Children and Adolescents

Children and Adolescents 150 150 Tony Guo

Children and Adolescents

 

  • It is often difficult to determine whether a child’s behavior indicates emotional problems.
  • An emotional problem exists if behavioral manifestations:
    • Are not age appropriate
    • Deviate from cultural norms
    • Interfere with adaptive functioning

 

  • Intellectual developmental disorder (I D D) has its onset prior to age 18 years and is characterized by impairments in measured intellectual performance and adaptive skills across multiple domains.

 

Theory

  • Genetic Factors
    • Research studies have linked genetic mutations to autism spectrum disorder, although no one gene has been identified to cause this.
    • Temperament, the style of behavior habitually used to cope with demands of the environment, is a constitutional factor thought to be genetically determined.
    • In the case of the difficult-child temperament, the caregiver is unable to respond positively to the child, there is an increased risk of insecure attachment, developmental problems, and mental disorders
    • Individuals, including children reacting in different ways to the same situation based on their unique temperament. 
  • Biochemical Factors
    • This includes alterations in neurotransmitters such as inadequate norepinephrine and serotonin levels which are related to depression and suicide. 
  • Environmental Factors
    • This cause stress to children and adolescents and shape their development psychological conditions.
    • Traumatic events such as marital discord, overcrowding parental mental illness have been linked to lead to higher probability of mental and physical issues occuring

 

Autism Spectrum Disorder

  • Autism spectrum disorder (A S D) is characterized by a withdrawal of the child into the self and into a fantasy world of his or her own creation.
  • Prevalence is about 1 in 59 children.
  • A S D occurs more often in boys than in girls.
  • Onset occurs in early childhood.
  • A S D often runs a chronic course.

 

The Nursing Process: ASD

  • Assessment
    • Social deficits such as bonding with parents, dislike of cuddling, poor eye contact, and lack of interaction with peers
    • Communication delays, rigid routines, and ritualized behaviors and interests
  • Diagnosis
    • Autism spectrum disorder is usually diagnosed around toddlerhood, when children begin to interact with one another although if developmental delays are severe or the assessor is experienced it may be diagnosed in infancy
  • Outcomes
  • Planning / Implementation
    • Includes behavioral management and cognitive therapies, early intervention, educational and school-based therapies, and joint therapy.
    • Medications including atypical antipsychotics such as risperidone (Risperdal) for aggression or self-harm and Seratonin selective reuptake inhibitors (S S R I) or beta-blockers for obsessive or anxious symptoms may be helpful.
  • Evaluation

 

Psychopharmacological Intervention: A S D

  • Medications approved by the F D A
    • Risperidone
      • Common side effects: Drowsiness, Increased appetite, Nasal congestion, Fatigue, Constipation, Drooling, Dizziness, Weight Gain (Most common)
    • Aripiprazole
      • Common side effects: Sedation, Fatigue, Weight gain, Vomiting, Somnolence, Tremor (Most common)
  • Targeted for the following symptoms
    • Aggression
    • Deliberate self-injury
    • Temper tantrums
    • Quickly changing moods
  • Dose based on child’s weight and response

 

Attention Deficit/Hyperactivity Disorder (A D H D)

  • Essential features of A D H D include developmentally inappropriate degrees of inattention, impulsiveness, and hyperactivity.
  • Categorized by clinical presentation
    • Combined type (meeting the criteria for both inattention and hyperactivity/impulsivity)
    • Predominantly inattentive presentation
  • Predominantly hyperactive/impulsive presentation 
  • Problems with concentration such as making careless mistakes, difficulty remaining focused, being easily distracted by things going around the individual, appearing not to listen when spoken to, lack of follow-through, struggling with organizational and time management skills

 

