What is Child Psychopathology?

The Child psychopathology Can be defined as the study of behavioral alterations in children, although in this article I will also include young people, since there is no exact point in which the child stops being a child and becomes a teenager.

In order to study the pathologies or disorders of children, a series of characteristics that differentiate them from those present in adults must be taken into account.

First, it is unusual for the child to realize that he or she has a problem and to ask for psychological help, what usually happens is that someone around him detects the problem and asks for help. This person is usually a relative or someone from the school environment (a teacher, tutor or counselor).

Secondly, it must be borne in mind that not all The children mature At the same rate, however, there is an interval within which the presence or absence of a behavior may be normal. For example, it is normal for children to not pee in bed for approximately two years, but it is not considered a disorder if the child does not reach age 5.

Finally, we must take into account the family and the close social circle that surrounds the child since children are highly susceptible and what happens around them can affect them much more than an adult, both psychologically and physiologically, They may even experience problems of cerebral maturity.

Then, the disorders that are given, or are initiated, in childhood or adolescence will be discovered.

Eating disorder

In the diagnostic manuals, anorexia nervosa, bulimia and others are usually included in this group Eating disorder But here too pica and rumination disorders will be included because, as you will see later, they are closely related to eating disorders.

Anorexia nervosa

This disorder Usually appears in childhood, although cases are found more often in younger people and even in children. There are two peaks of age in which the onset of this disorder is most common, the first being at 14 years and the second at 18.

It is estimated to affect approximately 1% of adolescents, of whom 90% are girls, although more and more children are affected by this disease.

People who suffer from it are usually described as responsible and normal young people. But, as the disorder progresses, they become more and more withdrawn.

The main symptom that alerts the family of the young is malnutrition, at first glance can be observed a physical decrease in the person that in the long may lead to reduce their vital signs, to save energy, and in severe cases can lead even to the death.

To diagnose anorexia nervosa, the following ICD-10-MIA criteria must be met:

1. Significant loss of weight or in prepubescent, not getting the right weight for its growing period. M.C. = Kg / m2
2. Through: 1) avoidance of consumption of" Fattening foods "and by One or more Of the following symptoms: 2) self-induced vomiting, 3) self-induced intestinal purges, 4) excessive exercise, and 5) consumption of anorexigenic drugs or diuretics
3. Distortion of body image With the character of an overvalued intrusive idea, of awe at the fatness or the flaccidity of the bodily forms, so that the patient imposes himself to remain below a maximum body weight limit
4. Generalized endocrine disorder affecting the hypothalamic-pituitary-gonadal axis, manifesting itself in the woman as Amenorrhea And in the male as a loss of sexual interest and potency
5. If the onset is prior to puberty, Is delayed The sequence of the manifestations of puberty, or even it stops (the growth stops, women do not develop the breasts and there is primary amenorrhea, in men the children's genitals persist). If a recovery occurs, puberty can be completed, but menarche is late.

The presence of purgative methods such as self-induced vomiting, self-induced intestinal purges, consumption of anorexigenic drugs or diuretics, laxative abuse and thyroid extracts. The underlined criteria are purgative methods. The presence of these is an indicator that the disease takes a long time.

Bulimia nervosa

This disorder Usually starts later than anorexia. It is estimated that between 1% and 3% of adolescents and young adults, of whom 90% are girls, as with anorexia.

The physical symptoms of bulimia are similar to those of anorexia, although there is no such a drastic drop in weight.

As for psychological symptoms, they share characteristics with anorexia, such as fear of gaining weight and inappropriate compensatory behaviors. But they differ in that people with bulimia perform binge and purgative behaviors from the start.

