Lesson 1: Common Childhood Disorders

Description

On the advice of a pediatrician, a distraught mother, Betty, brought her seven year-old daughter, Kayla, to a medical centre for assessment. Betty was unable to control her daughter’s behaviour. It was learned that Kayla had temper tantrums, hurled objects across the room, stole, swore, repeated what was said to her (echolalia), grunted, and “talked back” to her mother. As a baby, Kayla cried when she was picked up and, at six months of age, had a febrile seizure. By the time Kayla was three, she talked almost constantly and could not sit still. When placed in school, she was unable to remain in her seat and concentrate. She disobeyed the teacher, played pranks on the teacher, and began to lie. By the time Kayla reached grade three, she had acquired the vocal tic of grunting, was behind in her academic skills, and often had bad dreams and difficulty sleeping.

Kayla did not finish what she started (at school and at home) and needed constant supervision. She was easily distracted and did not listen to instructions - often acting before thinking about the potential consequences of her behaviour. Betty did not know how to deal with Kayla. Kayla purposefully disobeyed her mother and blamed other people for her actions.

It was learned that Kayla came from a very dysfunctional family. Her father was killed while attempting to murder another person, her mother had grunting tics and was poorly educated, her uncle was an alcoholic who beat his wife,

her younger brother had vocal tics and hyperactivity, and her maternal grandfather had tics, beat his wife, and consumed alcohol excessively. Also, during childhood, Betty had been molested by her father - Kayla’s grandfather.

Diagnosis

Kayla exhibited many negative behaviours. Her vocal tics (grunting, echolalia) suggest Tourette syndrome, but without many motor tics, a more appropriate diagnosis is vocal tic disorder. Her swearing may be linked to this disorder. As for her other behaviour problems, the symptoms (fidgeting, distractibility, excessive talking, lack of concentration, difficulty remaining seated, inability to complete projects, difficulty focusing on instructions) suggest attention deficit hyperactivity disorder. The level of severity regarding this disorder can be considered moderate because of social and school-related difficulties.

Because Kayla displayed the required minimum number of symptoms for oppositional defiant disorder (being quick to lose her temper, arguing with adults, and blaming others for her mistakes), her diagnosis also included this disorder. Kayla’s DSM summary is as follows:

Axis I: Chronic Vocal Tic Disorder Attention Deficit Hyperactivity Disorder, Moderate Oppositional Defiant Disorder, Moderate