NU 125 Mental Health Nursing: Specific Disorders of Childhood and Adolescence

Adverse Childhood Experiences (ACES)

traumatic childhood experiences, such as abuse, neglect, violence exposure, or death of a parent, that are linked to mental and physical health problems later in life

Risk factors for Children & their Development of Mental illness

Poverty

Homelessness

Child abuse and neglect

High levels of family stress (divorce, relationships, etc.)

Parents with mental illness/substance use

Foster care

Chronic illness, prematurity, or disability of child or caretaker

Death and grieving

Bullying

All of these risk factors and experiences interfere with what?

adaptive coping skills

There is a relationship between ACEs and..

negative health and well-being outcomes

Adverse Childhood Experiences (ACE) 10-Question Survery

surveys experiences of abuse, neglect, familial conditions, and emotional distress prior to one's 18th birthday to evaluate if they had any ACEs

Other effects of ACEs

Injury

Mental health conditions

Maternal health complications

Infectious diseases

Chronic disease

Risky behaviors

Educational or work opportunities

Neurodevelopmental Disorders

neurologically based disorders that are revealed during a child's developing years

What are some neurodevelopmental disorders?

Intellectual Development Disorder (Intellectual Disability)

Autism spectrum disorder

ADHD

Intellectual Development Disorder

onset during developmental period that includes both intelectual and adaptive functioning deficits (ADLs) in conceptual, social, and practical domains

What must be present for diagnosis of intellectual development disorder?

Intellectual and ADL deficits

How is Intellectual development disorder diagnosed?

IQ tests or social adaptability tests

Rate/Severity of Intellectual Development Disorder

1% of population with impairment ranging from mild to profound

Predisposing Factors to Intellectual Disability

Genetics

Damage in utero

Birth trauma

Medical conditions

Sociocultural factors

The most common predisposing factor is..

damage in utero, such as exposure to drugs/alcohol or pregnancy complications

Another very common factor is..

sociocultural factors, such as impoverished environments and deprivation of social stimuli

Degrees of Severity are measured by..

IQ level

IQ levels

Mild

Moderate

Severe

Profound

Mild IQ

50-70

Mild IQ: ADL Ability

Independent living

Mild IQ: Cognitive/Educational Capabilities

skills to 6th grade and work

Mild IQ: Social/Communication

functions well socially

Mild IQ: Psychomotor

not affected typically

Moderate IQ

35-49

Moderate IQ: ADL Ability

some independent activities, but some require supervision

Moderate IQ: Cognitive/Educational Capabilities

skills to 2nd grade, supportive work

Moderate IQ: Social/Communication

limited speech and social skills

Moderate IQ: Psychomotor

fair motor development

Severe IQ

20-34

Severe IQ: ADL Ability

requires complete supervision but is trained in basic skills

Severe IQ: Cognitive/Educational Capabilities

no benefit from school or work training

Severe IQ: Social/Communication

minimal verbal skills and acting out behaviors to get needs met

Severe IQ: Psychomotor

poor psychomotor skills, simple tasks require supervision

Profound IQ

below 20

Profound IQ: ADL Ability

no independent functioning and requires constant support

Profound IQ: Cognitive/Educational Capabilities

no profit from school or work training

Profound IQ: Social/Communication

little if any speech and NO social skills

Profound IQ: Psychomotor

lacks fine and gross motor skills and requires constant supervision

Average IQ is..

90-110

Superior IQ is..

over 120

95% of the population's IQ is..

between 70-130

Nursing Planning/Implementation for Intellectual Disabilities

Assessment focus on current adaptive skills, intellectual status and social functioning

Interventions based on level of functioning and needs

Essential for caregives to participate in care and rely on family to understand patient's ability

Autism Spectrum Disorder

a developmental disorder characterized by abnormal or impaired development in social interaction and communication with restricted activity and interests

Autism typically onsets at _______ and ranges from ________.

early in childhood, mild to severe

Someone with Autism Spectrum Disorder may..

withdraw into themselves or a fantasy world of their own

The autism spectrum is NOT ______.

linear

Nursing Planning/Implementation for Autism

Focus on physical health, neurological status, sleep, appetite, and medications

Teach self-care

Medications for behavioral symptoms

Are there any medications to treat social/language deficits?

NO, which is why early intervention is important

With an autistic patient, the nurse should..

Communicate clearly

Observe behavior

Maintain structure and appropriate environment

Attention Deficit Hyperactivity Disorder (ADHD)

a psychological disorder marked by high distractability, excessive motor activity, random movements, and impulsivity

When is ADHD typically recognized?

when a child enters school, they may not conform to classroom expectations

Who is ADHD more common in?

boys

Predisposing Factors to ADHD

Family history

Early exposure to pesticides

High blood lead concentration

Diet link

Abnormal neurotransmitter levels

Prenatal tobacco exposure

Family stress or ACEs

What is the diet link in ADHD?

