1. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 29Infant, Child, and Adolescent Clients

2. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Unity I dreamed I stood in a studio and watched two sculptors there. The clay they used was a young child’s mind and they fashioned it with care. One was a teacher; the tools she used were books and music and art. One a parent with a guiding hand and gentle loving heart. Day after day the teacher toiled with touch that was deft and sure, while the parent labored by the side and polished and smoothed it o’er. And when at last their task was done, they were proud of what they had wrought. For the things they had molded into the child could neither be sold nor bought. And each agreed they would have failed if they had worked alone, for behind the parent stood the school and behind the teacher, the home.  Author Unknown

3. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Learning Objectives After studying this chapter, you should be able to Explain the limitations involving the study of the genetics of behavioral disorders in children Articulate the relationship between the psychosocial process of attachment and child development Identify the seven groups of children considered to be at higher risk for mental health disorders Differentiate four types of intellectual disability (also referred to as mental retardation) ‏ Distinguish attention deficit hyperactivity disorder from conduct disorder

4. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Learning Objectives (cont.) ‏ Articulate the etiology and clinical symptoms of attention deficit hyperactivity disorder in adults Distinguish autistic disorder from Asperger’s disorder and Rett’s disorder Compare and contrast clinical symptoms of oppositional defiant disorder and conduct disorder Develop an assessment tool for childhood and adolescent depression

5. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Learning Objectives (cont.) ‏ Formulate a list of at least three nursing interventions for each of the following clients. –A 15-year-old girl with conduct disorder –A 12-year-old boy with clinical symptoms of depression –A 7-year-old boy with attention deficit hyperactivity disorder –A 4-year-old girl with autistic behavior –A 3-year-old girl with separation anxiety disorder –A 9-year-old boy with childhood psychosis Formulate a list of pharmacologic agents approved for use in the treatment of children and adolescents

6. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

8. The Crisis in Children’s Mental Health Services Is Influenced by the Following No single cause of mental health and psychiatric disorders Shortage of child and adolescent psychiatrists Scarcity of trained clinicians such as psychiatric–mental health clinical nurse specialists, advanced nurse practitioners, clinical child psychologists, and social workers Inadequate screening and referral

9. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Etiology—Mental Retardation Genetic Developmental Acquired syndromes

10. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Etiology — Pervasive Developmental Disorders (Autism Spectrum Disorders) ‏ These disorders are characterized by severe deficits and impairment in reciprocal social interaction and communication. These include stereotyped behaviors, interests, and activities. Rett’s disorder Autistic disorder Asperger’s disorder

11. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Etiology — Attention Deficit Hyperactivity Disorder (ADHD) ‏ Etiological hypotheses: Neuromaturational delay Catecholamine deficits Altered glucose metabolism in the brain Frontal lobe dysfunction Central nervous system infections Perinatal insults Brain injuries during or after birth

12. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Etiology — Childhood Psychosis Genetic factors Early-onset schizophrenia or other disorder Neuropathology Intrauterine stress Neuropsychological abnormalities Communication style Life events Stress

13. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Etiology — Anxiety Disorders include the following: –Separation anxiety disorder –Social phobia –School phobia –Panic disorder –Generalized anxiety disorder (GAD) ‏ Precipitating factors: –Stressful life events, loss of a parent, etc. –Etiology not well known; not enough data

14. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Etiology — Mood Disorders Genetic predisposition Environmental influences Risk factors include the following: –Learning disabilities –History of abuse or neglect –History of trauma –Loss of significant other

15. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Etiology — Disruptive Behavior Disorder: Conduct Disorders Parental and family factors Sociocultural factors Psychological factors School-related factors Neurobiological theories Medical and metabolic theories

16. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Risk Factors for the Development of Psychiatric–Mental Health Disorders Psychosocial Children in families with conflict or divorce Children who experience poverty Children of minority ethnic status Children who are abused Children of substance- abusing and mentally ill parents Children of teenage parents Children with chronic illness or disability Environmental Public schools Neighborhoods

17. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Clinical Symptoms and Diagnostic Characteristics Mental retardation Pervasive developmental disorders –Autistic disorder –Asperger’s disorder Attention deficit hyperactivity disorder and disruptive behavior disorder –ADHD –Disruptive behavior disorders Oppositional defiant disorder (ODD) ‏ Conduct disorders

18. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Clinical Symptoms and Diagnostic Characteristics (cont.) ‏ Tic disorders –Tourette’s syndrome Elimination disorders –Enuresis –Encopresis Other disorders –Separation anxiety disorder –Mood disorders –Adjustment disorders

19. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins The Nursing Process Assessment Nursing diagnoses Outcome identification Planning interventions Implementation Evaluation

20. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Assessment Assessment of a child – With autistic disorder – With ADHD Assessment of an adolescent Transcultural considerations

21. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Diagnoses ADHD Disturbed sleep pattern Interrupted family processes Risk for injury Conduct Disorder Risk for other-directed violence Impaired social interaction Hopelessness

22. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Diagnoses (cont.) Autistic Disorder Disturbed sensory perception Self-mutilation Impaired social interaction with peers and parents Impaired verbal communication Self-care deficit Separation Anxiety Disorder Disturbed sleep pattern Anxiety

23. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Outcome Identification Outcomes generally focus on the following: Reduction of clinical symptoms Decreased stress Progression of normal developmental stages Therapeutic changes

24. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Planning Interventions Nursing interventions are planned to Help the child or adolescent master developmental tasks to overcome regressive, slow, or impaired developmental behavior Establish a method of communication with clients who have difficulty communicating, such as the withdrawn, disoriented, mute, hostile, preoccupied, or autistic child or adolescent Identify stimuli that might foster abusive, destructive, or otherwise negative behavior Allow time for the client to respond to therapeutic interventions

25. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Implementation Interventions for mental retardation – Assistance in meeting basic needs – Client and family education Interventions for ADHD – Assistance in meeting basic needs – Client and family education

26. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Implementation (cont.) ‏ Interventions for ODD and conduct disorder – Assistance in meeting basic needs – Client and family education Interventions for autistic disorder – Assistance in meeting basic needs – Behavior management – Client and family education

27. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Implementation (cont.) Interventions for mood disorders – Assistance in meeting basic needs – Client and family education Interventions for anxiety – Assistance in meeting basic needs – Client and family education – Special needs of adolescents

28. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Implementation (cont.) Continuum of Care Inpatient hospitalization Day-treatment hospitals Alternative families Individual psychotherapy Family therapy (systems therapy) ‏ Group therapy Play therapy Behavioral therapy Art and music therapy Community- and school-based interventions

29. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Evaluation Positive responses to treatment will be evidenced in the following: Changes in mood or behavior since the initial assessment The efficacy of prescribed medication Improved family dynamics Socialization and progress in school

30. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Key Terms Asperger’s disorder Attachment theory ADHD Autistic disorder Conduct disorder Developmental disability Encopresis Enuresis Intellectual disability Mental retardation ODD Rett’s disorder Scapegoat Tic Tourette’s syndrome

31. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Reflection Reflect on the chapter-opening quote. What does the author imply in the final statement “For behind the parent stood the school and behind the teacher, the home?” ?