Download PN Mental Health Chapter 18

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Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Chapter 18Disorders and
Issues of
Children and Adolescents
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Etiologic Factors
• Genetic
– Family history of mental issues
• Environmental
– Neighborhood, family income, family educational
level
• Parental divorce
• Combined factors
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Developmental Disorders
• Child demonstrates symptoms of deficit before the age
18 years
• Characterized by performance testing of mentality, skills,
coordination, or activity that is substantially below that
anticipated for the child’s chronological age and
education level
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Types of Developmental Disorders
• Mental retardation
• Autistic disorder (pervasive)
• Asperger’s syndrome (pervasive)
• Psychosis (pervasive)
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Mental Retardation
• Intellectual functioning significantly below average
• IQ 70 or below
• Mild to profound
• Many behavior problems result from frustration with
communication limitations
• Signs and Symptoms Box 18.1 Page 279
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Autistic Disorder
• Severe impaired ability to socially interact and
communicate with the outside world
• Symptoms usually appear before 3 years of age
• Withdrawn, fantasy world – little interaction with
environment
• Deficient nonverbal behaviors (eye contact, facial exp)
• May demonstrate unusual or exaggerated responses to
sensory stimuli
• Inflexible and consistent routine of rituals
• Signs and Symptoms Box 18.2 Page 280
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Asperger’s Syndrome
• Difficulty with social interaction and communication
• Preoccupation with a particular subject (high level of expertise)
and avoid other activities
• Average or above average intelligence
• Develop normally in the areas of thinking and learning
language skills
• Speech is often centered around random factual information
• Poor social skills and limited interests
– Risk for isolation
• More common in boys; 2:10,000 children
• http://www.youtube.com/watch?v=WAfWfsop1e0
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Developmental Coordination Disorder
• Significant impairment in development of motor
coordination
• Clumsiness in motor activities
• Delays in developmental milestones  crawling, walking,
dressing
• May exhibit delays in other developmental areas, such as
language skills
• 6% of children 5-11; more common in boys
• Can lead to suicidal tendencies, substance use, etc.
• Signs and Symptoms of DCD Box 18.3 Page 281
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Case Application 18.1
• “From Martina’s World”
• Page 280
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Psychosis
• Not specifically a childhood disorder but sometimes
confused with autistic disorders
• Hallucinations, delusions, flat affect, disorganized speech,
stereotypical behaviors
• Poor development of intellectual, motor, emotional, and
social skills
• Unable to differentiate real and unreal
• Disturbed interpersonal relationships
• Signs and Symptoms of Psychosis in Children
Box 18.4 Page 281
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Types of Learning and Communication
Disorders
• Dyslexia
• Expressive language disorder
• Phonologic disorder
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Dyslexia
• Deficit in reading/written expression
• Normal to above average intelligence
– May be behind in the level of reading expected for their
grade level
• Inability to process incoming sensory stimuli with correct
interpretation
• Often letter confusion, letter reversal
• Signs & Symptoms of Dyslexia Box 18.5 Page 282
• Often undiagnosed until 4th grade or later
• More common in boys
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Expressive Language Disorder
• Impairment in both verbal and sign language as
evidenced by standardized testing
• Limited speech and vocabulary
• Difficulty learning new words or grammar
• Decreased ability to process incoming information
• Signs and Smptoms of Expressive Language
Disorder Box 18.2 Page 283
• Often younger than 3 when diagnosed
• 10-15% of children; more common in boys
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Phonologic Disorder
• Failure to utilize sounds or articulate syllables intelligibly during
speech
• Often a hearing impairment contributes to the speech problem
• Stuttering
• Increased anxiety often initiates the problem
– Leads to frustration and low self-esteem
• Signs and Symptoms of Phonologic Disorder Box 18.7
Page 283
• Typically seen between 2-7 years; less than 2% of children;
more common in boys
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Types of Behavior Disorders
• Attention deficit/hyperactivity disorder
• Conduct disorder
• Oppositional-defiant disorder
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Attention-Deficit/Hyperactivity Disorder
(ADHD)
• Pattern of inattention, hyperactivity, or impulsive
behavior
• Disruptive, inability to maintain focus
• Easily distracted
• 3 types
– Predominantly inattentive type
S/S of ADHD
Box 18.8
Page 284
• Attention Deficit Disorder
– Predominantly hyperactive-impulsive type
• Restless, fidgety, talks incessantly, inappropriate
– Combination
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Conduct Disorder
• Pattern of repetitive and continuous behavior that either
infringes on the basic rights of others or defies the rules
of society that would be appropriate for the child’s age
• Disruptive, destructive behavior
• Willful defiance, aggression, truancy, cruelty to animals
• Behaviors differ in several settings
