1. Mental Health Nursing IINURS 2310 Unit 11 Psychiatric Conditions Affecting Children and Adolescents

2. Objective 1 Identifying etiology and characteristics of specified childhood/adolescent psychiatric illnesses

3. Disorders Affecting Children/Adolescents ____________________________________ Intellectual Developmental Disorder Autism Spectrum Disorder Attention-Deficit/Hyperactivity Disorder Oppositional Defiant Disorder Conduct Disorder Tourette’s Disorder Separation Anxiety Disorder

4. Intellectual Developmental Disorder • Involves deficits in general intellectual functioning and adaptive functioning • General intellectual functioning = measured by an individual’s performance on IQ tests • Adaptive functioning = refers to the person’s ability to adapt to the requirements of daily living and the expectations of age and cultural group • IQ is 70 or below • Deficits/impairment in communication, self-care, self-direction, leisure, and safety

5. Intellectual Developmental Disorder (cont’d) • Predisposing factors: • Hereditary • Approximately 5% of cases • Down’s syndrome, Tay-Sachs disease • Early alterations in embryonic development • Drug/alcohol toxicity • Maternal illnesses/infections • Pregnancy and prenatal problems • Birth injuries • General medical conditions acquired in infancy or early childhood • Environmental influences and other mental disorders

6. Autism Spectrum Disorder • Characterized by a withdrawal into the self and into a fantasy world of one’s own creation • Development in social interaction and communication is markedly abnormal or impaired • Activities and interests are restricted; may be considered bizarre • Prevalence of approximately 1 in 150 children in the U.S. • Onset occurs before age 3

7. Attention-Deficit/Hyperactivity Disorder (ADHD) • Persistent pattern of inattention and/or hyperactivity-impulsitivity that is more frequent and severe than is typically observed in individuals at same developmental level • Hyperactivity = excessive psychomotor activity that may be purposeful or aimless, accompanied by physical movements that are usually more rapid than normal • Impulsitivity = acting without reflection and without thought to the consequences

8. ADHD (cont’d) • Onset of disorder difficult to diagnose in children younger than age 4 • ADHD often not recognized until child enters school • Five to nine times more common in boys than in girls • Believed to have strong genetic component • Parent with ADHD may have child with ADHD • Sibling string • Possible link to high serum lead levels

9. Oppositional Defiant Disorder (ODD) • Characterized by a pattern of negativistic, defiant, disobedient, and hostile behavior toward authority figures that occurs more frequently than is usually observed in individuals of same age/developmental level • Typically begins by age 8, and usually not later than early adolescence • May precede a conduct disorder • “Normal” oppositional phases occur in older infancy, toddlerhood, and adolescence

10. Conduct Disorder • Repetitive and persistent pattern of behavior in which basic rights of others or major age-appropriate societal norms or rules are violated • Physical aggression common • Childhood-onset = begins prior to age 10; more likely to have continued problems during adolescence, and antisocial as adult • Adolescent-onset = absence of any criteria characteristic of conduct disorder before age 10

11. Tourette’s Disorder • Presence of multiple motor tics along with one or more vocal tics • Tics may appear simultaneously or at different periods during the illness • Causes marked distress or interferes with various areas of functioning • Onset occurs before the age of 18 • Characterized by periods of remission • Symptoms usually diminish during adolescence and adulthood

12. Separation Anxiety Disorder • Involves excessive anxiety concerning separation from the home or from those to whom the person is attached • Considered in excess of what would be expected for developmental level • Interferes with social, academic, and occupational levels of functioning • More common in girls than in boys • Etiological factors may include stressful life events and/or family influences

13. Objective 2 Examining medical treatments and nursing interventions for clients experiencing a childhood/adolescent psychiatric disorder

14. Behavior Therapy • Classical conditioning, operant conditioning • Useful for disruptive behavior disorders • Family Therapy • Family Education • Behavior modification techniques • Consistency • Group Therapy • Opportunity to interact with peers • Learning of appropriate social behaviors • Psychopharmacology

15. Objective 3 Exploring concerns associated with providing psychiatric care to children and adolescents

16. Medication issues • Dosing problems • Addiction • Legal issues • Guardianship concerns • Safety • Developmental issues • Appropriateness of behaviors compared to norms of life stage • Parental/caregiver issues • Manipulation of health care system • Knowledge deficits

17. Objective 4 Applying the nursing process to the treatment of special populations

18. Assessment • Nursing Diagnosis • Planning • Implementation • Evaluation