• Specific learning disorder (often referred to as learning disorder or

learning disability) is a developmental disorder that begins during

school-age, although may not be recognized until adulthood.
• Learning disabilities refers to ongoing problems in one of three
areas, reading, writing and math, which are foundational to one’s
ability to learn.
• Other specific skills that may be impacted include the ability to put
thoughts into written words, spelling, reading comprehension,
math calculation and math problem solving.
• Difficulties with these skills may cause problems in learning
subjects such as history, math, science and social studies and may
impact everyday activities.
• Learning disorders, if not recognized and managed, can cause
problems throughout a person’s life beyond having lower
academic achievement. These problems include increased risk
of greater psychological distress, poorer overall mental health,
unemployment/under-employment and dropping out of
school.
 Diagnosis
• To be diagnosed with a specific learning disorder, a person must meet
four criteria.
• 1) Have difficulties in at least one of the following areas for at least six
months despite targeted help:
• Difficulty reading (e.g., inaccurate, slow and only with much effort)
• Difficulty understanding the meaning of what is read
• Difficulty with spelling
• Difficulty with written expression (e.g., problems with grammar,
punctuation or organization)
• Difficulty understanding number concepts, number facts or calculation
• Difficulty with mathematical reasoning (e.g., applying math concepts
or solving math problems)
• 2) Have academic skills that are substantially below what is
expected for the child’s age and cause problems in school,
work or everyday activities.
• 3) The difficulties start during school-age even if in some
people don’t experience significant problems until adulthood
(when academic, work and day-to-day demands are greater).
• 4) Learning difficulties are not due to other conditions, such
as intellectual disability, vision or hearing problems, a
neurological condition (e.g., pediatric stroke), adverse
conditions such as economic or environmental disadvantage,
lack of instruction, or difficulties speaking/understanding the
language.
• Types of Learning Disorders: Dyslexia, Dysgraphia, and Dyscalculia
• Dyslexia – Difficulty with reading-Reading, writing, spelling, speaking
• Dyslexia is a term that refers to the difficulty with reading. People with
dyslexia have difficulty connecting letters they see on a page with the
sounds they make. As a result, reading becomes a slow, effortful and
not a fluent process for them.
• Problems in reading begin even before learning to read, for example
when children have trouble breaking down spoken words into syllables
and recognizing words that rhyme. Kindergarten-age children may not
be able to recognize and write letters as well as their peers. People
with dyslexia may have difficulty with accuracy and spelling as well. It’s
a common misconception that all children with dyslexia write letters
backwards or those who write letters backwards all have dyslexia.
• People with dyslexia, including adolescents and adults, often try
to avoid activities involving reading when they can (reading for
pleasure, reading instructions). They often gravitate (attracted or
move) to other mediums such as pictures, video, or audio.
• Dysgraphia – Difficulty with writing-Handwriting, wrong spellings
for even simple words, organizing ideas and thoughts
• Dysgraphia is a term used to describe difficulties with putting
one’s thoughts on to paper. Problems with writing can include
difficulties with spelling, grammar, punctuation, and
handwriting.
• Mix of upper/lower case letters or cursive/print letters., Irregular letter shape
and sizes.
• Dyscalculia – Difficulty with math-Doing math problems, understanding
time, using money
• Dyscalculia is a term used to describe difficulties learning number related
concepts or using the symbols and formulas to perform math calculations.
Problems with math can include difficulties with number sense,
memorizing math facts, math calculations, math reasoning and math
problem solving.
• Confused by similar looking Arithmetic signs such as + and x; < and > ; -
and ÷
• Understand what adding means yet may become confused when asked to
add.
• Reverse numbers like 18 and 81, or transpose numbers like 752 becomes
572
• Problems with telling time
• Learning disorder can vary in severity:
• Mild: Some difficulties with learning in one or two academic
areas, but may be able to compensate
• Moderate: Significant difficulties with learning, requiring
some specialized teaching and some accommodations or
supportive services
• Severe: Severe difficulties with learning, affecting several
academic areas and requiring ongoing intensive specialized
teaching
• Dyspraxia (Sensory Integration Disorder) – Difficulty with fine
motor skills: Hand-eye coordination, balance, manual
dexterity
• Dysphasia/Aphasia – Difficulty with language: Understanding
spoken language, reading comprehension
• Auditory Processing Disorder – Difficulty hearing differences
between sounds: Reading, comprehension, language
• Visual Processing Disorder – Difficulty interpreting visual
information: Reading, math, maps, charts, symbols, pictures
 CAUSAL FACTORS
According to Myers & Hammill,1900-
 children who were born prematurely, had a low birth weight
 Brain damage or dysfunction- brain injury or dysfunction of CNS
 Heredity- Individuals with certain genetic syndromes may have an increased risk
of manifesting a particular type of learning disorder.
