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Mental Disorders Diagnosed in Childhood
Mental disorders diagnosed in childhood are divided into two categories: childhood disorders and learning disorders. These disorders are usually first diagnosed in infancy, childhood, or adolescence, as laid out in the DSM IV TR and in the ICD-10. The DSM-IV-TR includes ten subcategories of disorders including Mental Retardation, Learning Disorders, Motor Skills Disorders, Communication Disorders, Pervasive Developmental Disorders, Attention-Deficit and Disruptive Behavior Disorders, Feeding and Eating Disorders, Tic Disorders, Elimination Disorders, and Other Disorders of Infancy, Childhood, or Adolescence.

DSM-IV-TR
Mental Retardation is coded on Axis II of the DSM-IV-TR. The diagnostic criteria necessary in order to diagnose mental retardation consists of:
 * 317 Mild mental retardation
 * 318.0 Moderate mental retardation
 * 318.1 Severe mental retardation
 * 318.2 Profound mental retardation
 * 319 Mental retardation, severity unspecified
 * A. Functioning that is significantly below average with an IQ of about 70 or lower.  If diagnosing an infant, the clinician would take notice of intellectual functioning that is below average.
 * B. Multiple consecutive failures to meet standards set that are appropriate for one's age or cultural expectations. These deficits could be in at least two of the following areas: taking care of oneself, social skills, health, academic skills, communication, living at home, ability to self-direct, use of community resources, work, free time, and safety.
 * C. The presence of these symptoms must be detectable before age 18.

There are varying degrees of mental retardation, which are identified by an IQ test.
 * Mild Mental Retardation: IQ level 50-55 to approximately 70
 * Moderate Mental Retardation: IQ level 35-40 to 50-55
 * Severe Mental Retardation: IQ level 20-25 to 35-40
 * Profound Mental Retardation: IQ level below 20 or 25

Mental Retardation, Severity Unspecified: This unspecified diagnosis is given when there is a strong assumption that the child is mentally retarded, but cannot be tested because the individual is too impaired, not willing to take the IQ test or is an infant.

Etiology
Mental Retardation in children can be caused by genetic or environmental factors. The individual could have a natural brain malformation or pre or postnatal damage done to the brain caused by drowning or a traumatic brain injury, for example. Nearly 30 to 50% of individuals with mental retardation will never know the cause of their diagnosis even after thorough investigation. Prenatal causes of mental retardation include: Single-gene disorders that result in mental retardation include: These single-gene disorders are usually associated with atypical physical characteristics. About 1/4 of individuals with mental retardation have a detectable chromosomal abnormality. Others may have small amounts of deletion or duplication of chromosomes, which may go unnoticed and therefore, undetermined.
 * Congenital infections such as cytomegalovirus, toxoplasmosis, herpes, syphilis, rubella and human immunodeficiency virus
 * Prolonged maternal fever in the first trimester
 * Exposure to anticonvulsants or alcohol
 * Untreated maternal phenylketonuria (PKU)
 * Complications of prematurity, especially in extremely low-birth-weight infants
 * Postnatal exposure to lead
 * Fragile X syndrome
 * Neurofibromatosis
 * Tuberous sclerosis
 * Noonan's syndrome
 * Cornelia de Lange's syndrome

DSM-IV-TR

 * 315.00 [|Reading disorder]
 * 315.1 Mathematics disorder
 * 315.2 Disorder of written expression
 * 315.9 Learning disorder NOS: This category contains disorders in learning that do not meet the criteria for any specific Learning Disorder. This category is a catch all for an individual that either has problems in one, two or all areas of learning, and he or she can be diagnosed with Learning Disorder NOS even if their performance scores are not considerably below average for their age, age appropriate education, and measured intelligence.  The individual would need to experience a significant interference in which the cause is their learning skills on their academic achievements in order to be diagnosed with Learning Disorder NOS.

Etiology
Learning Disorders are believed to be caused by a nervous system abnormality. The abnormality could either be in the structure of the brain or in the functioning of chemicals in the brain. Because of this, he individual has problems receiving, processing or communicating information normally. Some causes of the nervous system abnormality include problems during pregnancy, birth or early infancy, brain trauma at a young age, exposure to toxins, and prematurity.

