Chapter 30: Mental Health Disorders Flashcards
Psychiatric Disorders of Children
- 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)
Neurodevelopment Disorders
- 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
Tourette’s
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
Tic Disorder
ONLY MUSCLE… no sounds
-sudden, rapid, repetitive, stereotyped motor movements or vocalizations
Dyslexia
- Reading Difficulty
- 20% of the general population
Dyscalculia
- Difficulty in comprehending math
- 3-5% of the general population
Dysgraphia
- Difficulty in hand writing and spelling
- 5-20% of the general population
Stereotypic Movement Disorder or Tic Disorders
-Observe while focus intently on an activity: symptoms must be present for at least a year or more
Intellectual Disability
Diagnostic Criteria:
- IQ of 70 or less
- Adaptive Behavior:
- Conceptual skills
- Social skills
- Practical skills
Autism Spectrum Disorder
- 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
DSM-5 no longer considers autism disorder and Asperger syndrome as separate disorders
- Have many overlapping symptoms
- Difficult to differentiate from each other
- Both considered as ASD differentiated by language or intellectual impairment
Usual characteristics of Autism
- 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
Autism Spectrum Disorders (Constant patterns)
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
Priority of Nursing Care for Children with autism
- 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)
Attention-Deficit Hyperactivity Disorder (ADHD)
- 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)
Clinical Course of ADHD
- 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?)
Etiology of ADHD
No single explanation; has multiple causes
Environment or genetic may cause greater risk for ADHD
(Discipline children before prescribing medication)
Biologic theories of ADHD:
Genetics; neurobiologic dysfunction
Psychosocial Theories of ADHD:
Family stress, marital discord, parental substance abuse, poverty, overcrowding, family dysfunction
Nursing Interventions for ADHD
Physical Intervention
-Modifying nutrition
-Promoting sleep
(warm milk, cinnamon, eucalyptus oil help with sleep because ADHD patient will have trouble sleeping)
Psychostimulants for ADHD:
- Methylphenidate, Amphetamine-dextroamphetamine (Adderal)– Increase risk for Abuse
- Atomoxetine (Strattera), Methylphenidate (Ritalin)- * Has potential for abuse*
Nursing Interventions for ADHD
Psychosocial Interventions
- Behavioral programs with rewards for positive behavior
- Behavioral parent training
- Behavioral classroom management
- Behavioral peer interventions
- CBT: “stop, look, and listen”
Separation Anxiety Disorder
- 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)
Teamwork/Collaboration: Working Towards Recovery for ADHD
- Interdisciplinary approach needed
- Child and parent psychoeducation, school consultation, CBT, SSRIs
(SSRIs are the first line of drugs for anxiety)
Enuresis
- Bedwetting 5 or older
- Most common in boys
- Etiology unknown
- Nursing Management
- Limit fluid intake in the evening
- Bell and pad
Encopresis
- Fecal soiling of clothing; fecal deposition in inappropriate places in patients 4 or older
- More common in boys
- Nursing management
- Education
- Behavioral Interventions
Oppositional Defiant Disorder (ODD)
- 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)
Conduct Disorder (CD)
- 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)
4 Categories of CD
- Physical aggression to people or animal
- Destruction of property
- Deceitfulness, lying, or theft
Serious Violations of rules-running away, skipping school