• Girls with turner syndrome (abnormality in X chromosome leads to heart defects,
problems with sexual development, premature ovarian failure, infertility) and
fragile X syndrome- changes in fragile X mental retardation 1 (FMR1) gene which
makes a protein FMRP (intellectual and developmental disabilities)
• and boys with Klinefelter syndrome (boy is born with an extra copy of the X
chromosome affect testicular growth, resulting in smaller than normal testicles
lead to lower production of testosterone) will have visual-perceptual (the way the
brain processes visual info is impaired. Difficulty interpreting and using visual info
effectively) learning disabilities.
• Genetic disorder linked with dyslexia.
 Biochemical imbalance- inability of a child’s bloodstream to
synthesize a normal amount of vitamins.
 Environmental factors-impoverished living conditions early in
child’s life can contribute to LD’s (malnutrition)
• Quality of information they receive
• Infants and toddlers who received infrequent communication
exchanges with their parents were more likely to show deficits
in vocabulary, language use, intellectual development before
entering school
 TREATMENT
• Learning disabilities are not curable; however, many can be reduced or
controlled with early screening and intervention
• Once diagnosed with a learning disability, your child’s most beneficial
treatment will be special education services, including a team approach
to planning your child’s Individualized Education Program (IEP), in
addition to other therapies.
• These might include speech therapy or occupational therapy. One-on-
one tutoring with a specialist who understands learning disabilities can
also make a difference in a child’s adaptation and progress.
• An Individualized Education Plan (or Program) is also known as an IEP.
This is a plan or program developed to ensure that a child with an
identified disability who is attending an elementary or secondary
educational institution receives specialized instruction and related
services.
• Occupational therapy can be helpful to children who experience
difficulty with motor skills, while educational therapists work
with school-aged individuals to improve skills in reading, writing,
and math.
• Speech therapists work with children who have language-based
or reading comprehension issues and can help them improve
their ability to understand and communicate in social situations.
• Solution-focused counseling may be appropriate for older
children and teens who are aware of their difficulties, as
a solution-focused therapist will be able to support youth as they
address a difficulty and help them determine what might be
working for them and what could be improved upon.
• Children and adults may also do well in therapy groups
or support groups,
• and play therapy can help young children learn interaction
skills, which may occasionally be lacking in the presence of a
learning difficulty.
• Counseling can also be helpful when those with a learning
difficulty feel shy, anxious, or otherwise find it challenging to
express themselves to others. Because emotional distress can
occur as a result, talking through these anxieties in therapy
may prove beneficial.
 Tic disorders
• Tic disorders- Tic disorders are characterised by the presence of tics. Tic
is an abnormal involuntary movement (AIM) which occurs suddenly,
repetitively, rapidly and is purposeless in nature.
• It is of two types:
1. Motor tic, characterised by repetitive motor movements.
2. Vocal tic, characterised by repetitive vocalisations.
• Tic disorders can be either transient or chronic.
• Transient (brief) tic disorders are more common in boys and can occur
in 5-20% of children. Tics are easily worsened by stressful life situations,
fatigue and/or use stimulants such as caffeine and nicotine.
• A vast majority of these disappear by adulthood. A special type of
chronic tic disorder is Gilles de la Tourette’s syndrome or Tourette’s
disorder.
• Tourette’s Disorder- Tourette’s disorder is
typically characterised by:
1. Multiple motor tics.
2. Multiple vocal tics.
3. Duration of more than 1 year.
4. Onset usually before 11 years of age and
almost always before 21 years of age.
• Motor Tics- The motor tics in Tourette’s
disorder can be simple or complex
i. Simple motor tics: These may include eye blinking, grimacing
(facial expression in which your mouth and face are twisted in
a way that shows disgust, disapproval or pain), shrugging of
shoulders, tongue protrusion.
ii. Complex motor tics: These are facial gestures, stamping (to put
your foot down very heavily and noisily), jumping, hitting self,
squatting, twirling, echo kinesis (involuntary repetition or
imitation of another person's actions), copropraxia (obscene
acts- inappropriate touching).
• Motor tics are often the earliest to appear, beginning in the
head region and then progressing downwards. These are later
followed by the vocal tics.
