F 90.0 decoding. Hyperkinetic conduct disorder. The goals of conservative treatment

/ F90 - F98 / Emotional and behavioral disorders, usually onset in childhood and adolescence / F90 / Hyperkinetic disorders This group of disorders is characterized by: early onset; a combination of overly active, poorly modulated behavior with pronounced inattention and lack of persistence when performing tasks; the fact that these behavioral characteristics are manifested in all situations and show constancy over time. It is believed that constitutional disorders play a decisive role in the genesis of these disorders, but knowledge of the specific etiology is still lacking. In recent years, the diagnostic term attention deficit disorder has been proposed for these syndromes. It is not used here because it presupposes knowledge of psychological processes. which is still not available, it involves the inclusion of anxious, absorbed in thought or "dreamy" apathetic children, whose problems are probably of a different kind. It is clear, however, that from a behavioral perspective, problems of inattention are the main hallmark of hyperkinetic syndromes. Hyperkinetic syndromes always occur early in the developmental process (usually in the first 5 years of life). Their main characteristics are lack of persistence in activities requiring cognitive efforts and a tendency to move from one activity to another without completing any of them, along with poorly organized, poorly regulated and excessive activity. These deficiencies usually persist during school years and even into adulthood, but many patients experience gradual improvement in activity and attention. Several other disorders can be combined with these disorders. Hyperkinetic children are often reckless and impulsive, prone to accidents, and discipline for rash, rather than outright defiant, rule violations. Their relationships with adults are often socially disinhibited, with a lack of normal caution and restraint; other children do not like them and they can become isolated. Cognitive impairments are common and specific delays in motor and speech development are disproportionately frequent. Secondary complications include dissocial behavior and low self-esteem. There has been a significant overlap of hyperkinesia with other manifestations of brutal behavior, such as "unsocialized conduct disorder". Nevertheless, current data confirm the selection of a group in which hyperkinesia is the main problem. Hyperkinetic disorders occur in boys several times more often than in girls. Concomitant reading difficulties (and / or other school problems) are common. Diagnostic guidelines: Disturbed attention and hyperactivity are cardinal signs required for diagnosis and must be found in more than one situation (eg, at home, in the classroom, in the hospital). Impaired attention is manifested by premature interruption of tasks when the lesson remains unfinished. Children often switch from one activity to another, seemingly losing interest in one task due to being distracted by another (although laboratory findings usually do not reveal unusual degrees of sensory or perceptual distraction). These defects of persistence and attention should be diagnosed only if they are excessive for the child's age and IQ. Hyperactivity involves being overly impatient, especially in situations that require relative calmness. This may, depending on the situation, include running and jumping around; or jumping up from a place when supposed to sit; or excessive talkativeness and noisiness; or fidgeting and wriggling. The standard for judgment should be that the activity is excessively high in the context of what is expected in the situation and in comparison with other children of the same age and intellectual development. This behavioral trait becomes most evident in structured, organized situations that require a high degree of self-control behavior. Disturbed attention and hyperactivity must be present; in addition, they must be noted in more than one situation (eg home, classroom, clinic). Associated clinical characteristics are not sufficient or even necessary for the diagnosis, but confirm it; disinhibition in social relationships; recklessness in situations that pose some danger; impulsive violation of social rules (evidenced by the child intruding or interrupting the activities of others or prematurely blurting out answers to questions before they are finished, or having difficulty waiting in line) are all characteristics of children with this disorder. Learning disorders and motor clumsiness are high rates; if present, they must be coded separately (under F80 - F89), but they must not form part of a true hyperkinetic disorder diagnosis. Conduct disorder symptoms are not exclusion or inclusion criteria for the primary diagnosis; but their presence or absence constitutes the main basis for the subdivision of the disorder (see below). The characteristic behavioral problems should be early onset (before age 6 years) and long in duration. However, hyperactivity is difficult to recognize before the age of school enrollment due to a variety of normal conditions: only extreme levels of hyperactivity should lead to diagnosis in preschool children. In adulthood, a diagnosis of hyperkinetic disorder can still be made. The basis for diagnosis is the same, but attention and activity should be viewed with reference to the relevant norms associated with the developmental process. If hyperkinesia has existed since childhood, but has subsequently been replaced by other conditions, such as dissocial personality disorder or substance abuse, then the current state should be coded, not the past. Differential diagnosis: It is often a mixed disorder and in this case, diagnostic preference should be given to general developmental disorders, if any. Differentiation from conduct disorder is a major problem in the differential diagnosis. Hyperkinetic disorder, when its criteria are met, should be given diagnostic preference over conduct disorder. However, milder degrees of hyperactivity and inattention are common in behavior disorders. When both signs of hyperactivity and conduct disorder are present, hyperkinetic conduct disorder (F90.1) should be diagnosed if the hyperactivity is severe and general in nature. A further problem is that hyperactivity and inattention (very different from those that characterize hyperkinetic disorder) can be symptoms of anxiety or depressive disorders. Thus, anxiety, which is a manifestation of agitated depressive disorder, should not lead to a diagnosis of hyperkinetic disorder. Similarly, anxiety, which is often a manifestation of severe anxiety, should not lead to a diagnosis of hyperkinetic disorder. If criteria for one of the anxiety disorders (F40.-, F43.-, or F93.x) are identified, then they should be given diagnostic preference over hyperkinetic disorder, unless it is clear that in addition to anxiety combined with anxiety, there is an additional presence of hyperkinetic disorder. Similarly, if the criterion for mood disorders (F30 - F39) is met, hyperkinetic disorder should not be diagnosed additionally only due to the fact that concentration of attention is impaired and psychomotor agitation is noted. A dual diagnosis should only be made when it is clear that there is a separate symptomatology of a hyperkinetic disorder that is not simply part of a mood disorder. Acute onset of hyperkinetic behavior in a school-age child is more likely due to some type of reactive disorder (psychogenic or organic), mania, schizophrenia, or neurological disease (eg, rheumatic fever). Excludes: - general disorders of psychological (mental) development (F84.-); - anxiety disorders (F40.- or F41.x); separation anxiety disorder in children (F93.0); - mood disorders (affective disorders) (F30 - F39); - schizophrenia (F20.-).

F90.0 Disorder of activity and attention

There remains uncertainty as to the most satisfactory subdivision of hyperkinetic disorders. However, follow-up studies show that outcome in adolescence and adulthood is strongly influenced by the presence or absence of concomitant aggressiveness, delinquency, or dissocial behavior. Accordingly, the main subdivision is carried out depending on the presence or absence of these accompanying features. This code should be used when the general criteria for hyperkinetic disorder (F90.x) are available, but the criteria for F91.x (conduct disorder) are not. Includes: - attention disorder with hyperactivity; - attention deficit hyperactivity disorder; - attention deficit hyperactivity disorder. Excludes: hyperkinetic disorder associated with conduct disorder (F90.1). F90.1 Hyperkinetic conduct disorder This coding should be done when the full criteria for both hyperkinetic disorders (F90.x) and conduct disorders (F91.x) are met. Includes: - hyperkinetic disorder associated with conduct disorder; - syndrome of motor disinhibition with conduct disorder; - hyperkinetic syndrome with conduct disorder.

F90.8 Other hyperkinetic disorders

F90.9 Hyperkinetic disorder, unspecified

This residual category is not recommended and should only be used when it is not possible to differentiate between F90.0 and F90.1, but common criteria for / F90 / are identified. Includes: - childhood hyperkinetic reaction NOS; - adolescent hyperkinetic reaction NOS; - hyperkinetic syndrome of childhood NOS; - adolescent hyperkinetic syndrome NOS.

