CHILDHOOD PSYCHOPATHOLOGY: MAIN DISORDERS AND THEIR CHARACTERISTICS - ECONOMÍA - 2025

The child psychopathology can be defined as the study of behavioral disorders in children and youth. In order to study childhood pathologies or disorders, a series of characteristics must be taken into account that differentiate them from those that are present in adults.

In the first place, it is not usual for the child to realize that he has a problem and ask for psychological help, what usually happens is that someone around him detects the problem and requests help. This person is usually a relative or someone from the school environment (a teacher, tutor or counselor).

Secondly, it must be borne in mind that not all children mature at the same speed, however, there is an interval within which the presence or not of a behavior may be normal. For example, it is normal that children do not pee in bed from about two years old, but it is not considered a disorder if the child does not reach the age of 5.

Finally, the family and the close social circle that surrounds the child must be taken into account since children are highly susceptible and what happens around them can affect them much more than an adult, both on a psychological and physiological level. they may even suffer from brain maturity problems.

Next, the disorders that occur, or begin, in childhood or adolescence will be discovered.

Eating disorder

In diagnostic manuals, anorexia nervosa, bulimia and other unspecified eating disorders are usually included within this group, but pica and rumination disorders will also be included here because, as you will see later, they are closely related to Eating disorder.

-Anorexia nervosa

This disorder usually appears in childhood, although cases are increasingly found in younger people and even in children. There are two age peaks in which the appearance of this disorder is more common, the first is at 14 years and the second at 18.

It is estimated that it affects approximately 1% of adolescents, of which 90% are girls, although more and more boys are affected by this disease.

People who suffer from it are usually described as responsible and normal young people. But, as the disorder progresses, they become more and more withdrawn.

The main symptom that alerts the family members of the young person is malnutrition, at first glance a physical decrease can be observed in the person that in the long run can lead to reduce their vital signs, to save energy, and in severe cases it can even lead to to the death.

To diagnose anorexia nervosa, the following ICD-10-MIA criteria must be met:

1. Significant weight loss or in pre-puberty, not getting the right weight for their growth period. MC = Kg / m2 <17.5
2. Through: 1) avoidance of consumption of “fattening foods” and by one or more of the following symptoms: 2) self-induced vomiting, 3) self-induced intestinal purges, 4) excessive exercise and 5) consumption of anorectic or diuretic drugs
3. Distortion of the body image with the character of an intrusive overvalued idea, of fear at the fat or flaccidity of the body forms, so that the patient imposes himself / herself to stay below a maximum limit of body weight
4. Generalized endocrine disorder that affects the hypothalamic-pituitary-gonadal axis, manifesting in women as amenorrhea and in men as loss of sexual interest and potency
5. If the onset is prior to puberty, the sequence of puberty manifestations is delayed, or even stopped (growth ceases, breasts do not develop in women and there is primary amenorrhea; infantile genitalia persists in men). If recovery occurs, puberty may be complete, but menarche is late.

The presence of purgative methods such as self-induced vomiting, self-induced intestinal purges, the use of anorectic or diuretic drugs, the abuse of laxatives and thyroid extracts. The underlined criteria are purgative methods. The presence of these is an indicator that the disease takes a long time.

-Bulimia nervosa

This disorder usually begins later than anorexia. It is estimated that between 1 and 3% of adolescents and young adults suffer from it, of which 90% are girls, as was the case with anorexia.

The physical symptoms of bulimia are similar to those of anorexia, although there is not such a drastic drop in weight.

In terms of psychological symptoms, they share characteristics with anorexia, such as fear of gaining weight and inappropriate compensatory behaviors. But they differ in that people with bulimia engage in bingeing and purging behaviors from the start.

To diagnose bulimia nervosa, the following ICD-10-MIA criteria must be met:

1. Continuous preoccupation with food, with irresistible desires to eat, so that the patient ends up succumbing to them, presenting episodes of polyphagia during which they consume large amounts of food in short periods of time
2. The patient tries to counteract the weight gain thus produced by one or more of the following methods: self-induced vomiting, abuse of laxatives, periods of fasting intervals, consumption of drugs such as appetite suppressants, thyroid extracts or diuretics. When bulimia occurs in a diabetic patient, he or she can abandon their insulin treatment.
3. Psychopathology consists of a morbid fear of gaining weight, and the patient strictly sets a weight threshold much lower than he had before the disease, or his optimal or healthy weight. Often, but not always, there is a previous history of anorexia nervosa with an interval between the two disorders of several months or years. This early episode can manifest itself in a flowery form or, on the contrary, adopt a minor or larvae form, with moderate weight loss or a transitory phase of menorrhea.