 Vocal Tics- The vocal tics in Tourette’s disorder can also
be simple or complex.
i. Simple vocal tics: Simple vocal tics include coughing,
barking, throat-clearing, sniffing, and clicking.
ii. Complex vocal tics: These include some very
characteristic, though not always present, symptoms
of Tourette syndrome; for example, echolalia
(repetition of heard phrases), palilalia (repetition of
heard words), coprolalia (use of obscene words), and
mental coprolalia (thinking of obscene words)
• Risk factors for Tourette syndrome include:
• Family history. Having a family history of Tourette
syndrome or other tic disorders might increase
the risk of developing Tourette syndrome.
• Sex. Males are about three to four times more
likely than females to develop Tourette syndrome.
• Prenatal health-Smoking during pregnancy,
Pregnancy complications, Low birth weight.
 Enuresis
• Persistent loss of bladder control after age 5 yrs
• Enuresis is repetitive voiding of urine, either during the day or night, at
inappropriate places. This state of affairs is normal in infancy.
• Most children achieve bladder control by the age of three years. By the
age of 5 years, there are still about 7% of children who wet their bed.
• Technically, enuresis is diagnosed only after 5 years of age (and at least
4 years of mental age).
• Enuresis can be either of: 1. Primary type, where bladder control has
never been achieved, or 2. Secondary type, where enuresis emerges
after a period of bladder control (at least one year).
• The majority (about 80%) of children with enuresis have nocturnal
(Active in the night)bed wetting only. Non-organic enuresis is more
common (about two times) in males
• Aetiology- The exact cause of enuresis is not known. A variety of
factors, which are implicated in its causation, are largely
biopsychosocial.
• About 75% of children with enuresis have a first degree relative
with history of enuresis.
• The most commonly occurring factors, however, are psychosocial,
such as emotional disturbances, insecurity, sibling rivalry, death of
a parent.
• An organic cause must be looked for in children with diurnal
enuresis (15% of all cases of diurnal enuresis- Diurnal enuresis is
an unintended leakage of urine during waking hours in an
individual old enough to maintain bladder control) and adolescents
with enuresis.
• The organic (anatomic or pathophysiologic changes occur in some bodily tissue
or organ) causes are present in about 5% of cases and include worm
infestation (itching around the anal area),
• spina bifida (Spina bifida is a birth defect that occurs when the spine and
spinal cord don't form properly),
• neurogenic bladder (Neurogenic bladder is when a problem in your brain,
spinal cord, or central nervous system makes you lose control of your bladder),
• urinary tract infection (an infection in any part of your urinary system — your
kidneys, ureters, bladder and urethra),
• diabetes mellitus (characterized by a high blood sugar level over a prolonged
period of time), and seizure disorder.
• In secondary enuresis, the age of onset is usually 5-8 years. Enuresis tends to
remit spontaneously and only 1% of children with enuresis continue to have
the disorder in adulthood
 Encopresis
• Encopresis is repetitive passage of faeces at inappropriate
time and/or place, after bowel control is physiologically
possible. This is not due to the presence of any organic cause,
which is called as faecal incontinence.
• Normally, toilet training is achieved between the ages of 2
and 3. Encopresis is defined as occurring after the age of 4
years.
• Encopresis can be either of: 1. Primary type, where toilet
training has never been achieved, or 2. Secondary type,
where encopresis emerges after a period of faecal continence
(inability to control bowel movements, causing stool (feces)
to leak unexpectedly from the rectum).
• This type typically occurs between the ages of
4 and 8. Encopresis is more common (about 3-
4 times) in males.
• By the age of 5 years, 1-1.5% of children suffer
from encopresis. It tends to remit
spontaneously with increasing age and by the
age of 16 there are virtually no adolescents
with encopresis. About 25% of these patients
have associated enuresis.
• Aetiology- The factors implicated in causation of encopresis include:
1. Inadequate, inconsistent toilet training.
2. Sibling rivalry.
3. Maturational lag- developmental delay of several neural system
aspects. For instance, it is hypothesized that children with ADHD have
a lag regarding some of their brain parts' development. The slowness
of this progress may be manifested as significant inattention, speech
delay, gross motor skill concerns, etc.
4. Underlying hyperkinetic disorder.
5. Emotional disturbances.
6. Mental retardation.
7. Childhood schizophrenia.
8. Autistic disorder.
 Separation anxiety disorder
• Separation anxiety disorder of childhood- It is normal for toddlers and preschool
children to show a degree of anxiety over real or threatened separation from
people to whom they are attached.
• Separation anxiety disorder (SAD) is a condition in which a child becomes fearful
and nervous when away from home or separated from a loved one -- usually a
parent or other caregiver -- to whom the child is attached.
• Some children also develop physical symptoms, such as headaches or
stomachaches, at the thought of being separated. The fear of separation causes
great distress to the child and may interfere with their normal activities, like
going to school or playing with other children.
