F94 social behavior disorders in childhood and adolescence

Heterogeneous group of alterations that have in common the presence of social behavior anomalies that begin during the development period, but that unlike generalized development disorders are not primarily characterized by an apparently constitutional incapacity or deficit generalized to all areas of behavior. In many cases, serious environmental distortions or deprivations are usually added that often play a crucial role in the etiology. There are no marked differences according to sex.

Content

• F94.0 selective mutism
• Diagnosis guidelines
• F94.1 reactive childhood bonding disorder
• Diagnosis guidelines
• F94.2 uninhibited childhood linkage disorder
• Diagnosis guidelines
• F94.8 Other social behavior disorders in childhood and adolescence
• F94.9 Social behavior disorder in childhood and adolescence without specification

F94.0 selective mutism

Disorder characterized by a remarkable selectivity of emotional origin in the way of speaking, in such a way that the child demonstrates his linguistic capacity in some circumstances, but stops speaking in other defined and predictable circumstances. The most frequent is that the disorder is manifested in early childhood. Its incidence is approximately the same in both sexes and is usually accompanied by marked features of social anxiety, withdrawal, hypersensitivity or negativism. It is typical for the child to speak at home or with his close friends but remain silent in school or before strangers. Other forms may also occur (even the opposite of what is described).

Diagnosis guidelines

1. Level of understanding of normal or almost normal language.
2. Language expression capacity that is sufficient for social communication.
3. Demonstrable presence that the patient can speak, and speaks normally or almost normally, in some specific situations.

However, a significant minority of children with selective mutism has a history of another language delay or presents its articulation problems which does not exclude the diagnosis, as long as there is an adequate level of language development for effective communication and a great disparity in how language is used according to the social context, such as that the child speaks fluidly on some occasions and remains mute or almost silent in others. In addition, a failure to speak in some specific social situations must be present but not in others. The diagnosis requires that language disorder be persistent and that there is constancy and possibility of predicting the situations in which oral expression takes place or not.

Includes:
Elective mutism.

Excludes:
Transitory mutism that is part of an anxiety of separation in early childhood (F93.0).
Specific speech and language development disorders (F80.-).
Generalized developmental disorders (F84.-). Schizophrenia (F20.-).

F94.1 reactive childhood bonding disorder

Disorder presented in the age of breastfeeding and early childhood, which is characterized by persistent abnormalities in the child's social relationship forms, accompanied by emotional alterations that are reactive to changes in environmental circumstances. The presence of inconsolatable fear and concern is typical. They are also a social relationship with the impoverished companions. Auto and heteroagressions, sadness and in some cases a growth delay are frequent. The syndrome is probably.

Diagnosis guidelines

An abnormal way of relationship with the people in charge of child care, which occurs before five years of age, which implies traits of bad adaptation not present in the normal child, who are persistent but still respond to changes sufficiently marked in the form of parenting.

Small children affected by this syndrome have very contradictory or ambivalent reactions that manifest themselves in moments of separation and in reunions. Thus, children can react when they are caught in arms with an attitude of remoteness or with rabid agitation or can respond to people who care for them with a mixture of emotional contact and rejection and resistance to be comforted. Emotional alterations may occur, such as an apparent sadness, loss of emotional responses, withdrawal, such as curling up on the ground, reactions or aggressive responses by feeling discomfort or perceiving it in others and in some cases a fear and hypervigilance (described to times as "frozen attention") that are insensitive to comfort. In most cases, children show interest in relationships with colleagues, but playful activity is inhibited by negative emotional responses.

Reactive linking disorders always make their appearance in relation to notoriously inappropriate care for the child. They can take the form of psychological abuse or negligence (as revealed by the presence of serious punishments, persistent lack of adaptation of responses to the child's demands or disability on the part of the parents to carry out their function) , or physical abuse or abandonment (as revealed by persistent carelessness of the basic needs of the child, repeated and deliberate aggressions, or insufficient nutrition). Since knowledge about the relationship between inappropriate care and this disorder is still scarce, the presence of environmental deficiencies and distortions are not a requirement for diagnosis. However, this diagnosis will be taken in the absence of abuse or negligence. Conversely, the diagnosis should not be done automatically based on the presence of abuse or negligence, since not in every mistreatment or abandoned child this disorder is presented.

Excludes:
Normal variation of selective linking modes.
Disinhibited childhood linkage disorder (F94.2).
Asperger Syndrome (F84.5).
Sexual or physical abuse in childhood with psícosocial problems (Z61.4-Z61.6).
Bad treatment syndrome in childhood with physical problems (T74).

F94.2 uninhibited childhood linkage disorder

Abnormal social behavior that makes its appearance during the first five years of life. Once consolidated, it presents a tendency to persist despite significant changes in environmental circumstances. Around two years it is manifested by sticky behavior and persistent and dispersed behavior of non -selective linkage. At four years, diffuse links remain, but sticky behaviors tend to be replaced by a search for care and indiscriminate affectionate behavior. In the middle and late period of childhood, affected children may have developed selective links, but the behavior of affection usually persists and a poorly modulated relationship is usual with their partners. Depending on the circumstances, emotional and behavior alterations may also occur. The syndrome has been recognized more clearly in children raised in childhood institutions, but is also presented in other circumstances in other circumstances. It is usually accepted that it is partly due to a lack of occasions to develop selective links, which is a consequence of extremely frequent changes of caregiver staff. The conceptual unity of the syndrome depends on the early appearance of diffuse linking, persistent impoverished social relations and the absence of specific trigger circumstances.

Diagnosis guidelines

The diagnosis is based on the evidence that the child presents a rare degree of dispersion in the selection of links during the first five years of his life, to which a characteristic behavior is associated in the form of a sticky behavior during childhood or an indiscriminate affectivity, and manifestations of call for attention in early and medium childhood. There is usually a difficulty in establishing intimate emotional relationships with classmates and there may also be emotional or behavior alterations (depending in part of other concomitant circumstances). In most cases there is a clear background of a raising in the first years characterized by a marked discontinuity of the people who care for the child or by multiple changes in family homes (as well as multiple homes in alternative families).

Includes:
Institutional Syndrome.
Psychopathy for affective lack.

Excludes:
Hypercinetic or attention deficit disorder (F90.-).
Reactive childhood linkage disorder (F94.1).
Asperger Syndrome (F84.5). Hospitalism in children (F43.2).

F94.8 Other social behavior disorders in childhood and adolescence

Includes:
Social behavior disorders with withdrawal and shyness due to deficiencies in sociability.

F94.9 Social behavior disorder in childhood and adolescence without specification