/ F91 / Conduct disorders

Conduct disorders are characterized by persistent types of dissocial, aggressive, or challenging behavior. Such behavior, at its most extreme, reaches a marked violation of age-appropriate social norms and is therefore more severe than the usual childish malice or adolescent rebellion. Isolated dissocial or criminal acts are not in themselves a basis for a diagnosis of persistent behavior. Conduct disorder signs can also be symptoms of other mental conditions for which the underlying diagnosis must be coded. In some cases, behavioral disorders can develop into dissocial personality disorder (F60.2x). Conduct disorder is often associated with adverse psychosocial environments, including unsatisfactory family relationships and school failure; it is more common in boys. Its distinction from emotional disorder is well established, but its distinction from hyperactivity is less clear and they often overlap. Diagnostic guidelines: Conduct disorder findings should take into account the child's developmental level. For example, outbursts of anger are a normal part of a 3-year-old's development and their presence alone cannot serve as a basis for a diagnosis. Equally, violation of the civil rights of others (as in violent crimes) is impossible for most 7-year-olds and therefore is not a necessary diagnostic criterion for this age group. Examples of behaviors on which the diagnosis is based include: excessive fighting or bullying; cruelty to other people or animals; severe destruction of property; arson, theft, deceit, truancy from school and leaving home, unusually frequent and severe outbursts of anger; provocative behavior; and constant blatant disobedience. Any of these categories, when expressed, is sufficient to make a diagnosis; but isolated dissocial acts are not the basis for diagnosis. Exclusion criteria include infrequent but serious underlying behavioral disorders such as schizophrenia, mania, general developmental disorder, hyperkinetic disorder, and depression. It is not recommended to make this diagnosis until the duration of the above behavior is 6 months or more. Differential diagnosis: Conduct disorders often overlap with other conditions. Emotional disorders, the onset of which is specific to childhood (F93.x) should lead to the diagnosis of mixed disorders of behavior and emotions (F92.x). If the criteria for a hyperkinetic disorder (F90.x) are met, then it is diagnosed. However, lighter and more situationally specific levels of hyperactivity and inattention are common among children with conduct disorders, as are low self-esteem and mild emotional distress; they do not rule out the diagnosis. Excludes: - mood disorders (affective disorders) (F30 - F39); - general disorders of psychological (mental) development (F84.-); - schizophrenia (F20.-); - mixed disorders of behavior and emotions (F92.x); hyperkinetic conduct disorder (F90.1) F91.0 Conduct disorder confined to family This group contains behavioral disorders, including antisocial or aggressive behavior (not just oppositional, defiant, brutal behavior), in which the abnormal behavior is completely or almost entirely confined to the home and / or relationships with the closest relatives or household members. The disorder requires all of the F91.x criteria to be met, and even severely impaired parent-child relationships are in themselves insufficient for a diagnosis. Theft from home may occur, often specifically focusing on money or property of one or two individuals. This may be accompanied by behavior that is intentionally destructive and also focused on specific family members, such as breaking toys or jewelry, ripping shoes, clothes, cutting furniture, or destroying valuable property. Violence against family members (but not others) and deliberate burning of the home are also the basis for the diagnosis. Diagnostic guidelines: The diagnosis requires that there are no significant behavioral disorders outside the family setting and that the child's social relationships outside the family are within the normal range. In most cases, these family-specific behavioral disorders arise in the context of some manifestation of a pronounced disorder in the child's relationship with one or more of the next of kin. In some cases, for example, a violation may arise in connection with a newly arrived step parent. The nosological relevance of this category remains uncertain, but it is possible that these situationally highly specific behavioral disorders usually do not have a poor prognosis associated with general behavioral disorders.

F91.1 Unsocialized conduct disorder

This type of conduct disorder is characterized by a combination of stubborn dissocial or aggressive behavior (meeting the general criteria / F91 / and not covering only oppositional, defiant, brutal behavior) with a significant general disruption in the child's relationship with other children. Diagnostic guidelines: Lack of effective integration in the peer group is a key difference from "socialized" behavior disorders, and this is the most important differential difference. Disturbed relationships with peers are mainly evidenced by isolation from and / or rejection by them or unpopularity with other children; lack of close friends or ongoing empathic relationships with other children in the same age group. In relationships with adults, there is a tendency to show disagreement, cruelty and resentment; however, good relationships with adults can happen, and if they do, this does not rule out the diagnosis. Often, but not always, concomitant emotional disorders are noted (but if their degree is sufficient to meet the criteria for mixed disorder, then it should be coded F92.x). It is characteristic (but not necessary) that the offender is lonely. Typical behaviors include bullying, excessive pugnacity, and (in older children) extortion or violent attacks; excessive disobedience, rudeness, individualism and resistance to authorities; severe outbursts of anger and uncontrollable rage, destruction of property, arson and cruelty to other children and animals. However, some lonely children may nevertheless become involved in a group of offenders; therefore, when making a diagnosis, the nature of the act is less important than the quality of personal relationships. Usually the disorder manifests itself in a variety of situations, but may be more evident in school; consistent with the diagnosis is situational specificity to a location other than home. Includes: - unsocialized aggressive behavior; - pathological forms of deviant behavior; - leaving school (at home) and vagrancy alone; - syndrome of increased affective excitability, solitary type; - a solitary aggressive type. Excluded: - leaving school (at home) and vagrancy in a group (F91.2); - syndrome of increased affective excitability, group type (F91.2). F91.2 Socialized conduct disorder This category applies to conduct disorders involving persistent dissocial or aggressive behavior (meeting the general criteria / F91 / and not limited to oppositional, defiant, brutal behavior) and occurring in children who are usually well integrated in the peer group. Diagnostic guidelines: The key differential is the presence of adequate long-term relationships with peers of approximately the same age. Often, but not always, the peer group consists of minors engaged in delinquent or dissocial activities (in which a child's socially unacceptable behavior may be approved by the peer group and regulated by the subculture to which he belongs). However, this is not a necessary requirement for the diagnosis; the child may be part of a non-differentiated peer group with his own dissocial behavior outside of it. In particular, if dissocial behavior includes bullying, relationships with victims or other children may be disrupted. This does not exclude the diagnosis in the event that the child has a certain peer group to which he is devoted and in which a long-term friendship has developed. There is a tendency for poor relationships with those adults who are in authority, but there may be good relationships with some adults. Emotional disturbances are usually minimal. Behavioral disorders may or may not include the family domain, but if they are confined to the home then this precludes the diagnosis. The disorder is often most noticeable outside the family, and the specificity of the disorder in the school setting (or other non-family setting) is consistent with the diagnosis. Includes: - conduct disorder, group type; - group delinquency; - offenses in terms of gang membership; - stealing with others; - leaving school (at home) and vagrancy in a group; - syndrome of increased affective excitability, group type; - skimping school, truancy. Excludes: - activity in a gang without manifest mental disorder (Z03.2).

F91.3 Oppositional defiant disorder

This type of conduct disorder is common in children under 9-10 years of age. It is defined by the presence of markedly defiant, rebellious, provocative behavior and the absence of more severe dissocial or aggressive actions that violate the law or the rights of others. The disorder requires the general criteria of F91 to be met; even serious disobedience or mischievous behavior alone is not sufficient for a diagnosis. Many believe that oppositional defiant behavior represents a less severe type of conduct disorder rather than a qualitatively different type. Research evidence is insufficient as to whether the difference is qualitative or quantitative. However, the available evidence suggests that the autonomy of this disorder can be adopted mainly only in young children. Use this category with caution, especially with older children. Clinically significant behavioral disturbances in older children are usually accompanied by dissocial or aggressive behavior that exceeds overt disobedience, disobedience, or brutality; although often they may be preceded by oppositional defiant disorders at an earlier age. This category is included to reflect general diagnostic practice and to facilitate the classification of disorders in young children. Diagnostic guidelines: The main feature of the disorder is persistently negative, hostile, defiant, provocative and brutal behavior that is outside the normal level of behavior for a child of the same age in the same socio-cultural conditions and does not include more serious violations of the rights of others , which are noted for aggressive and dissocial behavior in subheadings F91.0 - F91.2. Children with this disorder tend to frequently and actively ignore adult requests or rules and deliberately annoy other people. They are usually angry, resentful, and easily annoyed by other people, whom they blame for their own mistakes and difficulties. They usually have a low level of frustration tolerance and mild loss of composure. In typical cases, their defiant behavior is provocative in nature, so that they become instigators of quarrels and usually show excessive rudeness, unwillingness to interact and resist authorities. Often, the behavior is more apparent in interactions with adults and peers whom the child knows well, and signs of the disorder may not be apparent during the clinical interview. The key difference from other types of behavior disorder is the absence of behavior that violates the laws and fundamental rights of others, such as theft, violence, fighting, assault and destructiveness. The definite presence of any of the above behavioral signs excludes the diagnosis. However, oppositional defiant behavior, as defined above, is often seen in other types of behavior disorder. If another type is detected (F91.0 - F91.2), then it should be encoded instead of oppositional defiant behavior. Excludes: - conduct disorder, including overt or dissocial or aggressive behavior (F91.0 - F91.2).