To diagnose bulimia nervosa, the following ICD-10-MIA criteria must be met:

1. Continuous preoccupation with food, with irresistible desires to eat, so that the patient ends up succumbing to them, presenting episodes of polyphagia during which he consumes large quantities of food in short periods of time
2. The patient attempts to counteract the weight gain thus produced by One or more Of the following methods: self-induced vomiting, laxative abuse, periods of fasting intervals, use of drugs such as appetite suppressants, thyroid extracts, or diuretics. When bulimia occurs in a diabetic patient, he or she may give up treatment with insulin.
3. Psychopathology is a fear Morbid to get fat , And the patient is strictly fixed a lintel of weight much lower than he had before the disease, or the one of its optimum or healthy weight. Frequently, but not always, there is a prior history of anorexia nervosa with an interval between both disorders of several months or years. This early episode may manifest in a florid form or, on the contrary, adopt a minor or larval form, with moderate weight loss or a transient phase of minority.

The presence of purgative methods such as self-induced vomiting, self-induced intestinal purges, consumption of anorexigenic drugs or diuretics, laxative abuse and thyroid extracts. The underlined criteria are purgative methods. The presence of these is an indicator that the disease takes a long time.

Pica

The pica Consists in the persistent ingestion of non-nutritive substances, such as pebbles or sand, without showing any kind of disgust or aversion.

Moving from younger children to adolescents and adults, the substances you usually consume are:

• Paint, plaster, rope, hair or clothing
• Excrement, sand, insects, leaves or pebbles
• Earth or dung

To diagnose pica, the following ICD-10-MIA criteria must be met:

1. Persistent ingestion of non-nutritive substances, twice a week
2. Duration of at least one month
3. Absence of other psychiatric criteria of ICD-10, except mental retardation
4. Chronological and mental age must be at least two years
5. The disorder can not be a culturally accepted habit.

Rumination

It is considered an early disorder since it usually appears before the first year of the child's life.

Children who have this disorder regurgitate part of the partially digested food, spit a little and chew the rest to swallow and digest it again.

A characteristic feature of this disorder is that the child usually performs pre-regurgitation movements, such as arching from the back to the back.

The following criteria must be met to diagnose rumination (referred to as eating disorder in ICD-10-MIA and eating disorder in DSM-IV):

1. Persistent failure to eat properly or persistent rumination or regurgitation of food.
2. Failure to gain weight or weight loss over a period of at least one month.
3. Onset of the disorder before 6 years of age.
4. Criteria for any other ICD-10 psychiatric disorder are not met.
5. There is no organic disease that can explain the failure of eating behavior.

Disorders of elimination

Normal learning of sphincter control functions occurs in the following chronological order:

1. Night Rectal Control
2. Daytime Rectal Control
3. Daytime bladder control
4. Night bladder control

Enuresis

The enuresis Is defined as the frequent voluntary or involuntary emission of urine into the bed or clothes of children who are mature enough to control it and who do not suffer any organic problems.

The prevalence of nocturnal enuresis affects 7% in children and 3% in girls. The prevalence of daytime enuresis is 1-2% and is more frequent in girls.

Depending on the time of day, three types are contemplated: only nocturnal, only daytime, nocturnal and diurnal (ICD-10-MIA). Although daytime enuresis is often referred to simply as enuresis.

Depending on whether there has been a previous period of urinary continence, there are two subtypes: primary (when there was never such period) and secondary if the child had already learned to control the emissions.

The most common types are nocturnal enuresis and primary enuresis.

To diagnose enuresis, the following ICD-10-MIA criteria must be met:

1. Chronological and mental age must be at least five years.
2. Involuntary or intentional release of urine into bed or clothing that occurs at least twice a month in children under the age of seven and at least once in older children.
3. Enuresis is not the result of epileptic seizures, incontinence of neurological origin, structural abnormalities of the urinary tract or other physical disorders.
4. The picture must have been present for at least three

Encopresis

The Encopresis Is defined as the repeated evacuation of feces in inappropriate places, involuntarily or intentionally in children who are mature enough to control it and in the absence of any organic problem.

This problem affects approximately 1% of children 5 and is more frequent in children than in girls.

