Child and Adolescent Mental Health Flashcards
Why do some children get the same medication dosages or higher than adults?
Metabolism; children can metabolize things quickly leading to higher doses for desired effects.
Why is diagnosing children with BPD controversial?
Diagnoses can change as the frontal cortex continues to develop; somebody might be diagnosed as ADHD as a kid but as they get older, it may turn into BPD due to manic and depressive episodes.
Risk factors for child and adolescent mental health issues
- Bullying
- Physical/Sexual Abuse (i.e. trafficking)
- Neglect
- Witnessing Domestic Violence
- Being in foster care/DCS care (disruptive to child, will see how other kids use their tactics or manipulation, will learn how to get back into hospital)
- Family hx of mental health disorders (i.e. first degree relative with BPD)
- Parental divorce/death (hard for kids and adolescents, trauma, higher instances of mental health concerns)
- Multiple life changes (i.e. moving a lot - finding new friends constantly, injury or death to siblings, divorce, can depend on coping and resiliency mechanisms)
Admission Criteria for Children and Adolescents
- Ages 2 - 18
- Immediate danger to others or self (i.e. violent threats or actions
- Cannot contract for safety or maintain safety outside of the hospital/facility (no evidence contracts work; use safety planning or crisis hotline; help pt. develop a plan of what to do for what they can do in order to maintain safety)
- Need 24/7 care (i..e child was violent in group home, kicked out, and now has nowhere to go so they need to be admitted)
- Medically cleared (most places) (pt. has to be medically cleared before being admitted to inpatient psych unless it is something manageable like diabetes)
Common Disorder in Children and Adolescents
- Depression
- Anxiety
- Bipolar (CONTROVERSIAL DUE TO AGE)
- Oppositional Defiant Disorder (SUPER COMMON)
- Reactive Attachment Disorder
- Autism
- Conduct Disorder
- Attention Deficit/Hyperactivity Disorder
- Post Traumatic Stress Disorder
- Intermittent Explosive Disorder
What is Autism Spectrum Disorder?
A complex neurodevelopment disorder with a wide range of behaviors. ASD affects communication, social interactions, cognitive, and functional ability. ASD causes an inability to regulate mood.
Manifestations of Autism Spectrum Disorder
- Inability to maintain eye contact (avoid eye contact to avoid uncomforting feelings)
- Repetitive actions (coping mechanism; inducing stimulation)
- Strict observations of routines (structured day with schedule; communicate when things are expected to happen; try to keep things at the same time each day; communicate if any delays occur)
- Solo play (might not do well with busy group activities because noise can be overstimulating)
- Matter of fact thinking (can be difficult to practice nuances; seeing things from someone else’s perspective and sarcasm can be difficult (anything that requires abstract thought))
- Poor ADL functioning (some)
Nursing Interventions for Autism
- Maintain a routine like what they do at home (i.e. Familiar toys; Fidget spinners, things that help with stimuli !Cautious if they can harm themselves or others, choking hazard!)
- Remove overwhelming stimuli
- Do not look patient directly in the eye
- Do as many of your tasks at once (i.e. Limiting stimulation; Procedures, meds, vitals can be uncomfortable but if you can limit prolonged disruption, the better the patient will be)
- Encourage and reward positive social skills (i.e. Can provide incentives for getting along
- Encourage communication (i.e. Be patient, allow patients to speak, do your best to understand; We do not want people to shut down)
- Determine triggers and attempt to prevent them (If their parent or caregiver can let you know of any triggers, we can attempt to eliminate them from the environment if possible)
- Try to limit environmental stimuli
- Keep sudden changes to a minimum
What is Conduct Disorder?
Persistent pattern of behavior that violates the rights of others or rules and norms of society.
Examples: aggression, destruction of property, deceitfulness or theft, serious violations of rules
Manifestations of Conduct Disorder
- Lack of remorse or care for others (i.e. normally a child will feel bad)
- Bullies, threatens, intimidates others
- Low self-esteem, irritability, temper outbursts, reckless behavior
- Physical cruelty to others/animals
- Has used weapons
- Destroys property
- Runs away from home
- Lies, shoplifts
Contributing Factors of Conduct Disorder
- Parental rejection and neglect
- Difficult infant temperament
- Inconsistent child - rearing practices with harsh discipline
- Physical or sexual abuse
- Lack of supervision
- Early institutionalization
- Frequent changing of caregivers (i.e. parents > grandparents > aunts and uncles > foster families; makes it hard for them to be trusting or feel comfortable with someone)
- Large family size (less attention gets paid to each kid)
- Association with bad peer groups (may try to show off to others)
- Parents with a hx of psychological illness (i.e. parents who may be schizophrenic, substance abuse disorder, bipolar, etc.)
- Chaotic home life (i.e. lack of supervision)
- Lack of male role model (boys do not see a male role model containing their temper or behaving appropriately)
What is Disruptive Mood Dysregulation Disorder?
Recurrent temper outbursts that are severe and do not correlate with a situation
Manifestations of Disruptive Mood Dysregulation Disorder
- Verbal outburst
- Cursing, screaming, name calling
- Physical outburst
- Hitting, kicking, throwing things
- Inappropriate for developmental level (i.e. temper tantrums in older children)
- Occurs in most situations (i.e. not differentiated when they’re at home or at school; remains the same)
- Mood is generally irritable and angry
Nursing Interventions for DMDD, Impulse Control, Conduct Disorder, and ADHD
- Calm, firm, and respectful approach
- Model acceptable behaviors (i.e. should not be sharing inappropriate jokes; not flirting with staff or each other)
- Maintain child’s attention before giving directions
- Short and clear expectations
- Set clear limits on unacceptable behaviors; be consistent
- Utilize physical activity to use energy
- Develop a reward system
- Provide a safe environment
- Develop coping skills (i.e. notice any feelings they may be having)
Safety Concerns for a Danger to Others (DTO)
- Hitting, kicking, biting, spitting
- Verbally aggressive towards staff or patients
- Throwing items in the environment
- Threatening to harm or kill staff or patients