F91.8 Other conduct disorders

F91.9 Conduct disorder, unspecified

This is not a recommended residual category only for disorders that meet the general criteria for F91, but that are not identified as a subtype, or that do not meet criteria for any particular subtype. Includes: - childhood behavioral disorders NOS; - childhood behavioral disorder NOS.

/ F92 / Mixed Disorders of Conduct and Emotion

This group of disorders is characterized by a combination of persistently aggressive dissocial or defiant behavior with overt and visible symptoms of depression, anxiety, or other emotional disturbances. Diagnostic guidelines: The severity of the condition must be sufficient to meet the criteria for both childhood behavioral disorders (F91.x) and childhood emotional disorders (F93.x) or neurotic disorders characteristic of adulthood (F40 - F49) or mood disorders (F30 - F39). The studies performed are insufficient to be sure that this category is in fact independent of behavioral disorders. This subheading is included here because of its potential etiological and therapeutic importance, as well as its importance for the reproducibility of the classification.

F92.0 Depressive conduct disorder

This category requires a combination of childhood behavioral disorder (F91.x) with persistent severe depression, manifested by symptoms such as excessive suffering, loss of interest and pleasure in normal activities, self-blame and hopelessness. Sleep or appetite disturbances may also occur. Includes: - conduct disorder in F91.x in combination with depressive disorder in F32.- F92.8 Other mixed disorders of conduct and emotions This category requires a combination of childhood behavioral disorder (F91.x) with persistent pronounced emotional symptoms such as anxiety, fear, obsession or compulsion, depersonalization or derealization, phobias or hypochondria. Anger and resentment are signs of behavioral disturbances rather than emotional distress; they neither refute nor support the diagnosis. Includes: - conduct disorder in F91.x in combination with an emotional disorder in F93.x; - conduct disorder in F91.x in combination with neurotic disorders in F40 - F48. F92.9 Mixed disorder of conduct and emotions, unspecified

/ F93 / Emotional Disorders,

the onset of which is specific to childhood

In child psychiatry, a differentiation has traditionally been made between emotional disorders specific to childhood and adolescence and the type of neurotic disorders of adulthood. This differentiation was based on 4 arguments. First, research evidence has consistently shown that most children with emotional distress become normal adults: only a minority have neurotic disorders in adulthood. On the contrary, many neurotic disorders that emerge in adulthood do not have significant psychopathological precursors in childhood. Consequently, there is a significant gap between the emotional disorders encountered in these two age periods. Second, many childhood emotional disorders represent exaggerations of normal developmental tendencies rather than phenomena that are qualitatively abnormal in themselves. Third, in connection with the latter argument, there are often theoretical assumptions that the psychic mechanisms involved are not the same as in neuroses in adults. Fourth, childhood emotional disorders are less clearly differentiated into supposedly specific conditions, such as phobic disorders or obsessive-compulsive disorders. The third of these points lacks empirical evidence, and epidemiological evidence suggests that if the fourth is correct, it is only a matter of severity (given that poorly differentiated emotional disorders are common enough in childhood and adulthood). Accordingly, the second point (that is, developmental compliance) is used as a key diagnostic feature in determining the difference between emotional disorders, the onset of which is specific to childhood (F93.x), and neurotic disorders (F40 - F49). The significance of this difference is uncertain, but there is some empirical evidence suggesting that developmentally appropriate emotional disorders in childhood have a better prognosis. Excludes: - emotional disorders associated with conduct disorder (F92.x). F93.0 Separation anxiety disorder of children It is normal for infants and toddlers to show some degree of anxiety about real or threatening separation from the people to whom they are attached. This disorder is diagnosed when the fear of separation is central to anxiety and when such anxiety first occurs in the early years of life. It differentiates from normal separation anxiety in degrees that are beyond statistically possible (including abnormal resilience beyond normal age) and in combination with significant problems in social functioning. In addition, the diagnosis requires that there is no generalized disorder of personality development or functioning (if there is one, then one should think about coding from headings F40 - F49). Separation anxiety disorder occurring at an inappropriate age (eg, adolescence) is not coded here unless it constitutes an abnormal continuation of a developmental separation anxiety disorder. Diagnostic guidelines: The key diagnostic feature is excessive anxiety about separation from the people to whom the child is attached (usually parents or other family members), which is not part of generalized anxiety about many situations. Anxiety can take the form of: (a) unrealistic, absorbing worry about the potential harm to which the attachment is experienced, or fear that they will leave it and not return; b) unrealistic absorbing worry that some adverse event will separate the child from the person to whom there is great affection, for example, the child will be lost, kidnapped, admitted to hospital or killed; c) persistent unwillingness or refusal to go to school for fear of separation (and not for other reasons, for example, that something will happen at school); d) persistent reluctance or refusal to go to sleep in order to be close to a person to whom great affection is experienced; e) persistent inadequate fear of loneliness or fear of staying at home during the day without a person to whom there is great affection; f) recurring nightmares of separation; g) recurrent appearance of physical symptoms (such as nausea, abdominal pain, headache, vomiting, etc.) when separated from a person to whom attachment is felt, for example, when you have to go to school; h) excessive repetitive distress (manifested by anxiety, crying, irritation, suffering, apathy, or social autism) in anticipation of separation, during or immediately following separation from a person to whom there is a great deal of affection. Many separation situations also include other potential stressors or sources of anxiety. The diagnosis is based on the recognition that separation from the person to whom there is great attachment is common in various situations that give rise to anxiety. This occurs most often, apparently, with refusals to attend school (or "phobias"). Often this is really about separation anxiety disorder, but sometimes (especially in adolescents) it is not. Refusals to attend school for the first time in adolescence should not be coded under this heading, unless they are primarily a manifestation of separation anxiety and this anxiety first appeared in a pathological degree during preschool age. In the absence of criteria, the syndrome should be coded under one of the other headings F93.x or F40 - F48. Includes: - transient mutism as part of separation anxiety in young children. Excluded: - affective disorders (F30 - F39); - mood disorders (F30 - F39); - neurotic disorders (F40 - F48); phobic anxiety disorder of childhood (F93.1); childhood social anxiety disorder (F93.2)

F93.1 Phobic anxiety disorder of childhood

Children, like adults, may have fears that are focused on a wide range of objects and situations. Some of these fears (or phobias) are not a normal part of psychosocial development, such as agoraphobia. When such fears occur in childhood, they should be coded into the appropriate category in sections F40 - F48. However, some fears indicate a feature of a certain phase of development and arise to some extent in most children; for example, fears of animals in the preschool period. Diagnostic guidelines: This category should only be used for fears specific to certain developmental phases when they meet additional criteria that apply to all disorders in heading (F93.x), namely: a) onset at a developmentally appropriate age ; b) the degree of anxiety is clinically pathological; c) anxiety is not part of a more generalized disorder. Excludes: - generalized anxiety disorder (F41.1). F93.2 Childhood social anxiety disorder Caution towards strangers is normal during the second half of the first year of life, and some degree of social fear or anxiety is normal during early childhood when the child is faced with a new, unfamiliar socially threatening situation. Therefore, this category should only be used for disorders that occur before the age of 6 years, are unusual in severity, are accompanied by problems of social functioning and do not form part of a more generalized disorder. Diagnostic guidelines: A child with this disorder has persistent recurrent fear and / or avoidance of strangers. Such fear can mainly occur with adults or peers, or both. This fear is combined with a normal degree of selective attachment to parents and other loved ones. The avoidance or fear of social encounters is in its degree beyond the normal boundaries for the child's age and is combined with clinically significant problems in social functioning. Includes: - disorder of communication with strangers in children; - disorder of communication with strangers in adolescents; - childhood evasive disorder; - adolescent evasive disorder.

