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Disorders of Infancy, Childhood, and Adolescence

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Steve Lewis

on 13 March 2012

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Transcript of Disorders of Infancy, Childhood, and Adolescence

Childhood
Mental Health
Disorders Pervasive Development Disorders
Abnormalities of eating/sleeping

Stereotyped behaviors

Preoccupied with rituals/sameness

Lack of emotional reciprocity

Self injurious behaviors/variation in pain threshold

Intellectual limitations

Absent/poor language skills

Perceptual problems

Limited social skills

example: Temple grandin Autism Sustained social impairment

Restricted repetitive behaviors

No delays in development of language, cognitive skills

No clinically significant delays in age-appropriate self-help skills, adaptive behavior, or curiosity Attention-Deficit/
Hyperactivity Disorder (ADHD) Psychosocial, genetic, and neurochemical factors Motor hyperactivity (fidgets, runs about, leaves seat, talks excessively) Inattention (careless mistakes in schoolwork, difficulty sustaining attention in tasks or play, easily distracted) Impulsivity: blurts out answers, intrusive to others' conversations, frequent interruptions lead to academic problems Accident prone (often due to risk-taking) Mood lability: temper outbursts, bossiness, excessive demands Low self-esteem Learning Disorder: 10%-20% of children with ADHD (academic achievement not correlated with level of intelligence) Asperger's Disorder Learning Behavior Communication Separation Anxiety Disorder Clinically significant impairment in social, academic, or occupational functioning Excessive anxiety or distress r/t losing attachment figure Persistent refusal to go to school, due to fear of separation Nightmares (theme of separation) Tourette's Disorder Tic: Sudden rapid, recurrent, nonrhythmic, stereotyped motor movement or vocalization Simple motor tics
Complex motor tics
Simple vocal tics
Complex vocal tics Key Signs and Symptoms: self-consciousness; shame; rejection adversely impacts social, occupational, and academic functioning Story of David Conduct Disorder Repetitive, persistent pattern of violating rights of others (bully, threaten, intimidate, fight, act cruelly, force sex)

High-risk behaviors

Little empathy

Low stress tolerance and inadequate coping skills

Learning impairments

Parental rejection and neglect, physical or sexual abuse, early institutional living, bio/adoptive parent with Antisocial Personality Disorder Other problems
affecting children
and adolescents Suicide
Youth violence
Substance abuse
Depression
Bipolar disorder
Schizophrenia
Anxiety disorders Assessment Developmental stage Family psychopathology Identified client is child plus caregivers Physical assessment and mental status exam (thorough alcohol and drug history) Nursing diagnosis LOOK CAREFULLY AT: Safety issues Communication Relationships Family issues OUTCOME IDENTIFICATION FOCI: OUTCOME IDENTIFICATION Promotion of normal growth and development

Improving dysfunction

Specific, measurable, time-limited

Outcomes: safety, social interaction skills, self-esteem, communication, play, psychomotor energy, impulse self-control, anxiety reduction PLANNING Realistic expectations Mutual goal setting Involve treatment team Implementation Set consistent boundaries and limits Expect testing behaviors Maintain safety Provide therapeutic activity Behavior modification Goal setting ADLs Impulse control Relationships Rewards for accomplishment Chart for preschool and school age Contracts for older children, teens;
use increased priveleges Provide role model Nursing Interventions Non-pharmacological Interventions:

Maintain safe environment.
Contraband
Suicidality
Aggressive behavior

Communicate respect.

Promote boundaries, expectations.
Set fair limits

Increase self-confidence, self-esteem.
Realistic praise

Maintain realistic, hopeful outlook.

See outline: Pharmacological Interventions Thank You! Development of the
Human Brain Mental Health Mental Illness Historical Perspectives Spectrum More dynamic before birth than during adulthood

The volume of the human brain is 95% of its adult size by age 5

The majority of neurons are formed by the 24th week of gestation Both the neuron and its synapses are "plastic" and malleable Synaptogenesis occurs throughout lifetime Arborization of neurons continues, at least through adolescence Extrinsic Intrinsic 1950s - American Academy of Child Psychiatry formed

1950s - NIMH increased funding for psychiatric mental health nursing (child/adolescent)

Predominant thinking: "Mother's fault" Clinical Description Reactive Attachment Disorder Begins within the first few years of life

Children exposed to extreme poverty, parental neglect, abuse, or institutionalized care

Two subtypes: Inhibited and Disinhibited Stomach aches, headaches occur during acutal or anticipated separation Questions: The parent of a child with Tourette's disorder says to the nurse, "I think my child is faking the tics because they're absent during sleep." Select the nurse's accurate response.
1. "Perhaps your child was misdiagnosed."
2. "This finding indicates a worsening of the child's condition."
3. "Your observation indicates the medication is effective."
4. "Tics are often reduced or absent during sleep." A nurse counsels the parents of a child with autistic disorder. The parents say, "We are going to completely redecorate our child's room. We think that will help." Select the nurse's best response.
1. "Children with autistic disorder usually prefer that things stay the same."
2. "Bright colors are often stimulating for children with autistic disorder."
3. "Remember to not use rugs so that your child will not slip and fall."
4. "New toys and games will help develop your child's intellectual abilities." Social problems (do not follow rules of games/activites, appear uninterested, change topics of conversation inappropriately) Oppositional defiant disorder Pattern of negativistic, hostile, and defiant behavior lasting at least six months

More frequently in males prior to puberty. Male/female equal after puberty

Hostility is directed at those the child knows best

Blame others for making unreasonable demands

ADHD and learning disorders associated Intermittent Explosive Disorder Child unable to resist agressive impulses

Degree of violence is disproportionate to precipitating event Home environment Theories of Normal Growth and Development Erickson Piaget Psychosocial Cognitive
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