Chapter 30: Mental Health Disorders

Question 1

Psychiatric Disorders of Children

Answer 1

• Neurodevelopment disorders (intellectual disability, autism spectrum disorder, attention-deficit hyperactivity disorder, tic disorders)
• Separation anxiety disorder
• Obsessive-compulsive disorder
• Mood disorders
• Childhood schizophrenia
• Elimination disorders (enuresis, encopresis)

Question 2

Neurodevelopment Disorders

Answer 2

• Intellectual disability
• Autism spectrum disorders
• Attention-deficit hyperactivity disorder (ADHD)
• Tic disorders

Autistic children are are risk for violence… Some people may not know a person is autistic, and they may act violent towards them because of the way the autistic person acts

Tic is different from Tourette’s

Question 3

Tourette’s

Answer 3

Muscle movement with voice… as they are making the movement, also making noise

• Most severe Tic Disorder
• Onset about 7 years
• Multiple motor tics and one or more vocal tics can occurs simultaneously or at different times: symptoms must be present for 1 year or more

Question 4

Tic Disorder

Answer 4

ONLY MUSCLE… no sounds

-sudden, rapid, repetitive, stereotyped motor movements or vocalizations

Question 5

Dyslexia

Answer 5

• Reading Difficulty

- 20% of the general population

Question 6

Dyscalculia

Answer 6

• Difficulty in comprehending math

- 3-5% of the general population

Question 7

Dysgraphia

Answer 7

• Difficulty in hand writing and spelling

- 5-20% of the general population

Question 8

Stereotypic Movement Disorder or Tic Disorders

Answer 8

-Observe while focus intently on an activity: symptoms must be present for at least a year or more

Question 9

Intellectual Disability

Answer 9

Diagnostic Criteria:

• IQ of 70 or less
• Adaptive Behavior:
  
  • Conceptual skills
  • Social skills
  • Practical skills

Question 10

Autism Spectrum Disorder

Answer 10

• Persistent impairment in social communication and social interaction with others
• Children with ASD may or may not have intellectual disability, commonly show uneven pattern of intellectual strengths and weaknesses

Question 11

DSM-5 no longer considers autism disorder and Asperger syndrome as separate disorders

Answer 11

• Have many overlapping symptoms
• Difficult to differentiate from each other
• Both considered as ASD differentiated by language or intellectual impairment

Question 12

Usual characteristics of Autism

Answer 12

• Autistic people may have a lot of intellectual strength
• Autistic children may usually have problem with speech (Don’t talk on time, and no eye contact)
• They don’t know what boundaries are-or how to respect them

Question 13

Autism Spectrum Disorders (Constant patterns)

Answer 13

Restricted repetitive patterns of behavior
Severe verbal and nonverbal communication impairment
Stereotypic behavior**— flapping, rocking
Self-stimulating
Self-injurious
Severe and sustained impairment in social interaction
Social deficits

Question 14

Priority of Nursing Care for Children with autism

Answer 14

• Individualized treatment outcomes
• Ensuring physical safety
• Must consider child’s ability to communicate

-Consider child’s ability to complete basic functions such as ADLs, coping, social skills
(Treat the person individually)

Question 15

Attention-Deficit Hyperactivity Disorder (ADHD)

Answer 15

• Most commonly diagnosed disorder in school-aged children– ADHD
• Pattern of behaviors must be present in multiple settings before age 12– teacher is the first person to notice ADHD

(Before pt is diagnosed with ADHD need to hear it from multiple people/settings.. school, church, parents)

Question 16

Clinical Course of ADHD

Answer 16

• Persistent pattern of inattention, hyperactivity, and impulsiveness
• Difficult to focus on one activity
• Prone to impulsive, risk-taking behavior, fail to consider consequences of actions
• **Hyperactivity ** (Attentiveness)

-(They often gaze, and forget things, Chaos?)

Question 17

Etiology of ADHD

Answer 17

No single explanation; has multiple causes

Environment or genetic may cause greater risk for ADHD
(Discipline children before prescribing medication)

Question 18

Biologic theories of ADHD:

Answer 18

Genetics; neurobiologic dysfunction

Question 19

Psychosocial Theories of ADHD:

Answer 19

Family stress, marital discord, parental substance abuse, poverty, overcrowding, family dysfunction

Question 20

Nursing Interventions for ADHD

Physical Intervention

Answer 20

-Modifying nutrition
-Promoting sleep
(warm milk, cinnamon, eucalyptus oil help with sleep because ADHD patient will have trouble sleeping)

Question 21

Psychostimulants for ADHD:

Answer 21

• Methylphenidate, Amphetamine-dextroamphetamine (Adderal)– Increase risk for Abuse
• Atomoxetine (Strattera), Methylphenidate (Ritalin)- * Has potential for abuse*

Question 22

Nursing Interventions for ADHD

Psychosocial Interventions

Answer 22

• Behavioral programs with rewards for positive behavior
• Behavioral parent training
• Behavioral classroom management
• Behavioral peer interventions
• CBT: “stop, look, and listen”

Question 23

Separation Anxiety Disorder

Answer 23

• Fear and anxiety developmentally inappropriate
  
  • Worry about harm to or permanent loss of major attachment figure
  • School phobia as a common manifestation of anxiety
• Occurs at mean age of 7 years
• Common with other disorders: general anxiety disorder, social phobia, OCD, depression, conduct disorder(The silent twins movie)

(6-18 months it is normal for the child to cry when a parent leaves)
(By age 7 they shouldn’t be crying if mom isn’t around—anxiety bridge)

Question 24

Teamwork/Collaboration: Working Towards Recovery for ADHD

Answer 24

• Interdisciplinary approach needed
• Child and parent psychoeducation, school consultation, CBT, SSRIs

(SSRIs are the first line of drugs for anxiety)

Question 25

Enuresis

Answer 25

• Bedwetting 5 or older
• Most common in boys
• Etiology unknown
• Nursing Management
  - Limit fluid intake in the evening
  - Bell and pad

Question 26

Encopresis

Answer 26

• Fecal soiling of clothing; fecal deposition in inappropriate places in patients 4 or older
• More common in boys
• Nursing management
  - Education
  - Behavioral Interventions

Question 27

Oppositional Defiant Disorder (ODD)

Answer 27

• ODD usually starts before 8 years of age, but no later than by about 12 years of age.
• Children with ODD are disruptive, argumentative, hostile and disobedient
• Behavior is usually observed at home and is directed toward other known family members
• Children with ODD usually have social problems with peers and adults and impaired academic functioning

(May have a problem with IQ but not always)
(May have autism with ODD)
(Younger Version)

Question 28

Conduct Disorder (CD)

Answer 28

• Children with CD engage in antisocial behavior that violate rights of others and norms of society.
• The age of onset of a conduct disorder around11 yearsof age, but it can still develop in early adolescence.

(If ODD client doesn’t get better it then becomes CD)
(Psychological person: 18 years and older (older version)
(People usually meet them in middle or high school)

Question 29

4 Categories of CD

Answer 29

• Physical aggression to people or animal
• Destruction of property
• Deceitfulness, lying, or theft

Serious Violations of rules-running away, skipping school