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A. PERVASIVE AND DEVELOPMENTAL DISORDERS ¢ Marked impairment in the use of multiple
ž Characterized by impaired reciprocal social interactions, nonverbal behaviors such as eye-to-eye gaze,
aberrant language development, and restricted behavioral facial expression, body postures, and gestures
repertoire to regulate social interaction
ž Typically emerge in young children before the age of 3 ¢ Failure to develop peer relationships
years, and parents often become concerned about a child appropriate to developmental level
by 18 months as language development does not occur as ¢ A lack of spontaneous seeking to share
expected enjoyment, interests, or achievements with
ž Not identified with problems until school age, because they other people (e.g., by a lack of showing,
make relatively few demands and have minimal conflicts bringing, or pointing out objects of interest)
with others owing to their infrequent social engagement ¢ Lack of social or emotional reciprocity
ž Often exhibit idiosyncratic intense interest in a narrow ¡ Qualitative impairments in communication as
range of activities, resist change, and are not appropriately manifested by at least one of the following:
responsive to the social environment ¢ Delay in, or total lack of, the development of
ž The dsm-iv-tr includes five pervasive developmental spoken language (not accompanied by an
disorders: attempt to compensate through alternative
a) Autistic disorder modes of communication such as gesture or
b) Rett's disorder mime)
c) Childhood disintegrative disorder ¢ In individuals with adequate speech, marked
d) Asperger's disorder impairment in the ability to initiate or sustain
e) Pervasive developmental disorder not otherwise a conversation with others
specified ¢ Stereotyped and repetitive use of language or
idiosyncratic language
AUTISTIC DISORDER ¢ Lack of varied, spontaneous make-believe
ž Historically called early infantile autism, childhood autism, play or social imitative play appropriate to
or Kanner's autism developmental level
ž Characterized by symptoms from each of the following ¡ Restricted repetitive and stereotyped patterns of
three categories: behavior, interests, and activities, as manifested by at
ü Qualitative impairment in social interaction least one of the following:
ü Impairment in communication ¢ Encompassing preoccupation with one or
ü Restricted repetitive and stereotyped patterns of more stereotyped and restricted patterns of
behavior or interests interest that is abnormal either in intensity or
ž About 8 cases per 10,000 children (0.08 percent focus
ž The onset of autistic disorder is before the age of 3 years, ¢ Apparently inflexible adherence to specific,
although in some cases, it is not recognized until a child is nonfunctional routines or rituals
much older ¢ Stereotyped and repetitive motor
ž 4-5x more frequent in boys than in girls mannerisms (e.g., hand or finger flapping or
ž Girls with autistic disorder are more likely to have more twisting, or complex whole-body movements)
severe mental retardation ¢ Persistent preoccupation with parts of objects
ž Fragile X syndrome, a genetic disorder in which a portion of B. Delays or abnormal functioning in at least one of the
the X chromosome fractures, appears to be associated with following areas, with onset prior to age 3 years: (1) social
autistic disorder interaction, (2) language as used in social communication,
ž Tuberous sclerosis, a genetic disorder characterized by or (3) symbolic or imaginative play.
multiple benign tumors, with autosomal dominant C. The disturbance is not better accounted for by RETT'S
transmission is found with greater frequency among disorder or childhood disintegrative disorder
children with autistic disorder
ž Approx. 70% of children with autistic disorder have mental Course and prognosis:
retardation ž Generally a lifelong disorder with a guarded prognosis.
ž About one third of these children have mild to moderate ž With IQs above 70 and those who use communicative
mental retardation, and close to half of these children are language by ages 5 to 7 years tend to have the best
severely or profoundly mentally retarded. prognoses
ž Unusual or precocious cognitive or visuomotor abilities ž Symptom areas that did not seem to improve over time
occur in some autistic children. were those related to ritualistic and repetitive behaviors
ž The abilities, which may exist even in the overall retarded ž Prognosis is improved if the environment or home is
functioning, are referred to as splinter functions or islets of supportive and capable of meeting the extensive needs of
precocity. such a child
ž About 4 to 32 percent have grand mal seizures in late
DSM-IV-TR Diagnostic Criteria for Autistic Disorder childhood or adolescence, and the seizures adversely affect
A. A total of six (or more) items from (1), (2), and (3), with at the prognosis
least two from (1), and one each from (2) and (3):
¡ Qualitative impairment in social interaction, as
manifested by at least two of the following:

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Treatment: ¡ stereotyped and repetitive motor mannerisms (e.g.,
ž To target behaviors that will improve their abilities to hand or finger flapping or twisting, or complex whole-
integrate into schools, develop meaningful peer body movements)
relationships, and increase the likelihood of maintaining ¡ persistent preoccupation with parts of objects
independent living as adults C. The disturbance causes clinically significant impairment in
ž Treatment interventions aim to increase socially acceptable social, occupational, or other important areas of
and prosocial behavior, to decrease odd behavioral functioning.
