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Disorders of Infancy, Childhood, and Adolescence
Transcript of Disorders of Infancy, Childhood, and Adolescence
Disorders Pervasive Development Disorders
Abnormalities of eating/sleeping
Preoccupied with rituals/sameness
Lack of emotional reciprocity
Self injurious behaviors/variation in pain threshold
Absent/poor language skills
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)
Low stress tolerance and inadequate coping skills
Parental rejection and neglect, physical or sexual abuse, early institutional living, bio/adoptive parent with Antisocial Personality Disorder Other problems
and adolescents Suicide
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
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.
Promote boundaries, expectations.
Set fair limits
Increase self-confidence, self-esteem.
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