Food dyes

Artifical flavoring

Sugar

What must be known BEFORE the diagnosis of ADHD?

the normal childhood stages of development and how a child acts

Inattentive Type ADHD

cannot get or stay focused on task or activity

Hyperactive/Impulsive Type ADHD

hyperactive and impulsive

Primary Symptoms of Inattentive ADHD

difficulty sustaining attention, easily distracted, forgetful, disorganized

Primary Symptoms of Hyperactive/Impulsive ADHD

excessive activity, impulsivity, difficulty sitting still or waiting turns

Typical Behaviors of Inattentive ADHD

daydreaming, losing items, careless mistakes, appears not to listen, struggles completing tasks

Typical Behaviors of Hyperactive/Impulsive ADHD

excessive talking, fidgeting, inappropriate movement, interrupting, or blurting out answers

Social presentation of inattentive ADHD vs. Hyperactive/Impulsive

Quiet, withdrawn, "unmotivated" vs. loud, energetic, "disruptive"

Self-Regulation Issues of inattentive ADHD vs. Hyperactive/Impulsive

Forgetfulness or mental wandering vs. poor impulse control or physical restlessness

Detection of inattentive ADHD vs. Hyperactive/Impulsive

Inattentive is often overlooked, especially in girls while impulsive is noticed early due to disruptive behavior

Common misinterpretations of inattentive ADHD vs. Hyperactive/Impulsive

Shy, slow, unmotivated vs. defiant, oppositional, or "bad behaved"

Associated Risks of inattentive ADHD

Academic underachievement, low self esteem and anxiety

Associated Risks of Hyperactive/Impulsive ADHD

Peer rejection, accidental injury, disciplinary issues

Response to structure in Inattentive ADHD

Benefits from visual reminders and organization

Response to structure in Hyperactive/Impulsive ADHD

Benefits from movement breaks, clear rules, and consequences

Classroom Support for Inattentive ADHD

Color-coded folders, step-by-step instructions, extra time on assignments

Classroom Support for Hyperactive/Impulsive ADHD

Seated near teacher, short work periods, movement breaks

Nursing Plan/Implementation for ADHD

Develop trust

Realistic goals

Ensure safe environment

Plan activities for success

Offer recognition of success

ADHD Primary Medications

CNS stimulants, like Ritlain or Adderall

Other Medications for ADHD

Alpha agonists and drugs like Wellbutrin

Alpha Agonists

inhibit release of norepinephrine in the brain

CBS Stimulant Administration Guidelines

Last dose administered before 4 pm to prevent insomnia and provided before or after meals

Alpha Agonists Administration Guidelines

Monitor CNS effects, blood pressure, pulse, and weight changes

With CNS stimulants, we should monitor..

vitals, weight loss, and appetite supression

Medication education is..

KEY for families of children with ADHD

Disruptive Behavior Disorders

Oppositional Defiant Disorder

Conduct Disorder

Oppositional Defiant Disorder

characterized by persistent pattern of angry mood, defiant behavior, and interference with social, academic, and occuptation functioning

ODD is more common in _____, and often precedes ______.

boys before puberty, conduct disorder before age 10

Predisposing Factors for ODD

Family influences (power struggles)

Difficulty regulating emotions

Power struggle

parent may become frustrated with strong-willed child and increase attempt to enforce authority, causing the child to respond with anger and self-assertion

Those with oppositional defiant disorder are often..

misunderstood

Symptoms of Oppositional Defiant Disorder

Stubborness

Procrastination

Running away

Avoiding school

Poor academic performance

Lack of friends

Argumentative

Fighting

Tantrums

Unwillingness to compromise

Disobedience

Carelessness

DSM-5 Criteria for ODD

pattern of angry, argumentative, defiant behavior for at least 6 months with 4 symptoms from angry/irritable mood, argumentative/defiant behavior, or vindictiveness

Vindictiveness

a desire for revenge

Oppositional Defiant Disorder ranges from..

mild to severe

Mild Oppositional Defiant Disorder

symptoms are confined to only one setting

Moderate Oppositional Defiant Disorder

symptoms are present in at least two settings

Severe Oppositional Defiant Disorder

symptoms are present in three or more settings

Conduct Disorder

persistent pattern of behavior in which the basic rights of others and major-age appropriate societal norms/rules are violated

Types of Conduct Disorder

Child-onset

Adolescent-onset

Predisposing Factors of Conduct Disorder

Irritable, inattentive, impulsive temperment

High plasma seratonin correlated with aggression/violence

Poor peer relations or association with defiant peer groups

Family influences

Some family influences may be..

Parental substance use

Parental rejection

Frequent shifting of parental figures

Inadequate communication patterns

Parental permissiveness

Symptoms of Conduct Disorder

Often bullies others

Physical fights

Cruel to animals

Destruction of property

Lying

Shoplifting

Stays out past curfew

Skips school

Runs away

Childhood Onset Type

Occurs before age 10

Adolescent onset type

no symptoms shown before age 10

Nursing Planning/Implementation for Conduct Disorder

Ensure safety of client an dothers

Develop socially appropriate behaviors

Promote increased feelings of self-worth to decrease lying, truancy, aggression

What image is associated with conduct disorder?

"Tough guy"