Mental Health Nursing II NURS 2310 Unit 11 Psychiatric Conditions Affecting Children and Adolescents

Objective 1 Identifying etiology and characteristics of specified childhood/adolescent psychiatric illnesses

Disorders Affecting Children/Adolescents ____________________________________ Intellectual Developmental Disorder Autism Spectrum Disorder Attention-Deficit/Hyperactivity Disorder Oppositional Defiant Disorder Conduct Disorder Tourette’s Disorder Separation Anxiety Disorder

Intellectual Developmental Disorder Involves deficits in general intellectual functioning and adaptive functioning – –General intellectual functioning = measured by an individual’s performance on IQ tests – –Adaptive functioning = refers to the person’s ability to adapt to the requirements of daily living and the expectations of age and cultural group IQ is 70 or below Deficits/impairment in communication, self- care, self-direction, leisure, and safety

Intellectual Developmental Disorder (cont’d) Predisposing factors: – –Hereditary   Approximately 5% of cases   Down’s syndrome, Tay-Sachs disease – –Early alterations in embryonic development   Drug/alcohol toxicity   Maternal illnesses/infections – –Pregnancy and prenatal problems   Birth injuries – –General medical conditions acquired in infancy or early childhood – –Environmental influences and other mental disorders

Autism Spectrum Disorder Characterized by a withdrawal into the self and into a fantasy world of one’s own creation Development in social interaction and communication is markedly abnormal or impaired Activities and interests are restricted; may be considered bizarre Prevalence of approximately 1 in 150 children in the U.S. Onset occurs before age 3

Attention-Deficit/Hyperactivity Disorder (ADHD) Persistent pattern of inattention and/or hyperactivity-impulsitivity that is more frequent and severe than is typically observed in individuals at same developmental level Hyperactivity = excessive psychomotor activity that may be purposeful or aimless, accompanied by physical movements that are usually more rapid than normal Impulsitivity = acting without reflection and without thought to the consequences

ADHD (cont’d) Onset of disorder difficult to diagnose in children younger than age 4 ADHD often not recognized until child enters school Five to nine times more common in boys than in girls Believed to have strong genetic component – –Parent with ADHD may have child with ADHD – –Sibling string Possible link to high serum lead levels

Oppositional Defiant Disorder (ODD) Characterized by a pattern of negativistic, defiant, disobedient, and hostile behavior toward authority figures that occurs more frequently than is usually observed in individuals of same age/developmental level Typically begins by age 8, and usually not later than early adolescence May precede a conduct disorder “Normal” oppositional phases occur in older infancy, toddlerhood, and adolescence

Conduct Disorder Repetitive and persistent pattern of behavior in which basic rights of others or major age-appropriate societal norms or rules are violated Physical aggression common Childhood-onset = begins prior to age 10; more likely to have continued problems during adolescence, and antisocial as adult Adolescent-onset = absence of any criteria characteristic of conduct disorder before age 10

Tourette’s Disorder Presence of multiple motor tics along with one or more vocal tics Tics may appear simultaneously or at different periods during the illness Causes marked distress or interferes with various areas of functioning Onset occurs before the age of 18 Characterized by periods of remission Symptoms usually diminish during adolescence and adulthood

Separation Anxiety Disorder Involves excessive anxiety concerning separation from the home or from those to whom the person is attached Considered in excess of what would be expected for developmental level Interferes with social, academic, and occupational levels of functioning More common in girls than in boys Etiological factors may include stressful life events and/or family influences

Objective 2 Examining medical treatments and nursing interventions for clients experiencing a childhood/adolescent psychiatric disorder

Behavior Therapy – –Classical conditioning, operant conditioning – –Useful for disruptive behavior disorders Family Therapy Family Education – –Behavior modification techniques – –Consistency Group Therapy – –Opportunity to interact with peers – –Learning of appropriate social behaviors Psychopharmacology

Objective 3 Exploring concerns associated with providing psychiatric care to children and adolescents

Medication issues – –Dosing problems – –Addiction Legal issues – –Guardianship concerns – –Safety Developmental issues – –Appropriateness of behaviors compared to norms of life stage Parental/caregiver issues – –Manipulation of health care system – –Knowledge deficits

Objective 4 Applying the nursing process to the treatment of special populations

Assessment Nursing Diagnosis Planning Implementation Evaluation