The presence of purgative methods such as self-induced vomiting, self-induced intestinal purges, the use of anorectic or diuretic drugs, the abuse of laxatives and thyroid extracts. The underlined criteria are purgative methods. The presence of these is an indicator that the disease takes a long time.

-Pica

Pica consists of the persistent ingestion of non-nutritive substances, such as pebbles or sand, without showing any type of disgust or aversion. Going from the smallest children to adolescents and adults, the substances that you usually consume are:

• Paint, plaster, rope, hair, or clothing
• Droppings, sand, insects, leaves, or pebbles
• Dirt or manure

To diagnose pica, the following ICD-10-MIA criteria must be met:

1. Persistent ingestion of non-nutritive substances, twice / week
2. Duration of at least one month
3. Absence of other ICD-10 psychiatric criteria, except mental retardation
4. Chronological and mental age must be at least two years
5. The disorder cannot be a culturally accepted habit.

-Rumination

It is considered an early disorder since it usually appears before the child's first year of life. Children with this disorder regurgitate part of the partially digested food, spit out a little and chew the rest to swallow it and digest it again.

A characteristic feature of this disorder is that the child often performs movements prior to regurgitation, such as arching the back back.

To diagnose rumination (referred to as an eating disorder in ICD-10-MIA and an eating disorder in DSM-IV) the following criteria must be met:

1. Persistent failure to eat properly or persistent rumination or regurgitation of food.
2. Failure to gain or lose weight in a period of at least one month.
3. Onset of the disorder before 6 years of age.
4. Criteria for any other ICD-10 psychiatric disorder are not met.
5. There is no organic disease that can explain the failure of eating behavior.

Elimination disorders

Normal learning of toilet training functions occurs in the following chronological order:

1. Night rectal checkup
2. Daytime rectal check
3. Daytime bladder control
4. Night bladder control

-Enuresis

Enuresis is defined as the frequent voluntary or involuntary emission of urine in the bed or on the clothes of children who are already mature enough to control it and who do not suffer from any organic problem.

The prevalence of nocturnal enuresis affects 7% in boys and 3% in girls. The prevalence of daytime enuresis is 1-2% and is more common in girls.

Depending on the time of day, three types are contemplated: only nocturnal, only diurnal, nocturnal and diurnal (ICD-10-MIA). Although daytime enuresis is often referred to simply as enuresis.

Depending on whether there has been a previous period of urinary continence, there are two subtypes: primary (when this period never existed) and secondary, if the child had already learned to control emissions.

The most common types are nocturnal and primary enuresis.

To diagnose enuresis, the following ICD-10-MIA criteria must be met:

1. The chronological and mental age must be at least five years.
2. Involuntary or intentional emission of urine in bed or clothes that occurs at least twice a month in children under seven years of age and at least once in children over years.
3. Enuresis is not a consequence of epileptic seizures, neurological incontinence, or structural abnormalities of the urinary tract, or other physical disorders.
4. The painting must have been present for at least three

-Encopresis

Encopresis is defined as the repeated evacuation of stool in inappropriate places, involuntarily or intentionally in children who are already mature enough to control it and in the absence of any organic problem.

This problem affects about 1% of children aged 5 and is more common in boys than girls.

In addition, it is subdivided into primary / secondary and nocturnal / daytime such as enuresis, there is another subdivision: due to inadequate teaching in sphincter control, deliberate stool deposition in inappropriate places or liquid stools due to overflow secondary to retention

Diagnostic criteria for non-organic encopresis (ICD-10-MIA):

1. Repeated emission of stool in inappropriate places either unintentionally or intentionally (includes overflow incontinence secondary to functional fecal retention).
2. Chronological and mental age of at least four years.
3. At least one episode of encopresis per month.
4. Duration of at least six months.
5. Absence of organic pictures that could be a sufficient cause of encopresis.

Sleep disorders

-Dysomnias

These types of disorders affect the quantity, quality or schedule (duration) of sleep.

Insomnia

Insomnia such as difficulty starting or staying asleep, or the feeling of not having had a good night's sleep.

