EVERY CHILD COMES WITH A MESSAGE THAT GOD IS NOT YET DISCOURAGED OF MAN (JAMES)

Developmental and Behavioral Disorders

INTRODUCTION
Developmental disorder is the impairment of growth and the development of the Brain and Central Nervous System. Identify mental disorder in children can be very tricky for health care providers .Children differ from adults in that they experience many physical, mental, emotional changes as they progress through natural growth and development. Each child matures at his own pace. However any diagnosis of mental disorder must consider how well child function at home, with in family, at school, and with peers as well as child age and symptoms. Although developmental and behavioral disorders are increasingly wide spread they are still poorly understood by most of the society .The lack of knowledge is further compounded by the stigma that often accompanies a diagnosis of developmental and behavioral disorders. Parents and Physicians can educate themselves and other about the range of disorders as well as opportunities for the treatment and interventions. Wether a child has developmental delay or disorder, early identification and interventions are essential for achieving the best possible outcomes. The most common developmental disorder is the Mental Retardation. Cerebral palsy is the second most common disorder followed by autism spectrum disorder. The following list outlines the different types of developmental and behavioral disorders. Attention-Deficit Disorder (ADD)/Attention-Deficit Hyperactivity Disorder (ADHD)

Attention-deficit/hyperactivity disorder (ADHD) is one of the most common neurobehavioral disorders, characterized by problems with inattentiveness, overactivity, impulsivity, or a combination. Of these problems to be diagnosed as AD/HD,

they must be out of the normal range for the child's age and development. It is usually first diagnosed in childhood and often persists into adulthood. Treatment May include medical, educational, behavioral, and/or psychological interventions . ADHD is a lifelong disorder that can negatively impair many aspects of daily life if not treated, including home, school, work, and interpersonal relationships Angelman Syndrome Angelman Syndrome is a genetic disorder in which a gene on chromosome 15 is missing or unexpressed. Children with Angelman Syndrome typically have developmental delays that are frequently evident between 6-12 months of age. Diagnosis can be established through genetic and DNA testing as early as the first year of life. In affected children, language comprehension and non-verbal skills are usually more developed than spoken language and the affected child may have few if any words. Children with Angelman Syndrome have difficulties with movement and balance. Their behavior may combine frequent laughter and smiling, an easily excitable personality, hand flapping movements, hyperactive behavior, and a short attention span. Associated physical features and concerns, such as seizures, movement problems, sleep and feeding problems, are present in about 20-80% of children who have this disorder. Treatment. Many educational and behavioral interventions have been shown to be effective in addition to physical and occupational therapies, speech and language interventions, behavior modification, and parent training. Bipolar Disorder

Bipolar disorder (or manic depression) is a form of mood disorder characterized by a variation of moods that fluctuate between a manic phase of elation, hyperactivity and hyper imagination, and a depressive phase of inhibition, slowness to conceive ideas and move, and anxiety or sadness. Symptoms may be present from infancy or early childhood, or may suddenly emerge in adolescence or adulthood. Childrenwhose symptoms present differently than those of adultscan experience severe and sudden mood changes many times a day. For a diagnosis of bipolar disorder, adult criteria must

be met through a variety of measures. There are as yet no separate criteria for diagnosing children. Treatment Bipolar disorder is a chronic condition that can be managed with medication, close monitoring of symptoms, education about the illness, counseling or psychotherapy for the individual and family, stress reduction, dietary restrictions and nutritional supplements, regular sleep and exercise, and participation in a network of support. Central Auditory Processing Disorder (CAPD)

Central Auditory Processing Disorder (CAPD) is a complex and often misunderstood neurological disorder that occurs in individuals with normal hearing who have a reduced or impaired ability to discriminate, recognize, or understand sounds. The symptoms are highly individual, ranging from mild to severe with many different causes and expressions. Children with CAPD cannot fully process auditory information passed between the ear and the brain. They may have difficulties hearing amidst distracting background noise, remembering information, discriminating between similar sounds or words, or listening long enough to complete a task. CAPD may affect their ability to develop normal language skills, succeed academically, or communicate effectively. Cerebral Palsy Cerebral palsy is a disorder caused by damage to the brain that occurs before, during, or shortly following birth. It affects body movement and muscle coordination. Individuals with cerebral palsy may also experience seizures, abnormal speech, hearing and visual impairments, and mental retardation . Children with cerebral palsy may not be able to walk, talk, eat, or play in the same ways as most other children. Treatment. Cerebral palsy can include milder versions or more severe symptoms which lead to total dependency. Although cerebral palsy is a lifelong condition, training and therapy can help improve function. Down syndrome Down syndrome is a chromosomal abnormality that changes the course of development and causes the characteristics associated with the syndrome. Mild to severe mental retardation can be present among those affected. Speech and language may also be delayed. The diagnosis is usually suspected at birth due to the presence of physical 4

characteristics such as a large tongue, heart problems, poor muscle tone, and flat facial features. The diagnosis is confirmed through chromosomal testing.