In addition, subdivided into primary / secondary and nocturnal / diurnal as enuresis, there is another subdivision: by inadequate teaching in the control of sphincters, deliberate stool deposition in unsuitable places or liquid depositions by overflow secondary to retention

Non-organic Encopresis Diagnostic Criteria (ICD-10-MIA):

1. Repeated stool emission in inappropriate places either involuntarily or intentionally (includes overflow incontinence secondary to functional faecal retention).
2. Chronological and mental age of at least four years.
3. At least one episode of encopresis per month.
4. Duration of at least six months.
5. Absence of organic plaques that could be a sufficient cause of encopresis.

Sleep disorders

Disomnias

This type of disorders Affect the quantity, quality and schedule (duration) of the dream.

Insomnia

He insomnia Such as difficulty initiating or maintaining sleep, or feeling of not having a restful sleep.

You can categorize:

• According to the moment: conciliation, maintenance and terminal.
• According to its severity: precocious common and severe precocious (can manifest itself in two ways: calm and agitated, especially frequent in children who have subsequently been diagnosed with ASD).
• Depending on its duration: transient and persistent

Approximately 10% of children have insomnia problems, although it can be confused with difficulties sleeping.

Diagnostic criteria for non-organic insomnia (DSM-IV-R):

A) Complaints that usually consist of difficulties to fall asleep or to maintain or poor quality of the same.

B) This manifestation has been presented at least three times a week for at least one month.

C) Excessive worry, both during the day and at night, about not sleeping and its consequences.

D) The unsatisfactory quantity or quality of sleep causes a general malaise or interferes with the social and occupational functions of the patient.

Difficulty to sleep

It is more frequent than insomnia, and can reach up to 20% preschool.

It is imperative to conduct a good interview in order to obtain information from the parents about the habits of both them and their child at bedtime and during the night (it is also useful to obtain information about the conditions of the room).

According to history and records we can identify if any of these problems occur:

1. Relationship problems that do not meet the criteria of any specific mental disorder but which lead to clinical derivations for evaluation or resources (including difficulties in sleeping or feeding habits in young children).
2. Problem related to inadequate parental control and monitoring (several aspects would be affected).
3. Phobic anxiety disorder in infancy or F40.2 Specific phobia.

Narcolepsy

It defines Such as the presence of irresistible attacks in which the person falls asleep, can last from a few seconds to 20 minutes or more, and are often precipitated by monotonous or boring situations.

The usual is that it does not manifest itself until adolescence, in the general population there is a prevalence of approximately 0.1%.

Next to the main symptom,"sleep attacks", one or more of the following appear:

• Cataplejia : Sudden episodes in which muscle tone is lost (from a few seconds to a few minutes) occur after intense emotions and the subject remains conscious.
• Sleep paralysis : Inability to carry out voluntary movements when waking or falling asleep when sleeping or waking (from seconds to few minutes) and usually disappears when touching the subject.
• Hypnagogic hallucinations: they resemble the dreams we sometimes experience before falling asleep or waking up.

Sleep apnea

Sleep apnea Consists of the intermittent occurrence of episodes of cessation of breathing during sleep (for more than 10 seconds), up to 10 such episodes can be counted per hour. They are associated with heavy snoring and daytime drowsiness, which leads to children being associated with poor school performance, sleep attacks and morning headaches.

It is a rare disorder, the number of children with this disorder does not reach 1%.

There are three subtypes: obstructive, due to obstruction of the upper respiratory tract (it is the most frequent subtype), central, due to a dysfunction of the CNS mechanisms, and mixed (the latter subtype is infrequent).

Subjects have reduced the duration of the phases of deep sleep (awakening or superficialisation of sleep).

Parasomnias

Included in this category are disorders that occur during sleep or during the sleep-wake transition.

Nightmares

Nightmares are defined as distressing dreams that awaken the child. The child is able to make a structured account of his bad dream, whose content is threatening and remembered.

Episodes occur in the REM phase, except in the case of nightmares that occur due to a post-traumatic stress disorder.