They can be categorized:

• Depending on the moment: conciliation, maintenance and terminal.
• According to its severity: common early and severe early (it can manifest itself in two ways: calm and agitated, especially frequent in children who have subsequently been diagnosed with ASD).
• According to its duration: transitory and persistent

Approximately 10% of children have insomnia problems, although it can be confused with difficulties in falling asleep.

Diagnostic criteria for non-organic insomnia (DSM-IV-R):

a) Complaints that usually consist of difficulties in falling asleep or maintaining it or of a poor quality of it.

b) Said manifestation has been presented at least three times a week for at least one month.

c) Excessive worry, both during the day and at night, about not sleeping and its consequences.

d) The unsatisfactory quantity or quality of sleep causes general discomfort or interferes with the patient's social and occupational functions.

Difficulty to sleep

It is more frequent than insomnia, and can reach up to 20% in preschool age.

It is essential to carry out a good interview to obtain information from the parents about the habits that both they and their child have at bedtime and at night (it is also useful to obtain information on the conditions of the room).

Based on history and records, we can identify if any of these problems occur:

1. Relationship problems that do not meet the criteria for any specific mental disorder but that lead to clinical referrals for assessment or resources (includes difficulties in bedtime or feeding habits in young children).
2. Problem related to inadequate parental control and supervision (several aspects would be affected).
3. Phobic anxiety disorder in childhood or F40.2 Specific phobia.

Narcolepsy

It is defined as the presence of irresistible attacks in which the person falls asleep, can last from a few seconds to 20 minutes or more, and are usually precipitated by monotonous or boring situations.

The usual thing is that it does not manifest itself until adolescence, in the general population there is a prevalence of approximately 0.1%.

Along with the main symptom, "sleep attacks," one or more of the following appear:

• Cataplexy: sudden episodes in which muscle tone is lost (from a few seconds to a few minutes) occur after intense emotions and the subject remains conscious.
• Sleep paralysis: inability to carry out voluntary movements when waking up or falling asleep when sleeping or waking up (from seconds to a few minutes) and usually disappears when touching the subject.
• Hypnagogic hallucinations: these resemble the dreams that we sometimes experience before falling asleep or upon waking up.

Sleep apnea

Sleep apnea consists of the intermittent appearance of episodes of cessation of breathing during sleep (for more than 10 seconds), up to 10 episodes of this type per hour can be counted. They are associated with loud snoring and daytime sleepiness, which in children is associated with poor school performance, sleep attacks and morning headaches.

It is a rare disorder, the number of children with this disorder does not reach 1%.

There are three subtypes: obstructive, due to upper airway obstruction (it is the most common subtype), central, due to a dysfunction of the CNS mechanisms, and mixed (the latter subtype is rare).

Subjects have reduced duration of deep sleep phases (awakenings or superficialization of sleep).

-Parasomnias

This category includes disorders that occur during sleep or during the sleep-wake transition.

Nightmares

Nightmares are defined as distressing dreams that wake up the child. The child is capable of making a structured account of her bad dream, the content of which is threatening and remembered.

The episodes take place in the REM phase (REM phase), except in the case of nightmares that occur due to post-traumatic stress disorder. About 1 in 4 children over the age of 3 have occasional nightmares.

According to the ICD-10, the following criteria must be met to establish the diagnosis:

1. Waking up from a night's dream or nap with detailed and very vivid memories of terrifying dreams, which normally pose a threat to survival, safety, or self-esteem. Awakening can take place during any time of the sleep period, although it usually takes place during the second half.
2. Once awake, the individual quickly reaches the waking state and is oriented and alert.
3. Both the dream experience itself and the sleep disturbance cause great discomfort to the patient.

Night terrors

Children with this disorder often wake up with a scream and great vegetative activation. During episodes of night terrors, children “look but do not see”, they do not respond to attempts by parents to calm or wake them up.

After a few minutes the terror disappears and the child goes back to bed or ends up waking up without remembering the episode or at most being able to vaguely remember the experience of terror.

These episodes occur in phases III-IV of NMOR sleep (non-REM phase), slow wave sleep. It is more frequent between 4-12 years, in this interval, around 3% of children have night terrors.

