LEARNING DISORDERS CO-EXISTING BEHAVIOUR DISORDERS
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1 LEARNING DISORDERS & CO-EXISTING BEHAVIOUR DISORDERS
2 MIND & FUNCTIONS The mind s functions including the processes of Learning, Reading, Spelling, Writing, Language, etc. are all the result of efficient communication among specific brain areas. This is the importance of understanding the organic basis of the Mind.
3 Mind is generated by the Brain. Psychiatry is Application of Basic Neurosciences to man s day-to-day problems.
4 MIND & ITS FUNCTIONS: ORGANIC PERSPECTIVE MIND-BODY DUALISM Dichotomy: Visible Vs Invisible Exponentially grown technology. EEG, CT, MRI, PET, SPECT, f MRI, MRS etc Peep into live brain cells through these Windows. Think & Feel inside the Brain : Biochemical basis.
5 MIND : ORGANIC PERSPECTIVE MAPPING THE BRAIN Hot colours mark the areas working on various Tasks in these PET scans
6 MIND : ORGANIC PERSPECTIVE
7 Think & Feel inside the Brain : Biochemical basis SEROTONIN: AWAKENING OF THE SLEEPING GIANT ROLE IN DEPRESSION AS WELL AS ANXIETY
8 Think & Feel inside the Brain : Biochemical basis SOCIAL PHOBIA: FUNCTIONAL NEUROANATOMY INCREASED AMYGDALA AND CINGULATE ACTIVITY DECREASED BASAL GANGLIA ACTIVITY
9 LEARNING PROBLEMS IN SCHOOL CHILDREN MIND AND DYSFUNCTIONS: EMOTIONAL & BEHAVIOUR DISORDERS CO-EXISTING WITH LD (CO-MORBIDITY)
10 POOR SCHOOL PERFORMANCE : MIXED BAG COCHIN : THE LEARNING- EXPERIENCE Initially, children brought with PSP presentation. As we went on, overwhelming co-morbidity. Co-morbid disorders came up with focused evaluation by Multidisciplinary Team under same roof. Co-morbid conditions found as Primary psychiatric disorders, or secondary to PSP, or to Developmental Disorders.
11 POOR SCHOOL PERFORMANCE MIXED BAG COCHIN : THE LEARNING EXPERIENCE (n = 1310 of 2 years) 62.7% of confirmed diagnosis of LD (6-14 years) have additional Axis I or II Disorders A given child manifests one or more of these neuro-psychiatric disorders. High level co-morbidity. LD and the other 2 DD (CD + DCD) : 31.6% ADHD in 41% of LD cases Anxiety/Depression in 24% OC disorders in 22% ODD / Conduct in 12% Tourette/Tics in 5% NEED FOR MULTIDISCIPLINARY CGC : PSYCHIATRIST
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13 CHILDHOOD PSYCHIATRIC DISORDERS : CO-MORBIDITY WITH LD Developmental Externalising Internalising Disorders Disorders Disorders (with birth) (Disruptive) (Emotional) ASD MR (IQ) ADHD Anxiety LD ODD Phobias Language (CD) Conduct Diso OCD/OC Motor Co-ordination Tourette etc Depression etc. (DCD)
14 TYPES OF CO-MORBID DISORDERS Developmental Disorders Disruptive Behavior Disorders TYPES Emotional Disorders
15 CHILDHOOD PSYCHIATRIC DISORDERS : REPEAT CO-MORBIDITY WITH LD Developmental Externalising Internalising Disorders Disorders Disorders (with birth) (Disruptive) (Emotional) ASD MR (IQ) ADHD Anxiety LD ODD Phobias Language (CD) Conduct Diso OCD/OC Motor Co-ordination Tourette etc Depression etc. (DCD)
16 TYPES OF CO-MORBID DISORDERS Developmental Disorders COMMUNICATION DISORDERS Difficulty with Speech Difficulty with Receptive Language Difficulty with Expressive Language DEVELOPMENTAL COORDINATION DISORDER Difficulty with Fine tuning of movements affecting Pencil Grip Handwriting Shoe lacing Buttoning etc. LEARNING DISORDERS
17 TYPES OF CO-MORBID DISORDERS I. DEVELOPMENTAL DISORDERS (SDD) Developmental Disorder of Speech & Language (Articulation, Expressive and, Receptive Language) Developmental Disorder Scholastic Skills (LD) (Reading, Writing, Spelling, Arithmetic, Mixed) Developmental Disorder of Motor Skills (Fine Motor Skills, Co-ordination, Handedness etc ) Left Hemisphere : Table-top Hemisphere LD as Prototype Major cause for PSP.
