Comparable male and female prevalence rates are found for which of the following psychiatric disorders in children?
D. Pervasive developmental disorders such as autism and Asperger’s syndrome are more common in boys. Attention deficit hyperactivity disorder, tic disorders, oppositional defiance, and conduct disorders are also seen more often in boys than in girls. The rate of depression seems equal between both sexes before puberty. School refusal and selective mutism are also equally common in both boys and girls. Depression after puberty, specific phobia, eating disorders, and enuresis in daytime are more common in girls. Nocturnal enuresis in older children is more prevalent in boys.
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According to the Isle of Wight study the ratio of boys to girls with conduct disorder is:
A. Conduct disorders are four times more common in boys than in girls according to the Isle of Wight study. Girls are more prone to use verbal and relational violence, such as exclusion from groups and character defamation, than the physical attacks seen in boys. Consequently, girls are violent in a way that can be difficult to document and to describe as conduct disorder symptoms; this may be a reason for under-diagnosis of conduct issues in girls.
Reactive attachment disorder is a recognized category in both ICD-10 and DSM-IV.
Which of the following criteria used for diagnosing this condition is mentioned in DSM-IV but not ICD-10?
E. The core features of reactive attachment disorder (RAD) are preserved across both diagnostic nosologies, ICD and DSM. But the focus on subtypes and emphasis on the pathogenic nature of care giving are different. The DSM-IV includes inhibited and disinhibited types of RAD. In ICD-10, the term reactive attachment disorder stands for inhibited type, while disinhibited attachment disorder is separately defined. Both ICD and DSM endorse problems of social relatedness in RAD. Age of onset criteria (before 5 years) and exclusion of pervasive developmental disorders are common for both nosologies. In addition, DSM-IV also requires the presence of a known history of grossly pathogenic care, suggesting a causal link. Children with the disinhibited subtype may appear indiscriminately social.
The term frozen watchfulness is used in description of which of the following psychiatric conditions?
A. The term ‘frozen watchfulness’ describes an alertness or even hypervigilance that is maintained despite an overall inhibition of motor activity that may include mutism. Reactive attachment disorder (RAD) is associated with markedly disturbed and developmentally inappropriate social relatedness beginning before age 5 years. It commonly presents as persistent failure to initiate or respond to most social interactions. The responses can be excessively inhibited, hypervigilant, or highly ambivalent and contradictory. This is associated with avoidance of resistance to comforting or exhibiting a frozen watchfulness. This type of RAD is called the inhibited type. In disinhibited type, diffuse attachments manifested by indiscriminate sociability with marked inability to exhibit appropriately selective attachments are seen. This frozen watchfulness is different from aloofness seen in autism or dissociative features seen in PTSD. Frozen watchfulness is also seen in young victims of physical abuse.
Which of the following best defines the diagnosis of specific reading disorder when assessed using psychometric measures of reading age?
C. According to current classificatory systems, a learning disorder such as specific reading disorder can be diagnosed when the child achieves substantially lower than expected scores on individually administered, standardized tests of components of learning (reading, mathematics, or written expression) for a given age, schooling, and level of intelligence. Thus an explicit reference to psychometric assessments is made when diagnosing learning disorders. But a specific guideline as to the statistical meaning of being substantially below the expected norm is not clearly delineated in DSM IV. Nevertheless, ICD-10 states a score that is at least 2 standard errors of prediction below the expected value as diagnostic criteria for specific developmental disorders of scholastic skills.
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