mental health disorders in children and adolescents

common psychiatric disorders

ADD

ADHD

ODD

conduct disorder

autism spectrum disorder

other: bullying, mood disorders

attention deficit hyperactivity disorder

most common childhood psychiatric disorder

symptoms must be present by age 12

not explained by other psychiatric disorders

comorbidity: ODD, conduct, anxiety, depression

characterized by: hyperactivity, inattention, difficulty maintaining focus, irritability, disturbed sleep patterns, unable to take directions, anger, aggression

other problems: academic, learning, enuresis

ADHD assessment and interventions

physical exam to rule out medical condition

assess for sleep issues and tx them accordingly

improve nutrition and avoid trigger foods

assure child gets an hour of exercise daily

establish routines and schedules and share with child

assess potential anger/aggression

appropriate medications

ADHD psychotherapeutic management

nurse pt relationship and families: empathy, honesty, consistency

educate about meds; therapeutic and nontherapeutic effects

dextroamphetamine (dexedrine), methylphenidate (ritalin, concerta), dextroamphetamine and amphetamine salts (adderall), dexmethylphenidate (focalin, focalin XR)

oppositional defiant disorder

described as a pattern of the following:

• often loses temper

• touchy or easily annoyed

• angry and resentful

• argumentative/defiant

• argues with adults

• actively defies or refuses to comply with requests made by authority figures

• deliberately annoys others

• blames other for their mistakes, misbehavior, vindictiveness

confirmed with 4 or more are present for at least 6 months

risk for developing anxiety and depressive symptoms

conduct disorder

occurs more in males

persistent and repetitive pattern of behavior

violates basic rights of others and/or age appropriate social norms or rules

must exhibit 3 out of 4: aggression towards people or animals, destruction of property, deceitfulness or theft, serious violation of rules

r/f substance abuse and antisocial personality disorder

depression

12.5% experience depression by age of 18

girls at puberty

MDD- hopelessness, helplessness, low energy, social withdrawal

younger children- irritability

suicidal ideation- 3rd leading cause of death

meds- not all can be used; age dependent

fluoxetine- age 8

escitalopram- age 12

autism spectrum disorder

changed criteria with DSM-5: now viewed as a spectrum

criteria:

• persistent deficits in social communication and interaction across multiple contexts

• restricted and repetitive behaviors, interests, and activities

• symptoms must be present early in childhood (but may be delayed to a later age when social demands exceed the limits of the pt)

• symptoms cause significant impairment in social, occupational, or other areas of current functioning

meds used: antidepressants, antimanic, antianxiety, stimulants

atypical antipsychotics can be used as well- aripiprazole (abilify)

bullying

intentionally cruel and unprovoked behavior

verbal, relational, physical, cyberbullying

milieu interventions

safety

structure

norms

limit setting

balance