F93.3 Disorder due to sibling rivalry

A high percentage or even most young children show some degree of emotional distress following the birth of a younger sibling (usually the next in line). In most cases, the disorder is mild, but the rivalry or jealousy after the sibling is born can be persistent. It should be noted: V In this case, siblings (half-siblings) are children who have at least one common parent (sibling or adoptive). Diagnostic indications: The disorder is characterized by a combination of the following signs: a) the evidence of the existence of sibling rivalry and / or jealousy; b) the beginning during the months following the birth of the younger (usually next in a row) sibling; c) emotional disturbances, abnormal in degree and / or persistence and combined with psychosocial problems. The rivalry, jealousy of siblings can manifest itself as noticeable competition between children in order to gain the attention or love of parents; in order to be regarded as a pathological disorder, this must be combined with an unusual degree of negative feelings. In severe cases, this can be accompanied by open cruelty or physical injury to the sibling, malice towards him, belittling the sibling. In lesser cases, this can be manifested by a strong reluctance to share, a lack of positive attention, and a lack of friendly interactions. Emotional disorders can take many forms, often including some regression with a loss of previously acquired skills (such as controlling bowel and bladder function) and a tendency toward infant behavior. Often, too, the child wants to imitate the infant in activities that involve parental attention, such as eating. Confrontational or oppositional behavior with parents, outbursts of anger and dysphoria usually increase, manifested in the form of anxiety, unhappiness, or social withdrawal. Sleep can be disrupted and there is often increased pressure on parents to get their attention, especially at night. Includes: - jealousy of siblings; - half-sibling jealousy. Excludes: - peer rivalry (non-sibling) (F93.8). F93.8 Other childhood emotional disorders Includes: - identification disorder; - hyper anxiety disorder; - rivalry with peers (non-sibling). Excludes: - childhood gender identity disorder (F64.2x). F93.9 Childhood emotional disorder, unspecified Includes: - childhood emotional disorder NOS. / F94 / Disorders of social functioning, beginning which is typical for childhood and adolescence A fairly heterogeneous group of disorders for which disorders in social functioning that begin during development are common, but (unlike both developmental disorders) are not characterized, apparently, by constitutional social inability or deficits that extend to all areas of functioning. Serious distortions of adequate environmental conditions or deprivation of favorable environmental factors are often combined and in many cases are believed to play a decisive role in etiology. There are no discernible gender differences here. This group of social disorders is widely recognized by specialists, but there is uncertainty regarding the selection of diagnostic criteria, as well as disagreement regarding the most appropriate division and classification.

F94.0 Elective mutism

A state characterized by a pronounced, emotionally determined selectivity in conversation, so that the child finds his speech sufficient in some situations, but is not able to speak in other (certain) situations. Most often, the disorder first appears in early childhood; it occurs with approximately the same frequency in the two sexes and is characterized by a combination with pronounced personality traits, including social anxiety, withdrawal, sensitivity or resistance. Typically, the child speaks at home or with close friends, but is silent at school or with strangers; however, there may be other communication patterns (including the opposite). Diagnostic instructions: The diagnosis assumes: a) normal or almost normal level of speech understanding; b) a sufficient level in speech expression, which is sufficient for social communication; c) demonstrable information that the child can speak normally or almost normally in some situations. However, a significant minority of children with elective mutism have a history of either speech delay or articulation problems. The diagnosis can be made in the presence of such speech problems, but in the event that there is adequate speech for effective communication and a large discrepancy in the use of speech depending on social conditions, so that the child speaks fluently in some situations and is silent in others, or almost silent. It should be obvious that in some social situations the conversation fails and in others it is successful. The diagnosis requires that the inability to speak is constant over time and that situations in which speech is present or not is constant and predictable. In most cases, there are other socio-emotional disorders, but they are not among the necessary signs for the diagnosis. Such impairments are not permanent, but pathological traits are common, especially social sensitivities, social anxiety, and social exclusion, and oppositional behavior is common. Includes: - selective mutism; - selective mutism. Excludes: - general disorders of psychological (mental) development (F84.-); - schizophrenia (F20.-); - specific developmental disorders of speech and language (F80.-); - transient mutism as part of separation anxiety in young children (F93.0). F94.1 Reactive attachment disorder of childhood This disorder, which occurs in infants and young children, is characterized by persistent disturbances in the child's social relationships, which are combined with emotional disorders and is a reaction to changes in environmental conditions. Fearfulness and increased alertness are characteristic, which do not disappear with consolation, poor social interaction with peers is typical, aggression towards oneself and others is very frequent; suffering is common, and in some cases lack of growth occurs. The syndrome may arise as a direct result of severe parental neglect, abuse, or serious parenting mistakes. The existence of this type of behavioral disorder is fully recognized and accepted, but uncertainty remains regarding its diagnostic criteria, the boundaries of the syndrome, and nosological independence. However, this category is included here due to the importance of the syndrome to public health, because there is no doubt about its existence and this type of behavioral disorder clearly does not fit the criteria of other diagnostic categories. Diagnostic guidelines: The key symptom is an abnormal type of relationship with caregivers that occurs before the age of 5 years, including maladaptive manifestations, usually invisible in normal children, and which is constant, albeit reactive in relation to fairly pronounced changes in upbringing. Young children with this syndrome display highly conflicting or ambivalent social reactions, which are most evident during separation or reunification. So, babies can approach the caregiver, turning their gaze to the side, or gaze intently to the side, while being held in their arms; or may respond to caregivers with a reaction that combines intimacy, avoidance, and resistance to care. Emotional distress can manifest as external distress, lack of emotional response, autistic responses (for example, children may curl up on the floor) and / or aggressive responses to their own or others' distress. In some cases, there is fearfulness and heightened alertness (sometimes described as "frozen vigilance"), which are not affected by attempts at comfort. In most cases, children show an interest in peer interactions, but social play is delayed due to negative emotional responses. Attachment disorder may be accompanied by a lack of overall physical well-being and impaired physical growth (which should be coded with the appropriate somatic rubric (R62)). Many normal children show insecurity in their selective attachment to a parent, but this should not be confused with reactive attachment disorder, which has several crucial differences. The disorder is characterized by a pathological type of insecurity, manifested by clearly conflicting social reactions that are usually invisible in normal children. Pathological reactions are detected in various social situations and are not limited to a dyadic relationship with a specific caregiver; there is a lack of responsiveness to support and comfort; there are accompanying emotional disorders in the form of apathy, suffering or fear. There are five main features that differentiate this condition from general developmental disorders. First, children with reactive attachment disorder have normal social interactions and responsiveness, while children with general developmental disorders do not. Second, although the pathological type of social reactions in reactive attachment disorder is initially a common feature of the child's behavior in various situations, abnormal reactions decrease to a greater extent if the child is placed in a normal parenting environment, which requires a constant responsive caregiver. This does not happen with general developmental disorders. Third, although children with reactive attachment disorder may have impaired language development, they do not exhibit the pathological characteristics of autism in communication. Fourth, unlike autism, reactive attachment disorder is not associated with a persistent and severe cognitive impairment that is markedly unresponsive to environmental changes. Fifth, persistently limited, repetitive, and stereotyped behaviors, interests, and activities are not a sign of reactive attachment disorder. Reactive attachment disorder almost always results from grossly inadequate child care. This can take the form of psychologically abuse or neglect (evidenced by harsh punishments, persistent lack of response to a child's attempts to communicate, or a clear inability to parenthood); or physically abuse and neglect (as evidenced by persistent neglect of the child's basic physical needs, repeated intentional trauma, or inadequate nutritional support). Due to the lack of knowledge about whether the link between inadequate child care and the disorder is consistent, the presence of environmental deprivation and distortion is not a diagnostic requirement. However, caution is required in the diagnosis in the absence of evidence of child abuse or neglect. On the contrary, the diagnosis cannot be made automatically on the basis of child abuse or neglect: not all children who have been abused or neglected have this disorder. Excludes: - sexual or physical abuse in childhood leading to psychosocial problems (Z61.4 - Z61.6); Syndrome of abuse leading to physical problems (T74) - normal variation in the structure of selective attachment; Disinhibited attachment disorder of childhood (F94.2); Asperger's syndrome (F84.5) F94.2 Disinhibited attachment disorder of childhood A special manifestation of abnormal social functioning that occurs during the first years of life and which, once established, shows a tendency towards resilience, despite noticeable changes in the environment. Around 2 years of age, this disorder usually presents with stickiness in a relationship with diffuse, indiscriminate attachments. By age 4, diffuse attachments remain, but clinging tends to be replaced by attention-seeking and indistinct friendly behavior; In middle and late childhood, a child may or may not develop selective attachments, but attention-seeking behaviors are often persistent and poorly modulated peer interactions are common; coexisting emotional or behavioral disorders may also occur, depending on the circumstances. The syndrome is most clearly identified in children brought up in institutions from infancy, but it also occurs in other situations; it is thought to be due in part to a persistent lack of opportunities to develop selective attachments as a result of overly frequent changes in caregivers. The conceptual cohesion of the syndrome depends on the early onset of diffuse attachments, continued poor social interaction, and a lack of situational specificity. Diagnosis: The diagnosis is based on evidence that the child exhibits an unusual degree of diffuseness in selective attachments in the first 5 years of life, and this is combined with general sticky behavior in infancy and / or indiscriminately friendly, attention-seeking behavior in early and middle childhood. Difficulties in forming trusting close relationships with peers are usually noted. They may or may not be associated with emotional or behavioral disorders, in part depending on the circumstances of the child. In most cases, the anamnesis contains clear indications that in the first years of life there were changes of caregivers or numerous changes of family (as with repeated placement in foster families). Includes: - "unobtrusive psychopathy"; - psychopathy from lack of attachment; - syndrome of a closed children's institution; - institutional (institutional) syndrome. Excludes: - hyperkinetic disorders or attention deficit disorder (F90.-); reactive attachment disorder of childhood (F94. 1); - Asperger's syndrome (F84.5); - hospitalism in children (F43.2x). F94.8 Other childhood disorders of social functioning Includes: - Disorders of social functioning with autism and shyness due to lack of social competence. F94.9 Childhood disorder of social functioning, unspecified / F95 / Tiki Syndromes in which a type of tic is the predominant manifestation. A tic is an involuntary, rapid, repetitive, irregular movement (usually involving limited muscle groups) or vocal production that begins suddenly and is clearly aimless. Tics tend to feel overwhelming, but they can usually be suppressed for various periods of time. Both motor and vocal tics can be classified as simple or complex, although the boundaries are poorly defined. Common simple motor tics include blinking, neck twitching, shoulder shrugging, and grimacing. Common simple and vocal tics include coughing, barking, snorting, sniffing, and hissing. Common complex motor tics include self-tapping, bouncing, and jumping. A common complex of vocal tics includes the repetition of specific words and sometimes the use of socially unacceptable (often obscene) words (coprolalia), and repetition of one's own sounds or words (palilalia). There is tremendous variety in the severity of tics. On the one hand, the phenomenon is almost the norm, when one in five or ten children has transient tics at any time. On the other hand, Gilles de la Tourette's syndrome is a rare, chronic, disabling disorder. There is uncertainty as to whether these extremes represent different states or opposite poles of the same continuum, many researchers regard the latter as more likely. Tics are significantly more common in boys than in girls, and hereditary burden is common. Diagnostic guidelines: The main signs of differentiation of tics from other movement disorders are sudden, rapid, transient and limited nature of movements, along with a lack of evidence of an underlying neurological disorder; repetition of movements, (usually) their disappearance during sleep; and the ease with which they can voluntarily be summoned or suppressed. The lack of rhythm allows tics to be differentiated from the stereotypical repetitive movements seen in some cases of autism or mental retardation. Manner motor activity observed in the same disorders tends to encompass more complex and varied movements than is usually observed with tics. Obsessive-compulsive activity sometimes resembles complex tics, but the difference is that its shape tends to be determined by the goal (for example, touching certain objects or turning them a certain number of times), and not by the muscle groups involved; however, sometimes differentiation is very difficult. Tics are often seen as an isolated phenomenon, but they are often combined with a wide range of emotional disturbances, especially obsessive and hypochondriacal phenomena. Specific developmental delays are also associated with tics. There is no clear dividing line between tics with any associated emotional disorders and emotional disorders with any associated tics. However, the diagnosis should represent the main type of pathology.