Approximately 1 in 4 children over 3 years of age experience occasional nightmares.

According to ICD-10, the following criteria must be met to establish the diagnosis:

1. The awakening of a night dream or a nap with detailed and vivid memories of terrifying dreams, which normally imply a threat to survival, security or self-esteem. Awakening can take place during any time of the sleep period, although it usually takes place during the second half.
2. Once awake, the individual quickly reaches the waking state and is oriented and alert.
3. Both the dream experience itself and the sleep disturbance cause great discomfort to the patient.

Night terrors

Children who suffer This disorder Usually wake up with a cry and great vegetative activation. During episodes of night terrors, children"look, but do not see,"do not respond to attempts by parents to calm or awaken it.

After a few minutes the terror disappears and the child returns to bed or just wakes up without remembering the episode or at most being able to vaguely remember the experience of terror.

These episodes occur in phases III-IV of NMOR sleep (non-REM phase), slow wave sleep.

It is more prevalent in the 4-12 years, in this interval, about 3% of children have night terrors.

According to ICD-10, the following criteria must be met to establish the diagnosis:

1. The predominant symptom is the presence of repeated episodes of awakening during sleep, which begin with a panic cry and are characterized by intense anxiety, motor excitation and vegetative hyperactivity such as tachycardia, tachypnea and sweating.
2. These recurrent episodes have a characteristic duration of 1 to 10 minutes. They usually occur during the first third of nighttime sleep.
3. There is a relative lack of response to the attempts of other people to influence terror and almost constantly these attempts tend to happen a few minutes of disorientation and persevering movements.
4. The memory of the event, if any, is minimal (usually one or two fragmentary mental images).
5. There is no evidence of a somatic disorder, such as a brain tumor or epilepsy.

Somnambulism

This disorder Is described as the presence of motor activity in a child who was deeply asleep. The activity can be more or less complex and do not respond to the people around you. Children often have their eyes open during the episode.

It is a dissociation between motor activity and level of consciousness, since the person is not aware of the movements he is performing. Episodes can last up to 20 minutes.

It is more frequent between the 4-8 years, in this interval, approximately 3% of the children suffer it.

According to ICD-10, the following criteria must be met to establish the diagnosis:

1. The predominant symptom is the presence of repeated episodes of getting out of bed during sleep and wandering for a few minutes or up to half an hour, usually during the first third of nighttime sleep.
2. During the episode the individual has the blank look, does not fully respond to the efforts of others to modify their behavior or communicate with him and it is very difficult to wake him.
3. Upon awakening from the episode or the next morning, the individual remembers nothing of what happened.
4. After a few minutes of waking up after an episode, there is no evidence of any deterioration in mental activity or behavior, even though there may initially be a brief period of time in which there is some confusion and disorientation.
5. There is no evidence of an organic mental disorder, such as dementia or epilepsy.

Psychomotor disorders: tics

The tics Are defined as involuntary, rapid, repeated, and arrhythmic movements that usually affect a circumscribed group of muscles or a sudden-appearing vocalization that lack an apparent purpose.

They are experienced as irresistible and uncontrollable, but can be suppressed for varying periods of time. The consequence of its execution is a temporary decrease of the tension that the person suffers. More frequent ones occur in the upper body.

These disorders usually begin between 6 and 12 years, and it is more frequent in children than in girls. 15% of these children suffer transient tics disorder, 1.8% suffer from chronic motor or phonemic tics disorder and 0.5% suffer from Gilles de la Tourette's syndrome.

Observation is the safest means to diagnose this disorder. In the most serious cases it is advisable to perform a neurological examination, to check if there are antecedents of infectious and neurological pictures (own and familiar).

The classification differentiates between:

• Transient tics disorder.
• Chronic motor or phonemic tics disorder.
• Multiple tics and combined speech disorders ( Gilles de la Tourette's syndrome ).
• Other tic disorders.
• Tic disorder not specified.

