1. Chapter 18Disorders and Issues of Children and Adolescents

2. Copyright © 2016 Wolters Kluwer All Rights Reserved Types of Mental Disorders in Children and Adolescents Neurodevelopmental disorders Intellectual developmental disability –Deficits in general mental abilities such as reasoning, problem-solving, planning, abstract thinking, judgment, academic learning, and learning from experience (DSM-V) –Signs and symptoms o Intellectual functioning significantly below average; IQ ≤70 o Levels: mild ~ moderate ~ severe ~ profound –Incidence and etiology: biologic, psychosocial

3. Copyright © 2016 Wolters Kluwer All Rights Reserved Types of Mental Disorders in Children and Adolescents (cont.) Language and communication disorders –Impairment in both verbal and sign language –Difficulty in acquiring and using language Deficits in vocabulary comprehension or production –Signs and symptoms Limited speech, vocabulary Expressive or mixed disorders –Incidence and etiology

4. Copyright © 2016 Wolters Kluwer All Rights Reserved Types of Mental Disorders in Children and Adolescents (cont.) Speech sound disorder –Failure to use sounds or articulate intelligibly –Hearing impairment in many cases –Signs and symptoms Stuttering: repetitive or prolonged sounds or syllables, including pauses + monosyllabic broken words o Trigger: increased levels of anxiety/stress –Incidence and etiology

5. Copyright © 2016 Wolters Kluwer All Rights Reserved Types of Mental Disorders in Children and Adolescents (cont.) Autism spectrum disorder: range of complex neuro- developmental disorders involving delayed development of various basic skills –Communication; socializing with others –Processing, understanding external input –Autistic disorder: severe abnormal development of external social interaction and communication Signs and symptoms: lack of language development; unresponsive to interaction; nonverbal behaviors; inflexible, consistent routines Incidence and etiology

6. Copyright © 2016 Wolters Kluwer All Rights Reserved Types of Mental Disorders in Children and Adolescents (cont.) Attention-deficit/hyperactivity disorder –Persistent pattern of inattention, hyperactivity, or impulsive behaviors, with greater frequency than age-appropriate –Signs and symptoms: must be present ≥6 months Continual, often destructive physical activity Low tolerance of frustration –Incidence and etiology

7. Copyright © 2016 Wolters Kluwer All Rights Reserved Types of Mental Disorders in Children and Adolescents (cont.) Specific learning disorder –One’s standardized testing performance in reading, mathematics, written expression are significantly below expected norm –Dyslexia: inability to process incoming sensory stimuli with correct interpretation Signs and symptoms: reading, spelling, writing abilities inconsistent with intelligence of student Incidence and etiology

8. Copyright © 2016 Wolters Kluwer All Rights Reserved Types of Mental Disorders in Children and Adolescents (cont.) Disruptive, impulse-control, and conduct disorders –Problems in self-control of emotions and behaviors which violate rights of others –Oppositional-defiant disorder: repetitive pattern of angry mood, negative/defiant/hostile behavior toward authority figures Signs and symptoms o Incessant arguing with adults; active defiance o Vindictive; spiteful; blame others for behaviors Incidence and etiology

9. Copyright © 2016 Wolters Kluwer All Rights Reserved Types of Mental Disorders in Children and Adolescents (cont.) Disruptive, impulse-control, and conduct disorders (cont.) –Intermittent explosive disorder: angry, aggressive outbursts to minor situation (usually) with rapid onset, typically lasting ≤30 minutes Signs and symptoms o Impulsive, aggressive response significantly out of proportion to stressor o Chronic pattern; no warning period of behaviors Incidence and etiology

10. Copyright © 2016 Wolters Kluwer All Rights Reserved Types of Mental Disorders in Children and Adolescents (cont.) Disruptive, impulse-control, and conduct disorders (cont.) –Conduct disorder: repetitive + continuous behavior which infringes on basic rights of others, defies societal rules/norms Signs and symptoms: aggressive actions which result in/threaten harm to others or animals o Initiate hostile, bullying behavior; assaultive o Commonplace to lie, manipulate others Incidence and etiology