F95.0 Transient tics

Common criteria for tic disorder are identified, but tics do not persist for more than 12 months. This is the most common type of tic, and most common at 4 or 5 years of age; tics usually take the form of blinking, grimacing, or twitching of the head. In some cases, tics are noted as a single episode, but in other cases there are remissions and relapses after a certain period of time. F95.1 Chronic motor or vocal tics Meet the general criteria for a tic disorder in which there is a motor or vocal tic (but not both); tics can be either single or multiple (but usually multiple) and last more than a year. F95.2 Combination of vocalisms and multiple motor tics (Gilles de la Tourette's syndrome) A type of tic disorder in which there is, or has been, multiple motor tics and one or more vocal tics, although they do not always occur simultaneously. Onset is almost always noted in childhood or adolescence. Development of motor tics before vocal tics is common; symptoms often worsen during adolescence; and the disorder persists into adulthood. Vocal tics are often multiple with explosive, repetitive vocalizations, coughing, grunting, and obscene words or phrases may be used. Sometimes there is concomitant echopraxia of gestures, which can also be obscene (copropraxia). Like motor tics, vocal tics can be spontaneously suppressed for short periods of time, can be exacerbated by stress, and disappear during sleep.

F95.8 Other tics

F95.9 Tic disorder, unspecified

Not a recommended residual category for a disorder that meets the general criteria for tic disorder but does not specify a specific subheading or for which features do not meet criteria F95.0, F95.1, or F95.2. Included: - tics NOS. / F98 / Other emotional and behavioral disorders with onset usually in childhood and adolescence This heading covers a heterogeneous group of disorders that have common childhood onset, but are very different in other respects. Some of these conditions represent well-established syndromes, but others are nothing more than a complex of symptoms for which there is no evidence of nosological independence, but which are included here because of their frequency and combination with psychosocial problems, and also because they cannot be attributed to other syndromes. Excludes: - attacks of breath holding (R06.8); - gender identity disorder in childhood (F64.2x); - hypersomnolence and megaphagia (Kleine-Levin syndrome) (G47.8); - sleep disorders of inorganic etiology (F51.x); - obsessive-compulsive disorder (F42.x).

