Child & Adolescent Disorders Study Guide

Study Guide: Child and Adolescent Mental Health and Disorders

Overview

  • This study guide provides a comprehensive review of mental health disorders, neurodevelopmental challenges, and therapeutic interventions for children and adolescents from a clinical nursing perspective.
  • It covers:
    • Diagnostic criteria.
    • Physiological and psychological factors.
    • Nursing management of various conditions.

Enuresis

  • Definition: Enuresis is defined as repeated involuntary or intentional urination into bed or clothing at least twice a week for a minimum of three consecutive months.
  • Clinical Concern: Considered a clinical concern only when the child has reached a chronological or developmental age of at least 5 years.

Attention-Deficit/Hyperactivity Disorder (ADHD)

  • Clinical Presentations: ADHD is classified into three presentations:
    1. Inattentive:
    • Symptoms include distractibility and lack of focus.
    1. Hyperactive-Impulsive:
    • Characterized by fidgeting and impulsivity.
    1. Combined:
    • Displays symptoms of both inattentive and hyperactive-impulsive types.

ACE Score

  • Explanation: An ACE score is derived from the Adverse Childhood Experiences study, which measures the number of traumatic events a child has experienced, such as:
    • Abuse.
    • Neglect.
    • Household dysfunction.
  • Significance: A higher ACE score is directly linked to increased risk for:
    • Social, emotional, and cognitive impairment.
    • Chronic physical and mental health issues in adulthood.

Intellectual Disability (ID)

  • Severity Determination: The severity of Intellectual Disability is classified into four levels:
    1. Mild.
    2. Moderate.
    3. Severe.
    4. Profound.
  • Criteria: Rather than relying solely on IQ scores, severity is determined by functional impairment across:
    • Conceptual domains.
    • Social domains.
    • Practical domains.

Posttraumatic Stress Disorder (PTSD) in Children

  • Three Phases:
    1. Initial Phase:
    • Intense arousal lasting a few hours.
    1. Second Phase:
    • Lasts about two weeks where defense mechanisms like denial become mobilized.
    1. Third Phase:
    • Involves coping and inquiry, where children may "play out" the trauma to come to terms with their fears.

Encopresis

  • Pain–Retention–Pain Cycle:
    • Begins when a child experiences painful defecation.
    • Subsequently, the child withholds stool to avoid further pain.
    • As stool remains in the colon, it hardens, making it even more painful to pass.
    • Eventually leads to a loss of the urge to defecate and causes overflow incontinence.

Disruptive Mood Dysregulation Disorder (DMDD)

  • Introduction to DSM-5: DMDD was added to the DSM-5 to:
    • Provide a more accurate diagnosis for children exhibiting persistent irritability and frequent, severe temper outbursts.
    • Reduce the misdiagnosis of children with bipolar disorder.

Autism Spectrum Disorder (ASD)

  • Level 3 Characteristics:
    • Severe social deficits.
    • Limited, needs-based communication; some individuals remain nonverbal or use repetitive "echo" speech.
    • Extreme distress during changes in routine.
    • Repetitive behaviors that markedly interfere with functioning in all domains.

Conversion Reaction

  • Definition: A conversion reaction is a psychophysiologic disorder with a sudden onset of physical symptoms (e.g., paralysis or seizures) that have no organic medical cause.
  • Precipitating Factors: Typically traced to an environmental event or a major family crisis, such as:
    • Death of a parent.
    • Divorce of a parent.

Nursing Interventions for Medications Affecting Appetite

  • Decreased Appetite Management:
    • Advise parents to administer medications with or after meals to minimize the impact on hunger.
    • Suggest providing nutritious snacks in the evening as the medication wears off.
    • Recommend serving frequent, small, healthy meals to maintain adequate nutrition.

Glossary of Key Terms

  • ACE Score: A tally of different types of abuse, neglect, and other hallmarks of a difficult childhood used to assess risk for future health problems.
  • ADHD: Attention-Deficit/Hyperactivity Disorder; characterized by developmentally inappropriate degrees of inattention, impulsiveness, and hyperactivity.
  • Autism Spectrum Disorder (ASD): A neurodevelopmental disorder involving deficits in social/emotional interaction and repetitive patterns of behavior or interests.
  • Bibliotherapy: The use of books and literature to help children express feelings, gain insight, and learn new coping mechanisms.
  • Childhood Schizophrenia: A rare, severe psychotic disorder appearing before age 15, characterized by a lack of contact with reality and ego-functioning deviations.
  • Conduct Disorder (CD): A severe disruptive behavior disorder involving a persistent pattern of violating the rights of others and age-appropriate societal norms.
  • Conversion Reaction: A psychophysiologic disorder where emotional stress is "converted" into physical symptoms (e.g., pseudoseizures) without an organic cause.
  • DDAVP (Desmopressin): An analog of vasopressin used to treat enuresis by reducing urine production to a volume less than functional bladder capacity.
  • DMDD: Disruptive Mood Dysregulation Disorder; a condition in children involving chronic, severe irritability and frequent temper outbursts.
  • Encopresis: The repeated passage of feces into inappropriate places (clothing or bed) at least once a month for at least 3 months in a child at least 4 years old.
  • Enuresis: The repeated voiding of urine into bed or clothing at least twice a week for 3 months in a child at least 5 years old.
  • Intellectual Disability (ID): A disorder characterized by significant limitations in intellectual functioning and adaptive behavior across conceptual, social, and practical domains.
  • Milieu Therapy: A therapeutic approach that structures the environment (inpatient or residential) to facilitate growth, safety, and positive behavioral change.
  • Oppositional Defiant Disorder (ODD): A disorder involving a pattern of angry/irritable mood, argumentative behavior, or vindictiveness toward authority figures.
  • Pica: An eating disorder involving the persistent ingestion of nonfood substances such as dirt, paint chips, or hair.
  • PTSD: Posttraumatic Stress Disorder; a condition following exposure to a catastrophic event, involving re-experiencing trauma and increased arousal.
  • Reactive Attachment Disorder (RAD): A condition where a child is emotionally withdrawn and rarely seeks or responds to comfort, often due to inconsistent early caregiving.
  • Resilience: The ability of an individual to adapt to and overcome stressors and adversity through positive thoughts and behaviors.
  • School Phobia: Extreme reluctance or refusal to attend school due to severe anxiety or fear related to school experiences.
  • Stimming: Self-stimulatory behaviors (e.g., hand flapping, rocking) often seen in individuals with Autism Spectrum Disorder.
  • Temperament: A genetically influenced combination of personality traits (e.g., activity level, mood) that shapes how a child interacts with the world.
  • Tic: An involuntary, repetitive motor movement or vocalization characteristic of disorders like Tourette’s.