A score below seventy, and a word that will not come easily

These are class notes on mental disorders in children and adolescents. Among biological causes, a family history is named first. For ADHD, the incidence in a parent or a sibling is given as 30 to 50 percent, three times that of ordinary children. A child of a parent with depression is given as three times as likely to be set toward a mood disorder. A delayed maturation of the cerebrum makes sound judgement and the control of an impulse difficult, and is related, the notes say, to school violence. A neurochemical abnormality named for ADHD is a deficiency of norepinephrine and of dopamine. A neuroanatomical abnormality named is a lower glucose metabolism in the cerebrum and in the frontal region, and a lower activity of the frontal lobe. Psychological factors include a delay, a fixation, or a regression in development; Freud, on a conflict among the id, the ego, and the superego; Mahler, on a separation-individuation process between mother and child; and Bowlby, on the forming of an attachment. Environmental factors include rearing according to a mother’s temperament, including an older mother; early experience of a parent’s love and care; a parent’s pattern of rearing; a supportive sibling relation; a peer group and a school, with group life and rules; a single parent; and a low social status or a low education, including a mother’s young age. The figures and the names are left as the notes state them.

Intellectual developmental disorder is a defect of intellectual function and of adaptive function, with an intelligence quotient below 70 on a Wechsler intelligence test. In the Korean grading given on the page, an IQ of 69 or below is a third-grade intellectual disability. It is a neurodevelopmental disorder. The level of intelligence and of reasoning is low; self-direction and learning are hard; social adaptation is difficult; and the difficulty lasts a lifetime. The ego and the superego develop late, the capacity to regulate a wish is low, and the level of social and moral awareness is low. Behaviour may be dependent, hyperactive, and impulsive, with a fair amount of aggression and of self-injury, or it may be passive. Nursing aims include an adaptation to the environment, the maintenance of an independent life, and the acquisition of needed skills through special education. Repetitive problem behaviour is treated with behaviour therapy and with medication. Risk factors named on the page include being male, a low socioeconomic status, a perinatal risk, and a mother’s low level of education.

A language disorder is a difficulty in acquiring and using language: a reduced vocabulary, a limited sentence structure, and damage to discourse, such as explaining a sequence of events or connecting sentences, with understanding and expression lower than intellectual ability would suggest. Speech therapy, the notes say, should start as soon as the diagnosis is made. A speech-sound disorder is a problem of the organs of articulation, a difficulty in controlling the breath, and a continuing difficulty in producing speech sounds, so that effective communication is limited and the pronunciation is unclear. A social, or pragmatic, communication disorder is a failure to use verbal and nonverbal communication appropriately in a social situation, with a markedly reduced capacity to express. A childhood-onset fluency disorder, or stuttering, appears, the notes say, in an environment of dissatisfaction and stress. A specific learning disorder includes, even after an ordinary education, an inaccurate, slow, or laboured reading of words, a difficulty in understanding the meaning of what is read, and a difficulty with spelling, and also a difficulty with number sense, with not knowing the value of a simple calculation, and with the procedure of a calculation, and a difficulty with writing.

A shrug, a hum, and a rule that is broken on purpose

A developmental coordination disorder is a late motor development and a clumsy movement, which affect play and learning, and may be accompanied by a communication disorder, a disruptive behaviour disorder, and ADHD. A stereotyped movement disorder is a patterned act repeated without a particular purpose — repetitive, impulsive, and non-functional; simple stereotyped movement, the notes say, may appear in an infant and resolve with time. A tic disorder is a sudden, quick, unrhythmical movement of the body, or a sound, repeated as a maladaptive act, repetitive and irregular. A motor tic may be a blinking of the eyes, a shrugging of the shoulders, a grimace of the face, or a gesture of the hands. A vocal tic may be a hum, a harsh sound, a sound like a dog barking, a dry cough, a sniff, swearing, or obscene language. Tourette’s disorder, as the notes name it, is a motor tic plus one or more vocal tics, lasting a year or more, with the motor tic often first and the vocal tic at the same time.

Among disruptive and impulse-control disorders the notes place oppositional defiant disorder, intermittent explosive disorder, conduct disorder, pathological fire-setting, and pathological stealing. Oppositional defiant disorder is described as starting between the ages of three and six. Of those children, 25 percent, the notes say, go on to conduct disorder, and 10 percent, in adults, to antisocial personality disorder. A factor named is a problem of emotional regulation: a high emotional reactivity and a low tolerance of frustration. The main symptoms are an angry or irritable mood — flaring up, becoming angry, becoming irritated easily, and taking great offence; argumentative or defiant behaviour, with frequent arguments with a person in authority, uncooperative and negative, though without violence, and a deliberate bothering of other people; and a vengeful quality, a holding of malice or of a grudge. Antisocial, aggressive acts that violate another person’s rights are not many, which is the contrast drawn with conduct disorder.

