The tables in this section are drawn with permission from American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision, Washington, DC, 2000; and Dulcan M, Martini R, Lake MB: Concise Guide to Child and Adolescent Psychiatry, 3rd ed. Washington, DC, American Psychiatric Press, 2000.
Table 1. Risk Factors for Repeat Suicide Attempt| Patient history |
| Verbalization or threats regarding suicide |
| Substance abuse |
| Poor impulse control |
| A recent loss or other severe stressor |
| Previous suicide attempt(s) |
| A friend or family member who has committed suicide |
| Exposure to recent news stories or movies about suicide |
| Poor social supports |
| Victim of physical or sexual abuse |
| Nature of the attempt |
| Accidental discovery (versus attempt in view of others or telling others immediately) |
| Careful plans to avoid discovery |
| Hanging or gunshot |
| Family |
| Wishes to be rid of child or adolescent |
| Does not take child’s problems seriously |
| Overly angry and punitive |
| Depression or suicidality in family member |
| Unwilling or unable to provide support and supervision |
| Mental status examination |
| Depression |
| Hopelessness |
| Regret at being rescued |
| Belief that things would be better for self or others if dead |
| Wish to rejoin a dead loved one |
| Belief that death is temporary and pleasant |
| Unwillingness to promise to call before attempting suicide |
| Psychosis |
| Intoxication |
Table 2. Development Differences in DSM-IV-TR Criteria for Mood Disorders| Disorder | Adults | Children |
|---|
| Major depression | Depressed mood | Can be irritable mood |
| | Change in weight or appetite | Can be failure to make expected weight gains |
| Dysthymia | Depressed mood | Can be irritable mood |
| | 2-year duration | 1-year duration |
| Cyclothymia | 2-year duration | 1-year duration |
Table 2. Development Differences in DSM-IV-TR Criteria for Mood DisordersEnlarge table Table 3. Common Psychological Characteristics of Children and Adolescents With Conduct Disorder| Attention deficits, low frustration tolerance |
| Impulsivity, recklessness |
| Learning disorders, especially in reading |
| Negative mood |
| Sullenness |
| Irritability |
| Volatile anger |
| Low self-esteem |
| Impaired cognitions |
| Distortions of size and time awareness |
| Lack of or distorted connection between prior events and consequences |
| Limited ability to generate, evaluate, and implement alternative problem-solving strategies |
| Use of less adaptive intrapsychic defense mechanisms |
| Minimization |
| Avoidance |
| Externalization |
| Denial |
| Identification with the aggressor |
| Emotional deficits |
| Minimization of fear and sadness, exaggeration of anger |
| Lack of empathy |
| Lack of guilt |
| Impaired interpersonal relations |
| Suspiciousness or paranoia, with cognitive distortions |
| Attributional bias: misperception of others’ actions as hostile |
| Preference for nonverbal, action-oriented, aggressive solutions to problems |
Table 3. Common Psychological Characteristics of Children and Adolescents With Conduct DisorderEnlarge table Table 4. DSM-IV-TR Diagnostic Criteria for Attention-Deficit/Hyperactivity Disorder| A. Either (1) or (2): |
| | | 1. | six (or more) of the following symptoms of inattention have persisted for at least 6 months to a degree that is maladaptive and inconsistent with developmental level: Inattention | | a.a. | often fails to give close attention to details or makes careless mistakes in schoolwork, work, or other activities | | | a.b. | often has difficulty sustaining attention in tasks or play activities | | | a.c. | often does not seem to listen when spoken to directly | | | a.d. | often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (not due to oppositional behavior or failure to understand instructions) | | | a.e. | often has difficulty organizing tasks and activities | | | a.f. | often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (such as schoolwork or homework) | | | a.g. | often loses things necessary for tasks or activities (e.g., toys, school assignments, pencils, books, or tools) | | | a.h. | is often easily distracted by extraneous stimuli | | | a.i. | is often forgetful in daily activities |
| | 2. | six (or more) of the following symptoms of hyperactivity-impulsivity have persisted for at least 6 months to a degree that is maladaptive and inconsistent with developmental level: Hyperactivity | | b.a. | often fidgets with hands or feet or squirms in seat | | | b.b. | often leaves seat in classroom or in other situations in which remaining seated is expected | | | b.c. | often runs about or climbs excessively in situations in which it is inappropriate (in adolescents or adults, may be limited to subjective feelings of restlessness) | | | b.d. | often has difficulty playing or engaging in leisure activities quietly | | | b.e. | is often “on the go” or often acts as if “driven by a motor” | | | b.f. | often talks excessively Impulsivity | | | b.g. | often blurts out answers before questions have been completed | | | b.h. | often has difficulty awaiting turn | | | b.i. | often interrupts or intrudes on others (e.g., butts into conversations or games) |
|
|
| B. Some hyperactive-impulsive or inattentive symptoms that caused impairment were present before age 7 years. |
| C. Some impairment from the symptoms is present in two or more settings (e.g., at school [or work] and at home). |
| D. There must be clear evidence of clinically significant impairment in social, academic, or occupational functioning. |