F98.0 Non-organic enuresis

A disorder characterized by involuntary passing of urine, day and / or night, which is abnormal in relation to the child's mental age; it is not due to a lack of bladder control due to any neurological disorder or epileptic seizures or a structural abnormality of the urinary tract. Enuresis may be present at birth (abnormal delay in normal infant incontinence or following a period of acquired bladder control. Late onset (or secondary) usually occurs between the ages of 5-7 years. emotional or behavioral disorders.In the latter case, there is uncertainty about the mechanisms involved in this combination.Emotional problems may arise secondary to distress or shame associated with enuresis, bedwetting can contribute to the formation of other mental disorders, or bedwetting and emotional (behavioral) disorders can arise in parallel from related etiological factors.In each individual case, there is no direct and undeniable decision between these alternatives, and the diagnosis should be made on the basis of which type of disorder (i.e. enuresis or emotional (behavioral) disorder) is the main problem. Diagnostic guidelines: There is no clear distinction between normal age options for gaining bladder control and enuresis, a disorder. However, bedwetting usually should not be diagnosed in a child under 5 years of age or with mental age under 4 years of age. If enuresis is associated with any other emotional or behavioral disorder, it usually constitutes the primary diagnosis only if the involuntary loss of urine occurs at least several times a week, or if other symptoms show some temporary connection with enuresis. Enuresis is sometimes associated with encopresis; in this case, encopresis should be diagnosed. Sometimes the child has transient enuresis due to cystitis or polyuria (as in diabetes). However, this does not constitute the main explanation for bedwetting, which persists after infection has been treated or after polyuria has been brought under control. Often, cystitis can be secondary to enuresis, resulting from the introduction of infection into the urinary tract (especially in girls) as a result of constant humidity. Includes: - functional enuresis; - psychogenic enuresis; - non-organic urinary incontinence; - primary enuresis of inorganic nature; - secondary enuresis of inorganic nature. Excludes: - enuresis NOS (R32).

F98.1 Encopresis, inorganic

Repetitive, voluntary or involuntary discharge of feces, usually of normal or nearly normal consistency, in places that in a given socio-cultural environment are not intended for this purpose. The condition may be an abnormal continuation of normal infant incontinence, or may include loss of fecal retention skills following a period of acquired bowel control; or it is the intentional deposition of feces in inappropriate places, despite normal physiological control of bowel function. The condition may occur as a monosymptomatic disorder or be part of a broader disorder, especially an emotional disorder (F93.x) or conduct disorder (F91.x). Diagnostic instructions: The decisive diagnostic feature is the passage of feces in the wrong places. The condition can arise in several different ways. First, it may represent a lack of toilet training or a lack of adequate learning outcomes. Secondly, it may reflect a psychologically determined disorder in which there is normal physiological control over defecation, but for some reason, such as disgust, resistance, inability to obey social norms, defecation occurs in inappropriate places. Thirdly, it can arise from physiological stool retention, including tight constriction with secondary intestinal overflow and stool deposition in inappropriate places. Such delayed bowel movements can occur as a result of arguments between parent and child when learning to control bowel movements, as a result of delayed feces due to painful bowel movements (for example, due to anal fissure), or for other reasons. In some cases, encopresis is accompanied by smearing of stool over the body or environment, and less often there may be insertion of a finger into the anus or masturbation. There is usually some degree of concomitant emotional (behavioral) p

This includes:

activity and attention deficit disorder (F90.0) (attention deficit hyperactivity disorder or syndrome, attention deficit hyperactivity disorder);

hyperkinetic conduct disorder (F90.1)

Hyperkinetic syndrome - disorder characterized by violation of attention, motor hyperactivity and impulsive behavior .

The term "hyperkinetic syndrome" has several synonyms in psychiatry: "hyperkinetic disorder", "hyperactivity disorder", " attention deficit disorder"(Attention deficite syndrome)," attention deficit hyperactivity disorder "(Zavadenko NN et al., 1997).

V ICD-10 this syndrome is classified in the class "Behavioral and emotional disorders usually onset in childhood and adolescence" (F9), constituting the group " Hyperkinetic disorders"(F90).

Prevalence. The frequency of the syndrome among children in the first years of life ranges from 1.5-2%, among school-age children - from 2 to 20%. In boys, hyperkinetic syndrome occurs 3-4 times more often than in girls.

Etiology and pathogenesis ... There is no single cause of the syndrome and its development can be caused by various internal and external factors (traumatic, metabolic, toxic, infectious, pathologies of pregnancy and childbirth, etc.). Among them, psychosocial factors are also distinguished in the form of emotional deprivation, stresses associated with various forms of violence, etc. A large place is given to genetic and constitutional factors. All of these influences can lead to the form of cerebral pathology, which was previously designated as “ minimal brain dysfunction". In 1957. M. Laufer associated with her the clinical syndrome of the above-described nature, which he called hyperkinetic.

Molecular genetic studies, in particular, have suggested that 3 dopamine receptor genes may increase the predisposition to the syndrome.

Computed tomography confirmed dysfunctions of the frontal cortex and neurochemical systems projecting into the frontal cortex, the involvement of the fronto-subcortical pathways. These pathways are rich in catecholamines (which may partly explain the therapeutic effect of stimulants). There is also a catecholamine syndrome hypothesis.

Clinical manifestations of hyperkinetic syndrome correspond to the concept of delayed maturation of brain structures responsible for the regulation and control of attention function. This makes it legitimate to consider it in the general group of developmental distortions.

Clinical manifestations. Their main features are the lack of persistence in cognitive activity, the tendency to move from one task to another, without completing any of them; excessive but unproductive activity. These characteristics persist through school age and even into adulthood.

Hyperkinetic disorders often occur in early childhood ( up to 5 years), although they are diagnosed much later.

Disorders attention are manifested by increased distraction and inability to perform activities that require cognitive efforts. A child cannot hold attention for a long time on a toy, activities, wait and endure.

Motor hyperactivity manifests itself when a child has difficulty sitting still if necessary, while he often restlessly moves his arms and legs, fidgets, starts to get up, run, has difficulty in spending leisure time quietly, preferring motor activity. In prepubertal age, a child can briefly restrain motor restlessness, while feeling a sense of inner tension and anxiety.

Impulsiveness is found in the child's answers, which he gives without listening to the question, as well as in the inability to wait for his turn in play situations, in interrupting conversations or games of others. Impulsiveness is also manifested in the fact that the child's behavior is often unmotivated: motor reactions and behavioral actions are unexpected (jerks, jumps, jogging, inadequate situations, a sharp change in activity, interruption of the game, conversations with a doctor, etc.).

Hyperkinetic children are often reckless, impulsive, tend to get into difficult situations due to rash actions.

Relationships with peers and adults are disrupted, without a sense of distance.

With the beginning of schooling, children with hyperkinetic syndrome are often diagnosed with specific learning problems: writing difficulties, memory disorders, hearing and speech dysfunctions; intelligence is usually not impaired .

Emotional lability, perceptual movement disorders and coordination disorders are observed almost constantly in these children. In 75% of children, aggressive, protest, defiant behavior or, on the contrary, depressed mood and anxiety, often as secondary formations associated with disturbances in intrafamily and interpersonal relationships, develop rather steadily.

At neurological examination children show “mild” neurological symptoms and coordination disorders, immaturity of visual-motor coordination and perception, and auditory differentiation. The EEG reveals features characteristic of the syndrome.

In some cases, the first manifestations of the syndrome found in infancy: Children with this disorder are overly sensitive to stimuli and are easily traumatized by noise, light, changes in ambient temperature, environment. Typical are motor restlessness in the form of excessive activity in bed, in wakefulness and often in sleep, resistance to swaddling, short sleep, emotional lability.

Secondary complications include dissocial behavior and low self-esteem. Concomitant difficulties in mastering school skills (secondary dyslexia, dyspraxia, dyscalculia and other school problems) are often observed.

Learning disorders and motor clumsiness are quite common. They should be coded under the heading (F80-89) and should not be part of the disorder.

The clinic of the disorder is most clearly manifested at school age.

In adults, hyperkinetic disorder can manifest as dissocial personality disorder, substance abuse, or other condition with impaired social behavior.

Flow hyperkinetic disorders individually. As a rule, relief of pathological symptoms occurs at the age of 12-20 years, and at first they weaken, and then motor hyperactivity and impulsivity disappear; attention disorders regress last. But in some cases, a predisposition to antisocial behavior, personality and emotional disorders may be found. In 15-20% of cases, symptoms of attention disorder with hyperactivity persist for the entire life of a person, manifesting themselves at the subclinical level.

Differential diagnosis from other behavioral disorders, which can be manifestations of psychopathic disorders against the background of cerebral-organic residual dysfunctions, and also represent the debut of endogenous mental diseases.

If most of the criteria for hyperkinetic disorder are met, then a diagnosis should be made. When there are signs of severe general hyperactivity and conduct disorder, a diagnosis of hyperkinetic conduct disorder (F90.1) is made.