• Signs and Symptoms of Conduct Disorder Box 18.9
Page 285
• Higher incidence in cities than rural areas
• Onset can occur before 10 or during adolescence
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Oppositional-Defiant Disorder
• Repetitive behavior of negative, defiant, disobedient, hostility
toward authority figures
• Argue incessantly without compromise
• Blame others for own behavior
• Defiant refusal to obey rules or laws
• Vindictive, spiteful, and resentful
• Suspension and expulsion from school
• Predisposing Factors: rejection, neglect, abuse
• Signs and Symptoms of Oppositional-Defiant Disorder
Box 18.11 Page 286
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Anxiety Disorders
• Separation anxiety disorder
• Tic disorders (Tourette’s disorder)
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Separation Anxiety Disorder
• Severe anxiety when separated from love attachment figure
• Worry about harm to self/parent
• Fear of sleep without attachment person present
• Attention-demanding behavior
• Must occur before the age 18 and cause significant distress or
impairment in functioning for a period of at least 1 month
• C/O Somatic symptoms (Abd pain, N/V, H/As)
• Signs and Symptoms of Seperation Anxiety Disorder Box
18.12 Page 288
• Tx: reduce anxiety and reinforce a sense of security
• 4% of children – symptoms decrease during adolescence
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Tic Disorders (Tourette’s Disorder)
• Sudden, repetitive, arrhythmic, stereotyped motor
movement or speech that occurs before the age 18
• Never a symptom free period of more than 3 months
• Copropraxia/echopraxia (tic/repetitive movement)
• A person with tic has irresistible urge to perform tic and
feels relief once the behavior has occurred
• Incidence may increase during periods of stress of
demanding and competitive activities
• Signs and Symptoms of Tic Disorders Box 18.13
Page 288
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Elimination Disorders
• Encopresis
– Repeated episodes of fecal passage in inappropriate places
– Must be 4 or have attained defection control
– Must occur at least 1/month for 3 months to be dx
• Enuresis
– Repeated episodes of urine incontinence during day or
night
– Must be 5 or have urinary control
– Must occur 2/week for3 months during day or night to be
dx
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Treatment of Mental Disorders in Children
and Adolescents
• Pervasive developmental disorderscombined approach
of therapies and behavior management interventions
• Learning and communication disordersmainstream
education
• Behavior disorderscombination of medication and
behavior therapy
• Anxiety disordersmedication, cognitive-behavioral
therapy, group therapy
• Elimination disordersmost children outgrow problem,
some behavior approaches can be used
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Nursing Process Applied
• Assessment
Pg. 290
– Time when problematic behaviors began
– Significant occurrences
– Thorough medical and emotional assessment
– The child’s ability to communicate and interact
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Nursing Process Applied (cont.)
• Selected nursing diagnoses
Page 291
– Risk for injury, related to physical mobility or
aggressive behavior
– Impaired verbal communication, related to verbal
expression
– Impaired social interaction, related to inappropriate
behaviors and decreased self-esteem
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Nursing Process Applied (cont.)
• Expected outcomes may include
Page 291
– Initiates appropriate interactions with peers
– Remains free of self-harm and does not harm others
– Demonstrates increased autonomy
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Nursing Process Applied (cont.)
• Interventions may include
Page 291-292
– Maintain a safe physical environment
– Provide encouragement toward independent self-care
– Establish a trusting relationship
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Nursing Process Applied (cont.)
• Evaluation
Page 292
– Increased ability to interact and communicate with
others
– Progress in ability to trust others and initiate social
contact with another person
– Ability to control negative and self-harming behaviors
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Question
• An preoccupation with and expertise about a particular
topic is associated with which of the following disorders?
A. Dyslexia
B. Developmental coordination disorder
C. Attention deficit/hyperactivity disorder
D. Asperger’s syndrome
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Answer
• D. Asperger’s syndrome
• Rationale: Children with Asperger’s syndrome tend to
have a preoccupation with a particular subject and avoid
other activities. Children with this condition have average
to above average intelligence.
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Question
• Which of the following developmental disorders is
characterized by an IQ of 70 or below?
A. Mental retardation
B. Autistic disorder
C. Asperger’s syndrome
D. Psychosis
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Answer
• A. Mental retardation
• Rationale: According to the DSM-IV-TR, mental
retardation is characterized by an intellectual
functioning that is significantly below average (IQ of 70
or lower).
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Question
• Stuttering is a characteristic of
A. Attention deficit/hyperactivity disorder
B. Developmental coordination disorder
C. Phonologic disorder
D. Separation anxiety disorder
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Answer
• C. Phonologic disorder
• Rationale: Phonologic 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.
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