The Nursing Process: A D H D

  • Assessment
    • High levels of fidgeting activity in the child and behaviors such as running around the office or jumping on the furniture.
    • Once they start school, teachers may notice difficulty paying attention in the classroom, fidgeting jumping out of the seat, talking at inappropriate times, and inconsistent or messy assignments
  • Diagnosis 
    • A child should not be diagnosed until they turn 12 because possible signs or symptoms may come from another disorder. 
    • Medication exam: to help rule out other possible causes of symptoms
    • Information gathering such as any current medical issues, personal and family medical history, and school records.
    • Interviews or questionnaires for family members, child’s teachers or other people who know the child well such as baby sitters and coaches.
    • A D H D  criteria from the Diagnostic and Statistical Manual of Mental Disorder (DSM-5)
    • A D H D rating scales to help collect and evaluate information about the child.
  • Outcomes
  • Planning / Implementation
    • Behavioral modification therapy
    • Parent training 
    • School accommodation 
  • Evaluation

 

Psychopharmacological Intervention: A D H D

Central nervous system stimulants

  • Examples: Dextroamphetamine, methamphetamine, lisdexamfetamine, methylphenidate, dexmethylphenidate, dextroamphetamine/amphetamine mixture
  • Side effects: Insomnia, anorexia, weight loss, tachycardia, decrease in rate of growth and development
  • Children on A D H D drugs had a higher risk of injury-related hospital admissions.
  • Contrary to common beliefs, children with A D H D who are treated with medications are less likely to use illicit drugs later in life because their mental health symptoms have been addressed

 

Tourette Disorder

  • The essential feature of Tourette disorder is the presence of multiple motor tics and one or more vocal tics.
  • Onset may be as early as 2 years but occurs most commonly around age 6 or 7.
  • The disorder is more common in boys than in girls.

 

The Nursing Process: IDD

  • Assessment
  • Diagnosis 
  • Outcomes
  • Planning / Implementation
  • Evaluation

 

Pharmacological Intervention: Tourette Disorder

  • Pharmacological intervention for Tourette disorder is most effective when it is combined with other therapy, such as:
    • Behavioral therapy
    • Individual counseling or psychotherapy
    • Family therapy
  • Common medications used for Tourette disorder
    • Antipsychotics
    • Alpha agonists

 

Oppositional Defiant Disorder (O D D)

  • Characterized by a persistent pattern of angry mood and defiant behavior
  • Occurs more frequently than is usually observed in individuals of comparable age and developmental level
  • Interferes with social, educational, or vocational activities

 

The Nursing Process: ODD

  • Assessment
  • Diagnosis 
  • Outcomes
  • Planning / Implementation
  • Evaluation

 

Conduct Disorder

  • With this disorder, there is a persistent pattern of behavior in which the basic rights of others and major age-appropriate societal norms or rules are violated. 
    • Childhood-onset type
    • Adolescent-onset type

 

The Nursing Process: Conduct Disorder

  • Assessment
  • Diagnosis 
  • Outcomes
  • Planning / Implementation
  • Evaluation

 

Separation Anxiety Disorder

  • The essential feature of separation anxiety disorder is excessive anxiety concerning separation from those to whom the individual is attached.

 

The Nursing Process: Separation Anxiety Disorder

  • Assessment
  • Diagnosis 
  • Outcomes
  • Planning / Implementation
  • Evaluation

 

General Therapeutic Approaches: Separation Anxiety Disorder

  • Behavior therapy
  • Family therapy
  • Group therapy 
  • Psychopharmacology

 

Therapeutic modalities for child and adolescent disorders

  • Parental involvement and support
    • Recognized as a critical factor on the supportive and educational interventions for the child or adolescent
  • Group therapy
    • For younger children takes the form of play, as they get older, more talk therapy can occur.
    • Groups are effective for common issues such as bereavement, abuse, chronic illness, or addiction
    • One of the challenges of using groups with this category lies in the contagious effect of disruptive behavior.
  • Milieu therapy
    • Philosophical basis for structuring inpatient and other long-term treatment programs
    • The nurse and other team members collaborate to provide a therapeutic environment that facilitate growth, safety, and positive change.
  • Behavior modification and cognitive behavioral therapy
    • Based on the principle that rewarded behavior is more likely to be repeated.
    • Connections between thoughts, feelings, and behaviors are identified, and technique help to develop rational thinking better choices, and impulse control.
  • Removal and restraint
    • They are dangerous, controversial treatment for children and adults.
    • Injuries and even death have been associated with seclusion and restraint.

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