• Separation anxiety is normal in very young children (those between 8 and 14
months old). Kids often go through a phase when they’re "clingy" and afraid of
unfamiliar people and places.
• When this fear affects a child over age 6 years, is heavy, or lasts longer than 4
weeks, the child may have separation anxiety disorder.
• It is differentiated from normal separation
anxiety when it is of such severity that is
statistically unusual (including an abnormal
persistence beyond the usual age period) and
when it is associated with significant problems
in social functioning.
• In addition, the diagnosis requires that there
should be no generalized disturbance of
personality development of functioning.
• Diagnostic guidelines- The key diagnostic feature is a focused excessive anxiety
concerning separation from those individuals to whom the child is attached
(usually parents or other family members), that is not merely part of a
generalized anxiety about multiple situations.
• The anxiety may take the form of: (a)an unrealistic, preoccupying worry about
possible harm befalling (to happen especially as if by fate) major attachment
figures or a fear that they will leave and not return;
• (b)an unrealistic, preoccupying worry that some untoward event, such as the
child being lost, kidnapped, admitted to hospital, or killed, will separate him or
her from a major attachment figure;
• (c)persistent reluctance or refusal to go to school because of fear about
separation (rather than for other reasons such as fear about events at school);
• (d)persistent reluctance or refusal to go to sleep without being near or next to
a major attachment figure
• (e)persistent inappropriate fear of being alone, or otherwise
without the major attachment figure, at home during the day;
• (f)repeated nightmares about separation;
• (g)repeated occurrence of physical symptoms (nausea,
stomachache, headache, vomiting, etc.) on occasions that
involve separation from a major attachment figure, such as
leaving home to go to school;
• (h)excessive, recurrent distress (as shown by anxiety, crying,
tantrums, misery, apathy, or social withdrawal) in anticipation
of, during, or immediately following separation from a major
attachment figure.
• Phobic anxiety disorder of childhood -Children, like adults, can
develop fear that is focused on a wide range of objects or situations.
• Some of these fears (or phobias), for example agoraphobia, are not a
normal part of psychosocial development.
• Agoraphobia is a fear of being in situations where escape might be
difficult or that help wouldn't be available if things go wrong. Many
people assume agoraphobia is simply a fear of open spaces, but it's
actually a more complex condition. Someone with agoraphobia may
be scared of: travelling on public transport.
• However, some fears show a marked developmental phase specificity
and arise (in some degree) in a majority of children; this would be
true, for example, of fear of animals in the preschool period.
• Diagnostic guidelines This category should be used
only for developmental phase-specific fears,
namely that: (a)the onset is during the
developmentally appropriate age period; (b)the
degree of anxiety is clinically abnormal; and (c)the
anxiety does not form part of a more generalized
disorder.
• Generalized Anxiety Disorder (GAD) is
characterized by persistent and excessive worry
about a number of different things.
• Social anxiety disorder of childhood- A wariness
(characteristic of being very cautious or careful) of
strangers is a normal phenomenon in the second half of
the first year of life and a degree of social apprehension
or anxiety is normal during early childhood when children
encounter new, strange, or socially threatening situations.
• This category should therefore be used only for disorders
that arise before the age of 6 years, that are both unusual
in degree and accompanied by problems in social
functioning, and that are not part of some more
generalized emotional disturbance.
• Diagnostic guidelines- Children with this disorder show
a persistent or recurrent fear and/or avoidance of
strangers; such fear may occur mainly with adults,
mainly with peers, or with both.
• The fear is associated with a normal degree of selective
attachment to parents or to other familiar persons.
• The avoidance or fear of social encounters is of a degree
that is outside the normal limits for the child's age and
is associated with clinically significant problems in social
functioning.
 ADHD
• ATTENTION DEFICIT DISORDER (HYPERKINETIC DISORDER)-
• This is a syndrome fi rst described by Heinrich Hoff in 1854.
• Since then, it has been known by a variety of names such as minimal brain
dysfunc tion (MBD), hyperkinetic syndrome, Strauss syndrome, organic
drivenness and minimal brain damage.
• ADHD is a disorder that makes it difficult for a person to pay attention and
control impulsive behaviors. He or she may also be restless and almost
constantly active.
• A relatively common disorder, it occurs in about 3% of school age children.
• Males are 6-8 times more often affected. The onset occurs before the age of
7 years and a large majority of patients exhibit symptoms by the 4th year of
age.
• Attention deficit disorder (ADD) is of four clinical types: with hyperactivity,
without hyperactivity, residual type, and with conduct disorder.