18 II. TYPES OF CO-MORBID DISORDERS DISRUPTIVE DISORDERS (EXTERNALIZING DISORDERS) Attention Deficit Hyperactivity Disorders (ADHD) - Inattention Difficulty sustaining attention to tasks Makes careless mistakes Doesn t follow instructions Fails to complete tasks Frequently loses things Easily distracted Forgetful of daily activities
19 Attention Deficit Hyperactivity Disorders (ADHD) - Hyperactivity Often fidgets with hands or feet Difficulty remaining seated Talks excessively Runs about excessively Acts as if driven by motor
20 Attention Deficit Hyperactivity Disorders (ADHD) Impulsivity Often blurts out answers before question is completed Difficulty awaiting turn Intrudes into conversations or games Doesn t think of consequences
21 TYPES OF CO-MORBID DISORDERS DISRUPTIVE DISORDERS (EXTERNALIZING DISORDERS) Conduct Disorders Severe disobedience Defiance Frequent temper tantrums Mood swings Keeps away from school Lying Frequent fights Low self esteem
22 III. EMOTIONAL DISORDERS (INTERNALIZING DISORDERS) ANXIETY DISORDERS (Sense of fearful anticipation) Trembling of hands or legs Constant heaviness in the chest. Headache, Stomachache Palpitations, Breathlessness Dryness of mouth Sweating of palms Dizziness Frequent urination Tingling of hands and legs Nausea, Vomiting Loss of concentration Mind going blank (exams..) Feeling listless or wound up etc. POST-TRAUMATIC STRESS DISORDERS (PTSD) * ACUTE STRESS DISORDERS
23 EMOTIONAL DISORDERS (INTERNALIZING DISORDERS) PHOBIA Fear to specific activity or situation Exam Phobia Social Phobias Multiple Phobia
24 EMOTIONAL DISORDERS (INTERNALIZING DISORDERS) DEPRESSION Withdrawn from everyone Avoids pleasurable activities Brooding or day dreaming Pessimistic, Crying spells Feeling of Guilt Suicidal Thoughts Irritability Tantrums
25 Emotional Disorders (INTERNALIZING DISORDERS) OBSESSIVE DISORDERS Need for perfection Need to arrange and rearrange Need for checking and rechecking Intense need for cleanliness, washing Fussy about neatness, orderliness, sameness Doesn t like others sharing or touching belongings Slow in all activities, starting trouble Procrastination
26 EMOTIONAL DISORDERS (INTERNALIZING DISORDERS) TICS DISORDER (Involuntary rapid Vocal or Muscular Movements) Vocal Tics Throat Clearing Grunting Snorting Hissing Motor Tics Eye Blinking Neck Jerking Shoulder Shrugging Facial Grimaces etc.
27 PSP AND CHILDHOOD DISORDERS TAKE HOME MESSAGES Mixed-Bag is the clear message. Neuro-psychiatric disorders with possibly shared neuropathology. Diagnostic and pharmacological implications. Systematically look for each possible Co-morbid Disorder in every child with Learning problems. NEED FOR MULTIDISCIPLINARY C G C
28 TAKE HOME MESSAGES Learning Disorders (LD) hardly exist in isolation. Other Neuro-psychiatric disorders co-exist with LD. Deliberately look for each Neuro-psychiatric disorder. Learning Disorders (LD) predispose the child for later development of Anxiety/Depression, Phobias, ODD/Conduct Disorder. In child with primary psychiatric disorder, presence of LD predicts a worse prognosis of that disorder.
29 TAKE HOME MESSAGES For a case of PSP, a readymade checklist of possible co-existent diagnoses has been offered in the workshop. LD and these other disorders are not pure syndromes. Precise diagnosis will depend on Multidisciplinary assessment. Judicious medications, Multi-pronged Remediation. Create Educational Diagnosticians -- - TEACHERS, COUNSELORS & PARENTS
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