NURS 451 Childhood Impulse Control Disorders

oppositional defiant disorder

Pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness lasting at least 6 months as evidenced by at least four symptoms from any of the following categories, and exhibited during interaction with at least one individual who is not a sibling.

sx of oppositional defiant disorder

angry/irritable mood

argumentative/defiant behavior

vindictiveness

angry/irritable mood

¢Often loses temper

¢Is often touchy or easily annoyed

¢Is often angry and resentful

argumentative/defiant behavior

¢Often argues with authority figures

¢Often actively defies or refuses to comply with requests from authority figures or with rules.

¢Often deliberately annoys others

¢Often blames others for his or her mistakes or misbehavior

vindictiveness

¢Has been spiteful or vindictive at least twice within past 6 months

intermittent explosive disorder - Recurrent behavioral outbursts representing a failure to control aggressive impulses as manifested by either of the following:

1. Verbal aggression (temper tantrums, tirades, verbal arguments or fights) or physical aggression toward property, animals, or other individuals, occurring twice weekly, on average, for a period of 3 months. The physical aggression does not result in damage or destruction of property and does not result in physical injury to animals or other individuals.

2. Three behavior outburst involving damage or destruction of property and/or physical assault involving physical injury against animals or other individuals occurring within a 12-month period.

Aggression is grossly out of proportion

Aggression is not premeditated

Causes marked distress

Age is at least 6 years

conduct disorder sx (at least 3 in last 12 mo and one within last 6 mo)

aggression to people and animals

destruction of property

deceitfulness or theft

serious violation of rules

aggression to people and animals

Often bullies, threatens, or intimidates others

Often initiates physical fights

Has used a weapon that can cause serious physical harm

Has been physically cruel to people

Has been physically cruel to animals

Has stolen while confronting a victim

Has forced someone into sexual activity

destruction of property

Has deliberately engaged in fire setting

Has deliberately destroyed others property

deceitfulness or theft

Has broken into someone's house, building or car

Often lies to obtain goods or favors to avoid obligations

Has stolen items of nontrivial value without confronting victim (shoplifting, forgery)

serious violation of rules

Often stays out at night despite parental prohibitions, beginning before age 13

Has run away from home overnight at least twice

Is often truant from school, beginning before age 13

conduct disorder: symptoms in adolescent onset

¢Act out misconduct with peer group

¢School discipline problems

¢Boys: fight, steal, vandalize

¢Girls: truant, run away, abuse substances, engage in prostitution

Assessment

¢Disruptive behavior

¢Level of anxiety, aggression, anger, hostility, impulsivity\ability to understand impact of behavior

¢Inability to empathize with others

Nursing Diagnosis

¢Risk for other-directed violence

pyromania

¢Deliberate fire setting

¢Pleasure or relief when setting a fire, witnessing a fire or participating in the aftermath of a fire

¢For pleasure and not to conceal a crime

¢Occurs more in males

pyromania comobidities

alcohol, conduct disorder, adhd

kleptomania

¢Stealing objects not needed for personal use or monetary value

kleptomania comorbidities

MDD, Anxiety disorders, eating disorders and personality disorders

therapies for child and adolescent disorders

family therapy, group therapy, milieu therapy, behavioral therapy

family therapy

¢Parents actively involved in treatment

¢Multiple-family therapy with families as co-therapists

group therapy

¢Play for younger children

¢Play and talk for grade-school children

¢Talking about peer relationships and specific problems for adolescents

milieu therapy

¢Basis for structuring inpatient, residential, and day treatment programs

¢Therapeutic environment provides:

Physical and psychological security

Promotion of growth

Mastery of developmental tasks

Treatment for psychiatric disorders

behavioral therapy

¢Based on principle that behavior that is rewarded is more likely to be repeated

¢Specific treatments include:

Operant conditioning

Point and level system

¢Modifying disruptive behavior

Increasing the structure of an activity

Using all available resources

removal and restraint for child/adolescent disorders

seclusion, quiet room, time out, therapeutic holding

seclusion

Use is controversial

Reflects staff's lack of confidence in their ability to handle behavior

Perceived as punishment by the child/adolescent

Experience of being overpowered by adults terrifying for abused children

quiet room

Used to remove child from a situation for self-control or control by staff

Variations

¢Feelings room

¢Freedom room

time out

Intervening disruptive or inappropriate behavior by removing child from activity

Child regains self-control and reviews episode with staff

therapeutic holding

Used to control destructive behaviors

Prompt, firm, non-retaliatory protective restraint

Used to reduce the child's distress

Produces relaxation and returns self-control and trust in staff

play therapy guiding principles

¢Accept child as he is and follow the child's lead

¢Establish warm, friendly relationship to help the child express feelings

¢Recognize feelings and reflect them back so the child can gain insight into behavior

¢Accept the child's ability to solve personal problems

¢Set limits to provide reality and security

cognitive behavioral therapy goal

¢Remove maladaptive responses and replace with new cognitive and behavioral competencies

psychodrama

Also referred to as theater

Use of dramatic techniques to act out emotional problems and try out new behaviors

dramatic play

Use of hand puppets, puppet shows, or dramas to enable children to act out problems and solutions

mutual storytelling

Child is asked to make up a story with a beginning, middle, and end

At end of story child is asked the lesson or the moral of the story

Nurse then determines the psychodynamic meaning of the story

Nurse then uses an important theme to retell the story with the same characters and a similar setting, providing a healthier resolution

therapeutic games

¢Ideal for children who have difficulty talking about their feelings and problems

¢Help development of a therapeutic alliance

bibliotherapy

¢Use of children's literature to help child express feeling in a supportive environment

¢Book should reflect the situation or feelings the child is experiencing

therapeutic drawing

¢Drawings capture thoughts, feelings, and tensions children may not be able to express verbally