Treatment The disorder is associated with a lifelong disability but can be treated through a variety of appropriate educational and behavioral interventions in addition to occupational therapies, speech and language interventions, behavior modification, and parent training. Expressive Language Disorder

Expressive language disorder is a developmental disorder where a child will have problems expressing him or herself in speech. Characteristics may include limited vocabulary, difficulty recalling words and producing complex or lengthy sentences. Children with expressive disorder often start speaking late and experience delays acquiring expressive language. Expressive language disorders may interfere with academics and social communication. Treatment Speech therapy and social skills therapies may benefit children affected by this disorder. Fragile X Syndrome Fragile X Syndrome is a genetic disorder and is the most common form of inherited mental retardation. It is more common in boys than girls. Individuals with this disorder often have distinctive physical features, such as a long face, large prominent ears and hyperextensible joints. People with Fragile X syndrome may experience some degree of mental retardation or learning disabilities along with speech and language delays. In addition, 15-20% may also exhibit behaviors associated with autism. DNA testing can determine a diagnosis for Fragile X, which is a lifelong disorder with no cure, but treatable with behavioral and educational therapies. Landau-Kleffner Syndrome Landau-Kleffner Syndrome (LKS) is a childhood disorder that is characterized by a progressive loss of the ability to understand and use spoken language, following a period of normal speech development. LKS occurs most frequently in typically developing children who are between 3 and 7 years of age. It is often accompanied by nighttime seizure activity and is typically diagnosed through a sleep EEG.

Treatment Some treatments include medication to control the seizures, corticosteroid therapy to improve language ability, and sign language instruction. Although language recovery has been reported in some cases, it is impossible to predict the outcome of this disorder due to the range of differences in affected individuals and the relative lack of clinical and neurobehavioral research. Learning Disabilities (LD)

Learning disabilities are a group of neurological disorders which become evident in childhood and which are characterized by difficulty learning, sorting, and storing information. Usually affected individuals have with average or above average intelligence. Children with learning disabilities may have one or more difficulties with skills such as listening, speaking, reading, writing, reasoning, or mathematical abilities that interfere with academic performance, achievement and, in some cases, activities of daily living. Learning disabilities may overlap with other disorders or environmental influences, but are not the direct result of those conditions or influences. Often these disabilities are not identified until a child reaches school age. Performance on standardized tests is usually found to be below that expected for age, schooling, and level of intelligence. Treatment Standardized cognitive measures and diagnostic tools in addition to observations from education professionals help to identify areas where these children are experiencing problems. Some children find learning in a regular classroom difficult and LD classes may be recommended to help them receive more specific and intensive teaching. They may require information to be presented in multiple formats and broken down in manageable chunks before they can completely understand it. Learning disabilities are lifelong, but with proper intervention, training, and strategies, individuals can lead successful, fully functioning lives.

Mental Retardation

Mental retardation is a disability that occurs in childhood characterized by substantial limitations in intellectual functioning and adaptive skills. A person with mental retardation may have difficulties with communication, conceptual skills, social skills, self-care, home living, social skills, community use, self-direction, health and safety, functional academics, leisure, and work. Diagnosis is performed through a) Standardized testing; b) Determining an individuals strengths and challenges in intellectual and adaptive behavior skills, psychological and emotional considerations, physical and health considerations, and environmental considerations; and c) Determining supports needed through an interdisciplinary team. Treatment Interventional strategies are delivered by providing resource supports and specific strategies so as to promote the development, education, interests, and personal well-being of the affected child, adolescent or adult. Providing individualized supports can improve personal functioning, promote self-determination and societal inclusion, and improve personal well-being of a person with mental retardation. Neural Tube Defects Neural tube defects are birth defects that involve the central nervous system. These defects of the spinal cord and/or brain result from failure of the neural tube to properly form. These disorders may present varying degrees of disability, including learning disabilities, social issues, lower extremity paralysis, loss of bowel or bladder control, and hydrocephalus (water on the brain), which can produce retardation unless it is surgically treated. Spina bifida is the most common neural tube defect where the spinal cord does not close over the nerve column during the prenatal period . It may involve loss of sensation and severe muscle weakness of the body below the level of the lesion.