• hyperactivity, is characterized by difficulties that interfere with
effective task-oriented behavior in children— particularly
impulsivity, excessive or exaggerated motor activity, such as
aimless or haphazard running or fidgeting, and difficulties in
sustaining attention (Nigg et al., 2005; see DSM-5 Criteria for
Attention-Deficit/Hyperactivity Disorder).
• Children with ADHD are highly distractible and often fail to
follow instructions or respond to demands placed on them
(Wender, 2000).
• Children with ADHD also tend to talk incessantly(continue
without pause) and to be socially intrusive(coming without
invite) and immature
• ADHD is not just a childhood disorder. Although the
symptoms of ADHD begin in childhood, ADHD can continue
through adolescence and adulthood. Even though
hyperactivity tends to improve as a child becomes a teen,
problems with inattention, disorganization, and poor impulse
control often continue through the teen years and into
adulthood.
• Ccriteria for Attention-Deficit/Hyperactivity Disorder
A. A persistent pattern of inattention and/or hyperactivity,
impulsivity that interferes with functioning or development, as
characterized by (1) and/or (2):
1. Inattention: Six (or more) of the following symptoms have
persisted for at least 6 months to a degree that is inconsistent
with developmental level and that negatively impacts directly
on social and academic/occupational activities:
2. Hyperactivity and impulsivity: Six (or more) of the following
symptoms have persisted for at least 6 months to a degree that
is inconsistent with developmental level and that negatively
impacts directly on social and academic/ occupational activities
 CAUSAL FACTORS
• Genetic involvement- ADHD tends to run in families and, in
most cases, it's thought the genes you inherit from your
parents are a significant factor in developing the condition.
• Research shows that parents and siblings of a child with ADHD
are more likely to have ADHD themselves.
• Exposure to environmental toxins by a pregnant mother—
such as lead, found mainly in paint and pipes in older
buildings
• recent study found that prenatal alcohol exposure can
increase the severity of problems in children with ADHD
(Ware et al., 2012). prenatal exposure to heavy maternal
drinking can cause foetal alcohol syndrome, the behavioural
aspects of which include symptoms of inattention and
hyperactivity.
• Premature birth (before the 37th week of pregnancy) or with
a low birthweight
• with brain damage – which happened either in the womb or
after a severe head injury later in life
• Psychosocial adversity- Adverse social and family environments
such as low parental education, social class, poverty,
bullying/peer victimisation, negative parenting, maltreatment
and family discord are associated with ADHD.
• Some research has found different EEG (electroencephalogram)
patterns occurring in children with ADHD than in children
without ADHD (Barry et al., 2003).
• it detects abnormal activities in our brain.
 TREATMENT
• ADHD medication
• Stimulants such as Ritalin and Adderall are often prescribed for ADHD
—and they’re certainly not the only treatment.
• Medications for ADHD may help your child concentrate better or sit
still, at least in the short term. But to date, there is little evidence that
they improve school achievement, relationships, or behavioral issues
over the long term. And even in the short term, medication won’t
solve all problems or completely eliminate the symptoms of ADHD.
• Furthermore, there are concerns about the effects these powerful
drugs may have on a child’s developing brain. And the side effects—
such as irritability, loss of appetite, and insomnia—can also be
problematic.
• The bottom line: medication is a tool, not a cure.
• Everyone responds differently to ADHD medication. Some
children experience dramatic improvement while others
experience little to no relief. The side effects also differ from child
to child and, for some, they far outweigh the benefits. Because
everyone responds differently, finding the right medication and
dose takes time.
• ADHD medication should always be closely
monitored. Medication treatment for ADHD involves more than
just taking a pill and forgetting about it. Your child’s doctor will
need to monitor side effects, keep tabs on how your child is
feeling, and adjust the dosage accordingly. When medication for
ADHD is not carefully monitored, it is less effective and more
risky.
• ADHD treatment starts at home- Evidence shows that eating a healthy diet,
getting plenty of exercise, and making other smart daily choices can help your
child manage the symptoms of ADHD. That means your child can begin
treatment for ADHD today—at home.
• The power of exercise in the treatment of ADHD- Exercising is one of the
easiest and most effective ways to reduce the symptoms of ADHD. Physical
activity immediately boosts the brain’s dopamine, norepinephrine, and
serotonin levels—all of which affect focus and attention. In this way, exercise
and medications for ADHD such as Ritalin and Adderall (stimulants) work
similarly. But unlike ADHD medication, exercise doesn’t require a prescription
and it’s free of side effects.
• Activities that require close attention to body movements, such as dance,
gymnastics, martial arts, and skateboarding, are particularly good for kids
with ADHD. Team sports are also a good choice. The social element keeps
them interesting
• Good nutrition can help reduce ADHD symptoms
• Studies show that what, and when, you eat makes a difference when it
comes to managing ADHD.
