20 CHILD ANDADOLESCENTDISORDERS 485
Rett’s disorder develops between birth to 5 months of
age. The child loses motor skills and begins showing
stereotyped movements instead. She loses interest
in the social environment, and severe impairment
of expressive and receptive language becomes evident
as she grows older. Treatment is similar to those
for autism.
CHILDHOOD DISINTEGRATIVE
DISORDER
Childhood disintegrative disorderis characterized by
marked regression in multiple areas of functioning
after at least 2 years of apparently normal growth
and development (APA, 2000). Typical age of onset is
3 to 4 years. Children with childhood disintegrative
disorder have the same social and communication
deficits and behavioral patterns seen with autistic
disorder. This rare disorder occurs slightly more often
in boys than in girls.
ASPERGER’S DISORDER
Asperger’s disorderis a pervasive developmental dis-
order characterized by the same impairments of social
interaction and restricted, stereotyped behaviors seen
in autistic disorder but there are no language or cog-
nitive delays. This rare disorder occurs more often in
boys than in girls; the effects are generally life-long.◗ ATTENTIONDEFICIT AND
DISRUPTIVEBEHAVIORDISORDERS
ATTENTION DEFICIT
HYPERACTIVITY DISORDER
Attention deficit hyperactivity disorder (ADHD)
is characterized by inattentiveness, overactivity, and
impulsiveness. ADHD is a common disorder, espe-
cially in boys, and probably accounts for more child
mental health referrals than any other single dis-
order (McCracken, 2000a). The essential feature of
ADHD is a persistent pattern of inattention and/or
hyperactivity and impulsivity more common than
generally observed in children of the same age.
ADHD affects an estimated 3% to 5% of all school-
age children. The ratio of boys to girls ranges from
3 1 in nonclinical settings to 91 in clinical settings
(McCracken, 2000a). To avoid overdiagnosis of ADHD,
a qualified specialist, such as a pediatric neurologist
or a child psychiatrist, must conduct the evaluation
for ADHD. Children who are very active or hardScott is 8 years old. At 7 AM, his mother looks into Scott’s
bedroom and sees Scott playing. “Scott, you know the
rules: no playing before you are ready for school. Get
dressed and come eat breakfast.” Although these rules
for a school day have been set for the past 7 months,
Scott always tests them. In about 10 minutes, he is still
not in the kitchen. His mother checks his room and finds
Scott on the floor, still in his pajamas, playing with
miniature cars. Once he gets started doing or talking
about something, it is often difficult for Scott to stop.
“Scott, you need to get dressed first. Your jeans and
shirt are over here on the chair.” “Mom, after school
today, can we go shopping? There is the coolest new car
game that anyone can play. I’d love to try it out.” As he
is talking, Scott walks over to the chair and begins to pull
his shirt over his head. “Scott, you’re putting your shirt
over your pajamas. You need to take your pajamas off
first,” his mother reminds him.
Ten minutes later, Scott bounds into the kitchen, still
without socks and shoes, and hair tousled. “You forgot
your socks, and your hair isn’t combed,” his mother
reminds him. “Oh yeah. What’s for breakfast?” he says.
“Scott, finish dressing first.” “Well, where are my shoes?”
“By the back door where you left them.” This is the spe-
cial designated place where Scott is supposed to leave his
shoes so he doesn’t forget.CLINICALVIGNETTE: ATTENTIONDEFICITHYPERACTIVITYDISORDER
Scott starts toward his shoes but spots his younger
sister playing with blocks on the floor. He hurries to her.
“Wow, Amy, watch this—I can make these blocks into a
huge tower, all the way to the ceiling.” He grabs the
blocks and begins to stack them higher and higher.
“Scott makes a better tower than Amy,” he chants. Amy
shrieks at this intrusion, but she is used to Scott grab-
bing things from her. The shriek brings their mother
into the room. She notices Scott’s feet still do not have
socks and shoes.
“Scott, get your socks and shoes on now and leave
Amy alone!” “Where are my socks?” he asks. “Go to
your room and get a clean pair of socks and brush your
teeth and hair. Then come eat your breakfast or you’ll
miss the bus.”
“I will in just a minute, Mom.” “No! Now! Go get
your socks.” Scott continues stacking blocks.
Wearily, his mother directs him toward his room. As
he is looking for the socks, he is still chattering away. He
finds a pair of socks and bolts in the direction of the
kitchen, grabbing Amy and pinching her cheek as he
swirls by her. Amy shrieks again and he begins to chant,
“Amy’s just a baby! Amy’s just a baby!” “Scott, stop it
right now and come eat something! You’ve got just 10
minutes until the bus comes.”