Symptoms
Children with a learning disorder may display the following traits:
 * have trouble reading aloud
 * have trouble spelling, expressing themselves in writing, or in learning the alphabet
 * have trouble following directions
 * may have trouble comprehending what he or she reads
 * have trouble remembering how to pronounce written words
 * may have trouble organizing their thoughts to produce what he or she wants to say
 * may misinterpret or confuse math symbols or numbers
 * may not be able to retell a story in order
 * may have trouble beginning or figuring out the next step of a task

DSM-IV-TR

 * 315.4 Developmental coordination disorder

Etiology
The etiology behind Motor Skills Disorders is not exact, but the cause is usually genetic or environmental. Motor skills disorders are often associated with physiological or developmental abnormalities including ADHD, learning disorders, developmental disabilities and prematurity.

DSM-IV-TR

 * 315.31 Expressive language disorder
 * 315.32 Mixed receptive-expressive language disorder
 * 315.39 Phonological disorder
 * 307.0 Stuttering
 * 307.9 Communication disorder NOS

Etiology
The cause of Communication Disorders in children are usually biological, developmental or environmental. These causes include abnormalities in brain development, exposure to certain toxins during pregnancy, or genetic factors.

DSM-IV-TR

 * 299.00 Autistic Disorder
 * 299.80 Rett's Disorder
 * 299.10 Childhood Disintegrative Disorder
 * 299.80 Asperger’s Disorder
 * 299.80 Pervasive Developmental Disorder NOS

Etiology
Pervasive Developmental Disorders have no known cause yet, but researchers are interested in finding a connection between the disorders and problems in the nervous system. Studies are being done on the brain and spinal cord in children with PDD's to try and find a link.

Symptoms
Children with pervasive developmental disorders may exhibit the following symptoms:
 * have trouble expressing or understanding ideas
 * have trouble understanding non-verbal communication
 * difficulty in social interactions
 * temper tantrums
 * aggressive behavior
 * may play differently with toys than other children
 * may have difficulty adjusting to new places or people
 * anxious behavior

DSM-IV-TR

 * Attention-Deficit Hyperactivity Disorder
 * 314.01 Combined subtype:
 * 314.01 Predominantly hyperactive-impulsive subtype
 * 314.00 Predominantly inattentive subtype
 * 314.9 Attention-Deficit Hyperactivity Disorder NOS: This category is used for individuals that have pronounced symptoms of inattention or hyperactivity-impulsivity, yet do not meet the criteria for Attention-Deficit/Hyperactivity Disorder. These individuals may include:
 * 1. Individuals who meet the criteria for ADHD, Predominantly Inattentive Type, but their age of onset is later than 7 years old.
 * 2. Individuals who present inattentive symptoms and meet the full criteria for the disorder but also have a behavioral pattern that is defined by having low energy, daydreaming, and laziness.


 * Conduct disorder
 * 312.81 Childhood onset: At least one of the Diagnostic Criteria needs to be met for Conduct Disorder before age 10.
 * 312.82 Adolescent onset: The absence of any criteria characteristic of Conduct Disorder before the age of 10.
 * 312.89 Unspecified onset: The age of onset is unknown.
 * 313.81 Oppositional Defiant Disorder
 * 312.9 Disruptive Behavior Disorder NOS: This category includes disorders similar to conduct or oppositional defiant behaviors but do not meet the diagnostic criteria for either disorder, yet the impairment is clinically significant and causes significant impairment in the individual's life.

Etiology
With ADHD being one of the most common disorders diagnosed in childhood, the causes are often studied, yet still inconclusive. Many researchers say ADHD is caused by genetic factors, yet other studies are being done to expand on the etiology. One research study showed that children who carry a certain gene associated with ADHD had a thinner layer of tissue in the areas of the brain associated with attention. As the children grew older, the brain tissue thickened and their ADHD symptoms improved. Environmental factors, such as the mother smoking or drinking during pregnancy is connected to children with ADHD. Children exposed to lead at a young age will also have an increased chance of developing ADHD. Brain injuries could cause ADHD, yet only a small number of children diagnosed fit into this category. Researchers have looked into sugar intake as the cause of ADHD, but have found little to support that theory.