| E. The symptoms do not occur exclusively during the course of a pervasive developmental disorder, schizophrenia, or other psychotic disorder and are not better accounted for by another mental disorder (e.g., mood disorder, anxiety disorder, dissociative disorder, or a personality disorder). |
Table 4. DSM-IV-TR Diagnostic Criteria for Attention-Deficit/Hyperactivity DisorderEnlarge table Table 5. Medical Contribution to Attention-Deficit/Hyperactivity Disorder| Prenatal | Young mother |
| | Poor maternal health |
| | Maternal use of cigarettes, alcohol, or drugs |
| Birth complications | Bleeding |
| | Hypoxia |
| | Toxemia |
| | Prolonged labor |
| Perinatal | Low birth weight |
| | Postmaturity |
| Infancy | Malnutrition |
| Toxicity | Lead poisoning |
| Genetic disorders | Fragile X syndrome |
| | Glucose-6-phosphate dehydrogenase deficiency |
| | Generalized resistance to thyroid hormone |
| | Phenylketonuria |
| Brain injury | Trauma |
| | Infection |
Table 5. Medical Contribution to Attention-Deficit/Hyperactivity DisorderEnlarge table Table 6. DSM-IV-TR Diagnostic Criteria for Conduct Disorder| A. | A repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate society norms or rules are violated, as manifested by the presence of three (or more) of the following criteria in the past 12 months, with at least one criterion present in the past 6 months: |
| | Aggression to people and animals| 1. | often bullies, threatens, or intimidates others | | 2. | often initiates physical fights | | 3. | has used a weapon that can cause serious physical harm to others (e.g., a bat, brick, broken bottle, knife, gun) | | 4. | has been physically cruel to people | | 5. | has been physically cruel to animals | | 6. | has stolen while confronting a victim (e.g., mugging, purse snatching, extortion, armed robbery) | | 7. | has forced someone into sexual activity Destruction of property | | 8. | has deliberately engaged in fire setting with the intention of causing serious damage | | 9. | has deliberately destroyed others’ property (other than by fire setting) Deceitfulness or theft | | 10. | has broken into someone else’s house, building, or car | | 11. | often lies to obtain goods or favors or to avoid obligations (i.e., “cons” others) | | 12. | has stolen items of nontrivial value without confronting a victim (e.g., shoplifting, but without breaking and entering; forgery) Serious violations of rules | | 13. | often stays out at night despite parental prohibitions, beginning before age 13 years | | 14. | has run away from home overnight at least twice while living in parental or parental surrogate home (or once without returning for a lengthy period) | | 15. | is often truant from school, beginning before age 13 years |
|
| B. | The disturbance in behavior causes clinically significant impairment in social, academic, or occupational functioning. |
| C. | If the individual is age 18 or older, criteria are not met for antisocial personality disorder. |
Table 6. DSM-IV-TR Diagnostic Criteria for Conduct DisorderEnlarge table Table 7. Risk Factors Associated With Serious Substance Abuse in Adolescence| Rebelliousness |
| Aggression |
| Impulsivity |
| Low self-esteem |
| Elementary school underachievement |
| Failure to value education |
| Absence of strong religious convictions |
| Experimentation with drugs before age 15 years |
| Relationships with peers who have behavior problems and use drugs |
| Alienation from parents |
| History of physical or sexual abuse |
| Family lacking in clear discipline, praise, and positive relationships |
| Family history of substance abuse |
Table 7. Risk Factors Associated With Serious Substance Abuse in AdolescenceEnlarge table Table 8. Differential Diagnosis of Anorexia Nervosa| Normal thinness | |
| Physical disorders causing weight loss | Hyperthyroidism |
| | Other endocrine disorders |
| | Gastrointestinal disorders resulting in vomiting, loss of appetite, and/or malabsorption |
| | Malignancy |
| | Chronic infection |
| Psychiatric disorders causing loss of appetite and weight loss | Depression |
| | Peculiar eating behavior secondary to obsessive-compulsive disorder or to delusions in schizophrenia or psychotic depression |
| | Avoidance of eating caused by phobia of choking, with or without psychosis |
| | Vomiting secondary to conversion disorder |
| Hypothyroidism producing hypothermia and amenorrhea | |
Table 9. Physical Signs and Symptoms and Complications Associated With Anorexia Nervosa and Bulimia Nervosa| Cardiovascular | Hypotension (especially postural) |
| | Bradycardia (rates between 40 and 50 beats per minute) |
| | Arrhythmias (prolonged QT interval may be a marker for risk of sudden death) |
| | Mitral valve prolapse |
| | Cardiac arrest |
| | Edema and congestive heart failure during refeeding |
| | Cardiac failure secondary to cardiomyopathy from Ipecac (emetine) poisoning |
| Neuroendocrine | Amenorrhea or irregular menses (low levels of FSH and LH despite low estrogen levels |
| | Low basal metabolism rate |
| | Abnormal glucose tolerance test with insulin resistance |
| | Hypothermia |
| | Elevated levels of growth hormone and cortisol |
| | Sleep disturbances |
| Bone | Osteopenia |
| Fluid disturbance | Dehydration |
| | Electrolyte imbalance |
| | Abnormal urinalysis |
| Gastrointestinal | Constipation |
| | Diarrhea |
| Hematological | Leukopenia |
| | Anemia |
| | Thrombocytopenia |
| | Low sedimentation rate |
| Dermatological | Dry skin |
| | Lanugo (baby-fine body hair) |
| Oral, esophageal, and gastric damage from vomiting and/or binge eating | Loss of dental enamel |
| | Enlarged salivary glands |
| | Gastritis |
| | Esophagitis |
| | Increased rates of pancreatitis |
Table 9. Physical Signs and Symptoms and Complications Associated With Anorexia Nervosa and Bulimia NervosaEnlarge table 