According to the ICD-10, the following criteria must be met to establish the diagnosis:

1. The predominant symptom is the presence of repeated episodes of waking up during sleep, beginning with a cry of panic and characterized by intense anxiety, motor excitement, and vegetative hyperactivity such as tachycardia, tachypnea, and sweating.
2. These recurring episodes typically last 1 to 10 minutes. They usually occur during the first third of nighttime sleep.
3. There is a relative lack of response to other people's attempts to influence terror, and these attempts are often followed by a few minutes of disorientation and persistent movements.
4. The memory of the event, if there is one, is minimal (usually one or two fragmentary mental images).
5. There is no evidence of a somatic disorder, such as a brain tumor or epilepsy.

Somnambulism

This disorder is described as the presence of motor activity in a child who was sound asleep. The activity can be more or less complex and do not respond to the people around you. Children usually have their eyes open during the episode.

It is a dissociation between motor activity and level of consciousness, since the person is not aware of the movements they are making. Episodes can last up to 20 minutes.

It is more frequent between 4-8 years, in this interval, approximately 3% of children suffer from it. According to the ICD-10, the following criteria must be met to establish the diagnosis:

1. The predominant symptom is the presence of repeated episodes of getting out of bed during sleep and wandering for a few minutes or up to half an hour, usually during the first third of night's sleep.
2. During the episode the individual has a blank look, does not fully respond to the efforts of others to modify his behavior or communicate with him and it is very difficult to wake him up.
3. Upon awakening from the episode or the next morning, the individual has no recollection of what happened.
4. Within a few minutes of awakening after an episode, no deterioration in mental activity or behavior is apparent, although there may initially be a short period of time in which there is some confusion and disorientation.
5. There is no evidence of an organic mental disorder, such as dementia or epilepsy.

Psychomotor disorders: tics

Tics are defined as involuntary, rapid, repeated and arrhythmic movements that usually affect a circumscribed group of muscles or a sudden-onset vocalization and that lack any apparent purpose.

It is experienced as irresistible and uncontrollable, but can be suppressed for varying periods of time. The consequence of its execution is a temporary decrease in the tension suffered by the person. Those that occur in the upper body are more common.

These disorders usually begin between the ages of 6 and 12, and are more common in boys than girls. 15% of these children suffer from transient tic disorder, 1.8% suffer from chronic motor or speech tic disorder, and 0.5% suffer from Gilles de la Tourette syndrome.

Observation is the surest way to diagnose this disorder. In the most serious cases it is advisable to carry out a neurological examination, to check if there is a history of infectious and neurological conditions (own and family).

The classification differentiates between:

• Transient tic disorder.
• Chronic motor or phonatory tic disorder.
• Combined multiple and phonatory tic disorder (Gilles de la Tourette syndrome).
• Other tic disorders.
• Unspecified tic disorder.

Criteria for diagnosing transient tic disorder (according to DSM-IV-R):

1. Presence of simple or multiple tics, of a motor and / or phonatory type, which are repeated many times most of the days during a period of at least 4 weeks.
2. Duration not exceeding 12 months.
3. No history of Gilles de la Tourette syndrome. The disorder is not secondary to other physical disorders nor does it correspond to the side effects of any medication.
4. Appearance before 18 years of age.

Criteria for diagnosing chronic motor or phonatory tic disorder (according to DSM-IV-R):

1. Presence of motor or phonatory tics, but not both, which are repeated multiple times most days during a period of at least 12 months.
2. There are no remission periods during that year of more than two months.
3. No record on Gilles de la Tourette. The disorder is not secondary to other physical disorders nor does it correspond to the side effects of any medication.
4. Appearance before 18 years of age.

Criteria for diagnosing Gilles de la Tourette syndrome or multiple motor or phonatory tic disorder (according to DSM-IV-R):

1. The presence of multiple motor tics together with one or more phonatory tics must present at some point in the course of the disorder, but not necessarily together.
2. The tics must occur many times a day, almost every day for more than a year, with no period of remission during that year of more than two months.
3. The disorder is not secondary to other physical disorders nor does it correspond to the side effects of any medication.
4. Appearance before 18 years of age.

Anxiety disorders

Anxiety disorders are found in the section “Disorders of emotions with specific beginning in childhood” in DSM-IV. They are more common in girls.

This section includes childhood separation anxiety disorder (SAD), childhood phobic anxiety disorder (TAF), and childhood anxiety (hypersensitivity) disorder (TAH).

