Copyright 2011 Wolters Kluwer Health Lippincott Williams Wilkins

Chapter 18 Disorders and Issues of Children and Adolescents Copyright © 2011 Wolters Kluwer

Etiologic Factors • Genetic – Family history of mental issues • Environmental – Neighborhood,

Developmental Disorders • Child demonstrates symptoms of deficit before the age 18 years •

Types of Developmental Disorders • Mental retardation • Autistic disorder (pervasive) • Asperger’s syndrome

Mental Retardation • Intellectual functioning significantly below average • IQ 70 or below •

Autistic Disorder • Severe impaired ability to socially interact and communicate with the outside

Asperger’s Syndrome • Difficulty with social interaction and communication • Preoccupation with a particular

Developmental Coordination Disorder • Significant impairment in development of motor coordination • Clumsiness in

Case Application 18. 1 • “From Martina’s World” • Page 280 Copyright © 2011

Psychosis • Not specifically a childhood disorder but sometimes confused with autistic disorders •

Types of Learning and Communication Disorders • Dyslexia • Expressive language disorder • Phonologic

Dyslexia • Deficit in reading/written expression • Normal to above average intelligence – May

Expressive Language Disorder • Impairment in both verbal and sign language as evidenced by

Phonologic Disorder • Failure to utilize sounds or articulate syllables intelligibly during speech •

Types of Behavior Disorders • Attention deficit/hyperactivity disorder • Conduct disorder • Oppositional-defiant disorder

Attention-Deficit/Hyperactivity Disorder (ADHD) • Pattern of inattention, hyperactivity, or impulsive behavior • Disruptive, inability

Conduct Disorder • Pattern of repetitive and continuous behavior that either infringes on the

Oppositional-Defiant Disorder • Repetitive behavior of negative, defiant, disobedient, hostility toward authority figures •

Anxiety Disorders • Separation anxiety disorder • Tic disorders (Tourette’s disorder) Copyright © 2011

Separation Anxiety Disorder • Severe anxiety when separated from love attachment figure • Worry

Tic Disorders (Tourette’s Disorder) • Sudden, repetitive, arrhythmic, stereotyped motor movement or speech that

Elimination Disorders • Encopresis – Repeated episodes of fecal passage in inappropriate places –

Treatment of Mental Disorders in Children and Adolescents • Pervasive developmental disorders combined approach

Nursing Process Applied • Assessment Pg. 290 – Time when problematic behaviors began –

Nursing Process Applied (cont. ) • Selected nursing diagnoses Page 291 – Risk for

Nursing Process Applied (cont. ) • Expected outcomes may include Page 291 – Initiates

Nursing Process Applied (cont. ) • Interventions may include Page 291 -292 – Maintain

Nursing Process Applied (cont. ) • Evaluation Page 292 – Increased ability to interact

Question • An preoccupation with and expertise about a particular topic is associated with

Answer • D. Asperger’s syndrome • Rationale: Children with Asperger’s syndrome tend to have

Question • Which of the following developmental disorders is characterized by an IQ of

Answer • A. Mental retardation • Rationale: According to the DSM-IV-TR, mental retardation is

Question • Stuttering is a characteristic of A. Attention deficit/hyperactivity disorder B. Developmental coordination

Answer • C. Phonologic disorder • Rationale: Phonologic disorder is a failure to utilize

Slides: 35

Download presentation

Etiologic Factors • Genetic – Family history of mental issues • Environmental – Neighborhood, family income, family educational level • Parental divorce • Combined factors Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

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 Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Types of Developmental Disorders • Mental retardation • Autistic disorder (pervasive) • Asperger’s syndrome (pervasive) • Psychosis (pervasive) Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

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 Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

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 Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

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=WAf. Wfsop 1 e 0 Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

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 Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

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 18. 4 Page 281 Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Box

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 4 th grade or later • More common in boys Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

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 Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

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 Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

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 Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

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 Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

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 Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

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 Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

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 Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

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 for 3 months during day or night to be dx Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

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 Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

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 Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

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 Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

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 Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

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 Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

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 Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

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 Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

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. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

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 Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

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). Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Question • Stuttering is a characteristic of A. Attention deficit/hyperactivity disorder B. Developmental coordination disorder C. Phonologic disorder D. Separation anxiety disorder Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

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. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins