coexists with intellectual impairment & structural language disorder, noted
under relevant specifiers when applicable.
Commonly observed in ASD are specific learning difficulties in literacy & numeracy,
as well as developmental coordination disorder.
Medical conditions associated with ASD like epilepsy, sleep problems, & constipation

Prevalence
third most common developmental disability
reported frequencies across U.S. & non- U.S. countries have approached
1% of pop. with similar estimates in child & adult samples.

Gender Differences
diagnosed 4 times more often in boys than in girls.
In clinical samples, girls more often exhibit intellectual disability than boys

Risk Factors
Environmental Factors: Nonspecific risk factors like advanced parental age, low birth
weight, or fetal exposure to valproate might contribute
Genetic & Physiological Aspects: Heritability estimates vary widely, from 37% to
potentially over 90%, based on twin concordance rates. Approx 15% of ASD cases
seem linked to known genetic mutations.
 Case Study
Matthew is 5 years old. He rarely speaks to others and almost never makes direct and
sustained eye contact. Matthew's parents began to notice 3 years ago that while other
children were starting to put words together into sentences and have back-and-forth
conversations with their parents, he never seemed to develop these abilities. Matthew
spends much of his time alone, often playing with his toys in his room. While doing so, he
frequently engages in repetitive movements over and over again, such as wheeling his toy
train back and forth hundreds of times in a row. Matthew doesn't like to leave his home,
which his parents think has to do with him being overly sensitive to all of the sights
and sounds outside. He also struggles when things deviate from his normal daily routine,
which leads him to repeatedly scream at the top of his lungs several dozen times in a
row.

ATTENTION-DEFICIT/ HYPERACTIVITY DISORDER

Definition
Disorder which is characterized by a persistent pattern of difficulties sustaining
attention &/or impulsiveness & excessive or exaggerated motor activity.

Diagnostic Criteria

A persistent pattern of inattention and/or hyperactivity-impulsivity that interferes

with functioning or development, as characterized by (1) and/or (2):

Inattention: 6 (or more) of following symptoms have persisted for least 6 months
to degree that is inconsistent with developmental level & that negatively impacts
directly on social & academic/occupational activities:
Often fails to give close attention to details or makes careless mistakes in
schoolwork, at work, or during other activities (overlooks or misses details, work is
inaccurate).
Often has difficulty sustaining attention in tasks or play activities(has difficulty
remaining focused during lectures, conversations, or lengthy reading).
Often does not seem to listen when spoken to directly (mind seems else-where,
even in absence of any obvious distraction).
Often does not follow through on instructions & fails to finish schoolwork, chores,
or duties in workplace (starts tasks but quickly loses focus & is easily
sidetracked).
Often has difficulty organizing tasks & activities (difficulty managing sequential
tasks; difficulty keeping materials & belongings in order; messy, disorganized
work; has poor time management; fails to meet deadlines).
Often avoids, dislikes, or reluctant to engage in tasks that require sustained
mental effort (schoolwork/homework; for older adolescents & adults, preparing
reports, completing forms, reviewing lengthy papers).
 Often loses things necessary for tasks/activities (school materials, pencils, books,
tools, wallets, keys, paperwork, eyeglasses, mobile telephones).
Often easily distracted by extraneous stimuli (for older adolescents & adults,
may include unrelated thoughts).
Often forgetful in daily activities (doing chores, running errands; for older
adolescents & adults, returning calls, paying bills, keeping appointments).

Hyperactivity & impulsivity: 6 (or more) of following symptoms have persisted for at
least 6 months to degree that is inconsistent with developmental level & that
-vely impacts directly on social & academic/occupational activities:
Often fidgets with or taps hands or feet or squirms in seat.
Often leaves seat in situations when remaining seated is expected (leaves his or
her place in classroom, in office or other workplace, or in other situations that
require remaining in place).
Often runs about or climbs in situations where it is inappropriate.
Often unable to play or engage in leisure activities quietly.
Often "on the go," acting as if "driven by motor" (unable to be or uncomfortable
being still for extended time, as in restaurants, meetings; may be experienced by
others as being restless or difficult to keep up with).
Often talks excessively.
Often blurts out an answer before a question has been completed (e.g., completes
people's sentences; cannot wait for turn in conversation).
Often has difficulty waiting his or her turn (while waiting in line).
Often interrupts or intrudes on others (butts into conversations, games, activities;
may start using other people's things without asking or receiving permission; for
adolescents & adults, may intrude into or take over what others are doing

Several inattentive or hyperactive-impulsive symptoms were present prior to age 12

years.

