12.4 Tourette, Oppositional Defiance, Conduct disorder, Separation Anxiety

Question 1

Tourette Disorder

Answer 1

• Presence of multiple motor tics and one or more vocal tics.
• Commonly seen in childhood

Motor Tic
- Most commonly eye blinking but can also be neck jerking, shoulder shrugging, facial grimace
- Tics start out in the face and neck then progress downward towards torso and limbs over time.

Vocal Tic
- Various sounds such as squeaks, grunts, barks, snorts, coughs

Palilalia - Repeating one’s own words
Echolalia - Repeating what others say

• Tics can be suppressed until they cannot hold it in any longer. Worse during stress and better when relaxed.

Care
- Focused on risk for violence, impaired social interaction, and low self-esteem.
- Monitor self destructive behavior

Medications
- Most effective if combined with other therapy such as behavioral therapy.
- Medications include antipsychotics and alpha agonist (Haldol, Pimozide) (Clonidine, Guanfacine)

Question 2

Oppositional Defiant Disorder (ODD)

Answer 2

• Persistent pattern of angry mood and defiant behavior that occurs more frequently than other comparable age group children.
• Onset usually before adolescents.

Characteristics
- Stubborn
- Procrastinates
- Disobedient
- Careless
- Negative
- Tests limits
- Resists Directions
- Temper Tantrums
- Argumentative
- Usually believe the problem is others and not themselves. School performance is usually poor due to resistance to external demands.

Diagnosis
- Noncompliance with therapy
- Defensive coping
- Impaired social interaction

Goals
- Takes direction from staff without being defensive
- Complies with treatment
- They should complete tasks willingly

Interventions
- Structured plan for therapeutic activities
- Provide immediate positive feedback

Question 3

Conduct Disorder

Answer 3

• Repetitive and persistent pattern of behavior in which basic rights of others or societal norms are violated.
• Usually uses physical aggression in violating others rights.
• May steal or lie. Children lack guilt
• May act like a “tough guy” due to low self esteem.

Nursing Diagnosis
- Risk for injury to others.
- Defensive coping

Goal
- Prevent patient from harming others. Increase self worth.
- Redirect violent behavior with physical outlets.

• Precursor to anti-social disorder

Question 4

Separation Anxiety Disorder

Answer 4

• Excessive fear/anxiety of separation from those who the individual is attached to.
• Anticipation of separation can result in tantrums, crying, screaming.
• Children may refuse to go to school.
• RELATIONSHIPS ARE USUALLY NOT A PROBLEM WITH THIS DISORDER

Diagnosis
- Anxiety
- Ineffective Coping
- Impaired Social Interactions

Goals
- Maintain anxiety and a manageable level and adaptive coping strategies.