Criteria for diagnosing transient tic disorder (DSM-IV-R):

1. Presence of single or multiple tics, motor type and / or phonatory, which are repeated multiple times most of the days for a period of at least 4 weeks.
2. Duration not exceeding 12 months.
3. Absence of antecedents of the Gilles de la Tourette syndrome. The disorder is not secondary to other physical disorders nor does it correspond to the side effects of any medication.
4. Appearance before 18 years of age.

Criteria for diagnosing chronic motor or phonemic tics disorder (according to DSM-IV-R):

1. Presence of motor or phonics tics, but not both that are repeated multiple times most of the days during a period of at least 12 months.
2. There are no referral periods during that year for more than two months.
3. Absence of antecedents of Gilles de la Tourette. The disorder is not secondary to other physical disorders nor does it correspond to the side effects of any medication.
4. Appearance before 18 years of age.

Criteria for diagnosing Gilles de la Tourette syndrome or multiple motor or phonemic tics disorder (according to DSM-IV-R):

1. The presence of multiple motor tics along with one or more phonics tics should occur at some point in the course of the disorder but not necessarily together.
2. The tics must be presented many times a day, almost every day for more than a year, with no period of remission during that year over two months.
3. The disorder is not secondary to other physical disorders nor does it correspond to the side effects of any medication.
4. Appearance before 18 years of age.

Anxiety disorders

Anxiety Disorders Are found under the section"Disorders of specific onset emotions in childhood"in DSM-IV. They are more common in girls.

This section includes the Disorder of separation anxiety in childhood (TAS), phobic anxiety disorder in childhood (TAF), and anxiety (hypersensitivity) disorder in childhood (TAH).

Separation anxiety disorder

The diagnostic criteria for this disorder are:

1. At least three of the following:
2. An irrational concern for possible damages that could occur to significant persons or fear of being abandoned;
3. An irrational concern for an adverse event to separate him from significant persons (such as being lost, abducted, hospitalized or murdered);
4. A persistent reluctance or refusal to go to school for fear of separation (more than for other reasons, such as fear of something that might happen in school);
5. A reluctant reluctance or refusal to go to bed without the company or closeness of any significant person;
6. An inappropriate and persistent fear of being alone, or without the significant person at home during the day;
7. Repeated nightmares about separation;
8. Repeated somatic symptoms (such as nausea, gastralgia, headaches or vomiting) in situations involving the separation of a significant person, such as leaving home to go to school;
9. Excessive and recurrent discomfort (in the form of anxiety, crying, tantrums, sadness, apathy or social withdrawal) in anticipation, during or immediately after the separation of a significant person;
10. Absence of generalized anxiety disorder in childhood.
11. Appearance before age 6.
12. Absence of generalized alterations in personality or behavioral development (F40-48: Neurotic disorders, secondary to stressful and somatomorphic situations), psychotic disorders or disorders Use of psychoactive substances .
13. Duration of at least 4 weeks.

Phobic anxiety disorder

Diagnostic criteria according to ICD-10:

1. The beginning has taken place in the proper evolutionary period.
2. The degree of anxiety is clinically abnormal.
3. Anxiety is not part of a more generalized disorder.

In DSM-IV this disorder is called a specific phobia, and the characteristics are as follows:

• Disproportionate fear of an object or situation.
• High activation: tantrums, immobilization, crying, hugs, etc.
• They provoke avoidance or are endured with great effort.
• Irrational character.
• They interfere notably in the adaptation of the child
• It is required that you have been present 6 months.
• Not explainable by another major anxiety disorder.
• Many refer spontaneously years later.

