M05.09.01 Childhood and Adolescence: Mental Health Conditions

This section provides an overview of some common mental health conditions affecting children and adolescents. Understanding their presentation, diagnosis, and treatment is crucial for medical students.

Intellectual Disability (ID)

• Definition:
  • Significantly impaired intellectual functioning and adaptive behavior that originates before age 18.
  • Characterized by limitations in cognitive skills, communication, social participation, self-care, and independent living.
• Epidemiology:
  • Affects approximately 1-3% of the population.
  • Fetal alcohol syndrome (FAS) is the most common known cause.
  • Down syndrome and Fragile X syndrome are the most common genetic causes.
• Classification by Severity (DSM-5):

Autism Spectrum Disorders (ASD)

• Hallmark: Inability to connect with others and form meaningful relationships.
• Diagnosis: Typically before age 3; boys are more commonly affected than girls.
• Clinical Features:
  • Social Communication Difficulties:
    • Abnormal or delayed language development.
    • Impaired verbal and non-verbal communication.
    • Difficulty with social interaction and reciprocity.
    • Lack of separation anxiety.
    • Pronoun reversal.
    • Difficulty with eye contact and appropriate physical contact.
  • Restricted and Repetitive Behaviors (RRBs):
    • Stereotypical movements or repetitive speech (echolalia).
    • Inflexibility to routines and changes.
    • Intense focus on specific interests or objects.
    • Preference for sameness and predictability.
• Genetics:
  • Monozygotic twins have a higher concordance rate than dizygotic twins, suggesting a genetic component.
  • Severity may correlate with the degree of intellectual disability.
• Other Considerations:
  • Electroencephalogram (EEG) may be abnormal.
  • Seizures can occur in up to 25% of patients.
• Differential Diagnosis:
  • Rett syndrome (primarily affects girls and presents with microcephaly).
  • Social communication disorder (lacks the repetitive behaviors characteristic of ASD).
• Treatment:
  • Behavioral techniques (shaping) are the mainstay of treatment.
  • Antipsychotics like risperidone may be used to manage aggression.

Tourette Syndrome

• Characteristics: Multiple motor and vocal tics occurring frequently (>1 year) for most of the day.
• Epidemiology: More common in males (3:1 ratio).
• Clinical Features:
  • The mean onset is around age 7, with symptom onset before age 18.
  • Tics can be simple (rapid, repetitive movements) or complex (more ritualistic and purposeful).
  • Simple tics typically appear first.
  • Possible genetic component (higher concordance rate in monozygotic twins).
  • Associated with increased dopamine levels.
  • May co-occur with ADHD and OCD.
• Treatment: Medications like haloperidol, pimozide, or clonidine can help manage tics.

Attention Deficit Hyperactivity Disorder (ADHD)

• Characteristics: Inattention, impulsivity, and/or hyperactivity that significantly impair functioning in daily life.
• Epidemiology: More common in males (10:1 ratio).
• Diagnosis:
  • Symptoms present for at least 6 months.
  • Symptoms first appear before age 12.
  • Impairment in at least two settings (e.g., home, school).
• Possible Cause:
  • Dopamine and norepinephrine imbalance in the brain.
• Treatment: Medications like methylphenidate, dextroamphetamine, atomoxetine, or guanfacine can help manage symptoms.

Table 1: Conduct Disorder vs. Oppositional Defiant Disorder