The phenomena of hyperactivity and inattention can be symptoms of anxiety or depressive disorders (F40 - F43, F93), mood disorders (F30-F39). The diagnosis of these disorders is made if their diagnostic criteria are available. Dual diagnosis possible when there is a separate symptomatology of hyperkinetic disorder and, for example, mood disorders.

The presence of an acute onset of hyperkinetic disorder at school age can be a manifestation of a reactive (psychogenic or organic) disorder, a manic state, schizophrenia, or a neurological disease.

Treatment. There is no single point of view on the treatment of hyperdynamic syndrome. In the foreign literature, the emphasis in the treatment of these conditions is placed on cerebral stimulants: methylphenidate (Rhytilin), pemoline (Zilert), dexadrin. It is recommended to use drugs that stimulate the maturation of nerve cells (Cerebrolysin, Cogitum, Nootropics, B vitamins, etc.), which improve cerebral blood flow (Cavinton, Sermion, Oxybral, etc.) in combination with Etaperazine, Sonapax, Teralen, etc. An important place in therapeutic measures are devoted to psychological support of parents, family psychotherapy, establishing contact and close cooperation with the educator and teachers of children's collectives where these children are brought up or study.

Disorder of activity and attention (F90.0)

(Attention Deficit Hyperactivity Disorder or Disorder, Attention Deficit Hyperactivity Disorder)

Previously called minimal brain dysfunction(MMD), hyperkinetic syndrome, minimal brain damage. It is one of the most common childhood behavioral disorders and persists into adulthood for many.

Etiology and pathogenesis. The disorder has previously been associated with intrauterine or postnatal brain damage (“minimal brain damage”). Revealed a genetic predisposition to this disorder. The congenital tendency to hyperactivity increases under the influence of certain social factors, since this behavior is more common in children living in unfavorable social conditions.

Prevalence among schoolchildren from 3 to 20%. The disorder is more common in boys between 3: 1 and 9: 1. In 30-70% of cases, the syndromes of the disorder pass into adulthood. in adolescence, the activity of many disorders decreases, but the risk of developing antisocial psychopathy, alcoholism and drug addiction is high.

Clinic. Symptoms almost always appear before 5-7 years of age. The average age to see a doctor is 8-10 years. Disorders of activity and attention can be divided into 3 types: the predominance of inattention; with a predominance of hypeactivity; mixed.

Major manifestations include:

- Disturbances of attention. Inability to maintain attention, decrease in selective attention, inability to concentrate on a subject for a long time, frequent forgetting of what needs to be done; increased distractibility, excitability. Such children are fussy, restless. Attention decreases even more in unusual situations when it is necessary to act independently. Some kids can't even watch their favorite TV shows to the end.

- Impulsiveness. In the form of sloppily doing school assignments despite efforts to do them right; frequent shouts from the place, noisy antics during classes; "Getting involved" in the conversation or work of others; impatience in line; inability to lose (as a result of this, frequent fights with children). At an early age, this is urinary and fecal incontinence; at school - excessive activity and extreme impatience; in adolescence - hooligan antics and antisocial behavior (theft, drug use, etc.). The older the child is, the more pronounced and more noticeable the impulsiveness is to others.

- Hyperactivity. This is an optional feature. In some children, physical activity may be reduced. However, physical activity is qualitatively and quantitatively different from the age norm. In preschool and early school age, such children run continuously and impulsively, crawl, jump up, and are very fussy. By puberty, hyperactivity often diminishes. Children without hyperactivity are less aggressive and hostile to others, but they are more likely to experience partial developmental delays, including school skills.

Additional signs

Coordination disorders are noted in 50-60% in the form of impossibility of fine movements (tying shoelaces, using scissors, coloring, writing); balance disorders, visual-spatial coordination (inability to play sports, ride a bicycle, play with a ball).

Emotional disturbances in the form of imbalance, hot temper, intolerance of failure. There is a delay in emotional development.

Relationships with others. In mental development, children with impaired activity and attention lag behind their peers, but strive to be leaders. It is difficult to be friends with them. These children are extroverts, they look for friends, but they quickly lose them. Therefore, they are more likely to communicate with more “docile” younger ones. Relationships with adults are difficult. They are not affected by punishment, affection, or praise. It is precisely the "lack of education" and "bad behavior" from the point of view of parents and teachers that is the main reason for going to doctors.

Partial developmental delays. The criterion is the lag of skills from the due at least 2 years. Despite a normal IQ, many children perform poorly at school. The reasons are inattention, lack of perseverance, intolerance of failure. Partial delays in the development of writing, reading, and counting are characteristic. The main symptom is the discrepancy between high intellectual level and poor school performance.

Behavioral Disorders. Not always observed. Not all children with conduct disorders have impaired activity and attention.

Bed-wetting. Disturbed falling asleep and sleepy in the morning.

Diagnostics. It is necessary to have inattention or hyperactivity and impulsivity (or all manifestations at the same time) that do not correspond to the age norm.

Features of behavior:

1. appear up to 8 years old;

2. found in at least two areas of activity - school, home, work, games, clinic;

3. not caused by anxiety, psychotic, affective, dissociative disorders and psychopathies;

4. cause significant psychological discomfort and maladjustment.

Carelessness:

1. Inability to focus on details, careless mistakes.

2. Failure to maintain attention.

3. Inability to listen attentively to the speech being addressed.

4. Failure to follow through on assignments.

5. Low organizational skills.

6. Negative attitude towards tasks that require mental stress.

7. Loss of items needed to complete the assignment.

8. Distraction to extraneous stimuli.

9. Forgetfulness. (Of the listed signs, at least six should persist for more than 6 months.)

Hyperactivity and impulsivity(of the following signs, at least four must persist for at least 6 months):

hyperactivity: the child is fussy, restless. Jumps up without permission. Runs aimlessly, fidgets, climbs. Cannot rest, play quiet games;

impulsiveness: shouts out the answer without hearing the question. Can't wait in line.

Differential diagnosis. The phenomena of hyperactivity and inattention can be symptoms of anxiety or depressive disorders, mood disorders. The diagnosis of these disorders is made if their diagnostic criteria are available.

Hyperkinetic conduct disorder (F90.1)

The diagnosis is made if there is criteria for hyperkineticdisorders and general criteria for conduct disorder.

Previously called minimal brain dysfunction (MMD), hyperkinetic syndrome, minimal brain damage. It is one of the most common childhood behavioral disorders and persists into adulthood for many.

Prevalence

The disorder is more common in boys. The relative prevalence among boys and girls ranges from 3: 1 to 9: 1, depending on the criteria for diagnosis. Currently, the prevalence among schoolchildren is from 3 to 20%. In 30-70% of cases, the syndromes of the disorder pass into adulthood. Hyperactivity in adolescence decreases in many, even if other disorders remain, however, the risk of developing antisocial psychopathy, alcoholism and drug addiction is high.

What provokes Disruption of activity and attention:

Previously, hyperkinetic disorder has been associated with intrauterine or postnatal brain damage ("minimal brain damage"). Revealed a genetic predisposition to this disorder. Identical twins have higher concordance than fraternal twins. 20-30% of parents of patients suffered or suffer from impaired activity and attention. The congenital tendency to hyperactivity increases under the influence of certain social factors, since this behavior is more common in children living in unfavorable social conditions. Parents of patients are more likely than the general population to have alcoholism, antisocial psychopathy and affective disorders. Supposed causes of the disorder have been linked to food allergies, long-term lead toxicity and exposure to food additives, but these hypotheses are not supported by conclusive evidence. A strong link has been found between impaired activity and attention and insensitivity to thyroid hormones, a rare condition based on a mutation in the gene for the beta receptor of thyroid hormones.

Symptoms of Impaired activity and attention:

The diagnostic criteria for the disorder have changed somewhat over the years. Symptoms almost always appear before 5-7 years of age. The average age to see a doctor is 8-10 years.