-Separation anxiety disorder

The diagnostic criteria for this disorder are:

1. At least three of the following:
2. an irrational concern about possible harm that might befall significant others or fear of being abandoned;
3. an irrational concern that an adverse event will separate you from significant others (such as being lost, abducted, admitted to hospital, or killed);
4. a persistent reluctance or refusal to go to school for fear of separation (more than for other reasons, such as fear of something that might happen at school);
5. a persistent reluctance or refusal to go to bed without the company or closeness of a significant other;
6. an inappropriate and persistent fear of being alone, or without significant others at home during the day;
7. repeated nightmares about separation;
8. Repeated somatic symptoms (such as nausea, gastralgias, headaches, or vomiting) in situations that involve separation from a significant other, such as leaving home to go to school;
9. excessive and recurring distress (in the form of anxiety, crying, tantrums, sadness, apathy, or social withdrawal) in anticipation of, during or immediately after separation from a significant other;
10. Absence of generalized anxiety disorder in childhood.
11. Appearance before 6 years.
12. Absence of generalized alterations in the development of personality or behavior (F40-48: Neurotic disorders, secondary to stressful situations and somatoform), psychotic disorders or disorders due to psychoactive substance use.
13. Duration of at least 4 weeks.

-Phobic anxiety disorder

Diagnostic criteria according to ICD-10:

1. The beginning has taken place in the proper evolutionary period.
2. The degree of anxiety is clinically abnormal.
3. Anxiety is not part of a more generalized disorder.

In DSM-IV this disorder is called a specific phobia, and the characteristics are as follows:

• Disproportionate fear of an object or situation.
• High arousal: tantrums, immobilization, crying, hugging, etc.
• They provoke avoidance or are endured with great effort.
• Irrational character.
• They significantly interfere with the child's adaptation
• They are required to have been present for 6 months.
• Not explainable by another major anxiety disorder.
• Many remit spontaneously years later.

-Social hypersensitivity disorder in childhood

Diagnostic criteria according to ICD-10:

1. Persistent anxiety in social situations in which the child is exposed to the presence of unfamiliar people, including schoolmates, and which manifests itself in the form of social avoidance behavior
2. Self-observation, feelings of shame, and excessive concern about the appropriateness of their behavior when encountering unfamiliar figures
3. Significant interference with social relationships (including with schoolmates) that are in restricted consequences. When they are forced to face new social situations, there is a state of intense discomfort and discomfort manifested by crying, lack of spontaneous language or flight from the situation
4. Social relationships with family figures (family members or very close friends) are satisfactory
5. GAT criteria are not met
6. Absence of generalized alterations in the development of personality and behavior, psychotic disorders or psychoactive substance use.

-Generalized anxiety disorder

• Excessive worry (past or future events) and fearful behavior not limited to a specific event or object
• Concern for their own competence in different fields
• Associated symptoms (several months): apprehension, fatigue, decreased concentration, irritability, muscle tension, sleep disturbances
• It is not better explained by Phobias, Panic T., OCD, nor does it appear exclusively during a Depressive T.

Mood disorders: childhood depression

This disorder is defined as a persistent area in the behavior of a child consisting of a decrease in their ability to enjoy events, communicate with others and perform in their areas of competence in relation to their possibilities, and that is also accompanied of plural protest actions (Del Barrio, 1998).

In Spain, it is estimated that 1.8% of children between 8 and 11 years old suffer from major depressive disorder, while up to 6.4% suffer from dysthymic disorder. During childhood there is no difference between the sexes, but in adolescence it is much more frequent in girls.

-Major depressive episode

The diagnostic criteria for major depressive disorder are as follows (DSM-IV):

1. Presence of five (or more) of the following symptoms over a 2-week period, representing a change from previous activity. One of the symptoms must be (1) or (2).
   • depressed mood most of the day, almost every day as indicated by the subject himself (eg, feels sad or empty) or observation by others (eg, crying). Or irritable mood in children and adolescents
   • marked decrease in interest or in the capacity for pleasure in all or almost all activities, most of the day, almost every day (as reported by the subject himself or observed by others) (anhedonia)
   • significant weight loss without dieting or weight gain, or loss or increase in appetite almost every day. Or failure to gain weight in children
   • insomnia or hypersomnia almost every day
   • psychomotor agitation or slowing almost every day (observable by others, not just feelings of restlessness or being sluggish)
   • fatigue or loss of energy almost every day
   • excessive or inappropriate feelings of worthlessness or guilt (which can be delusional) almost every day (not simple self-blame or guilt over being sick)
   • decreased ability to think or concentrate, or indecision, almost every day (either a subjective attribution or an outside observation)
   • recurrent thoughts of death (not just fear of death), recurrent suicidal ideation without a specific plan or a suicide attempt or a specific plan to commit suicide (not necessary to check that it happens almost every day).
2. Symptoms do not meet criteria for a mixed episode
3. Symptoms cause clinically significant distress or impairment of the individual's social, occupational, or other important areas of activity
4. The symptoms are not due to the direct physiological effects of a substance or a general medical condition.
5. Symptoms are not better explained by the presence of grief (eg, after the loss of a loved one), symptoms persist for more than two months or are characterized by marked functional disability, morbid worries of worthlessness, suicidal ideation psychotic symptoms, or psychomotor slowdown