Symptoms
Children with Attention Deficit and Disruptive Behavior Disorders may show the following symptoms:
 * impulsivity or distractibility
 * difficulty socializing
 * aggressive behavior
 * difficulty following rules or directions
 * difficulty completing a task
 * problems at school
 * frustration
 * alcohol or drug use

DSM-IV-TR

 * 307.52 Pica
 * 307.53 Rumination disorder
 * 307.59 Feeding disorder of infancy or early childhood: Diagnosed if met by the following criteria:
 * A. Feeding problems that are established due to continued failure to eat adequately that causes significant weight gain or significant weight loss over a period of at least one month.
 * B. The disturbance is not related to a gastrointestinal abnormality or any other general medical condition.
 * C. The disturbance is not the cause of another mental disorder or by the lack of available food.
 * D. The symptoms must be present before age 6.

Etiology
There are a number of factors that could potentially contribute to the development of feeding and eating disorders of infancy or early childhood. These factors include:
 * Physiological Factors- a chemical imbalance effecting the child's appetite could cause a feeding or eating disorder.
 * Developmental Factors- developmental abnormalities in oral-sensory, oral-motor, and swallowing can impact the child's eating ability and illicit a feeding or eating disorder.
 * Environmental Factors- simple issues such as inconsistent meal times can cause a feeding or eating disorder. Giving the child food that they are not developmentally acquired for can also cause these disorders.  Family dysfunction and sociocultural issues could also play a role in feeding or eating disorders.
 * Relational Factors- when the child is not securely attached to the mother, it can cause feeding interactions to become disturbed or unnatural. Other factors, such as parental emotional unavailability and parental eating disorders can cause feeding and eating disorders in their children.
 * Psychological/Behavioral Factors- these factors include one involving the child's temperament. Characteristics such as being anxious, impulsive, distracted, or strong-willed personality types are ones that could affect the child's eating and cause a disorder.  The individual could have learned to reject food due to a traumatic experience such as choking or being force fed.

DSM-IV-TR

 * 307.23 Tourette’s Disorder
 * 307.22 Chronic motor or vocal tic disorder
 * 307.21 Transient tic disorder: Must meet the following criteria in order to be diagnosed:
 * A. Either one or multiple motor and/or vocal tics, for example, motor or vocal noises that are rapid, repeated, sudden, and nonrhythmic.
 * B. The tics happen multiple times over the course of the day, almost every day for at least 4 weeks, but do not occur continually for any longer than 1 year.
 * C. Symptoms are present before the age of 18.
 * D. The tics are not a result of any effects due to drug use, or any other medical condition, for example, Huntington's disease.
 * E. The individual does not have symptoms that meet the criteria for Tourette's Disorder or Chronic Motor or Vocal Tic Disorder.
 * 307.20 Tic disorder NOS: This category is for disorders characterized by tics but do not meet the diagnostic criteria of the DSM-IV-TR.

Etiology
No definitive cause of tic disorders has been declared, but for the most part, the etiology lies within biological, chemical, or environmental factors. Studies have shown that abnormal neurotransmitters, such as dopamine and serotonin, which are active in chemical messages in the brain, can serve as a cause of tic disorders. Researchers have also found abnormal changes in certain parts of the brain that cause strain on the blood flow within the brain, which is likely a contributor of tic disorders. 75% of tic disorders have a genetic component. It appears that tic disorders can be caused or worsened by recreational or prescription drug use. Tics can form simply if a person repeats sounds or words they hear over the course of a normal day.