Social hypersensitivity disorder in childhood

Diagnostic criteria according to ICD-10:

1. Persistent anxiety in social situations in which the child is exposed to the presence of unfamiliar people, including schoolmates, and manifests itself in the form of social avoidance behavior
2. Self-observation, feelings of shame and excessive concern about the adequacy of his behavior when encountering unfamiliar figures
3. Significant interference with social relationships (including schoolmates) that are in restricted consequences. When faced with new social situations by force, there is a state of intense discomfort and discomfort manifested by crying, lack of spontaneous language or flight from the situation
4. Social relationships with family members (family members or close friends) are satisfactory
5. The T.A.G criteria are not met.
6. Absence of generalized alterations of the development of the personality and the behavior, psychotic disorders or by use of psychoactive substances.

Generalized anxiety disorder

• Excessive concern (past or future events) and fearful behavior not limited to a specific fact or object
• Concern for their own competence in different areas
• Associated symptoms (Several months): Apprehension, fatigue, decreased concentration, irritability, muscle tension, sleep disturbances
• It is not explained better by Phobias, Panic T , T.O.C. , Nor appears exclusively during a depressive T.

Mood Disorders: Childhood Depression

This disorder is defined as a persistent environment in the behavior of a child consisting of a decrease in his ability to enjoy events, to communicate with others and to yield in their areas of competence in relation to their possibilities, and which is also accompanied Of actions of plural protest (Del Barrio, 1998).

In Spain, it is estimated that 1.8% of children between 8 and 11 years of age suffer from major depressive disorder, while up to 6.4% suffer from dysthymic disorder. During childhood there is no difference between sexes, but in adolescence it is much more frequent in girls.

Major depressive episode

The diagnostic criteria for major depressive disorder are as follows (DSM-IV):

1. Presence of five (or more) of the following symptoms over a 2-week period, representing a change from previous activity. One of the symptoms should be (1) or (2).
   • Depressed mood most of the day, almost every day as the subject itself indicates ( Ex. Feel sad or empty ) Or the observation made by others ( P. I cry ). Or irritable mood in children and adolescents
   • Decreased interest or pleasure for all or almost all activities, most of the day, almost every day ( According to the subject or observe the others ) (Anhedonia)
   • Significant weight loss without regimen or weight gain, or loss or increase in appetite almost every day. OR Failure to increase Weight in children
   • Insomnia Hypersomnia almost every day
   • Agitation or slowing down almost every day ( Observable by others , Not mere feelings of restlessness or being slowed down )
   • Fatigue or loss of energy almost every day
   • Excessive or inappropriate feelings of worthlessness or guilt (Who may be delirious) almost every day ( Not simple self-reproaches or guilt over being sick )
   • Decreased ability to think or concentrate, or indecision, almost every day ( Either a subjective attribution or a foreign observation )
   • Recurrent thoughts of death ( Not just fear of death ), Recurrent suicidal ideation without a specific plan or suicide attempt or a specific suicide plan (Not necessary to verify that it happens almost every day).
2. Symptoms do not meet the criteria for a mixed episode
3. Symptoms cause clinically significant distress or impairment in social, work, or other important areas of the individual's activity
4. The symptoms are not due to the direct physiological effects of a substance or a medical illness
5. The symptoms are not explained better by the presence of a duel ( Eg after the loss of a loved one ), The symptoms persist for more than two months or are characterized by a marked functional disability, morbid preoccupations of futility, suicidal ideation, psychotic symptoms or psychomotor retardation

Dysthymic Disorder

The diagnostic criteria for Dysthymic disorder Are as follows (DSM-IV):

1. Chronically depressed (irritable) mood most of the day, most days for at least 1 year

In children and adolescents (in adults, 2 years)

Specify early onset (before age 21)

1. Presence while you are depressed for at least two of the following:
   1. Loss / increased appetite
   2. Insomnia or hypersomnia
   3. Lack of energy or fatigue
   4. low self-esteem
   5. Difficulty concentrating or making decisions
   6. Feelings of hopelessness
2. During this year, it has not been without symptoms more than two months in a row
3. Without EDM during this first year ( Nor chronic, nor in remission ). Then, double depression
4. No manic or mixed episodes
5. Not only during a psychotic episode
6. Not due to a medical substance or illness
7. Symptoms cause significant discomfort or deterioration

Behavioral Disorders: Dissocial Disorders

The Disorders Are characterized by a persistent and repeated form of behavioral alteration, aggressive or defiant, and, in serious cases, by violations of social norms.