Conduct disorder is a repeated, continuing violation of a basic right, or of a social norm or a rule. It often peaks between thirteen and sixteen. There may be a difficult, hard-to-control early childhood, and a cognitive function below the ordinary level, including a lowering of verbal IQ. Main symptoms include aggression — bullying, threats, intimidation, and the use of a weapon such as a bat; intentional destruction of property; fraud or theft, including a car, and lying; and a serious breaking of rules, with little regret or guilt, a coldness and a lack of empathy, an indifference to performance, and a shallow or absent feeling. Causes named include coercive discipline, contradictory parenting, an absence of supervision, life in a protective facility, company with delinquent peers, and a parent’s substance use. Pathological fire-setting is an inability to hold back an impulse to set a fire, with tension or emotional excitement before the act, and a satisfaction only for oneself. Pathological stealing is not about the value of the object; there is tension just before the theft, and pleasure, satisfaction, and relief when the object has been taken. A cause named is stress; after the theft there may be a low mood and a feeling of guilt, with a knowledge that the act was wrong and unreasonable.

A child who will not stay alone at night, and a room with a few toys

Among anxiety disorders the notes place separation anxiety disorder and selective mutism. Separation anxiety shows itself as a refusal of school, as bodily complaints, and as a child who, even at home, will not stay alone at night. A serious stress named on the page is the death of a pet, and also illness, physical violence, and sexual violence. Selective mutism is a consistent not speaking in a particular social situation, with a high level of social anxiety. Childhood depression may show itself as a low mood, a feeling of guilt, irritability, bodily complaints, and a negative, defiant attitude. A disruptive mood dysregulation disorder is described as a depressed state plus intermittent bursts of anger, with a mood of being continuously angry. Among disorders of attachment, a reactive attachment disorder is a failure to form a stable, healthy attachment: a mixed attitude of approach and avoidance toward a carer, a resistance to comfort, a coldness and a wariness, an excessive friendliness toward a stranger, and a difficulty in choosing an attachment figure, seen more often, the notes say, in a broken family and in a group under economic difficulty. A disinhibited social engagement disorder is more an approaching type: more active toward a stranger, behaviour that seeks to be liked, little concern when a carer leaves, and a still behaviour when the carer returns.

In a first interview with a child, the child is seen together with a parent, and dissatisfaction and the relation with the mother are of interest. In an interview with an adolescent, an interview with the parent before the young person’s own interview is to be avoided. A first interview should be without a preconceived idea, and a contract of confidentiality is important, with a line of what will be kept confidential. The room should be comfortable but not excessively so, with toys provided, unstructured play, and open questions. A nursing diagnosis starts from target symptoms or from a problem behaviour. Target symptoms commonly found in children and adolescents include inattention, distraction, emotional instability, anxious behaviour, impulsivity, a disordered thought, and aggression. A deeper assessment then looks at social skill, problem-solving, academic achievement, the holding back of behaviour, and communication. When there is a risk of self-harm or of a suicidal act, that, the notes say, is the highest nursing priority. Suicide is named in the notes as the leading cause of death among adolescents, with fantasy and impulsivity named beside it; the fundamental treatment is prevention — education in the prevention of suicide, an early screening of a group at risk, and an individual programme. Self-harm is described as a non-suicidal injuring of the body, which a person may express as a feeling of ease from stress, knowing that the act is not fatal, and which may also be a self-punishment, a seeking of attention, a way of causing guilt in another person, or a matter of a tie with peers.

Why a set of class notes is kept on this page

A score, a shrug, and a child who will not stay alone after a pet has died are the cases these notes chose to keep in one place. The same Korean class notes, at fuller length, are on CampusDown.

Sources

1. Class notes summarising mental disorders in children and adolescents, centred on intellectual developmental disorder, conduct disorder, and separation anxiety (Korean source page).
2. Figures as the notes state them, including an IQ below 70 on a Wechsler test, a Korean third-grade threshold at 69 or below, family-history figures for ADHD, and a contrast between oppositional defiant disorder and conduct disorder.
3. Interview guidance and a nursing priority when there is a risk of self-harm or of suicide, as set out in the notes.

Last updated: 14 November 2026