Symptoms
Children with a tic disorder may exhibit the following symptoms:
 * overwhelming urge to make movement
 * jerking of arms
 * clenching of fists
 * excessive eye blinking
 * shrugging of shoulders
 * kicking
 * raising eyebrows
 * flaring of nostrils
 * production of repetitive noises such as grunting, clicking, moaning, snorting, squealing, or throat clearing

DSM-IV-TR

 * 307.6 Enuresis (not due to a general medical condition)
 * 307.7 Encopresis, without constipation and overflow incontinence
 * 787.6 Encopresis, with constipation and overflow incontinence

Etiology
Encopresis: The most common cause of Encopresis is constipation. When a child becomes constipated, feces build up in and stretch the rectum. This stretching causes the nerve endings to become dull. The child may not feel when he or she needs to eliminate the feces or if the waste is coming out. Inside the rectum, the feces could become too large or solid to eliminate without feeling pain. While the mass of feces is stuck in the child's rectum, liquid feces could leak from around the mass and out of the child's body. The main causes of constipation are diet, lack of sufficient amounts of water, stress, not enough exercise, and inconsistent bathroom routines.

Enuresis: The cause of Enuresis is thought to be unclear and usually is attributed to many factors.


 * Genetic- there is a genetic component within Enuresis and it tends to run in families.
 * Inability to feel that the bladder is full and be aroused from sleep.
 * Insufficient size of bladder- the child's bladder is too small to contain the amount of urine produced.
 * Psychological Factors- these are not main factors that contribute to Enuresis, but stress may be a cause.
 * Maturational Delay- the child's recognition that the bladder is full and he or she needs to go to the bathroom is a developmental issue. Many children with Enuresis will develop this skill as they grow older.

DSM-IV-TR

 * 309.21 Separation anxiety disorder
 * 313.23 Selective mutism
 * 313.89 Reactive attachment disorder of infancy or early childhood
 * 307.3 Stereotypic movement disorder
 * 313.9 Disorder of infancy, childhood, or adolescence NOS: This category is a residual category for disorders with onset in infancy, childhood, or adolescence that do not meet criteria for any specific disorder in the Classification.

Etiology
There are multiple factors that contribute to the cause of other disorders of infancy, childhood, or adolescence. The majority of the etiological factors are going to be physical or environmental. Some of the disorders could be caused by parental influence, such as their inability to properly take care of their child. Most of the other disorders diagnosed in infancy, childhood, or adolescence involve anxiety. If the child is continually put in anxiety producing situations, they could show symptoms of these disorders. Usually, the symptoms will be mild and the child will not get help, which may cause the symptoms to become worse.

Symptoms
Separation anxiety disorder
 * excessive stress when separated from home or family
 * fear of being alone
 * refusal to sleep alone
 * clinginess
 * excessive worry about safety
 * excessive worry about getting lost
 * frequent medical complaints with no cause
 * refusal to go to school

Selective mutism
 * unable to speak in certain social situations, even though they are comfortable speaking at home or with friends
 * difficulty maintaining eye contact
 * may have blank facial expressions
 * stiff body movements
 * may have a worrisome personality
 * may be incredibly sensitive to sound
 * difficulty with verbal and non-verbal expression
 * may appear shy, when in reality, they have a fear of people.

Reactive attachment disorder of infancy or early childhood
 * withdrawing from others
 * aggressive attitude towards peers
 * awkwardness or discomfort
 * watching others but not engaging in social interaction

Stereotypic movement disorder
 * head banging
 * nail biting
 * hitting or biting oneself
 * hand waving or shaking
 * rocking back and forth

Treatment
Separation anxiety disorder Selective mutism Reactive attachment disorder of infancy or early childhood Stereotypic movement disorder
 * Cognitive behavioral therapy is oftentimes used to treat separation anxiety disorder. Family therapy may also be helpful to get to the core of the issue.  Systemic desensitization techniques are usually used to help the child get used to being comfortable away from home.
 * It is important not to "enable" the child with selective mutism by allowing them to remain silent in the social settings that they are uncomfortable in. Both parents and teachers need to be involved in the treatment of selective mutism.  The most important factor to remember is that the child does not have a speech disorder; it is an anxiety disorder.
 * Treatment almost always involves the child and his or her parents or caregivers. Parents may need to take parenting skills classes and attend family therapy with the child.  Individual therapy with the child and therapist is effective.  Another technique is keeping close physical contact between the child and his or her parents.
 * Behavioral techniques and psychotherapy are the most effective treatment for children with this disorder. It is important to change the child's environment so that they are unable to harm themselves.  Medication is also effective.