Impairment of social relationships, lack of appropriate emotional response, inappropriate clinging

disorders. Appropriate remedial training for reading and arithmetical disorders. 3. Attention Defect Disorders This disorder is characterised by inattention and impulsivity which is inappropriate for the level of development and which results in impairment in social and occupational functioning. It may be associated with epilepsy, mental retardation, and certain neurological disorders characterised by the presence of non-localising neurological signs ('soft sign'). SYMPTOMS - usually appear before age of 8 years. The child is reported to be easily distractable, with learning difficulties and resultant difficulty in concentration and need for supervision. TYPES - (a) Associated with hyperactivity - excessive fidgetiness, difficulty in sitting still or seated, excessive movements during sleep. (b) Not associated with hyperactivity TREATMENT 1 Drugs - Haloperidol 0.25-1.5 mg t.d.s may be effective in some. CNS stimulants such as methylphenidate 10-20 mg/day may also be effective. Imipramine 25-50 mg/day is sometimes effective. Therapy with anti-epileptic drug if associated epilepsy. 2. Counselling of parents. 4. Conduct Disorders This disorder is characterised by repetitive and persistent antisocial behaviour. ETIOLOGY (a) Commonly found in children from broken, unstable, insecure and rejecting families. (b) Also related to social class and other adverse factors in the wider social environment of neighbourhood and school. (c) Temperament - e g children who tend to respond to new environmental stimuli either by withdrawal, slow adaptation, or by a negative approach, have been shown to be more likely to develop behavioural abnormalities. (d) Organic factors - Children with brain damage and epilepsy. CLINICAL FEATURES: Essential feature is persistent abnormal conduct which is more serious than ordinary childish mischief. This is most evident in the home environment in the form of persistent lying, stealing, disobedience, and verbal and physical aggression. Subsequently the abnormal conduct becomes evident outside the home environment in the form of truancy from school, belligerency, poor scholastic performance, reckless behaviour, thefts, alcohol and drug abuse, assault and vandalism TYPES - (a) Undersocialised aggressive (b) Undersocialised non-aggressive. (c) Socialised aggressive. (d) Socialised non-aggressive. PROGNOSIS - Conduct disorders generally run a prolonged course and as a rule the prognosis is poor. TREATMENT: 1. Family therapy or social case-work. 2. Behaviour therapy - Desirable behaviour is rewarded, undesirable behaviour is not re-inforced. 5. Childhood Psychosis Clinical features: Psychosis in children, as in adults, can be either organic or functional in origin. Clinical features of organic psychosis in children are similar to those seen in adults and are the result of some impairment of brain tissue function. Types of functional psychosis - (1) Infantile autism - ETIOLOGY - (i) Genetic factors have been implicated. (ii) Organic factors in the form of 'soft signs' (iii) Parental factors - Parents of autistic children are commonly found to be cold, obsessive and detached. (iv) Language -According to some workers, infantile autism is due to a basic defect in language development of perception CLIINICAL FEATURES. (a) Onset of symptoms usually before age of 21/2 years. (b) Autism - Perversive lack of responsiveness to other persons or inability to make warm, emotional relationships with other people. (c) Speech and language defects - Speech may never appear, or may develop late If speech is present, peculiar speech patterns may be evident in the form of misuse of pronouns, inappropriate repetition of words spoken by others (echolalia), or use of metaphorical language. This affects speech, and non-verbal communications and these children do not take part in imitative games. (d) Obsessive desire for sameness -Preference for same food repeatedly, insistence on wearing same clothes or engaging in repetitive games. Any change in the environment is accompanied by distress. (e) Other features - Inappropriate rage, odd movements and peculiar attachments to certain animate or inanimate subjects may also be present. TREATMENT: 1. Management of abnormal behaviour - Behaviour therapy is necessary in some patients. (b) Neurolepic drugs, e. g. haloperidol and anti-serotoninergic drug like fenfluramine may be of some use in controlling behavioural abnormalities. (c) Special schooling. (d) Counselling and psychotherapy for family members. (2) Childhood onset perversive development disorder - Severe disturbance in emotions, behaviour and interpersonal relationships after a period of normal development CLINICAL FEATURES. (a) Onset of symptoms usually after age of 21/2 years. (b) Impairment of social relationships, lack of appropriate emotional response, inappropriate clinging, asocial behaviour, lack of sympathy. (c) Emotional disturbances - Sudden excessive anxiety or panic attacks, over-reaction to everyday occurrences, lack of appropriate fear response, unexplained rage reactions and extreme fluctuations in mood. (d) Hyper-or hypo-sensitivity to sensory stimuli. (e) Self-mutilation, biting or biting self, head banging, etc. TREATMENT: Similar to autism. 6. Neurosis Neurotic disorders in childhood are similar to those seen in adults Types: 1. Anxiety disorder - ETIOLOGY - (a)