Treatment Surgically treated. Although outcomes vary widely, with new medical treatments and technology, many people with spina bifida can expect to live a normal life, and often have careers, get married, and have families. Phenylketonuria (PKU) PKU is an inherited metabolic disorder in which the body cannot metabolize the amino acid that is present in many common foods. If treatment of the disease is not started within the first few weeks of life, PKU can cause various degrees of mental retardation, seizures, and other neurological problems. Because of the very positive outcome when children are identified and treated early, newborn screening for PKU is carried out in every state in the U.S. and in many other countries. Dietary restriction of very high protein foods and use of a synthetic formula as a nutritional substitute can reduce or eliminate these problems, thus helping children with PKU to expect normal Prader-Willi Syndrome Prader-Willi Syndrome is a combination of birth defects caused by inheriting both copies of the 15 chromosome from the mother (25%) or by inheriting a deletion of a region of chromosome 15 from the father (75% of PWS). Signs of PWS include hypotonia, global developmental delay evident before age 6, feeding problems in infancy, narrow face, almond-shaped eyes, small-appearing mouth, hypo pigmentation, motor planning problems, behavioral problems, sleep disturbances and compulsive eating problems. Diagnosis is made through genetic and DNA testing. Treatments Treatments include food restriction, daily exercise, medication, physical and occupational therapies, speech therapy, growth hormone therapy, and special education services. If weight is controlled, life expectancy may be normal, and the individuals health and functioning can be maximized. Seizure Disorders Seizure disorders are neurological disorders that may cause physical convulsions, minor physical signs, thought disturbances, or a combination of symptoms that are the result of uncontrolled electrical activity in the brain. An individual with a seizure disorder, such as epilepsy, may experience one or more different types and levels of severity of seizure. The condition can develop at any time of life, especially in early childhood, during adolescence and old age. Treatments Treatments included seizure-preventing medicines, surgery, ketogenic diet (primarily in children), or electrical stimulation of the vagus nerve, a large nerve leading into the brain. Although seizure medications are not a cure, they control seizures in the majority of people with epilepsy. For some, seizure disorders will be a temporary problem, easily controlled with medication and outgrown after a few years. For others, it may be a lifelong challenge affecting many areas of life.

Tourette syndrome Tourette Syndrome is a neurological disorder characterized, in mild form, by recurring involuntary body movements and sounds (called tics) and, in advanced cases by large involuntary bodily movements, noises like barks and whistles, and in many instances an uncontrollable urge to utter obscenities. People with Tourette Syndrome are often impulsive and have other symptoms of Attention Deficit Disorder. While the average age of onset of Tourette syndrome is 6-7 years old, there are many cases where parents later realized that their child's tics had actually started much younger. In almost all cases, Tourette Syndrome emerges before age 18, but there are exceptions. The diagnosis is based on patient history, observation, and testing to rule out other conditions. There are a variety of medications that may provide some relief from the tics and at least one empirically validated non-medication treatment for tics. Traumatic Brain Injury (TBI) Traumatic Brain Injury (TBI) is a disability category that occurs as the result of an injury to the brain as a result of an accident, insufficient oxygen, poisoning or infection at any time during an individuals life. It does not include congenital or degenerative brain injuries or brain injuries caused by birth trauma. Traumatic brain injuries may result in impairment in cognition, language, social skills, memory, attention, reasoning, behavior, physical functioning, psychological functioning, information processing, or speech. Physical challenges can include ambulation, balance, coordination, fine motor skills, and strength. Medical and neurology specialists determine a diagnosis using behavioral and neuropsychological assessments. Treatment In addition to rehabilitation services, individuals with TBI are treated with many of the services and supports as individuals with developmental disabilities. Outcomes vary by level of injury, with the goal for many being to return to school or to work, but with new and different levels of support. Williams Syndrome Williams Syndrome is a rare genetic disorder present at birth that is associated with deletion of genetic material in chromosome 7. The disorder is characterized by the following physical features: unique elfin facial features, heart and blood vessel problems, elevated blood calcium levels, slow weight gain, feeding problems, colic, dental problems, kidney problems, hernias, and hypotonia . Children with Williams Syndrome may be excessively social and have developmental delays, learning disabilities, and attention deficit. The disorder is diagnosed by genetic blood test through a technique called fluorescence in situ hybridization (FISH). Treatment Treatment typically includes physical, occupational and speech therapies l. Most adults with Williams Syndrome are able to complete school and hold jobs. Many live with their parents, in supervised settings or on their own

Posttraumatic Stress Disorder (PTSD)