• Schedule regular meals or snacks no more than three hours apart. This
will help keep your child’s blood sugar steady, minimizing irritability and
supporting concentration and focus.
• Try to include a little protein and complex carbohydrates at each meal or
snack. These foods will help your child feel more alert while decreasing
hyperactivity.
• Add more omega-3 fatty acids to your child’s diet. Studies show that
omega-3s reduce hyperactivity and impulsivity and enhance concentration
in kids (and adults) with ADHD. Omega-3s are found in salmon, tuna,
sardines, and some fortified eggs and milk products. However, the easiest
way to boost your child’s intake is through fish oil supplements
• Behavioral therapy for ADHD
• Behavioral therapy, also known as behavior modification, has been
shown to be a very successful treatment for children with ADHD. It
is especially beneficial as a co-treatment for children who take
stimulant medications and may even allow you to reduce the
dosage of the medication.
• Behavior therapy involves reinforcing desired behaviors through
rewards and praise and decreasing problem behaviors by setting
limits and consequences. For example, one intervention might be
that a teacher rewards a child who has ADHD for taking small steps
toward raising a hand before talking in class, even if the child still
blurts out a comment. The theory is that rewarding the struggle
toward change encourages the full new behavior.
• Behavior Therapy for ADHD in Children
• According to the American Academy of Pediatrics, there are three
basic principles to any behavior therapy approach:
• Set specific goals. Set clear goals for your child such as staying
focused on homework for a certain time or sharing toys with
friends.
• Provide rewards and consequences. Give your child a specified
reward (positive reinforcement) when he or she shows the desired
behavior. Give your child a consequence (unwanted result or
punishment) when he or she fails to meet a goal.
• Keep using the rewards and consequences. Using the rewards and
consequences consistently for a long time will shape your child’s
behavior in a positive way.
• Social skills training
• Because kids with attention deficit disorder often have
difficulty with simple social interactions and struggle with low
self-esteem, another type of treatment that can help is social
skills training.
• Normally conducted in a group setting, social skills training is
led by a therapist who demonstrates appropriate behaviors
and then has the children practice repeating them. A social
skills group teaches children how to “read” others’ reactions
and how to behave more acceptably. The social skills group
should also work on transferring these new skills to the real
world.
• Treatment- The management of ADD consists of the following methods:
• Pharmacotherapy : 1. Stimulant medication: Dextro-amphetamine or
dexamphetamine (2.5-20 mg/day) and methyphenidate (5-60 mg/day) have been
traditionally used.
• Currently, Methylphenidate is the drug of choice in the treatment of ADD, with a
high response rate. Methylphenidate is also available in sustained release
formulations which are preferable due to improved treatment concordance and
convenience of once a day dose.
• Both dexamphetamine and methylphenidate act on the reticular activating system,
causing stimulation of the inhibitory influences on the cerebral cortex, thus
decreasing hyperactivity and/or distractibility.
2. Others: When stimulant medication is not available or is not effective, other drugs
can be used after careful individual consideration of the risks and benefits in the
individual patient. These include clonidine, tricyclic antidepressants (such as
imipramine), bupro pion, venlafaxine, chlorproma zine, thiorida zine, and lithium
carbo nate
• Behaviour Modification Counselling and
Supportive Psychotherapy-
• Behaviour modification and counselling are
very important in the successful management
of ADD and can be used along with drug
therapy
 CONDUCT DISORDERS
• Conduct disorder is a mental health condition characterised
by a persistent and significant pattern of conduct (series of
act), in which the basic rights of others are violated or rules of
society are not followed.
• It is a patterns of violating societal norms and the rights of
others.
• Children with conduct disorder behave in angry, aggressive,
argumentative, and disruptive ways (to prevent something
from continuing or operating in a normal way).
• (The diagnosis is only made when the conduct is far in excess
of the routine mischief of children and adolescents).
• The onset occurs much before 18 years of age,
usually even before puberty (10-12 in boys
and 14-16 in girls)
• According to the studies, the disorder is much
more (about 5-10 times) common in males. In
United States of America, about 10% of all
male children under the age of 18 have
conduct disorder.
• oppositional defiant disorder is usually apparent by about age
8, and conduct disorder tends to be seen by age 9. These
disorders are closely linked (Thomas, 2010)
• The characteristic clinical features include:
1. Frequent lying.
2. Stealing or robbery.
3. Running away from home and school.
4. Physical violence such as rape, fi re-setting, assault or
breaking-in, use of weapons.