symptoms, and to improve verbal and nonverbal D. There is no clinically significant general delay in language
communication (e.g., single words used by age 2 years, communicative
ž Educational and behavioral interventions are currently phrases used by age 3 years).
considered the treatments of choice. E. There is no clinically significant delay in cognitive
ž Structured classroom training, in combination with development or in the development of age-appropriate
behavioral methods, is the most effective treatment for self-help skills, adaptive behavior (other than in social
many autistic children interaction), and curiosity about the environment in
childhood.
ASPERGERS DISORDER F. Criteria are not met for another specific pervasive
ž Characterized by impairment and oddity of social developmental disorder or schizophrenia.
interaction and restricted interest and behavior reminiscent
of those seen in autistic disorder ž Factors associated with a good prognosis are a normal IQ
ž Unlike autistic disorder, in asperger's disorder no significant and high-level social skills
delays occur in language, cognitive development, or age- ž Treatment of Asperger's disorder is supportive, and goals
appropriate self-help skills are to promote social behaviors and peer relationships.
ž Hans asperger, an austrian physician, described a syndrome ž Some of the same techniques used for autistic disorder are
that he named “autistic psychopathy” likely to benefit patients with Asperger's disorder with
ž Original description of the syndrome applied to persons severe social impairment
with normal intelligence who exhibit a qualitative
impairment in reciprocal social interaction and behavioral B. ATTENTION DEFICIT DISORDERS
oddities without delays in language development cause is ATTENTION-DEFICIT/HYPERACTIVITY DISORDER (ADHD)
unknown ž Characterized by a pattern of diminished sustained
ž Family studies suggest a possible relationship to autistic attention and higher levels of impulsivity in a child or
disorder adolescent than expected for someone of that age and
ž Clinical features include at least two of the following developmental level
indications of qualitative social impairment: ž The diagnosis of adhd is based on the consensus of experts
a) Markedly abnormal nonverbal communicative that three observable subtypes: inattentive,
gestures, the failure to develop peer relationships, the hyperactive/impulsive, or combined are all manifestations
lack of social or emotional reciprocity, of the same disorder.
b) Impaired ability to express pleasure in other persons' ž To meet the criteria for the diagnosis of adhd, some
happiness symptoms must be present before the age of 7 years,
although adhd is not diagnosed in many children until they
DSM-IV-TR Diagnostic Criteria for Asperger's Disorder are older than 7 years when their behaviors cause problems
in school and other places
A. Qualitative impairment in social interaction, as manifested
ž To confirm a diagnosis of adhd, impairment from
by at least two of the following:
inattention and/or hyperactivity-impulsivity must be
¡ marked impairment in the use of multiple nonverbal
observable in at least two settings and interfere with
behaviors such as eye-to-eye gaze, facial expression,
developmentally appropriate functioning socially,
body postures, and gestures to regulate social
academically, or in extracurricular activities
interaction
ž Adhd is not diagnosed when symptoms occur in a child,
¡ failure to develop peer relationships appropriate to
adolescent, or adult with a pervasive developmental
developmental level
disorder, schizophrenia, or other psychotic disorder.
¡ a lack of spontaneous seeking to share enjoyment,
ž From 2 to 20 percent of grade-school children
interests, or achievements with other people (e.g., by
ž More prevalent in boys than in girls, with the ratio ranging
a lack of showing, bringing, or pointing out objects of
from 2 to 1 to as much as 9 to 1
interest to other people)
ž Siblings of children with adhd are also at higher risk than the
¡ lack of social or emotional reciprocity
general population to have learning disorders and academic
B. Restricted repetitive and stereotyped patterns of behavior,
difficulties
interests, and activities, as manifested by at least one of the
ž The etiology of adhd involves complex interactions of
following:
neuroanatomical and neurochemical systems is based on
¡ encompassing preoccupation with one or more
twin and adoption family genetic studies, dopamine
stereotyped and restricted patterns of interest that is
transport gene studies, neuroimaging studies, and
abnormal either in intensity or focus
neurotransmitter data
¡ apparently inflexible adherence to specific,
nonfunctional routines or rituals

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DSM-IV-TR Diagnostic Criteria for Attention-Deficit/Hyperactivity Disorder E. The symptoms do not occur exclusively during the course of
A. Either (1) or (2): a pervasive developmental disorder, schizophrenia, or
¡ Six (or more) of the following symptoms of inattention other psychotic disorder and are not better accounted for
have persisted for at least 6 months to a degree that by another mental disorder (e.g., mood disorder, anxiety
is maladaptive and inconsistent with developmental disorder, dissociative disorder, or a personality disorder).