Major manifestations include:

• - Disturbances of attention. Inability to maintain attention, decrease in selective attention, inability to concentrate on a subject for a long time, frequent forgetting of what needs to be done; increased distractibility, excitability. Such children are fussy, restless. Attention decreases even more in unusual situations when it is necessary to act independently. Some kids can't even watch their favorite TV shows to the end.
• - Impulsiveness. V the sight of sloppily completing school assignments despite efforts to do them right; frequent shouts from the place, noisy antics during classes; "Getting involved" in the conversation or work of others; impatience in line; inability to lose (as a result of this, frequent fights with children). With age, the manifestations of impulsivity can change. At an early age, this is urinary and fecal incontinence; at school - excessive activity and extreme impatience; in adolescence - hooligan antics and antisocial behavior (theft, drug use, etc.). However, the older the child is, the more pronounced and more noticeable the impulsiveness is to others.
• - Hyperactivity. This is an optional feature. In some children, physical activity may be reduced. However, physical activity is qualitatively and quantitatively different from the age norm. In preschool and early school age, such children run continuously and impulsively, crawl, jump up, and are very fussy. By puberty, hyperactivity often diminishes. Children without hyperactivity are less aggressive and hostile to others, but they are more likely to experience partial developmental delays, including school skills.

Additional signs

• - Disorders of coordination are noted in 50-60% in the form of impossibility of fine movements (tying shoelaces, using scissors, coloring, writing); balance disorders, visual-spatial coordination (inability to play sports, ride a bicycle, play with a ball).
• - Emotional disturbances in the form of imbalance, irascibility, intolerance of failures. There is a delay in emotional development.
• - Relationships with others. In mental development, children with impaired activity and attention lag behind their peers, but strive to be leaders. It is difficult to be friends with them. These children are extroverts, they look for friends, but they quickly lose them. Therefore, they are more likely to communicate with more “docile” younger ones. Relationships with adults are difficult. They are not affected by punishment, affection, or praise. It is precisely the "lack of education" and "bad behavior" from the point of view of parents and teachers that is the main reason for going to doctors.
• - Partial developmental delays. Despite a normal IQ, many children perform poorly at school. The reasons are inattention, lack of perseverance, intolerance of failure. Partial delays in the development of writing, reading, and counting are characteristic. The main symptom is the discrepancy between high intellectual level and poor school performance. The criterion for partial delay is considered to be the lag of skills from the due at least 2 years. However, other causes of failure must be ruled out: perceptual disorders, psychological and social causes, low intelligence and inadequate teaching.
• - Behavioral disorders. Not always observed. Not all children with conduct disorders have impaired activity and attention.
• - Bedwetting. Disturbed falling asleep and sleepy in the morning.

Disorders of activity and attention can be divided into 3 types: with a predominance of inattention; with a predominance of hyperactivity; mixed.

Diagnostics Impaired activity and attention:

It is necessary to have inattention or hyperactivity and impulsivity (or all manifestations at the same time) that do not correspond to the age norm.

Behavior features:

• 1) appear up to 8 years old;
• 2) are found in at least two areas of activity - school, home, work, games, clinic;
• 3) are not caused by anxiety, psychotic, affective, dissociative disorders and psychopathies;
• 4) cause significant psychological discomfort and maladjustment.

Inattention:

• 1. Inability to focus on details, careless mistakes.
• 2. Failure to maintain attention.
• 3. Inability to listen attentively to the speech being addressed.
• 4. Failure to follow through on assignments.
• 5. Low organizational skills.
• 6. Negative attitude towards tasks that require mental stress.
• 7. Loss of items needed to complete the assignment.
• 8. Distraction to extraneous stimuli.
• 9. Forgetfulness. (Of the listed signs, at least six should persist for more than 6 months.)

Hyperactivity and impulsivity(of the following signs, at least four should persist for at least 6 months):

• - hyperactivity: the child is fussy, restless. Jumps up without permission. Runs aimlessly, fidgets, climbs. Cannot rest, play quiet games;
• - impulsiveness: shouts out the answer without hearing the question. Can't wait in line.

Differential diagnosis

To make a diagnosis, you need: a detailed life history. Information must be found out from everyone who knows the child (parents, educators, teachers). Detailed family history (presence of alcoholism, hyperactivity disorder, tics in parents or relatives). Data on the child's current behavior.

Information is required about the performance and behavior of the child in the educational institution. There are currently no informative psychological tests to diagnose this disorder.

Disorders of activity and attention do not have clear pathognomonic signs. This disorder can be suspected on the basis of history and psychological testing, taking into account diagnostic criteria. For the final diagnosis, a trial appointment of psychostimulants is shown.

The phenomena of hyperactivity and inattention can be symptoms of anxiety or depressive disorders, mood disorders. The diagnosis of these disorders is made if their diagnostic criteria are available. The presence of an acute onset of hyperkinetic disorder at school age can be a manifestation of a reactive (psychogenic or organic) disorder, a manic state, schizophrenia, or a neurological disease.

Treatment Impaired activity and attention:

Drug treatment is effective in 75-80% of cases, with the correct diagnosis. Its action is mostly symptomatic. Suppressing the symptoms of hyperactivity and attention deficits facilitates the child's intellectual and social development. Drug treatment is subject to several principles: only long-term therapy that ends in adolescence is effective. The selection of the drug and dose is based on the objective effect, and not on the patient's feelings. If the treatment is effective, then it is necessary to take trial breaks at regular intervals to find out if the child can do without drugs. It is advisable to arrange the first breaks during the holidays, when the psychological load on the child is less.

The pharmacological agents used to treat this disorder are CNS stimulants. The mechanism of their action is not fully understood. However, psychostimulants not only calm the child, but also affect other symptoms. The ability to concentrate increases, emotional stability, sensitivity to parents and peers appear, and social relations are improved. Mental development can improve dramatically. Currently, amphetamines (dexamphetamine (Dexedrine), methamphetamine), methylphenidate (Ritalin), pemoline (Zielert) are used. Individual sensitivity to them is different. If one of the drugs is ineffective, they switch to another. The advantage of amphetamines is the long duration of action and the presence of prolonged forms. Methylphenidate is usually taken 2–3 times a day and is more likely to have a sedative effect. The intervals between doses are usually 2.5-6 hours. Prolonged forms of amphetamines are taken 1 time per day. Doses of psychostimulants: methylphenidate - 10-60 mg / day; methamphetamine - 5-40 mg / day; pemoline - 56.25-75 mg / day. Treatment is usually started with low doses with a gradual increase. Physical dependence usually does not develop. In rare cases of development of tolerance, they switch to another drug. It is not recommended to prescribe methylphenidate to children under 6 years of age, and dexamphetamine to children under 3 years of age. Pemoline is prescribed for amphetamines and methylphenidate ineffectiveness, but its effect may be delayed over 3 to 4 weeks. Side effects - decreased appetite, irritability, epigastric pain, headache, insomnia. Pemoline - increased activity of liver enzymes, possible jaundice. Psychostimulants increase heart rate, blood pressure. Some studies indicate a negative effect of drugs on height and body weight, but these are temporary disorders.

If psychostimulants are ineffective, imipramine hydrochloride (tofranil) is recommended in doses from 10 to 200 mg / day; other antidepressants (desipramine, amfebutamone, phenelzine, fluoxetine) and some antipsychotics (chlorprothixene, thioridazine, sonapax). Antipsychotics do not contribute to the child's social adaptation, therefore, the indications for their appointment are limited. They should be used in the presence of severe aggressiveness, uncontrollability, or when other therapy and psychotherapy are ineffective.

Psychotherapy

Psychological assistance to children and their families can achieve a positive effect. Rational psychotherapy is advisable, explaining to the child the reasons for his failures in life; behavioral therapy, teaching parents how to reward and punish. Reducing psychological tension in the family and at school, creating a child-friendly environment contribute to the effectiveness of treatment. However, as a method of radical treatment of disorders of activity and attention, psychotherapy is ineffective.

Monitoring the child's condition should be established from the beginning of treatment and carried out in several directions - the study of behavior, school performance, social relationships.

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