It is normal for disorders to get worse if they are not treated and for children to have little or no awareness of the problem.

Most of the children who suffer from this disorder are boys, there is a 3/1 ratio in favor of the boys.

Behavioral disorders include:

• Dissocial disorder limited to the family context: this is the mildest disorder, followed by the oppositional defiant. It is frequent when one of the parents has a new partner.
• Dissocial disorder in non-socialized children: this disorder is the most serious. It is usual for the child to relate to other equals who are equally disocial.
• Dissocial disorder in socialized children.
• Challenging and oppositional dysfunctional disorder.

Dissocial disorders

Diagnostic criteria according to ICD-10:

• Duration must be at least 6 months
• It gives rise to four subcategories plus mixed ones

Some of the following symptoms are present, often or frequently:

• Serious tantrums
• Discussions with adults
• Challenges to the requirements of adults
• Does things to annoy other people
• Blames others for their misconduct or misconduct
• Easily bothered by others
• Is angry or resentful
• Is spiteful and vindictive

Aggression to people and animals

• Intimidation of others
• Starts fights (except with siblings)
• Has used a weapon that can cause serious damage to others
• Physical Cruelty with Others
• Physical Cruelty to Animals
• Forcing another to have sex
• Violent or confrontational crime

Destruction of property

• Deliberate destruction of the property of others (not fire)
• Deliberate fires to cause damage

Fraudulence or Theft

• Robberies of value without confrontation with the victim (outside or inside the home)
• Lies or breaks promises for benefits and favors
• Burglary of foreign dwelling or vehicle

Serious violations of standards

• Abandonment of the home at least 2 times at night (or 1 more than one night), except for avoiding abuse
• He stays out of the house at night despite the paternal prohibition (start
• Absences from school (start

Does not meet the criteria of Dissocial personality disorder, schizophrenia, manic episode, TGD, Depressive Disorder (TD depressive), or Hyperkinetic T. (Hyperkinetic Disocial T.).

Underlined symptoms should only be given once to diagnose this disorder.

You must specify if it is:

• Dissocial disorder limited to family context

1. 3 or more symptoms ranging from 9-23
2. At least one present at least 6 months
3. The alteration is limited to the family environment

Normal external social relationships.

• Dissocial disorder in non-socialized children

1. 3 or more symptoms ranging from 9-23
2. At least one present at least 6 months
3. Poverty in relations with peers, with isolation, rejection...

Sometimes it can carry out group disocial acts.

• Dissocial disorder in socialized children

1. 3 or more symptoms ranging from 9-23
2. At least one present at least 6 months
3. Behavioral disorders include extrafamilial
4. Normal relationships with peers

You can act with a dissocial gang or not.

• Challenging and Oppositional Dissocial Disorder

1. 4 or more symptoms of F91, but no more than 2 should be of items 9-23.
2. These symptoms are unsuitable for the child's developmental level
3. At least 4 of the symptoms should be present for at least 6 months.

Attention deficit disorder and hyperactivity

He Attention Deficit Hyperactivity Disorder (ADHD) Is a developmental disorder that is defined by disabling levels of inattention, disorganization, and / or hyperactivity-impulsivity.

Lack of attention and organization leads to the inability to stay or complete the tasks corresponding to their educational level, which often give the impression that they do not listen.

Hyperactivity-impulsivity leads to overactivity, restlessness, inability to sit, meddling in the activities of others, and inability to wait.

The prevalence is 5% in children and 2.5% in adults. It is a fairly stable disorder, although in some cases it is aggravated in adolescence. In adulthood, hyperactivity is less obvious, but symptoms such as sleep, inattention, impulsivity and lack of organization persist.

It is more common in boys than in girls, both in adolescence and in adulthood.

