(Exam 4) Child & Adolescent Mental Health

core concepts of children and adolescents (4)

- disorder onset can disrupt the normal pattern of childhood development

- early dx and tx is essential

- children belong to a family system

- prognosis good w/ treatment

what are 8 factors impacting children mental health

- genetic background

- family hx

- adverse experiences

- family conflict

- poverty

- chronic illnesses

- temperament (good!!)

- resilience (good!!)

what are the 6 characteristics of resilient children

- adaptable to changes in the environment

- able to form relationships with other adults (if parent unavailable)

- able to distance themselves from emotional chaos

- social intelligence

- problem-solving skills

- able to perceive the future

what are the assessments a nurse would do for children

MSE: adapted to be appropriate for child's developmental stage

- HUGE look on characteristics of play

Developmental Assessment: learning and adapting to the environment and bonding w/ others

- HUGE look to see if the child is on tract

what are the 4 general interventions with children

- play therapy

- expressive arts therapy

- behavioral interventions

- family interventions

play therapy

children to express feelings through natural use of play

- good for younger children to access and work through bad memories

expressive arts therapy

provides nonverbal means of expressing difficult or confusing emotions

behavioral interventions

aim to reward desired behaviors to reduce maladaptive ones

family interventions

nurses help families to develop goals and work to achieve the goals for the family

what are our neurodevelopmental disorders (6)

- communication disorders

- motor disorders

- specific learning disorders

- intellectual disability

- autism spectrum disorder

- attention-deficit/hyperactivitiy disorder

what are communication disorders (concept and 4 specific disorders)

manifested in deficits in language, speech, communication ; result in impairments in academic acheivement, socialization, or self-care

- language disorder

- speech sound disorder

- child-onset fluency disorder

- social communication disorder

language disorder

difficulty attaining and using language due to deficits in production or comprehension of language

speech sound disorder

problems in making sounds

- ex: saying wabbit for rabbit

child-onset fluency disorder

aka stuttering

social communication disorder

problems using verbal and non-verbal means for interacting socially

- autism must be ruled out first

what are our motor disorders (3)

- developmental coordination disorder

- stereotypic movement disorder

- tic disorders

developmental coordination disorder

impairments in motor skill development

stereotypic movement disorder

repetitive movements; like hand-waving, rocking, head banging, etc

Tic disorders

sudden, nonrhythmic, and rapid motor movements or vocalizations

- motor tics: involve head, torso, or limbs

- vocal tics: spontaneous production of words and sounds

- tourette's disorder: multiple motor tics and at least one vocal tic for more than 1 year

tourette's disorder: nursing process (3)

- onset 4-6 years

- USUALLY peaks in early childhood and subside w/ age

- child may have low self-esteem, feel ashamed, self-conscious, rejected by peers

what are the interventions for tourettes (2)

- FOCUS on safety: helmets for children who are at risk for head injury

- behavioral techniques reduce tic expression

pharm tx for tourettes

antipsychotics (haloperidol, aripiprazole, risperidone

alpha 2A agonist: guanfacine, clonidine

specific learning disorder (3)

- dx when a child demonstrates persistent difficulty in reading (dyslexia), math (dyscalculia), and/or writing (dysgraphia)

- identified during school years

- receive treatment through school-based settings (like communication disorders)

intellectual disability (4)

characterized by deficits in three areas: intellectual functioning, social functioning, daily functioning

- ranges from mild to severe

- children cared for through early community intervention programs

- can require short-term hospitalization (aggression, self-harm, self-care deficits)

- CHRONIC

autism spectrum disorder (2) and S/S

complex neurobiological and developmental disability; affecting social interaction and communication skills

- neurodevelopmental delays (with or w/o intellectual disability)

- onset in early childhood

- RANGES

S/S: repetitive speech, over-adherence to routines or rituals, hyper or hypoactivity to sensory input

nursing process for autism spectrum disorder

1. protection from self-harm (protective devices)

2. improvement in social functioning

3. improvement in communication

what are potential medications for autism

antipsychotics: risperidone, aripiprazole to improve

- irritability

- severe temper tantrums

- aggression

- compulsive behavior

attention-deficit/hyperactivity disorder (ADHD) (3)

persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development

- sx present before 12

- sx present in TWO or more settings

- sx interferes with functioning

some children are inattentive but not hyperactive (ADHD aka ADD)

ADHD S/S

- low frustration tolerance

- temper outburst

- labile moods

- poor school performance

- peer rejection

- low self-esteem

ADHD nursing interventions (6)

- structure environment

- Reinforce positive behaviors

- use simple, clear instructions

- discuss expectations: checklist with rewards

- set up a schedule

- medication teaching

ADHD medications (stimulants)

1. methylphenidate, dexmethylphenidate

2. amphetamines, lisdexamphetamine

SE: insomnia, WL, tremor, tachycardia, HTN, arrhythmias

- avoid caffiene

- monitor growth (weight, BP, pulse) --> drug holiday

- take AFTER meal

- take AM

ADHD medications (non-stimulants)

atomoxetine (SNRI)

SE: GI disturbance, dizziness, fatigue, insomnia, liver injury

clonidine, guanfacine (alpha 2A agonist)

SE: dry mouth, dizziness, constipation, sedation --> slow taper so no rebound SE

what are our impulse control disorders (3)

- oppositional defiant disorder

- conduct disorder

- intermittent explosive disorder

Oppositional Defiant Disorder (3)

- pattern of angry/irritable mood

- argumentative/defiant behavior

- vindictiveness

affects child's life and makes school functioning, friendships, and family life difficult

conduct disorder

shows antisocial personality disorder S/S but under the age of 18

Intermittent Explosive Disorder (2)

A pattern of behavioral outbursts characterized by

- inability to control one's aggressive impulses (verbal or physical)

- targeted towards other people, animals, poverty, or even oneself

nursing interventions for impulse control disorder (7)

- promote a climate of safety

- set limits and expectations

- provide structure and boundaries

- follow through w/ consequences of rule breaking

- provide opportunities for achievement

- Seclusion and restraint may be necessary to ensure safety

- pharm aimed at targeting sx such as outburst, anger, and aggression

family interventions (3)

structure may be determined based on affection, emotional ties, sense of belonging, and durability of membership

- increase the level of differentiation of self while remaining in touch with the family system

- facilitate change in family structure

- change destructive communication patterns among family members

family functioning assessment (6)

communication: express honest feelings; all members participates

self-concept reinforcement: members feel loved, valued

family expectations: realistic, flexible, individualized

handling differences: open, nonattacking manner

interactional patterns: constructive, promote needs of all members

family climate: founded on trust, reflected in openess

family interventions: boundaries

clear boundaries: adaptive and healthy

diffuse boundaries: promote enmeshment, or exaggerated connectedness

rigid boundaries: promote disengagement, or extreme separateness