Several inattentive or hyperactive-impulsive symptoms are present in 2 or more

settings (at home, school, or work; with friends or relatives; in other activities).

There is clear evidence that symptoms interfere with, or reduce quality of, social,
academic, or occupational functioning.

Symptoms don't occur exclusively during course of schizophrenia or another psychotic

disorder & are not better explained by another mental disorder.

Clinical Features
For ADHD, DSM-5 differentiates 2 categories of symptoms;
1st is characterized by problems of inattention, which manifests as wandering off
task, lacking persistence, having difficulties focusing & being disorganized
2nd category is characterised by impulsivity, which refers to hasty actions that occur
in moment without forethought & have high potential for harming individual; it
may reflect a desire for immediate rewards or an inability to delay gratification.

Academic Performance: Typically achieve less educationally, display poorer vocational

outcomes, & often exhibit reduced intellectual scores compared to peers.

Social Performance:
Family relations may be marked by discord & -ve interactions.
ADHD individuals often face peer rejection, neglect, or teasing,
impacting their social relationships sig.
Frustration, low tolerance & mood irritability
Sig % show behavioral symptoms of aggression & defiance.

Later Vocational Performance

Poorer occupational performance, attainment, attendance, & higher probability of
unemployment as well as elevated interpersonal conflict.
Inadequate or variable self-application to tasks that require sustained effort
Disruptions in memory & executive functioning

Onset, Nature & Course:

most often identified during elementary school years, (earlier years difficult
to distinguish) & inattention becomes more prominent & impairing.
course of ADHD is variable. Symptoms have been shown to persist into adolescence
in 60-85 % of cases, & into adult life in approx 60 % of cases.
Overactivity is usually 1st symptom to remit, & distractibility is last.
When remission occurs, it is usually between ages of 12 & 20.
Learning problems often continue throughout life.

Differential Diagnosis:

Oppositional defiant disorder.

Individuals resist work because they resist conforming to others'
demands unlike ADHD which is inability

Intermittent explosive disorder

Show serious aggression toward others, which is not characteristic of ADHD,
& they do not experience problems with sustaining attention

Specific learning disorder

Not impairing out side of academic work.

Intellectual disability (intellectual developmental disorder)

Diagnosis of ADHD in ID requires inattention/hyperactivity excessive for mental age.
 Autism spectrum disorder
social dysfunction must be distinguished from social disengagement,
isolation, & indifference to facial and tonal communication cues

Personality disorders
ADHD is not characterized by fear of abandonment, self-injury,
extreme ambivalence, or other features of personality disorder.

Comorbidity:
Oppositional defiant disorder co-occurs in aprrox half of children
Conduct disorder co-occurs in about a quarter of children
Others: disruptive mood dysregulation disorder, Specific learning disorder, Anxiety
disorders & major depressive disorder

Prevalence:
fairly prevalent, occurring in most cultures in 5% of children & 2.5% of adults.
India, study found prevalence of ADHD among primary school children was 11.32%.
It was found to be highest b/w age group of 9 & 10 years.

Gender Differences:
much higher amongst boys (13%) as compared to in girls
(4%), with ratio approx being 2:1.

Risk Factors:
Parents & siblings of children with ADHD(2-8 times greater than in gen. Pop)
First-degree biological relatives (siblings of probands with ADHD)
Parents of children with ADHD show increased incidence of substance use disorders

Case Study:
Justin, 9-year-old African American adopted boy, was referred for evaluation due to
impulsive and aggressive behaviors observed by his 4th-grade teacher. His adoptive parents,
with limited information about his biological family, knew his biological mother was a
polydrug abuser currently incarcerated. Since kindergarten, teachers noted Justin's struggles
to concentrate, listen, and stay seated. By 2nd grade, his academic performance declined
significantly, facing challenges in reading, writing, and math. He engaged in arguments
and fights with peers, often needed extensive help for simple tasks, and displayed
disruptive behaviors when frustrated. Justin's impulsive conduct and academic difficulties
resulted in alienation and bullying by classmates. His behavior alternated between
rambunctiousness and sadness. Following a confrontation, Justin expressed thoughts of self-
harm to his adoptive parents. An evaluation, including parental and teacher rating scales,
confirmed a diagnosis of Attention-Deficit/Hyperactivity Disorder, combined presentation,
based on his clinical history and observations.