Criteria according to DSM-IV:

1. A persistent pattern of inattention and / or overactivity / impulsivity that interferes with normal functioning or development is characterized by (1) and / or (2):
   • Inattention : Six (or more) of the following symptoms that have persisted for at least 6 months to an extent inconsistent with the level of development and which impact directly and negatively on social and academic / occupational activities:

Note: Symptoms not only manifest in behavior of opposition, hostility or failure to understand tasks or instructions. For older adolescents and adults (17 years or older), it is necessary at least the presence of five symptoms.

1. Failure usually to pay attention to details or make mistakes of carelessness in homework, work or other activities.
2. He usually has difficulty sustaining attention in tasks or idle activities.
3. He usually does not seem to listen when spoken to directly.
4. Usually does not follow directions and does not end school activities.
5. They usually have difficulty organizing tasks and activities.
6. Usually rejects, refuses, or dislikes tasks that require sustained attention.
   • Excessive activity and impulsivity: six (or more) of the following symptoms that have persisted for at least 6 months to an extent inconsistent with the level of development and which have a direct and negative impact on social and academic / occupational activities:

Note: Symptoms not only manifest in behavior of opposition, hostility or failure to understand tasks or instructions. For older adolescents and adults (17 years or older), it is necessary at least the presence of five symptoms.

1. He usually moves excessively, tapping hands or feet or writhing in the seat.
2. He usually gets up from the seat in situations where he is expected to sit.
3. Usually runs and climbs in situations where it is inappropriate. ( Note : In adolescents or adults, may be limited to feeling restless).
4. They are usually unable to play or engage in leisure activities in silence.
5. It is often"in motion"as if it had an engine.
6. He usually talks in excess.
7. Usually he rushes to respond before they complete the question.
8. He usually has difficulty waiting his turn.
9. Usually interrupts or intrudes on what others are doing.
10. Some symptoms of inattention or hyperactivity-impulsivity were present before the age of 12 years.
11. Some symptoms of inattention or hyperactivity-impulsivity are present in several different contexts.
12. There is clear evidence that symptoms interfere with or diminish the quality of functioning of social, academic, or occupational activities.
13. Symptoms do not occur exclusively during the course of an outbreak of schizophrenia or other psychotic disorder and can not be better explained by another mental disorder.

Specify if

• 01 (F90.2) Combined presentation : If the two criteria A1 (inattention) and A2 (hyperactivity-impulsivity) were present in the last 6 months.
• 01 (F90.0) Predominantly inattentive presentation : If criterion A1 (inattention) is present, but criterion A2 (hyperactivity-impulsivity) was not present in the last 6 months.
• 01 (F90.1) Predominantly hyperactive / impulsive presentation : If criterion A2 (hyperactivity-impulsivity) is presented, but criterion A1 (inattention) was not present in the last 6 months.

Specify if:

In partial remission : When all the above criteria were met, unless all criteria have been met during the last 6 months, and symptoms still lead to deterioration of social, academic or work activity.

Specify current severity

Mild : Few or no symptoms required to establish the diagnosis are present in excess, and symptoms result in no more than a slight deterioration in social or occupational functioning.

Moderate : Symptoms or functional deficit between"mild"and"severe"are present.

Severe : Many of the symptoms required to establish the diagnosis, or some particularly serious symptoms, are present, or the symptoms result in marked deterioration in social or occupational functioning.

References

1. American Psychiatric Association. (April 15, 2016). Start-up disorders in childhood, childhood or adolescence .
2. World Health Organization. (April 14, 2016). CONDUCT DISORDERS AND EMOTIONAL DISORDERS WHEN STARTED HABITUALLY IN CHILDREN AND ADOLESCENCE (F90-F98) . Obtained from Ministry of Health Social Services and Equality.
3. Rodróguez Sacristán, J., Mesa Cid, P. J., & Lozano Oyola, J.F. (2009). Basic Psychopathology. Madrid: Pyramid.