All children and adolescents experience stressful events which can affect them both emotionally and physically. Their reactions to stress are usually brief, and they recover without further problems. A child or adolescent who experiences a catastrophic event may develop ongoing difficulties known as posttraumatic stress disorder (PTSD). The stressful or traumatic event involves a situation where someone's life has been threatened or severe injury has occurred (ex. they may be the victim or a witness of physical abuse, sexual abuse, violence in the home or in the community, automobile accidents, natural disasters (such as flood, fire, earthquakes), and being diagnosed with a life threatening illness). A child's risk of developing PTSD is related to the seriousness of the trauma, whether the trauma is repeated, the child's proximity to the trauma, and his/her relationship to the victim(s). Following the trauma, children may initially show agitated or confused behavior. They also may show intense fear, helplessness, anger, sadness, horror or denial. Children who experience repeated trauma may develop a kind of emotional numbing to deaden or block the pain and trauma. This is called dissociation. Children with PTSD avoid situations or places that remind them of the trauma. They may also become less responsive emotionally, depressed, withdrawn, and more detached from their feelings. A child with PTSD may also re-experience the traumatic event by: 1. Having frequent memories of the event, or in young children, play in which some or all of the trauma is repeated over and over 2. Having upsetting and frightening dream 3. Acting or feeling like the experience is happening again 4. Developing repeated physical or emotional symptoms when the child is reminded of the event 5. Children with PTSD may also show the following symptoms: 1. Worry about dying at an early age 2. losing interest in activities 3. Having physical symptoms such as headaches and stomachaches

10

4. 5. 6. 7. 8.

Showing more sudden and extreme emotional reactions Having problems falling or staying asleep Showing irritability or angry outbursts Having problems concentrating Acting younger than their age (for example, clingy or whiny behavior, thumb sucking) 9. Showing increased alertness to the environment 10. Repeating behavior that reminds them of the trauma Treatment The symptoms of PTSD may last from several months to many years. The best approach is prevention of the trauma. Once the trauma has occurred, however, early intervention is essential. Support from parents, school, and peers is important. Emphasis needs to be placed upon establishing a feeling of safety. Psychotherapy (individual, group, or family) which allows the child to speak, draw, play, or write about the event is helpful. Behavior modification techniques and cognitive therapy may help reduce fears and worries. Medication may also be useful to deal with agitation, anxiety, or depression.

Parenting of Children with Developmental and Behavioral Disorders

Like other serious illness taking care of a child with mental illness is hard on parents, family and other care givers. Parents Management Training (PMT) PMT refers to the procedures in which parents have been trained to alter their Childs behavior in home PMT alters the pattern of ineffective parenting by encouraging the parent to practice the prosocial behavior(positive, specific feedback for desirable behavior),

11

Before a child is diagnosed frustration, blame, and anger may have built up with in family. Parents and children may need special help to undo these unhealthy interactions patterns. Children with mental illness need guidance and understanding from their parents. This support can help a child to achieve his or her full potential and successed in social environment. Mental health professionals can counsel the child and family to help every one to develop new skills attitude and way of relating to each other. Parents can also help by taking part in parenting skills training. This help parents how to handle difficult behavior and situation. Training encourage parents to share a pleasant or relaxing activity with their child to notice and point out what their child does well and to praise their childs strengths and abilities. Parents arrange the family situation in more positive way. Some time the whole family needs counseling. Therapist can help the family members find better ways to handle disruptive behaviors and encourage behavior change. Support group helps parents and families connect with other who has similar problems and concerns. Group often meet regularly to share frustration and success to change information about recommended therapist specialists and to talk with expert. Caregivers often must tend to medical needs of there loved ones, and also deal with how it effects their own health. The stress that care givers are under may lead to missed work or lost free time. It can strain the relationship with people who may not understand the situation and to lead to physical and mental exhaustion. Stress from caregiver can make it hard to cope with your childs symptoms. STUDY (Bettina E Bernstein, 2000)

One study shows that if a care giver is under stress his or her loved one has more difficulty sticking to the treatment plan. It is important to look after your own physical and mental health. Parents may also find it helpful to join a local support group.

12

1. Mental health specialists such as, Psychiatrists, Psychologists, Social workers, or Mental health counselors. 2. Health Maintainess Organization. 3. Community Mental Health Centers. 4. Family Services, Social Agencies. 5. Peers Support Groups. 6. Local Medical and Psychiatric Societies. Trained professional help the people deal with their illness, after by taking through strategies for understanding and dealing with their symptoms, thoughts and behaviors. Types of psychotherapies supportative, cognitive behavior, interpersonal, group, family therapy. Creative therapies such as art therapy, play therapy is helpful for childrens to communicate their feelings and thoughts.

13