Disorders of Childhood & Adolescence

Objectives

  • Clinical Features & Behaviors

    • Understand the characteristics associated with childhood disorders.

  • Nursing Concepts

    • Develop patient outcomes and interventions for Autism Spectrum Disorder (ASD) and Attention Deficit Hyperactivity Disorder (ADHD).

  • Prevalence

    • Identify the significance and prevalence of psychiatric disorders in children and adolescents.

  • Contributing Factors

    • Examine influences that contribute to disorders in childhood and adolescence.

  • Mental Health Characteristics

    • Identify factors promoting resilience and mental health in young populations.

  • Assessment

    • Discuss the assessment strategies for children and adolescents.

  • Medications

    • Review medications prescribed for children and adolescents with mental health issues.

Disorders of Childhood & Adolescence

  • Emotional & Behavioral Disorders: Include depression, separation anxiety, phobias, PTSD, and adjustment disorders.

    • Symptoms of these disorders may manifest as tantrums, health complaints, and school performance issues.

  • Suicide Risk:

    • The incidence of suicide among children and adolescents is increasing.

Mental Health Care: Key Differences in Children vs. Adults

  • Vulnerability

    • Children are more dependent on adults for care and to initiate treatment.

  • Assessment

    • Assessment strategies change depending on the child's developmental stage.

  • Expression of Feelings

    • Children may not articulate their feelings; assessments often rely on observations.

  • Family Involvement

    • Higher emphasis on including family in the treatment processes.

Neurodevelopmental Disorders

  • Characteristics

    • Developmental deficits and functional impairments affecting personal, social, academic, and occupational areas.

  • Disorders Include:

    • Autism Spectrum Disorder (ASD), ADHD, communication disorders, motor disorders, specific learning disorders, and intellectual disabilities.

Autism Spectrum Disorder (ASD)

  • Diagnostic Criteria

    • Persistent differences in social communication and interaction:

    • Social-emotional reciprocity

    • Nonverbal communication behaviors

    • Relationship understanding

    • Restricted or repetitive behaviors:

    • Movement/speech patterns (e.g., echolalia)

    • Routines or rituals

    • Sensory input responses

  • Spectrum Levels

    • Level 1: Requires some support

    • Level 2: Requires substantial support

    • Level 3: Requires very substantial support

    • Not degenerative; learning strategies evolve over time.

Autism Spectrum Disorder (ASD) Statistics

  • Prevalence:

    • Occurs in all socioeconomic levels; currently about 1 in 35 children are diagnosed, a significant rise from previous years.

  • Recognition typically occurs in early childhood, significantly more prevalent in boys (4:1).

Symptoms and Presentation of ASD

  • Common Symptoms:

    • Anxiety and social difficulties, sensory aversions, literal thinking, stimming behaviors, and difficulty with transitions.

  • Communication Challenges:

    • Echolalia, nonverbal cues.

Interventions for ASD

  • Laws and Programs:

    • Mandated insurance coverage; early intervention programs.

  • Therapies:

    • Applied Behavioral Analysis (ABA) is the gold standard treatment.

  • Medications include atypical antipsychotics and SSRIs.

Attention Deficit Hyperactivity Disorder (ADHD)

  • Definition:

    • Persistent pattern of inattention and/or hyperactivity-impulsivity, affecting social, academic, or work functioning.

  • Types of ADHD:

    • Predominantly inattentive, predominantly hyperactive-impulsive, combined type.

Symptoms of ADHD

  • Hyperactive:

    • Excessive movement, talking, difficulty remaining still.

  • Inattentive:

    • Difficulty focusing, easily distracted, poor organizational skills, forgetfulness.

Treatment Approaches for ADHD

  • Management: Non-pharmacological approaches (e.g., behavioral strategies, parent training, CBT).

  • Pharmacological: CNS stimulants as first-line treatment for ADHD; also consider non-stimulant medications for some cases.

Co-occurring Disorders and Risk Factors

  • ADHD may coexist with anxiety disorders, learning disabilities, and conduct disorders. Careful evaluation and tailored treatment plans are essential for effective management.

Oppositional Defiant Disorder (ODD)

  • Definition: A pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness lasting at least 6 months.

  • Characteristics: Includes frequent temper loss, arguing with authority figures, actively refusing to comply with requests, and blaming others for mistakes.

Treatment Approaches for Oppositional Defiant Disorder (ODD)

  • Therapeutic Interventions: Parent management training, cognitive-behavioral therapy, and social skills training.

  • Medications: May include stimulants or antidepressants if co-occurring disorders are present.

Conduct Disorder (CD)

  • Definition: A more severe form of behavioral disorder characterized by persistent patterns of behavior that violate the rights of others or age-appropriate societal norms.

  • Symptoms: May include aggression to people and animals, destruction of property, deceitfulness, and serious violations of rules.

Treatment Approaches for Conduct Disorder (CD)

  • Therapeutic Interventions: Multi-systemic therapy (MST), which addresses the various influences on the youth, parents, and family as a whole.

  • Medications: Antipsychotics or mood stabilizers may be used, particularly in cases with aggression or severe behavioral disturbances.

Intermittent Explosive Disorder (IED)

  • Definition: Involves recurrent outbursts of anger that are disproportionate to the situation, resulting in behavioral or verbal outbursts.

  • Characteristics: Outbursts can lead to damage to property or injury to others, generally representing a failure to control aggressive impulses.

Treatment Approaches for Intermittent Explosive Disorder (IED)

  • Therapeutic Interventions: Cognitive-behavioral therapy to help manage anger and develop coping strategies.

  • Medications: Selective serotonin reuptake inhibitors (SSRIs) or mood stabilizers may be effective in reducing the frequency of outbursts.