5. Cruelty towards other people and animal
• DSM 5 criteria for Conduct Disorder -
• A repetitive and persistent pattern of behavior in which the
basic rights of others or major age- appropriate societal norms
or rules are violated, as manifested by the presence of at least
three of the following 15 criteria in the past 12 months from
any of the categories below, with at least one criterion present
in the past 6 months:
• Aggression to People and Animals
1. Often bullies, threatens, or intimidates (scare) others.
2. Often initiates physical fights.
3. Has used a weapon that can cause serious physical harm to
others (e.g., a bat, brick, broken bottle, knife, gun).
• Has been physically cruel to people.
• Has been physically cruel to animals.
• Has stolen while confronting a victim (e.g., mugging, purse
snatching, extortion, armed robbery).
• Has forced someone into sexual activity.

• Destruction of Property-
• Has deliberately engaged in fire setting with the intention of
causing serious damage.
• Has deliberately destroyed others’ property (other than by
fire setting).
• Deceitfulness (dishonest or try to hide truth to get an advantage) or Theft–
• Has broken into someone else’s house, building, or car.
• Often lies to obtain goods or favors or to avoid obligations (i.e., “cons”
others).
• Has stolen items of nontrivial (significant)value without confronting a
victim (e.g., shoplifting, but without breaking and entering; forgery- illegal
copy of a document or signature).

• Serious Violations of Rules-

• Often stays out at night despite parental prohibitions, beginning before
age 13 years.
• Has run away from home overnight at least twice while living in the
parental or parental surrogate home, or once without returning for a
lengthy period.
• Is often truant (regularly absent without permission)from
school, beginning before age 13 years.
• The disturbance in behavior causes clinically significant
impairment in social, academic, or occupational functioning.
• If the individual is age 18 years or older, criteria are not met
for antisocial personality disorder (disregard for right and
wrong, persistent lying, using charm to manipulate others,
violating the right of others, aggressive, violent, lack of
empathy ) because adults with antisocial PD shows symptoms
of Conduct D before the age of 15
 Causal factors
• Genetics: Many children and teens with conduct disorder have
close family members with mental illnesses, including
mood disorders, anxiety disorders, substance use disorders and
personality disorders. This suggests that a vulnerability to conduct
disorder may be at least partially inherited.
• Environmental: Factors such as a dysfunctional family life,
childhood abuse, traumatic experiences, a family history of
substance abuse, and inconsistent discipline by parents may
contribute to the development of conduct disorder.
• Social: Low socioeconomic (individual with low educational
achievement, or low household income) status and not being
accepted by their peers appear to be risk factors for the
development of conduct disorder.
• Biological
• Various studies indicate a moderate degree of
heritability for antisocial behavior, impulsivity,
temperament, aggression, and insensitivity to
punishment.
• Low levels of 5-Hydroxy Indole acetic acid (5-HIAA)
levels in cerebrospinal fluid correlates with
aggression and violence in adolescence.
• High testosterone levels are also associated with
aggression.
• Parental and Family
• A home environment that lacks structure and adequate
supervision with frequent marital conflicts between parents
and inconsistent discipline leads to maladaptive behavior
and/or the following:
– harsh parenting with verbal and physical aggression towards children
– children exposed to frequent domestic violence
– the family history of criminality
– substance abuse particularly alcohol dependence in parents
– living in low social, economic conditions with overcrowding and
unemployment lead to economic and social stress with lack of
adequate parenting.
• School- lack of positive feedback from
teachers
• lack of supportive staff and counseling to
address socio-economic difficulties in children
• exposure to increased gang violence in the
community
 Treatment
• Treatment will depend on your child’s symptoms, age, and general health.
It will also depend on how severe the condition is.
• Treatment for conduct disorder may include:
• Psychotherapy: Psychotherapy (a type of counseling) is aimed at helping
the child learn to express and control anger in more appropriate ways.
• Cognitive-behavioral therapy aims to reshape the child's thinking
(cognition) to improve problem solving skills, anger management, moral
reasoning skills, and impulse control.
• Family therapy. Family therapy may be used to help improve family
interactions and communication among family members.
• A specialized therapy technique called parent management training (PMT)
teaches parents ways to positively alter their child's behavior in the home.
• Peer group therapy. A child develops better social and interpersonal skills.
• Medicines. These are not often used to treat
conduct disorder. But a child may need them
for other symptoms or disorders such as
ADHD. These other disorders often occurs
along with symptoms of conduct disorder.
• Medication treatment is mainly used for
comorbid conditions, such as ADHD, and is not
a sole (or main) response to treating CD.