11. Copyright © 2016 Wolters Kluwer All Rights Reserved Types of Mental Disorders in Children and Adolescents (cont.) Anxiety disorders –Separation anxiety disorder: excessive anxiety related to separation from home, attachment figures Signs and symptoms o Uncomfortable to the point of misery when separation occurs o Somatic complaints possible o Anxiety range: from uneasiness to panic + depression Incidence and etiology

12. Copyright © 2016 Wolters Kluwer All Rights Reserved Types of Mental Disorders in Children and Adolescents (cont.) Anxiety disorders –Tic disorder (Tourette’s): sudden, repetitive, arrhythmic, stereotyped motor movement or verbal speech; never symptom-free ≥3 months Signs and symptoms o Simple tics: eye blinking; nose wrinkling; neck, shoulder jerking; grimacing o Complex tics: hand gestures; facial contortions; jumping; retracing steps; hopping; posturing Incidence and etiology

13. Copyright © 2016 Wolters Kluwer All Rights Reserved Types of Mental Disorders in Children and Adolescents (cont.) Elimination disorders –Encopresis: repeated passage of feces into inappropriate places –Enuresis: repeated episodes of urine incontinence during day or night –Signs and symptoms Usually involuntary, may be intentional behavior –Incidence and etiology

14. Copyright © 2016 Wolters Kluwer All Rights Reserved Treatment of Child + Adolescent Disorders Neurodevelopmental disorders –Combined approach of therapies, behavior management interventions Learning and communication disorders –Mainstream education with added speech, language therapies Anxiety disorders –Cognitive-behavioral therapy, group therapy, antianxiety medication Elimination disorders –Rule out physical cause; behavioral approaches

15. Copyright © 2016 Wolters Kluwer All Rights Reserved Application of the Nursing Process Assessment –Assess all potentially contributing factors to child’s behavior –History of behaviors –Thorough medical and emotional assessment of child –The child’s ability to communicate and interact with family members

16. Copyright © 2016 Wolters Kluwer All Rights Reserved Application of the Nursing Process (cont.) Selected nursing diagnoses: diagnosis from data review Expected outcomes –Target realistic, measureable outcomes Interventions: cognitive-behavioral, safety/security-based –Include parents Evaluation –Criteria dependent upon problematic behavior being addressed

17. Copyright © 2016 Wolters Kluwer All Rights Reserved Question Which of the following is not a specific listing in the DSM-V? A.Dyslexia B.Conduct disorder C.Attention deficit/hyperactivity disorder D.Asperger’s syndrome

18. Copyright © 2016 Wolters Kluwer All Rights Reserved Answer D. Asperger’s syndrome Rationale: The DSM-V no longer includes Asperger’s syndrome, which is now included in the broader category of ASD.

19. Copyright © 2016 Wolters Kluwer All Rights Reserved Question Which of the following developmental disorders is characterized by an IQ of 70 or below? A.Intellectual developmental disability B.Autistic disorder C.Asperger’s syndrome D.Psychosis

20. Copyright © 2016 Wolters Kluwer All Rights Reserved Answer A. Intellectual developmental disability Rationale: According to the DSM-V, intellectual developmental disability is characterized by an intellectual functioning that is significantly below average (IQ of 70 or lower).

21. Copyright © 2016 Wolters Kluwer All Rights Reserved Question Stuttering is a characteristic of A.Attention deficit/hyperactivity disorder B.Developmental coordination disorder C.Speech sound disorder D.Separation anxiety disorder

22. Copyright © 2016 Wolters Kluwer All Rights Reserved Answer C. Speech sound disorder Rationale: Speech sound disorder is a failure to utilize sounds or articulate syllables intelligibly during speech. Stuttering (prolonged or repetitive sounds or syllables that include pauses and broken words) is a common characteristic of the disorder.