level:
Inattention ž Code based on type:
¢ Often fails to give close attention to details or ü Attention-deficit/hyperactivity disorder, combined
makes careless mistakes in schoolwork, work, type: if both Criteria A1 and A2 are met for the past 6
or other activities months
¢ Often has difficulty sustaining attention in ü Attention-deficit/hyperactivity disorder,
tasks or play activities predominantly inattentive type: if Criterion A1 is met
¢ Often does not seem to listen when spoken to but Criterion A2 is not met for the past 6 months
directly ü Attention-deficit/hyperactivity disorder,
¢ Often does not follow through on instructions predominantly hyperactive-impulsive type: if
and fails to finish schoolwork, chores, or Criterion A2 is met but Criterion A1 is not met for the
duties in the workplace (not due to past 6 months
oppositional behavior or failure to understand ü Coding note: For individuals (especially adolescents
instructions) and adults) who currently have symptoms that no
¢ Often has difficulty organizing tasks and longer meet full criteria, “in partial remissionâ€
activities should be specified.
¢ Often avoids, dislikes, or is reluctant to ž No specific laboratory measures are pathognomonic of
engage in tasks that require sustained mental ADHD.
effort (such as schoolwork or homework) ž The course of ADHD is variable.
¢ Often loses things necessary for tasks or ž Symptoms have been shown to persist into adolescence or
activities (e.g., toys, school assignments, adult life in approximately 50 percent of cases.
pencils, books, or tools) ž Overactivity is usually the first symptom to remit, and
¢ Is often easily distracted by extraneous stimuli distractibility is the last.
¢ Is often forgetful in daily activities ž Remission does occur, usually between the ages of 12 and
¡ Six (or more) of the following symptoms of 20.
hyperactivity-impulsivity have persisted for at least 6 ž Most patients with the disorder, however, undergo partial
months to a degree that is maladaptive and remission and are vulnerable to antisocial behavior,
inconsistent with developmental level: substance use disorders, and mood disorders.
Hyperactivity ž Learning problems often continue throughout life.
¢ Often fidgets with hands or feet or squirms in ž Children with the disorder whose symptoms persist into
seat adolescence are at risk for developing conduct disorder.
¢ Often leaves seat in classroom or in other ž Children with both ADHD and conduct disorder are also at
situations in which remaining seated is risk for developing a substance-related disorder.
expected ž Pharmacologic treatment is considered to be the first line
¢ Often runs about or climbs excessively in of treatment for ADHD.
situations in which it is inappropriate (in ž Central nervous system stimulants are the first choice of
adolescents or adults, may be limited to agents in that they have been shown to have the greatest
subjective feelings of restlessness) efficacy with generally mild tolerable side effects.