-Dysthymic disorder

The diagnostic criteria for dysthymic disorder are as follows (DSM-IV):

1. Chronically depressed (irritable) mood most of the day, most days for at least 1 year.
2. During this year, he has not been without symptoms for more than two months in a row.
3. No major depressive episode during this first year (neither chronic, nor in remission). Then double depression.
4. No manic or mixed episodes.
5. Not just during a psychotic episode.
6. Not due to a substance or medical illness.
7. Symptoms cause significant discomfort or impairment.

Conduct Disorders: Conduct Disorders

Conduct disorders are characterized by a persistent and repeated form of aggressive or defiant behavioral disturbance, and, in severe cases, by violations of social norms.

Typically, the disorders worsen if they are not treated and that children have little or no awareness of the problem. Most of the children with this disorder are boys, there is a ratio of 3/1 in favor of boys.

Conduct disorders include:

• Conduct disorder limited to family context: this is the mildest disorder, followed by oppositional defiant. It is common when one of the parents has a new partner.
• Conduct Disorder in Non-socialized Children: This disorder is the most serious. It is usual for the child to interact with other equals who are just as dissocial as he is.
• Conduct disorder in socialized children.
• Defiant and oppositional conduct disorder.

- Conduct disorders

Diagnostic criteria according to ICD-10:

• The duration must be at least 6 months
• It gives rise to four subcategories plus mixed ones

Some of the following symptoms are present, often or frequently:

• Severe tantrums
• Discussions with adults
• Challenges to adult requirements
• Do things to annoy other people
• Blames others for their faults or misconduct
• Gets annoyed easily with others
• Is angry or resentful
• He's spiteful and vindictive

Aggression to people and animals:

• Intimidation of other people
• Starts fights (except with siblings)
• Has used a weapon that can cause serious harm to others
• Physical cruelty to other people
• Physical cruelty to animals
• Forcing another to have sex
• Violent or confrontational crime

Destruction of property:

• Deliberate destruction of someone else's property (no fires)
• Deliberate fires to cause damage

Fraudulence or theft:

• Theft of value without confrontation with the victim (outside or inside the home)
• Lies or breaks promises to get benefits and favors
• Trespassing on someone else's home or vehicle

Serious rule violations:

• Leaving home at least 2 times a night (or 1 more than a night), except to avoid abuse
• Stays away from home at night despite parental prohibition (onset <13)
• School absences (start <13)

Attention deficit disorder and hyperactivity

Attention Deficit Hyperactivity Disorder (ADHD) is a developmental disorder that is defined by disabling levels of inattention, disorganization, and / or hyperactivity-impulsivity.

The lack of attention and organization leads to the impossibility of staying or completing the tasks corresponding to their educational level, for which they often give the impression that they are not listening.

Hyperactivity-impulsivity involves overactivity, restlessness, an inability to sit still, intrusiveness in the activities of others, and an inability to wait.

The prevalence is 5% in children and 2.5% in adults. It is a fairly stable disorder, although in some cases it worsens in adolescence. In adulthood, hyperactivity is less obvious, but some symptoms persist, such as sleepiness, inattention, impulsivity and lack of organization.

References

1. American Psychiatric Association. (April 15, 2016). Onset disorders in infancy, childhood or adolescence.
2. World Health Organization. (April 14, 2016). BEHAVIORAL DISORDERS AND EMOTIONAL DISORDERS WHOSE ONSET USUALLY PRESENTS IN CHILDHOOD AND ADOLESCENCE (F90-F98). Obtained from the Ministry of Health, Social Services and Equality.
3. Rodróguez Sacristán, J., Mesa Cid, PJ, & Lozano Oyola, JF (2009). Basic Childhood Psychopathology. Madrid: Pyramid.