 ODD
• ODD is a behavioral disorder that results in a persistent pattern of
anger, defiance (Resisting authority), and vindictiveness (holding
grudes and seek revenge to harm someone) against authority figures
could be a sign of oppositional defiant disorder (ODD).
• It can affect a person’s work, school, and social life.
• Oppositional defiant disorder (ODD) is a type of behavior disorder. It is
mostly diagnosed in childhood.
• Children with ODD are uncooperative, defiant, and hostile toward
peers, parents, teachers, and other authority figures. They are more
troubling to others than they are to themselves.
• ODD affects between 1 and 16 percent of school age children. It’s more
common in boys than girls. Many children start to show symptoms of
ODD between the ages of 6 and 8 years. ODD also occurs in adults.
• The Diagnostic and Statistical Manual of Mental Disorders (DSM-5),
published by the American Psychiatric Association, lists criteria for
diagnosing ODD. The DSM-5 criteria include emotional and behavioral
symptoms that last at least six months.
1. Angry and irritable mood:
• Often and easily loses temper
• Is frequently touchy(easily offended, irritated) and easily annoyed by others
• Is often angry and resentful
1. Argumentative and defiant (refuse to obey authority) behavior:
• Often argues with adults or people in authority
• Often actively defies or refuses to comply with adults' requests or rules
• Often deliberately annoys or upsets people
• Often blames others for his or her mistakes or misbehavior
• Vindictiveness (the act of showing a wish to harm someone because you
think that they have harmed you):
• Is often spiteful (behaving in a cruel way to hurt or annoy somebody) or
vindictive
• Has shown spiteful or vindictive behavior at least twice in the past six
months
1. The disturbance in behaviour is associated with distress in the individual
or others in his or her immediate social context (e.g., family, peer group)
or it impacts negatively on social, educational, occupational or other
important areas of functioning.
( if the disturbance in behavior is associated with distress in the person
or their immediate social circle. The disruptive behavior may negatively
affect important areas like their social life, education, or occupation.)
• The behaviors do not occur during the course of a psychotic,
substance use, depressive or bipolar disorder. Also, the
criteria are not met for disruptive mood dysregulation
disorder.
• (it’s not linked to substance abuse or mental health episodes
• For diagnosis, the behaviors can’t occur exclusively during the
course of episodes that include:
• substance abuse
• depression
• bipolar disorder
• psychosis)
• ODD can vary in severity:
• Mild. Symptoms occur only in one setting,
such as only at home, school, work or with
peers.
• Moderate. Some symptoms occur in at least
two settings.
• Severe. Some symptoms occur in three or
more settings.
 Causal factors
• Developmental theory. This theory suggests that the problems start
when children are toddlers. Children and teens with ODD may have had
trouble learning to become independent from a parent or other main
person to whom they were emotionally attached. Their behavior may
be normal developmental issues that are lasting beyond the toddler
years.
• Learning theory. This theory suggests that the negative symptoms of
ODD are learned attitudes. They mirror the effects of negative
reinforcement methods used by parents and others in power. The use
of negative reinforcement increases the child’s ODD behaviors. That’s
because these behaviors allow the child to get what he or she wants:
attention and reaction from parents or others.
• Environment — problems with parenting that may involve a lack of
supervision, inconsistent or harsh discipline, or abuse or neglect
• Other possible factors in the development of ODD may
include:
• permissive parenting, when a parent too often and too easily
gives in to the child’s demands
• strong will in the child, which can be caused by any or all of
the following:
– ingrained personality characteristics
– the mother’s exposure to certain harmful agents (such as cigarette
smoke) while pregnant
– lack of positive attachment to a parent
– significant stress or a lack of predictable structure in the home or
community environment
 treatment
• Treatment for oppositional defiant disorder
• Early treatment is essential for people with ODD. Teens and
adults with untreated ODD have increased risk for depression
and substance abuse, according to the
American Academy of Child & Adolescent Psychiatry. Treatment
options can include:
• Individual cognitive behavioral therapy: A psychologist will work
with the child to improve:
• anger management skills
• communication skills
• impulse control
• problem-solving skills
• Family therapy: A psychologist will work with the whole family to
make changes. This can help parents find support and learn
strategies for handling their child’s ODD.
• Parent-child interaction therapy (PCIT): Therapists will coach the
parents as they interact with their children. Parents can learn more
effective parenting techniques. (increasing positive reinforcements
and reducing negative reinforcements, using consistent punishment
for bad behavior)
• Peer groups: The child can learn how to improve their social skills
and relationships with other children.
• Medications: These can help treat causes of ODD, such as
depression or ADHD. However, there is no specific medication to
treat ODD itself.