¢ Often has difficulty playing or engaging in
leisure activities quietly C. DISRUPTIVE BEHAVIOR DISORDERS
¢ Is often “on the go†or often acts as if ž Can Be Divided Into Two Distinct Constellations Of
“driven by a motor†Symptoms Categorized As Oppositional Defiant Disorder
¢ Often talks excessively And Conduct Disorder, Both Of Which Result In Impaired
¡ Impulsivity Social Or Academic Functioning In A Child
¢ Often blurts out answers before questions
have been completed OPPOSITIONAL DEFIANT DISORDER
¢ Often has difficulty awaiting turn ž A child's temper outbursts, active refusal to comply with
¢ Often interrupts or intrudes on others (e.g., rules, and annoying behaviors exceed expectations for
butts into conversations or games) these behaviors for children of the same age
B. Some hyperactive-impulsive or inattentive symptoms that ž An enduring pattern of negativistic, hostile, and defiant
caused impairment were present before age 7 years. behaviors in the absence of serious violations of social
C. Some impairment from the symptoms is present in two or norms or of the rights of others
more settings (e.g., at school [or work] and at home). ž Can begin as early as 3 years of age, it typically is noted by
D. There must be clear evidence of clinically significant 8 years of age and usually not later than adolescence
impairment in social, academic, or occupational ž Occur at rates ranging from 2 -16 %
functioning. ž More prevalent in boys than in girls before puberty, and the
sex ratio appears to be equal after puberty

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DSM-IV-TR Diagnostic Criteria for Oppositional Defiant Disorder ž More common among boys than girls, and the ratio ranges
A. A pattern of negativistic, hostile, and defiant behavior from 4 to 1 to as much as 12 to 1
lasting at least 6 months, during which four (or more) of the ž Occurs with greater frequency in the children of parents
following are present: with antisocial personality disorder and alcohol
¡ Often loses temper dependence than in the general population
¡ Often argues with adults
¡ Often actively defies or refuses to comply with adults' DSM-IV-TR Diagnostic Criteria for Conduct Disorder
requests or rules A. A repetitive and persistent pattern of behavior in which the
¡ Often deliberately annoys people basic rights of others or major age-appropriate societal
¡ Often blames others for his or her mistakes or norms or rules are violated, as manifested by the presence
misbehavior of three (or more) of the following criteria in the past 12
¡ Is often touchy or easily annoyed by others months, with at least one criterion present in the past 6
¡ Is often angry and resentful months:
¡ Is often spiteful or vindictive ž Aggression to people and animals
B. Note: Consider a criterion met only if the behavior occurs ¡ Often bullies, threatens, or intimidates others
more frequently than is typically observed in individuals of ¡ Often initiates physical fights
comparable age and developmental level. The disturbance ¡ Has used a weapon that can cause serious
in behavior causes clinically significant impairment in social, physical harm to others (e.g., a bat, brick,
academic, or occupational functioning. broken bottle, knife, gun)
C. The behaviors do not occur exclusively during the course of ¡ Has been physically cruel to people
a psychotic or mood disorder. ¡ Has been physically cruel to animals
D. Criteria are not met for conduct disorder, and, if the ¡ Has stolen while confronting a victim (e.g.,
individual is age 18 years or older, criteria are not met for mugging, purse snatching, extortion, armed
antisocial personality disorder. robbery)
¡ Has forced someone into sexual activity
ž Most children who have ADHD and conduct disorder ž Destruction of property
develop conduct disorder before the age of 12 years. ¡ Has deliberately engaged in fire setting with
ž Most children who develop conduct disorder have a history the intention of causing serious damage
of oppositional defiant disorder. ¡ Has deliberately destroyed others' property
ž The primary treatment of oppositional defiant disorder is (other than by fire setting)
family intervention using both direct training of the parents ž Deceitfulness or theft
in child management skills and careful assessment of family ¡ Has broken into someone else's house,
interactions. building, or car
ž Children with oppositional defiant behavior may also ¡ Often lies to obtain goods or favors or to avoid
benefit from individual psychotherapy. obligations (i.e., “cons†others)
¡ Has stolen items of nontrivial value without
CONDUCT DISORDER confronting a victim (e.g., shoplifting, but
ž Likely to demonstrate behaviors in the following four without breaking and entering; forgery)
categories: physical aggression or threats of harm to ž Serious violations of rules
people, destruction of their own property or that of others, ¡ Often stays out at night despite parental
theft or acts of deceit, and frequent violation of age- prohibitions, beginning before age 13 years
appropriate rules ¡ Has run away from home overnight at least
ž Conduct disorder is an enduring set of behaviors that twice while living in parental or parental
evolves over time, usually characterized by aggression and surrogate home (or once without returning
violation of the rights of others for a lengthy period)
ž Associated with many other psychiatric disorders including ¡ Is often truant from school, beginning before
ADHD, depression, and learning disorders age 13 years
ž Also associated with certain psychosocial factors, such as B. The disturbance in behavior causes clinically significant
harsh, punitive parenting; family discord; lack of impairment in social, academic, or occupational
appropriate parental supervision; lack of social functioning.
competence; and low socioeconomic level C. If the individual is age 18 years or older, criteria are not met
ž DSM-IV-TR criteria require three specific behaviors of the for antisocial personality disorder.
