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Ch. 26: Children and Adolescents
Terms in this set (22)
Been implicated in a number of childhood mental disorders, including autism, bipolar disorders, schizophrenia, ADHA, and intellectual developmental disorders (mental retardation).
The style of behavior habitually used to cope with demands of the environment, is a constitutional factor thought to be genetically determined. Maybe be modified by a parent-infant relationship.
If the caregiver is unable to respond positively to the child, there is an increased risk fo insecure attachment, developmental problems, and mental disorders.
In childhood psychopathological conditions, as in adult conditions, include alterations in neurotransmitters. Ex. Inadequate NE and serotonin levels are r/t depression and suicide. Pts with predominantly hyperactive-impulse type have a variation in their dopamine transporter gene. These examples explain why certain meds are more effective with other certain subtypes.
Causes stress to children and adolescents and shape their development. Any type of abuse or neglect increases a child's risk for developing psychopathological conditions. Brain is moldable or malleable during the critical developmental time frame of childhood, with neuronal chains being rapidly connected. These early connections can guide thoughts and behaviors for the rest of their lives; without intervention to form more positive neuronal pathways.
Children and adolescents who tend to have a strong relationship with a nurturing adult, an adaptive temperament, and problem-solving skills. Prior success in navigating stressful situations builds this trait.
Who is the often the first to a have contact with the young patient and often completes a holistic assessment?
The nurse, this assessment includes:
-The presenting problem
-Medical and developmental issues
-Mental status assessment
-Assessing protective strengths and developmental maturity
In adolescents, important to consider:
What is one popular assessment tool?
Denver II Developmental Screening Test,
For infants and children up to 6 years of age.
Mental status assessment, include:
documents a dysfunction and determines how that dysfunction affects self-care in everyday life.
-Coordination of Motor Function
-Manner of Relating
-Thought Processes and Content
-Characteristics of Child's Play
Methods of collecting data
Include interviewing, screening, testing (neurological, psychological, intelligence), observing, and interacting with the child or adolescent. Hx are taken from parents or caregiver, including child. Teachers also provide insight or answer questionnaires. Drawing, games, and interactive play.
Play therapy can allow the nurse/care professional to gain information in a non threatening manner.
Observing interactions with parents, siblings, or caregivers can provide insight as well.
The child/adolescent should spend some alone time with the interviewer so the opportunity to disclose abuse is made available.
Autism spectrum disorder (ASD)
Presents with deficits in social and communication interactions, as well as repetitive patterns of behavior, interests, or activities. Children may twirl, walk on tippy toes, flap their arms, or rock. Mannerisms may progress from self-stimulation to self-injuries, such as head banging and biting. A lack of interest in social interaction (key symptom). Often loners and dislike physical affection and contact, except in limited amount from parents or close relations.
Nurse will observe for social deficits, including
-bonding with parents
-dislike of cuddling,
-Poor eye contact
-Lack of interaction with peers
Addition: communication delays, rigid routines, and ritualized behaviors and interest may be noted.
Usually diagnosed around toddlerhood, when begin to interact with one another.
If developmental delays are severe or the assessor is experienced it may be diagnosed in infancy.
Psychiatrist, psychiatric nurse practitioners, and psychologists use the DSM-5 criteria, hx from parents and teachers, and observation to make the diagnosis.
Treatment can include behavioral management and cognitive therapies
-Educational and school-based therapies
-Joint therapy (improving ability to follow pointing, showing, and coordinating looks between a person and object, all of what I are important in communication and language learning).
-Medication: atypical antipsychotics (risperidone [Resperdal] for aggression or self-harm. SSRIs or beta-blockers for obsessive or anxious symptoms.
Attention-Deficit/Hyperactivity Disorder (ADHD)
Assessed as mild, moderate, or severe and symptoms present prior to age 12.
-Problems with concentration such as making careless mistakes (inattention), difficulty remaining focus, being easily distracted by things going on around the individual
-Appearing not to listen when spoken to, lack of following-through
-Struggling with organizational and time management skills
-Avoid tasks that require sustained mental effort, misplace items, and tend to be messy.
Fidget, squirm, leave their seat at school, run or climb when not appropriate, blurt out answers or comments, interrupt, or talk excessively.
These symptoms cause children to be disciplined repeatedly in the classroom and at home, and peers may tease them, leading to problems with self-esteem. May have excellent projects and poor assignments with multiple eraser marks.
Nurse may notice a high level of fidgeting activity in the child and behaviors such as running around the office or jumping on the furniture.
Once school starts, teachers may notice difficulty paying attention in the classroom, fidgeting (hyperactivity), jumping out of the seat, talking at inappropriate times (impulsivity), and inconsistent or messy assignments.
Risk factors (per PP)
-Cigarette smoking, alcohol use or drug use during pregnancy
-Exposure to environment toxins include: lead during pregnancy
-Low birth weight
**These risk factors do not have to ALWAYS be to get ADHD.
Should not be diagnosed until the age of 12 because possible signs or symptoms may come from another disorder. However, if the symptoms have been present early on and have been disruptive to the family/school environment, a diagnosis may be made.
Diagnosis will likely include:
-Interviews or questionnaires
-Behavior modification therapy
-Nonstimulant (atomoxetine [Strattera], guanfacine [Tenex])
-Stimulant (methylphenidate [Ritalin], dextroamphetamine.levoamphetamine [Adderall], lisdexamfetamine [Vyvanse])
**Some learn to compensate and no longer need medication in adulthood, while others continue to require it.
**Contrary, children treated with ADHD who are treated with meds are LESS likely to use illicit drugs later in life because their mental health symptoms have been addressed.
Motor disorders - Tourette's disorder
-motor as well as vocal tics, with an onset in early childhood.
-Tics can be mild, such as clearing the throat or jerking a limb
-Severe as loudly yelling out an animal noise or curse word, with spasms intense enough to cause the patient to be flung out of a chair.
*** Tics can be embarrassing to children and adolescents, as they attempt the navigate the social and dating scene.
Assessment, Diagnosis, and Implementation
May be difficult to pinpoint, while severe symptoms such as jerking, cursing, or difficulty learning to write may be noticed by parents or nurses right away.
Psychiatrists or psychiatric nurse practitioners diagnose the disorder with the DSM-5 criteria, history, and observation.
No treatment globally successful.
-PT and OT. Have better outcomes
-Comprehensive Behavioral Intervention for TIcs (CBIT) is anew treatment that includes habit reversal, insight, education, and relaxation techniques shown to reduce tics.
-Propranolol (Inderal), used for tremor
-Haloperidol (Haldol) decreasing tics
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