CHAPTER 19 CHILDHOOD AND ADOLESCENT MENTAL HEALTH ISSUES

1. CHAPTER 19 CHILDHOOD AND ADOLESCENT MENTAL HEALTH ISSUES

2. Objectives • Discuss disorders affecting a patient’s mental/emotional health. • Define ADHD. • Explain the signs and symptoms of ADHD. • Describe the occurrence of ADHD across the life span. • Describe how ADHD is diagnosed and treated. • Describe how the IDEA Act helps people with ADHD. • Describe the classification of medications used to treat ADHD?

3. Objectives cont… • Define Autism Spectrum Disorder. • What are the symptoms of ASD? • Explain the impact on the family. • Describe how the IDEA Act helps people with ASD? • List treatments and services to help the person with ASD. • Describe self-injurious behavior. • List the signs a nurse will recognize as SIB. • Describe the risk factors for self injury. • Describe the treatments for SIB.

4. Objectives cont… • Define the criteria for diagnosis of conduct disorder according to the DSM5. • Describe the onset and which gender predominates. • Explain what other mental illnesses may be associated with CD. • List causes and/or contributing factors to conduct disorder. • Describe the treatments for conduct disorder.

5. Risk for Mental Health Problems • Many children are dealing with anxieties that were unknown in previous generations which contribute to a variety of disorders • 13% of children ages 8 to 15 had a diagnosable mental disorder within the previous year • Family dynamics as well as genetics play an important role

6. Attention Deficit/Hyperactivity Disorder (ADHD) • Most common childhood mental health disorder • Impact often continues into adulthood • Characterized by a variety of age-inappropriate behaviors • Can be inattentive and/or hyperactivity/impulsivity types • Other behaviors exhibited • Inability to focus on task • Underachievement (academic, social, etc.) • Hyperactivity, noncompliance (with rules, regulations, norms, etc.) • Impulsive actions • Poor self-concept, both leading into the disorder and after exhibiting the inappropriate behavior • The diagnosis is generally made before age 12 and must be exhibited in multiple locations (e.g., the child may display the impulsiveness at home and in church, at school, or in a shopping mall)

7. Medical Treatment for ADHD • Pharmacological treatment includes use of psychostimulants, which have a calming effect on ADHD sufferers • Examples include: Methylphenidate (Ritalin) and Dextroamphetamine/amphetamine (Adderall) • Individual and family therapy, as well as family education, need to be part of treatment

8. Clicker Question 2. Which of these behaviors in most common in ADHD? A. Panic and anxiety B. Inattention and hyperactivity C. Recurrent and persistent bizarre thoughts D. Physical aggression

9. Answer Correct answer: B Rationale: Inattention and hyperactivity are the two categories of ADHD.

10. Conduct Disorder • Long-term (chronic) behavior problems associated with physical aggression, defiance, rule breaking, and disturbed peer relationships • Persistent pattern of violating rights of others, breaking rules • Underlying cause of the anger is hidden • Seems to affect males two to three times more frequently than females • Begins in childhood or adolescence

11. Conduct Disorder Treatment • Rule out other possible causes • Individual and family therapy • Parent management training

12. Autism • Now called Autism Spectrum Disorder with gradient of mild to severe • Considered the most difficult to treat and least likely to be reversed • Incidence of autism is on the rise • Affects males three to four times more frequently than females • At this time, it is not curable • Children with autism are considered disabled for life • Should not be confused or misdiagnosed as schizophrenia, although some behaviors may be similar • May demonstrate failure to achieve developmental milestones • Most common symptom is impaired social interaction • Etiology is still unknown

13. Common Symptoms of Autism • No response to their name by 12 months • Avoiding eye contact and wanting to be alone • Having trouble understanding other people's feelings or talking about their own • Delayed speech and language skills • Unusual reactions to the way things sound, smell, taste, look, or feel and/or appear to be in their own world

14. Medical Treatment of Autism • Early diagnosis to begin intervention services early to help children from birth to 3 years old learn important skills and enhance development by taking advantage of the brain’s ability to adapt • Family education and counseling • Speech, occupational, and physical therapies • Supportive environment in home and school • The FDA has approved the use of risperidone (Risperdal) and aripiprazole (Abilify) when aggressiveness or self-injury is present

15. Self Injurious Behavior (SIB) • The act of deliberately harming your own body. • It is not usually a form of suicide, although fatalities have occurred. • It is an unhealthy way to cope with emotional pain, anger and frustration.

16. SIB • Signs/Symptoms: • Scars from burns or cuts • Fresh wounds • Keeping sharp objects close by • Hiding scars and wounds • Spending a lot of time alone • Persistent problems with relationships • Impulsivity • Emotional Instability • Statements of helplessness, hopelessness

17. SIB • Why? • To reduce intense stress or anxiety • To provide a distraction from the emotional pain • To feel a sense of control • To feel something, anything when emotionally empty. • To express internal feelings in an external way. • To communicate distress. • To be punished for perceived faults.

18. SIB • Risk Factors: • Female gender • Age • Having friends who self injure. • Emotional trauma • Mental health conditions • Substance Abuse

19. SIB • Complications: • Worsening feelings of shame, guilt and self-esteem • Infection • Blood Loss • Scarring • Increased suicide risk

20. SIB • Treatments: • Psychotherapy • CBT • DBT • Mindfulness-based therapies Treat underlying mental health conditions with medications

21. Medical Treatment for Children and Adolescents With Mental Health Issues • Children and adolescents who have a real or perceived threat to their mental health will react to that threat in different ways • Medical providers must do a comprehensive examination and evaluation of the individual • Medications or therapy will be ordered on an individual, as-needed basis • Listen to the child/adolescent and take his/her concerns seriously

22. Alternative Treatment for Children and Adolescents With Mental Health Disorders • Children benefit from alternative therapies, as do adults • Herbal preparations and nutritional supplements assure adequate nutrition to support normal growth and development • Aromatherapy • Play therapy • Massage • Neurolinguistic programming • Biofeedback (when age-appropriate)

23. Nursing Care for Children and Adolescents With Mental Health Issues • Provide safetyin the examination area, the hospital room, and the school • Communicate effectively • Honest, age-appropriate communication is essential • Listen to and then do something • If the child or adolescent believes someone took what he or she said seriously and attempted to address that concern, chances for continued meaningful communication are greatly improved • Maintain agency policies regarding apparel, items allowed onsite, etc. • Monitor and teach child and family regarding medications • Model, educate, support parents on behavioral management • Other interventions that may be specific to the situation