15 listed, which include bullying, threatening, or
intimidating others, and staying out at night despite ž Code based on age at onset:
parental prohibitions, beginning before 13 years of age ü Conduct disorder, childhood-onset type: onset of at
ž DSM-IV-TR also specifies that truancy from school must least one criterion characteristic of conduct disorder
begin before 13 years of age to be considered a symptom prior to age 10 years
of conduct disorder. ü Conduct disorder, adolescent-onset type: absence of
ž The disorder can be diagnosed in a person older than 18 any criteria characteristic of conduct disorder prior to
years only if the criteria for antisocial personality disorder age 10 years
are not met. ü Conduct disorder, unspecified onset: age at onset is
ž Range from 1 to 10 percent, with a general population rate not known
of approximately 5 percent

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ž Specify severity: D. The behavior is not due exclusively to the direct
ü Mild: few if any conduct problems in excess of those physiological effect of a substance (e.g., a diuretic) or a
required to make the diagnosis and conduct problems general medical condition (e.g., diabetes, spina bifida, a
cause only minor harm to others seizure disorder).
ü Moderate: number of conduct problems and effect ž Specify type:
on others intermediate between “mild†and ü Nocturnal only
“severe†ü Diurnal only
ü Severe: many conduct problems in excess of those ü Nocturnal and diurnal
required to make the diagnosis or conduct problems ž Enuresis is often self-limited, and a child with enuresis may
cause considerable harm to others have a spontaneous remission without psychological
sequelae.
ž In general, the prognosis for children with conduct disorder ž A treatment plan for typical enuresis can be developed after
is most guarded in those who have symptoms at a young organic causes of urinary dysfunction have been ruled out.
age, exhibit the greatest number of symptoms, and express ž Modalities that have been used successfully for enuresis
them most frequently. include both behavioral and pharmacological interventions.
ž A good prognosis is predicted for mild conduct disorder in ž Other useful techniques include restricting fluids before
the absence of coexisting psychopathology and the bed and night lifting to toilet train the child.
presence of normal intellectual functioning. ž Classic conditioning with the bell (or buzzer) and pad
ž Multimodality treatment programs that use all the available apparatus is generally the most effective treatment for
family and community resources are likely to bring about enuresis, with dryness resulting in more than 50 percent of
the best results in efforts to control conduct-disordered cases.
behavior. ž Imipramine (Tofranil) is efficacious and has been approved
ž Multimodal treatments can involve the use of behavioral for use in treating childhood enuresis, primarily on a short-
interventions in which rewards may be earned for prosocial term basis.
and nonaggressive behaviors, social skills training, family
education and therapy, and pharmacologic interventions. E. MOOD DISORDERS
ž Depressive disorders occur in children of all ages, but are
D. Elimination Disorders much more prevalent with increasing age.
ž These disorders are considered after age 4 years, for ž Children and adolescents with depressive disorders often
encopresis, and after age 5 years for enuresis, when a child display irritability, withdrawal from family and peers, and
is chronologically, developmentally, and physiologically deterioration in academic investment, leading to
expected to be able to master these skills. devastating social isolation.
ž Although suicidal thoughts and behaviors can occur in the
DSM-IV-TR Diagnostic Criteria for Encopresis context of a depressive disorder, most youth who
A. Repeated passage of feces into inappropriate places (e.g., contemplate, attempt, or complete suicide are not in the
clothing or floor) whether involuntary or intentional. midst of a major depression.
B. At least one such event a month for at least 3 months. ž Mood disorders among preschool-age children are
C. Chronological age is at least 4 years (or equivalent extremely rare
developmental level). ž boys whose fathers died before they were 13 years of age
D. The behavior is not due exclusively to the direct are at greater risk than controls to develop depression
physiological effects of a substance (e.g., laxatives) or a ž According to the DSM-IV-TR diagnostic criteria for major
general medical condition except through a mechanism depressive episode, at least five symptoms must be present
involving constipation. for a period of 2 weeks, and there must be a change from
ž Code as follows: previous functioning.
ü With constipation and overflow incontinence ž Among the necessary symptoms is either a depressed or
Without constipation and overflow incontinence irritable mood or a loss of interest or pleasure.
ž The treatment plan for encopresis cannot be established ž Other symptoms from which the other four diagnostic
until a medical assessment of bowel function is completed criteria are drawn include a child's failure to make expected
as well as a full psychiatric assessment. weight gains, daily insomnia or hypersomnia, psychomotor
ž Supportive psychotherapy and relaxation techniques may agitation or retardation, daily fatigue or loss of energy,
be useful in treating the anxieties and other sequelae of feelings of worthlessness or inappropriate guilt, diminished
children with encopresis ability to think or concentrate, and recurrent thoughts of
death.
DSM-IV-TR Diagnostic Criteria for Enuresis ž These symptoms must produce social or academic
impairment.
A. Repeated voiding of urine into bed or clothes (whether
ž Mood disorders tend to be chronic if they begin early.
involuntary or intentional).
Childhood onset may be the most severe form of mood
B. The behavior is clinically significant as manifested by either
disorder and tends to appear in families with a high
a frequency of twice a week for at least 3 consecutive
incidence of mood disorders and alcohol abuse.
months or the presence of clinically significant distress or
ž The children are likely to have such secondary
impairment in social, academic (occupational), or other
complications as conduct disorder, alcohol and other
important areas of functioning.
substance abuse, and antisocial behavior.
C. Chronological age is at least 5 years (or equivalent
developmental level).

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Treatment ž onset is frequently insidious; after first exhibiting
ž Cognitive-behavioral therapy is widely recognized as an inappropriate affects of unusual behavior, a child may take
efficacious intervention for the treatment of moderately months or years to meet all of the diagnostic criteria for
severe depression in children and adolescents; aims to schizophrenia
challenge maladaptive beliefs and enhance problem-solving ž Important predictors of the course and outcome of early-
abilities and social competence onset schizophrenia include the child's level of functioning
ž Family education and participation are necessary before the onset of schizophrenia, the age of onset, IQ,
ž selective serotonin reuptake inhibitors (SSRIs) as first-line response to pharmacologic interventions, how much
pharmacological intervention functioning the child regained after the first episode, and
ž Fluoxetine is currently the only antidepressant that has FDA the amount of support available from the family.
approval in the treatment of depression in children and ž Childhood-onset schizophrenia appears to be a more
adolescents malignant type of schizophrenia which presents a greater
challenge to treat with pharmacology and psychosocial
Early-Onset Bipolar Disorders interventions.
ž Bipolar I disorder is being diagnosed with increasing ž It seems to respond less to medication than schizophrenia
frequency in prepubertal children, with the caveat that with adult onset or adolescent onset, and the prognosis
“classic” manic episodes are uncommon in this age group, may be poorer.
even when depressive symptoms have already appeared
ž Features of the mood and behavior disturbances among Treatment
prepubertal children who are currently diagnosed with ¡ Requires A Multimodal Approach, Including Pharmacologic
bipolar disorder by some clinicians include extreme mood Interventions, Family Education, Social Skills Interventions,
variability, intermittent aggressive behavior, high levels of And Appropriate Educational Placement
distractibility, and poor attention span. ¡ Atypical Antipsychotics, Serotonin-Dopamine Antagonists
ž A classic manic episode in an adolescent emerges as a Are Current First-Line Treatment For Children And
distinct departure from a preexisting state often Adolescents With Schizophrenia
characterized by grandiose and paranoid delusions and ¡ Risperidone, Olanzapine, And Clozapine
hallucinatory phenomena. ¡ Psychosocial Interventions Aimed At Family Education
ž According to the text revision of the 4th edition of ¡ Long-Term Intensive And Supportive Psychotherapy
Diagnostic and Statistical Manual of Mental Disorders Combined With Pharmacotherapy Is The Most Effective
(DSM-IV-TR), the diagnostic criteria for a manic episode are Approach To This Disorder
the same for children and adolescents as for adults
ž When mania appears in an adolescent, there is a higher
incidence of psychotic features than occurs in adults, and
hospitalization is often necessary.
ž Presently, it is not known if early-onset bipolar disorders
have the same natural history over time as bipolar disorders
with an onset during adolescence or early adulthood.
ž Predictors of more rapid cycling included lower
socioeconomic status (SES), presence of lifetime psychosis,
and bipolar disorder not otherwise specified diagnosis.
ž when the illness emerges in young children, recovery rates
are lower

Treatment
ž Mood stabilizing agents
¡ Lithium
¡ Valproate
¡ Lamotrigine
ž Atypical antipsychotics
¡ Olanzapine
¡ Risperidone
¡ Quetiapine
ž Psychotherapy

F. EARLY-ONSET SCHIZOPHRENIA
ž Childhood-onset schizophrenia (COS) is a rare and severe
form of schizophrenia characterized by an onset of
psychotic symptoms by age 12 years
ž it is estimated to occur in less than 1 of 10,000 children
ž boys often become identified at a younger age than girls
ž all of the symptoms included in adult-onset schizophrenia
may be manifest in children with the disorder

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